Therapy of Relapsed Hodgkin Lymphoma

Cashen, Amanda F.; Bartlett, Nancy L.

doi:10.1016/j.blre.2007.06.001

Cited by 16 publications

(8 citation statements)

References 76 publications

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“…Similarly, those patients with a negative pre-ASCT FDG-PET have an improved 3-year OS rate (91%), compared to patients with a positive pre-ASCT FDG-PET (64%); however, the difference in OS did not reach statistical significance (p=.08). Since cHL patients that relapse after ASCT transiently respond to a number of different salvage approaches, including recent clinical trials with novel agents (5), it is not surprising that the difference in OS is not significant. These outcomes suggest that relapsed cHL patients that receive standard salvage therapy and ASCT and have a negative pre-ASCT FDG-PET enjoy a greater than 75% chance of long term, disease free survival.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these improvements, a substantial number of cHL patients relapse or have primary refractory disease. The currently accepted therapy for relapsed/refractory cHL is standard dose salvage chemotherapy followed by high dose chemotherapy and autologous stem cell transplantation (ASCT) in chemosensitive patients, which results in long term disease free survival for 50–60% of patients (2–5). Pre-ASCT identification of relapsed cHL patients who have a poor prognosis despite ASCT would help direct higher risk patients to investigational therapies.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Significance of FDG-PET in Relapsed or Refractory Classical Hodgkin Lymphoma Treated with Standard Salvage Chemotherapy and Autologous Stem Cell Transplantation

Smeltzer

Cashen

Zhang

et al. 2011

Biology of Blood and Marrow Transplantation

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SUMMARY Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) has emerged as the standard response assessment tool in front-line therapy for classical Hodgkin lymphoma (cHL). The ability of FDG-PET to predict outcomes in patients with relapsed cHL treated with modern standard salvage chemotherapy and autologous stem cell transplantation (ASCT) remains uncertain. Forty-six patients with relapsed/refractory cHL treated from 2001–2007 with standard salvage/ASCT therapy had FDG-PET available for blinded review. The results of pre-ASCT FDG-PET interpreted by the international harmonization project (IHP) criteria were compared to published prognostic models for prediction of event free survival (EFS) and overall survival (OS). Overall, 3 year EFS was 62% and OS was 78% with a median follow-up of 38 months. Pre-ASCT FDG-PET response significantly predicted 3 year EFS in FDG-PET negative (82%) versus FDG-PET positive (41%) patients (p=0.02). A trend was observed for 3 year OS comparing FDG-PET negative (91%) versus positive (64%) patients (p=0.08). Multivariate analysis demonstrated the independent prognostic significance of pre-ASCT FDG-PET for EFS with a HR of 3.2 (CI 1.1–9.0, p=0.03). Pre-ASCT FDG-PET scans predict EFS in patients with relapsed cHL patients treated with modern salvage/ASCT therapy, and warrant prospective evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of FDG-PET in Relapsed or Refractory Classical Hodgkin Lymphoma Treated with Standard Salvage Chemotherapy and Autologous Stem Cell Transplantation

Smeltzer

Cashen

Zhang

et al. 2011

Biology of Blood and Marrow Transplantation

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“…[2][3][4]6 More commonly used conditioning regimens in adults and children have achieved event-free survival rates between 40 and 60%. 2,[4][5][6]10,12,15 Although the NRM for those with HL treated with auto-SCT has decreased with time, the use of HDC with or without RT is not without toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] With the exception of certain subgroups who might be cured with chemotherapy and/or RT, the treatment of refractory/relapsed disease often poses more of a challenge, although long-term survival rates have improved to 40-60% over the last 20 years with the use of high-dose chemotherapy (HDC) and auto-SCT. 2,3 Most of the reported data describe an adult rather than a pediatric population, and the few reported pediatric series involve small numbers of patients. 2,[4][5][6] However, several studies suggest that the adult literature describing the use of auto-SCT in relapsed/refractory HL can be extrapolated to children and young adults.…”

Section: Introductionmentioning

confidence: 99%

Single-agent high-dose melphalan followed by auto-SCT for relapsed and refractory Hodgkin lymphoma in children and adolescents

Guilcher

Lewis

et al. 2011

Bone Marrow Transplant

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“…Indeed, in another series, positive early PET after two courses of R-CHOP was not predictive, whereas end-of-treatment PET strongly correlated with the outcome. 11 However, so far, outside clinical trials, a modification of treatment based on early PET results is not supported by clinical evidence. IPI remains the best tool to separate DLBCL into different prognostic groups and tailor the treatment accordingly.…”

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confidence: 99%

The Treatment of Diffuse Large B-cell Lymphoma with Poor Prognosis in the Rituximab Era – State of the Art and Future Perspectives

Vitolo¹,

Chiappella²,

Frairia³

et al. 2010

European Oncology &Amp; Haematology

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Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), accounting for 30% of all newly diagnosed cases and >80% of aggressive lymphomas.The cyclophosphamide, doxorubicine, vincristine and prednisone (CHOP) regimen has been the mainstay of therapy for several decades, but a marked improvement in the outcome was demonstrated with the development of the anti-CD20 monoclonal antibody rituximab.Several studies have reported a significant advantage of adding rituximab to CHOP (R-CHOP) in elderly newly diagnosed DLBCL patients and young patients with a favourable prognostic profile. [1][2][3] Although the combination of rituximab with CHOP as the standard regimen has led to improved outcomes, there is a group of poor-risk patients who have a lower chance of being cured with standard R-CHOP and who need alternative treatment strategies. Prognostic FactorsClinical and molecular models were devised to better discriminate patients with poor prognosis at presentation.The International Prognostic Index (IPI) has become the primary clinical tool to predict outcome for patients with aggressive NHL. 4 Based on the number of negative prognostic features (>60 years of age, stage III-IV, lactate dehydrogenase (LDH) level, performance status (PS) >1 and more than one extranodal site), four distinct risk groups were identified, with a five-year overall survival (OS) ranging from 26 to 73%. Recently, on the basis that risk assessment is a moving target, a Revised International Prognostic Index (R-IPI) was retrospectively applied to patients with DLBCL treated with R-CHOP, and in so doing distinguished between three separate prognostic groups with different four-year OS rates: very good risk 94%, good risk 79% and poor risk 55%. and stromal-2 -were identified: stromal-1 includes genes that are expressed in fibronectin, suggesting the fibrotic nature of many DLBCLs, while the stromal-2 signature is accompanied by new blood vessel formation and is associated with adverse outcomes (see Figure 1).

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Therapy of Relapsed Hodgkin Lymphoma

Cited by 16 publications

References 76 publications

Prognostic Significance of FDG-PET in Relapsed or Refractory Classical Hodgkin Lymphoma Treated with Standard Salvage Chemotherapy and Autologous Stem Cell Transplantation

Prognostic Significance of FDG-PET in Relapsed or Refractory Classical Hodgkin Lymphoma Treated with Standard Salvage Chemotherapy and Autologous Stem Cell Transplantation

Single-agent high-dose melphalan followed by auto-SCT for relapsed and refractory Hodgkin lymphoma in children and adolescents

The Treatment of Diffuse Large B-cell Lymphoma with Poor Prognosis in the Rituximab Era – State of the Art and Future Perspectives

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