Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

Brusamolino, Ercole; Bacigalupo, Andrea; Barosi, Giovanni; Biti, Giampaolo; Gobbi, Paolo G.; Levis, Alessandro; Marchetti, Monia; Santoro, Armando; Zinzani, Pier Luigi; Tura, S

doi:10.3324/haematol.2008.002451

Cited by 62 publications

(46 citation statements)

References 112 publications

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“…This figure should be compared with NRM from other series of patients both grafted from HLA identical siblings or unrelated donors: 18,19,20 the average NRM is reported to be 50% for myeloablative regimens and 21% for reduced intensity conditioning. 21 In the San Martino Unit, we could identify 21 HD patients receiving an allograft from an HLA identical sibling and 16 from an alternative donor: their NRM was, respectively, 33% and 37%, with no significant difference according to the intensity of the conditioning regimen. The actuarial 3-year survival of alternative donor transplants was 30%, compared with 77% in this report.…”

Section: Discussionmentioning

confidence: 99%

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Raiola

Dominietto

Varaldo

et al. 2013

Bone Marrow Transplant

141

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Twenty-six patients with advanced Hodgkin's disease received a related HLA haploidentical unmanipulated BMT, following a nonmyeloablative conditioning with low-dose TBI, proposed by the Baltimore group; GvHD prophylaxis consisted of high-dose posttransplantation CY (PT-CY), mycophenolate and a calcineurin inhibitor. All patients had received a previous autograft, and 65% had active disease at the time of BMT. Sustained engraftment of donor cells occurred in 25 patients (96%), with a median time to neutrophil recovery (40.5 Â 10 9 /L) and platelet recovery (420 Â 10 9 /L) of þ 18 and þ 23 days from BMT. The incidence of grade II-IV acute GVHD and of chronic GVHD was 24% and 8%, respectively. With a median follow-up of 24 months (range 18-44) 21 patients are alive, 20 disease free. The cumulative incidence of TRM and relapse was 4% and 31%, respectively. The actuarial 3-year survival is 77%, the actuarial 3-year PFS is 63%. In conclusion, we confirm that high-dose PT-CY is effective as prophylaxis of GVHD after HLA haploidentical BMT, can prevent rejection and does not appear to eliminate the allogeneic graft versus lymphoma effect.

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Section: Discussionmentioning

confidence: 99%

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Raiola

Dominietto

Varaldo

et al. 2013

Bone Marrow Transplant

141

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“…Only primary refractory younger patients or patients showing an early relapse following the completion of treatment are referred to more specialized hematologic centres. Furthermore, the majority of patients are not enrolled in prospective clinical trials and receive therapy according to well-established clinical guidelines (24). The aim of this retrospective study was to review the current management of HL in a northern Italian region (Liguria), with special emphasis on long-term outcome and toxicity.…”

Section: Discussionmentioning

confidence: 99%

Therapy of Hodgkin’s lymphoma in clinical practice: A retrospective long-term follow-up analysis

et al. 2011

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Abstract. Treatment of Hodgkin's lymphoma (HL) is perceived to be relatively straightforward. Consequently, patients are not usually referred to hemato-oncologically specialized centres and are treated locally instead. Comprehensive findings beyond prospective controlled trials are therefore lacking. Clinical data of 209 patients who had received a HL diagnosis were collected. A total of 7 patients received radiotherapy (RT) alone (3%), 75 (35%) were treated with a combination of chemotherapy (CT) and RT and 127 patients received CT alone [mainly doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD)]. Complete response (CR) following first-line treatment was achieved in 178 patients (85%) and in 195 (93%) after salvage treatment. Favorable disease (p=0.000359), limitedstage disease (p=0.0003), involvement of lymph nodes above the diaphragm (p=0.05) and absence of mediastinal bulky tumor involvement positively affected the CR rate following first-line treatment. Out of the 195 patients that achieved CR, 31 relapsed. Male gender (p=0.043) and age over 45 years (p=0.047) were significantly associated with an increased incidence of relapse. Age at diagnosis was the key factor affecting long-term outcome. The event-free survival (EFS) projected at 120 months was 80 and 57% for patients younger and older than 45 years, respectively (p=0.022). The overall survival (OS) projected at 120 months was 92 and 38% for patients younger and older than 45 years, respectively (p=0.00561). A second neoplasia was diagnosed in 8 patients. The development of a tumor in 4 cases (breast, lung and thyroid cancer) was likely RT-related. Only 1 patient not receiving RT developed acute myeloid leukemia. The EFS and OS of the 141 early-stage patients treated with CT + RT (n=62) or with CT alone (n=79) were not statistically different.

