Treatment of early and intermediate stages of supradiaphragmatic Hodgkin's disease: The Swedish National Care Programme Experience

Glimelius, Bengt; Kälkner, M.; Enblad, Gunilla; Gustavsson, Anita; Jakobsson, M.; Branehög, I; Lenner, Per

doi:10.1093/oxfordjournals.annonc.a059009

Cited by 20 publications

(16 citation statements)

References 41 publications

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“…Although, the response of early-stage HD to conventional combined modality therapy had been excellent, [27][28][29][30][31][32] concerns over late effects of therapy on young growing children resulted in efforts to design treatment programs for children and adolescents with HD that would reduce toxicity without jeopardizing response rate and survival. The first step taken by pediatric oncologists to limit toxicity was to reduce the amount of radiation by increased reliance on effective chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

POG 8625: A Randomized Trial Comparing Chemotherapy With Chemoradiotherapy for Children and Adolescents With Stages I, IIA, IIIA1 Hodgkin Disease

Kung

Schwartz

Ferree

et al. 2006

Journal of Pediatric Hematology/Oncology

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To determine if 6 courses of chemotherapy alone could achieve the same or better outcome than 4 courses of chemotherapy followed by radiation therapy (chemoradiotherapy) in pediatric and adolescent patients with Hodgkin disease. Children < or =21 years old with biopsy-proven, pathologically staged I, IIA, or IIIA1 Hodgkin disease were randomly assigned 6 courses of alternating nitrogen mustard, oncovin, prednisone, and procarbazine/doxorubicin, bleomycin, vinblastine, and dacarbazine (treatment 1) or 4 courses of alternating nitrogen mustard, oncovin, prednisone, and procarbazine/doxorubicin, bleomycin, vinblastine, and dacarbazine +2550 cGy involved-field radiotherapy (treatment 2). The complete response rate was 89%, with a complete response and partial response rate of 99.4%. There was no statistically significant difference in event-free survival (EFS) or overall survival between arms. The EFS for those who achieved an early complete response was significantly higher than for those who did not. For pediatric patients with asymptomatic low-stage and intermediate-stage Hodgkin disease, chemotherapy and chemoradiotherapy both resulted in 3-year EFS of approximately 90% and statistically indistinguishable 8-year EFS and overall survival, without significant long-term toxicity. Early response to therapy was associated with higher EFS, a concept that has led to the Children's Oncology Group paradigm of response-based risk-adapted therapy for pediatric Hodgkin disease.

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Section: Discussionmentioning

confidence: 99%

POG 8625: A Randomized Trial Comparing Chemotherapy With Chemoradiotherapy for Children and Adolescents With Stages I, IIA, IIIA1 Hodgkin Disease

Kung

Schwartz

Ferree

et al. 2006

Journal of Pediatric Hematology/Oncology

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“…The Stockholm Hodgkin Lymphoma Study Group was established in 1973 23 and national Swedish treatment recommendations for HL were introduced in 1985 and have been updated over the years. [24][25][26] In 1975, the successful use of the combination ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) was reported, 27 and since the early 1980s, a variety of chemotherapy combinations other than conventional MOPP, including ABVD, MOPP/ABVD, MOPP/ABV (for younger patients), and ChLVPP (chlorambucil, vinblastine, procarbazine, prednisolone), LVPP/OEPA (chlorambucil, vinblastine, procarbazine, vincristine, etoposide, prednisone, doxorubicin), and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone; mostly elderly patients) were used in previously untreated patients with stage IIB-IV disease. [28][29][30][31][32] Since the 1980s patients with advanced disease reaching a complete remission after 2 cycles traditionally received a total of 6 cycles of chemotherapy.…”

