Predictive and discriminating three‐risk‐group prognostic scoring system for staging Hodgkin lymphomas

Maucort-Boulch, Delphine; Djeridane, Malika; Roy, Pascal; Riche, Benjamin; Colonna, P; Andrieu, Jean‐Marie

doi:10.1002/cncr.22394

Cited by 15 publications

(11 citation statements)

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“…[2][3][4]21,22 Recent studies of prognostic scoring systems for adult HL have not identified BM involvement as a significant predictor of outcome 18,23 and have not included it in the prognostic scoring system. 18,23,24 In previous pediatric studies, the incidence of BM involvement at diagnosis ranged from 1.8% to 6.5%. [7][8][9] In our study, the incidence was 5.5% in the whole cohort.…”

Section: Discussionmentioning

confidence: 95%

Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

Hines-Thomas¹,

Howard²,

Hudson³

et al. 2010

Haematologica

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BackgroundBone marrow biopsy is considered essential for the staging and risk-adapted treatment of Hodgkin's lymphoma with unfavorable risk features. We reviewed the cases of pediatric Hodgkin's lymphoma in our institution to determine the impact of bone marrow involvement on treatment, relapse, and survival. Design and MethodsWe reviewed the clinical characteristics and outcome of 383 patients treated for Hodgkin's lymphoma at St. Jude Children's Research Hospital between August 1990 and August 2008. The 5-year survival estimates for patients with and without bone marrow involvement were compared. ResultsOf 228 patients who had a bone marrow biopsy at diagnosis, 21 had bone marrow involvement. Bone marrow findings changed the disease stage in only seven patients (3.1%): from IB to IVB (n=1), from IIA (with bulky disease) to IVA (n=1), from IIB to IVB (n=1), and from IIIB to IVB (n=4). One patient's risk assignment changed from intermediate to unfavorable risk without his chemotherapy being altered. No statistically significant difference was observed between patients with stage IV Hodgkin's lymphoma who did (n=21) and did not (n=61) have bone marrow involvement in 5-year relapse-free survival (89.6± 7% versus 73.9±6.1%; P=0.25) or 5-year overall survival (95.2±8.2% versus 87.3±4.9%; P=0.82). ConclusionsAlthough bone marrow involvement changed the stage in 3.1% of pediatric Hodgkin's lymphoma patients, it did not change risk-adapted treatment or prognosis. We conclude that bone marrow biopsy need not be performed at diagnosis in patients who have unfavorable risk features, although this finding should be confirmed by larger prospective studies.Key words: bone marrow, risk features, Hodgkin's lymphoma. 's lymphoma. Haematologica 2010;95(10):1691-1696. doi:10.3324/haematol.2010 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n Citation: Hines-Thomas MR, Howard SC, Hudson MM, Krasin MJ, Kaste SC, Shulkin BL, and Metzger ML. Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

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Section: Discussionmentioning

confidence: 95%

Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

Hines-Thomas¹,

Howard²,

Hudson³

et al. 2010

Haematologica

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“…In contrast to other risk scores, the four variables in the prognostic scoring system that were associated with poorer overall survival did not include male gender, but did include age, number of involved lymphoid areas, visceral disease, and B-symptoms. 9 None of the above mentioned prognostic scores allow an individual's risk profile to be determined before or during treatment. Furthermore, prognostic factors determined in the past gradually lose their predictive power as treatment is successfully adapted to the disease burden.…”

Section: Gender As a Prognostic Factor For Patients With Hodgkin Lympmentioning

confidence: 99%

Differences in hematotoxicity between male and female patients with Hodgkin lymphoma and other malignancies

