Excess mortality among 10‐year survivors of classical Hodgkin lymphoma in adolescents and young adults

Xavier, Ana C.; Epperla, Narendranath; Taub, Jeffrey W.; Costa, Luciano J.

doi:10.1002/ajh.24964

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…Multimodality therapies based on clinical risk stratification (AIEOP‐LH2004 protocol) led to overall excellent outcomes (five‐year OS: 94%; five‐year PFS: 81%), despite a subset of patients experienced progression and even died of disease. These figures are in keeping with previously reported studies 2,3 and emphasize the need to better identify high‐risk cases, who may benefit from intensified therapies.…”

Section: Discussionsupporting

confidence: 89%

Histology of pediatric classic Hodgkin lymphoma: From diagnosis to prognostic stratification

Pizzi

Tazzoli

Carraro

et al. 2020

Pediatric Blood & Cancer

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Aims Classic Hodgkin lymphoma (cHL) is a common malignancy of the pediatric age. Although clinical‐radiological features are routinely used for disease risk stratification, the role of tumor histology has yet to be defined. This study aimed to characterize the clinical‐pathological features of a large cohort of pediatric cHL specifically investigating the relevance of tumor histology for the prognostic stratification of patients. Methods and results The study considered 96 clinically annotated cases of pediatric cHL treated according to the AIEOP‐LH2004 protocol. The following histological parameters were considered: (i) cHL variant; (ii) grade of nodular sclerosis (NS); (iii) staining for Bcl2 and p53, and expression of B‐cell (BCA) and T‐cell antigens (TCA) by Hodgkin/Reed‐Sternberg cells. The study population consisted of 51 males and 45 females (median age: 13.6 years) with five‐year overall and progression‐free survival of 94% and 81%, respectively. Most cases featured NS morphology (96%) with a prevalence of NS1 over NS2 grades. Two NS2 variants were recognized (sarcomatous/syncytial and fibrohistiocytic). A consistent subset of cases disclosed positivity for BCA (34%), TCA (26%), p53 (13%), and Bcl2 (19%). Clinical‐pathological correlations showed a more aggressive clinical course for NS2 over NS1 cases. The NS2 fibrohistiocytic variant was associated with the worst outcome. No other histological features correlated with prognosis. Conclusions Pediatric cHL is a clinically and histologically heterogeneous neoplasm. The majority of cases disclose NS morphology and aberrant phenotypes are frequently encountered. In the pediatric population, NS grading and NS2 subtyping bear significant prognostic impact.

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Section: Discussionsupporting

confidence: 89%

Histology of pediatric classic Hodgkin lymphoma: From diagnosis to prognostic stratification

Pizzi

Tazzoli

Carraro

et al. 2020

Pediatric Blood & Cancer

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“…Third, data on chemotherapy, radiotherapy, risk of CVD factors were not included in our study. [28][29][30] Radiotherapy, chemotherapy, history of CVD, and risk factors of CVD incurred increased risk of CVD mortality. The phenomenon reflected in our study was induced by a combination of the risk factors mentioned previously.…”

Section: Discussionmentioning

confidence: 99%

“…Statistical bias and residual confounding could not be eliminated. Third, data on chemotherapy, radiotherapy, risk of CVD factors were not included in our study 28‐30 . Radiotherapy, chemotherapy, history of CVD, and risk factors of CVD incurred increased risk of CVD mortality.…”

Section: Discussionmentioning

confidence: 99%

Long‐term risk of cardiovascular disease mortality among classic Hodgkin lymphoma survivors

Teng

Ning

et al. 2022

Cancer

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BACKGROUND:The temporal trend of cardiovascular disease (CVD) mortality in patients with classic Hodgkin lymphoma (cHL) throughout follow-up remains unclear. This study aimed to assess this temporal trend in patients with cHL. METHODS: This multicenter cohort included 15,889 patients with cHL diagnosed between 1983 and 2015, covering all ages. The proportional mortality ratio, cumulative incidence of cause-specific mortality accounting for competing risk, standard mortality ratio, and absolute excess risk were analyzed. RESULTS: Among patients in stage I and stage II cHL, the proportional mortality ratio for CVD exceeded that for cHL, after approximately 60 or 120 months of follow-up, respectively. For almost all the patients with stage I or stage II disease, the cumulative incidence of CVD mortality exceeded that of cHL and other neoplasms over time. In recent decades, the risk of cHL mortality declined sharply, but the risk of CVD mortality among patients with cHL declined quite slowly or even remained unchanged among some populations. Patients with stage I or stage II disease experienced a higher risk of CVD mortality than the general population in almost all follow-up intervals. The absolute excess CVD risk among patients in stage I reached 48.5. CONCLUSIONS: The risk of CVD mortality exceeded that of cHL and other neoplasms and became the leading cause of death over time, among patients with stage I or stage II disease. More effective measures should be taken to reduce the risk of CVD mortality.

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“…The choice of OS as the only parameter defining outcome excludes relapses or long-term harmful effects that profoundly affect the quality of life [ 57 ]. One useful end-point could be EFS, which includes second tumors, frequently registered in AYAs affected by HL [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hodgkin’s Lymphoma in Children and Adolescents. A Twenty Year Experience with MH’96 and LH2004 AIEOP (Italian Association of Pediatric Hematology and Oncology) Protocols

Burnelli

Fiumana

Rondelli

et al. 2020

Cancers

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Adolescents and young adults (AYAs) represent a distinct group of patients. The objectives of this study were: To compare adolescent prognosis to that of younger children; to compare the results achieved with the two consecutive protocols in both age groups; to analyze clinical characteristics of children and adolescents. Between 1996 and 2017, 1759 patients aged <18 years were evaluable for the study. Five hundred and sixty patients were treated with the MH’96 protocol and 1199 with the LH2004 protocol. Four hundred and eighty-two were adolescents aged ≥15 years. Patients in both age groups showed very favorable prognoses. In particular, OS improved with the LH2004 protocol, especially in the adolescent group and in the low risk group, where radiation therapy was spared. Adolescent characteristics differed significantly from the children’s according to sex, histology, and the presence of symptoms. Remarkable is the decrease both in mixed cellularity in the children and in low stages in both age groups in the LH2004 protocol with respect to MH’96 protocol. Based on our experience, adopting pediatric protocols for AYA does not compromise patient outcomes.

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Excess mortality among 10‐year survivors of classical Hodgkin lymphoma in adolescents and young adults

Cited by 10 publications

References 29 publications

Histology of pediatric classic Hodgkin lymphoma: From diagnosis to prognostic stratification

Histology of pediatric classic Hodgkin lymphoma: From diagnosis to prognostic stratification

Long‐term risk of cardiovascular disease mortality among classic Hodgkin lymphoma survivors

Comparison of Hodgkin’s Lymphoma in Children and Adolescents. A Twenty Year Experience with MH’96 and LH2004 AIEOP (Italian Association of Pediatric Hematology and Oncology) Protocols

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