Early versus late intensification for patients with high‐risk Hodgkin lymphoma—3 Cycles of intensive chemotherapy plus low‐dose lymph node radiation therapy versus 4 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine plus myeloablative chemotherapy with autologous stem cell transplantation

Arakelyan, Nina; Berthou, Christian; Desablens, B; Guibert, Sophie de; Delwail, Vincent; Moles, Marie‐Pierre; Quittet, Philippe; Jaı̈s, Jean-Philippe; Colonna, P; Andrieu, Jean‐Marie

doi:10.1002/cncr.23979

Cited by 31 publications

(13 citation statements)

References 21 publications

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“…HCT was given for the treatment of lymphoproliferative diseases (16 trials), [13][14][15][16][17][18][19][20][21][22][23][24]29,30,32 solid malignancies (16 trials) 25,27,28,31,[33][34][35][36][37][38][39][40][41][42][43][44] and plasma cell disorders [10][11][12]26 (4 trials). Two trials used purged autografts as the graft source.…”

Section: Resultsmentioning

confidence: 99%

Secondary malignancies following high dose therapy and autologous hematopoietic cell transplantation-systematic review and meta-analysis

Vaxman

Ram

Gafter‐Gvili

et al. 2015

Bone Marrow Transplant

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We performed a systematic review and meta-analysis of randomized controlled trials comparing autologous hematopoietic cell transplantation (HCT) with other treatment modalities to analyze the risk for various secondary malignancies (SMs). Relative risks (RR) with 95% confidence intervals were estimated and pooled. Our search yielded 36 trials. The median follow-up was 55 (range 12-144) months. Overall, the RR for developing SMs was 1.23 ((0.97-1.55), I 2 = 4%, 9870 patients). Subgroup analysis of trials assessing TBI-containing preparative regimens and of patients with baseline lymphoproliferative diseases, showed there was a higher risk for SMs in patients given autografts (RR = 1.61 (1.05-2.48), I 2 = 14%, 2218 patients and RR = 1.62 (1.12-2.33), I 2 = 22%, 3343 patients, respectively). Among all patients, there was a higher rate of myelodysplastic syndrome MDS/AML in patients given HCT compared with other treatments (RR = 1.71 (1.18-2.48), I 2 = 0%, 8778 patients). The risk of secondary solid malignancies was comparable in the short term between patients given HCT and patients given other treatments (RR = 0.95 (0.67-1.32), I 2 = 0%, 5925 patients). We conclude that overall the risk of secondary MDS/AML is higher in patients given autologous HCT compared with other treatments. In the subgroup of patients given a TBI-based regimen and in those with a baseline lymphoproliferative disease, there was a higher risk of overall SMs.

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Section: Resultsmentioning

confidence: 99%

Secondary malignancies following high dose therapy and autologous hematopoietic cell transplantation-systematic review and meta-analysis

Vaxman

Ram

Gafter‐Gvili

et al. 2015

Bone Marrow Transplant

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“…17 This study examined an early intensive nonmyeloablative chemotherapy (VABEM: vindesine, doxorubicin, carmustine, etoposide and methylprednisolone) and ABVD for 4 cycles followed by delayed myeloablative intensification (BEAM high-dose therapy and ASCT). The authors reported the results of 158 patients (82 in the VABEM arm, 76 in the ASCT arm) and compared FFTF (primary endpoint) and OS in a randomized phase II trial.…”

Section: Consolidation Post Primary Chemotherapymentioning

confidence: 99%

Standard therapy of advanced Hodgkin lymphoma

Kuruvilla

2009

Hematology

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ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) continues to be the standard of care for patients with advanced-stage Hodgkin lymphoma (HL). Consolidation of primary chemotherapy with radiation or autologous stem cell transplantation (ASCT) has not demonstrated an improvement in overall survival in randomized controlled trials. Regimens such as escalated BEACOPP have more acute and late toxicities and survival benefits have yet to be confirmed.Despite effective therapy, ultimately 30% to 40% of patients with advanced HL will relapse. ASCT has become the standard of care for patients with relapsed or refractory HL based on two randomized trials. The optimal salvage chemotherapy and high dose therapy regimen are not known. Similarly, non-ASCT strategies including salvage radiotherapy or non-ASCT chemotherapy strategies have been reported and have a potential role in selected clinical scenarios.This review summarizes recent clinical trial results in the initial treatment of advanced HL and will focus on second-line treatment strategies for patients with relapsed or refractory disease.