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“…2,37 For patients belonging to the standard-risk group with any additional risk factors (bulky relapse, relapse in irradiated site, B symptoms), the expert panel recommends the strategy proposed for the intermediate-risk group, consisting of BEAM and ASCT after having obtained chemosensitivity by second-line chemotherapy. For any patient from the standard-risk group with chemoresistance to second-line treatment, the expert panel recommends a double transplant strategy provided that the patient eventually responds to third-line regimen.…”

Section: Standard-risk Groupmentioning

confidence: 99%

“…Demonstrated responses to donor lymphocyte infusion (DLI) and a trend toward a lower relapse rate after allogeneic SCT than after ASCT, especially when chronic graft-versus-host disease (GVHD) occurs, are direct and indirect arguments for a GVHL effect. [37][38][39] Because of the negative aspect of treatment-related mortality (TRM) of myeloablative conditioning regimens, reduced intensity conditioning (RIC) regimens have emerged as a potential option with acceptable TRM and long-term response. 40,41 Importantly, several studies have shown that chemosensitivity at transplantation remains a major predictor of outcome of RIC allogeneic SCT (RIC-allo).…”

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confidence: 99%

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

et al. 2013

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Key pre-salvage treatment risk factors that were almost consistently found to independently prognosticate outcome in Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant open-access paper. doi:10.3324/haematol.2012.072090 Manuscript received on January 15, 2013. Manuscript accepted on May 6, 2013 .beThe Hodgkin's Lymphoma Committee of the Lymphoma Study Association (LYSA) gathered in 2012 to prepare guidelines on the management of transplant-eligible patients with relapsing or refractory Hodgkin's lymphoma. The working group is made up of a multidisciplinary panel of experts with a significant background in Hodgkin's lymphoma. Each member of the panel of experts provided an interpretation of the evidence and a systematic approach to obtain consensus was used. Grades of recommendation were not required since levels of evidence are mainly based on phase II trials or standard practice. Data arising from randomized trials are emphasized. The final version was endorsed by the scientific council of the LYSA. The expert panel recommends a risk-adapted strategy (conventional treatment, or single/double transplantation and/or radiotherapy) based on three risk factors at progression (primary refractory disease, remission duration < 1 year, stage III/IV), and an early evaluation of salvage chemosensitivity, including 18 fluorodeoxy glucose-positron emission tomography interpreted according to the Deauville scoring system. Most relapsed or refractory Hodgkin's lymphoma patients chemosensitive to salvage should receive high-dose therapy and autologous stem-cell transplantation as standard. Efforts should be made to increase the proportion of chemosensitive patients by alternating non-cross-resistant chemotherapy lines or exploring the role of novel drugs. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o nN o c o m m e r c i a l u s e relapsing and refractory HL are primary refractoriness, short time to HL relapse, and advanced clinical stage at relapse. 2,12,13 The expert panel recommends using these robust prognostic factors to stratify patients into three risk groups (Table 1). There have been inconsistent reports of other predictive risk factors, sometimes with independent value, such as anemia, poor performance status (PS), presence of B symptoms, extranodal relapse, relapse in previous radiation field, age, or bulky disease, but the latter were not retained by the expert panel to serve in the risk group definition. 2,14,15 Primary refractoriness is defined either by progression at any time during chemotherapy or radiotherapy (RT) and up to three months after the end of treatment, and/or by persistence of a PET positive residual mass, using the quantitative 5-point scale Deauville score (DS) for PET interpretation. Using these criteria, a positive FDG-PET (i.e. DS 4 or 5) after 3-4 cycles of ABVD for supra-diaphragmatic HL, and after four cycles of BEACOP Pesc or ABVD for advanced HL, is considered as primary refractory disease...

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Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

Cited by 62 publications

References 112 publications

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Unmanipulated haploidentical BMT following non-myeloablative conditioning and post-transplantation CY for advanced Hodgkin’s lymphoma

Therapy of Hodgkin’s lymphoma in clinical practice: A retrospective long-term follow-up analysis

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

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