G‐CSF is not necessary to maintain over 99% dose–intensity with ABVD in the treatment of Hodgkin lymphoma: low toxicity and excellent outcomes in a 10‐year analysis

Evens, Andrew M.; Cilley, Jeffrey; Ortiz, Taylor M.; Gounder, Mrinal M.; Hou, Nanjiang; Rademaker, Alfred; Miyata, Sarah; Catsaros, Kara; Augustyniak, Connie; Bennett, Charles L.; Tallman, Martin S.; Variakojis, Daina; Winter, Jane N.; Li, Gordon

doi:10.1111/j.1365-2141.2007.06598.x

Cited by 76 publications

(51 citation statements)

References 26 publications

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“…11 However, 2 well-conducted studies, a retrospective review 12 and a prospective clinical trial, 13 have failed to substantiate this suspicion. Neutrophil growth factors should be used sparingly in the management of Hodgkin lymphoma 14 ; however, when they are necessary, there is no need to avoid them due to concern over coincident use of bleomycin.…”

Section: Risk Factors Intrinsic To the Patientmentioning

confidence: 99%

Risk assessment in the management of newly diagnosed classical Hodgkin lymphoma

Connors

2015

Blood

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Treatment of Hodgkin lymphoma is associated with 2 major types of risk: that the treatment may fail to cure the disease or that the treatment will prove unacceptably toxic. Careful assessment of the amount of the lymphoma (tumor burden), its behavior (extent of invasion or specific organ compromise), and host related factors (age; coincident systemic infection; and organ dysfunction, especially hematopoietic, cardiac, or pulmonary) is essential to optimize outcome. Elaborately assembled prognostic scoring systems, such as the International Prognostic Factors Project score, have lost their accuracy and value as increasingly effective chemotherapy and supportive care have been developed. Identification of specific biomarkers derived from sophisticated exploration of Hodgkin lymphoma biology is bringing promise of further improvement in targeted therapy in which effectiveness is increased at the same time off-target toxicity is diminished. Parallel developments in functional imaging are providing additional potential to evaluate the efficacy of treatment while it is being delivered, allowing dynamic assessment of risk during chemotherapy and adaptation of the therapy in real time. Risk assessment in Hodgkin lymphoma is continuously evolving, promising ever greater precision and clinical relevance. This article explores the past usefulness and the emerging potential of risk assessment for this imminently curable malignancy.

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Section: Risk Factors Intrinsic To the Patientmentioning

confidence: 99%

Risk assessment in the management of newly diagnosed classical Hodgkin lymphoma

Connors

2015

Blood

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“…Specifically protocol ABVD given on schedule, without delay and no growth factor support regardless of the absolute neutrophil count on the day of treatment, is advocated. Of note, however, is the use of stimulatory peptide increases bleomycin induced lung toxicity [53] and [54]. Alternatives are Stanford V and escalated BEACOPP [55] and [56] where encouraging results are offset by a marked increase in both short-and long-term toxicities, including infertility, infectious complications and second malignancies so that there is a relevance to use BEACOPP routinely.…”

Section: Advancedmentioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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“…99 Recently, 2 separate studies confirmed that ABVD chemotherapy can be safely administered at the full-dose intensity without any growth factor support. 100,101 The NCCN Guidelines do not recommend the routine use of growth factors with ABVD regimens.…”

Section: Myelosuppressionmentioning

confidence: 99%

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Hoppe¹,

Advani²,

Ai³

et al. 2017

J Natl Compr Canc Netw

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OverviewHodgkin lymphoma (HL) is an uncommon malignancy involving lymph nodes and the lymphatic system. Most patients are diagnosed between 15 and 30 years of age, followed by another peak in adults aged ≥55 years. In 2017, an estimated 8,260 people will be diagnosed with HL in the United States and 1,070 will die of the disease. AbstractThis portion of the NCCN Guidelines for Hodgkin lymphoma (HL) focuses on the management of classical HL. Current management of classical HL involves initial treatment with chemotherapy or combined modality therapy followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale). The introduction of less toxic and more effective regimens has significantly advanced HL cure rates. However, long-term follow-up after completion of treatment is essential to determine potential long-term effects. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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G‐CSF is not necessary to maintain over 99% dose–intensity with ABVD in the treatment of Hodgkin lymphoma: low toxicity and excellent outcomes in a 10‐year analysis

Cited by 76 publications

References 26 publications

Risk assessment in the management of newly diagnosed classical Hodgkin lymphoma

Risk assessment in the management of newly diagnosed classical Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

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