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“…Although the definition of "high-risk" has varied and included only elements of the IPS, randomized clinical trials have concluded no benefit for early intensification with autologous stem cell transplantation in patients with unfavorable disease responding to anthracycline-based therapy. [28][29][30] The pertinent question becomes how to identify up front the ϳ 20% or so of cases that may not do well with standard approaches. Emerging data support that a negative PET may be predictive after 2 cycles of chemotherapy.…”

Section: Can We Adapt Therapy Based On Clinical or Biological Risk Famentioning

confidence: 99%

Optimal Therapy of Advanced Hodgkin Lymphoma

Advani

2011

Hematology

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Advanced-stage Hodgkin lymphoma (HL) has become a curable disease in the majority of patients. Research during the last decade has challenged chemotherapy with Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) as the standard of care and debates continue regarding the role of radiation therapy (RT) in this patient population. The incorporation of interim positron emission tomography (PET) imaging and, recently, further characterization of HL on cellular and molecular levels are emerging as tools for treatment stratification and predictors of disease status. Newer targeted therapies have emerged that are very effective in the relapsed setting and are actively being explored as frontline therapy. Lastly, the expanding population of survivors cured of HL outnumbers patients with the disease and needs to be monitored for therapy-related late effects.Therapeutic advances over the past 3 decades have resulted in the cure of the majority of patients with advanced-stage Hodgkin lymphoma (HL). Several questions emerge when considering what constitutes optimal therapy with a balance between a high cure rate and minimizing short-and long-term toxicity. This review focuses on 3 key elements: (1) what is the optimal chemotherapy?; (2) what is the role of radiation therapy (RT) in advanced HL?; and (3) can we adapt therapy based on clinical biological risk factors? What is the optimal chemotherapy?In North America, combination chemotherapy with Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) is considered the standard of care for advanced HL, providing an excellent balance of efficacy and toxicity. 1 Over the past decade, new regimens have been developed for patients with advanced HL based on the premise of either improved efficacy or reduced toxicity (Table 1). The major challenge to the clinician is how to interpret results from various clinical trials to individualize therapy and achieve a high cure rate while at the same time minimizing acute and late toxicity for patients with advanced HL. Dose-escalated bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone (escalated BEACOPP or escB), developed by the German Hodgkin Study Group (GHSG), has emerged as a very effective regimen and yielded significantly better survival compared with conventional-dose regimens in the GHSG HD9 study. 2 In a 3-armed trial, patients with stage IIB-IV HL were randomized to 8 cycles of COPP-ABVD, baseline BEACOPP (basB), or escB. Results from the most recent update of the study with 1196 evaluable patients and a median follow-up of 111 months suggest that responses are durable, with the 10-year freedom-from-treatment-failure (FFTF) significantly higher in the escB arm than in the basB and COPP-ABVD arms (82%, 70%, and 64%, respectively, P Ͻ .0001). The corresponding 10-year overall survival (OS) rates were 86%, 80%, and 75%, respectively (P ϭ .0005). 2 In contrast to the original publication, which indicated an OS benefit across all risk groups, on longer follow-up, the ...

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Cited by 31 publications

References 21 publications

Secondary malignancies following high dose therapy and autologous hematopoietic cell transplantation-systematic review and meta-analysis

Secondary malignancies following high dose therapy and autologous hematopoietic cell transplantation-systematic review and meta-analysis

Standard therapy of advanced Hodgkin lymphoma

Optimal Therapy of Advanced Hodgkin Lymphoma

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