Klimm

Engert

2008

Nat Rev Clin Oncol

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With improved treatment strategies and prognosis for patients with Hodgkin lymphoma (HL), interest has increasingly focused on high-risk groups. These groups include a small proportion of patients who experience relapse or who have primary refractory disease despite state-of-the-art treatment. Although many research efforts have been made in this field, specific biological markers that reliably predict unfavorable outcome during first-line treatment are lacking. Recent analyses in HL and other malignancies, however, have demonstrated an important impact of patient-related factors, such as individual differences in hematologic toxicity and drug metabolism, on disease outcome. A different cytochrome enzyme status and slower drug clearance in female patients, resulting in higher systemic toxicity and effectiveness of treatment, indicate that sex-specific aspects are important. In this Review, we discuss the current data on hematotoxicity among male and female patients with HL and other malignancies. In addition, we highlight the potential causes of hematotoxicity and its impact on treatment outcome and the role of future strategies.

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“…1 It is important to note that the median followup of this large group of patients exceeded 10 years and by 5 years no patient had been lost to follow-up. The size of the patient sample, as well as its extensive follow-up, enabled us to obtain stable and reliable 10-year survival and 5-year event-free survival (EFS) probabilities.…”

Section: Author Replymentioning

confidence: 87%

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Maucort‐Boulch

Colonna

Andrieu

2007

Cancer

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W e read with interest the article by Maucort-Boulch et al. regarding a new prognostic scoring system for Hodgkin lymphoma.1 In a series of 955 patients treated between 1981 and 1996, the authors found that only 4 variables present at diagnosis (age, number of lymphoid areas, visceral involvement, and B-symptoms) remained associated with overall survival (OS) on multivariate analysis. The 4 variables were used to identify 6 prognostic groups according to a point system. These groups were then joined to build a 3-stage prognostic scoring system (PSS), the discrimination and prediction properties of which were found to perform better than other prognostic scores tested.We have applied the PSS in a series of 370 patients with Hodgkin lymphoma who were treated with the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine between 1996 and 2005 in 2 public institutions. The median age of the patients was 29 years (range, 15-82 years). There were 197 men (53%) and 173 women. Localized disease, defined as Ann Arbor stages IA-IIA, was present in 151 patients (41%), whereas advanced disease was present in 219 patients. With a median follow-up of 3.92 years in surviving patients, the 5-year OS rate was 87%.The patient distribution across the 6 prognostic groups was: 84 patients in Group 0 (23%), 104 patients in Group 1 (28%), 81 patients in Group 2 (22%), 54 patients in Group 3 (14.5%), 35 patients in Group 4 (9.5%), and 12 patients in Group 5 (3%). The 5-year OS rates for these groups were 97%, 93%, 80%, 77%, 86%, and 67%, respectively (P ¼ .0004). The 5-year progression-free survival (PFS) rates of these same groups were 86%, 86%, 74%, 63%, 73%, and 67%, respectively (P ¼ .005).When the PSS was applied, the 5-year OS rates for the early (Groups 0 and 1), intermediate (Groups 2 and 3), and advanced groups (Groups 4 and 5) were 95%, 79%, and 80%, respectively. However, when patients were grouped in a slightly different manner, 3 distinct prognostic groups were clearly identified: early (Groups 0 and 1), with a 5-year OS rate of 95%; intermediate (Groups 2, 3, and 4), with a 5-year OS rate of 81%; and advanced (Group 5), with a 5-year OS rate of 66%. The difference between the early and intermediate groups was significant at a P value of .0001, but the difference between the intermediate and advanced groups was not found to be significant (P ¼ .1).The same calculation was performed for the 5-year PFS, but we were unable to identify 3 distinct prognostic groups, even when grouping the patients as shown above.We conclude that the PSS did not perform as well in our series as it did in the original study. This finding illustrates anew the difficulties in developing reproducible prognostic systems in the setting of Hodgkin lymphoma.

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Predictive and discriminating three‐risk‐group prognostic scoring system for staging Hodgkin lymphomas

Cited by 15 publications

References 51 publications

Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma

Differences in hematotoxicity between male and female patients with Hodgkin lymphoma and other malignancies

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