Section: Treatment Principles Of Hl During the Study Periodmentioning

confidence: 99%

Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Sjøberg

Halthur

Kristinsson

et al. 2012

Blood

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In recent decades, attention has focused on reducing long-term, treatment-related morbidity and mortality in Hodgkin lymphoma (HL). In the present study, we looked for trends in relative survival for all patients diagnosed with HL in Sweden from 1973-2009 (N ‫؍‬ 6949; 3985 men and 2964 women; median age, 45 years) and followed up for death until the end of 2010. Patients were categorized into 6 age groups and 5 calendar periods (1973-1979, 1980-1986, 1987-1994, 1994-2000, and 2001-2009 IntroductionOver the past 40 years, major advances have been made in the management of patients with Hodgkin lymphoma (HL). These include the introduction of more accurate radiotherapy, effective multiagent chemotherapy, immunotherapy, improved staging procedures, and important developments in supportive measures for myelosuppression and infectious and other complications. 1 Therefore, HL has gone from being an invariably fatal disorder to one of the few malignancies that are now highly curable. This is particularly true for patients with early-stage disease, but today disease control rates also exceed 70% in patients presenting with high-risk features. 2 This therapeutic success has unfortunately been darkened by elevated risks of secondary primary cancers, cardiovascular disease (CVD), cerebrovascular disease, and infections in longterm HL survivors. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] CVD has been reported to be the most important cause of excess mortality after HL and second malignancies. [10][11][13][14] During the last 2-3 decades, treatment strategies have been and are being adapted based on increased knowledge of treatment-related morbidity and mortality. Awaiting novel and less toxic targeted therapies of HL, the largest potential for improving survival and healthrelated quality of life in long-term survivors 17 is by reducing the excess morbidity and mortality from causes other than HL. To evaluate progress in long-term outcome, we studied patient survival among all 6949 HL patients diagnosed in Sweden between 1973 and 2009 and followed up for death to the end of 2010. Our aim was to assess trends in patient survival and long-term excess mortality in the entire population during this 37-year period starting when curative treatment principles were well-established. Methods Central registers and patientsInformation regarding patients diagnosed with a malignant disorder in Sweden is reported to a population-based nationwide Swedish Cancer Register that was established in 1958. The register contains information on diagnosis, sex, date of birth, date of diagnosis, and the hospital where the diagnosis was made, 18-19 but does not contain detailed clinical information such as symptoms, routine laboratory tests, treatment, or comorbidities.In Sweden, every physician and pathologist/cytologist is obliged by law to report each occurrence of cancer to the registry. All deaths are recorded in the nationwide causes of death register. Each person in Sweden is given a unique national registration number used to index a...

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“…A drawback of the study is that the Swedish Cancer Register holds no therapy data, but studies have shown that up to 90% of patients were given radiotherapy during our study period (Glimelius et al, 1994, Molin et al, 2003. Many HL patients were probably diagnosed as nonHodgkin's lymphoma (NHL), but because most of them were older patients with a short survival, this will not affect the present results, especially those with long follow-up that are compared with the general population.…”

Section: Risk Of Second Primary Malignancies After Hl a Andersson Et Almentioning

confidence: 92%

Family history of cancer as a risk factor for second malignancies after Hodgkin's lymphoma

et al. 2008

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This study estimated the risk of second primary malignancies after Hodgkin's lymphoma (HL) in relation to family history of cancer, age at diagnosis and latency, among 6946 patients treated for HL in Sweden in 1965 -1995 identified through the Swedish Cancer Register (SCR). First-degree relatives (FDRs) to the HL patients and their malignancies were then ascertained together with their malignancies through the Multi-Generation Registry and SCR. The HL patient cohort was stratified on the number of FDRs with cancer, and standardised incidence ratios (SIRs) of developing SM were analysed. In the HL cohort, 781 SM were observed 1 year or longer after HL diagnosis. The risk for developing SM increased with the number of FDRs with cancer, SIRs being 2.26, 3.01, and 3.45 with 0, 1, or X2 FDRs with cancer, respectively. Hodgkin's lymphoma long-term survivors treated at a young age with a family history of cancer carry an increased risk for developing SM and may represent a subgroup where standardised screening for the most common cancer sites could be offered in a stringent surveillance programme.

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Treatment of early and intermediate stages of supradiaphragmatic Hodgkin's disease: The Swedish National Care Programme Experience

Abstract: The tailored principles, which usually entail less staging and/or treatment than is generally the case, produced favourable results when applied to an entirely unselected group of patients with early and intermediate stages of HD.

Cited by 20 publications

References 41 publications

POG 8625: A Randomized Trial Comparing Chemotherapy With Chemoradiotherapy for Children and Adolescents With Stages I, IIA, IIIA1 Hodgkin Disease

POG 8625: A Randomized Trial Comparing Chemotherapy With Chemoradiotherapy for Children and Adolescents With Stages I, IIA, IIIA1 Hodgkin Disease

Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Family history of cancer as a risk factor for second malignancies after Hodgkin's lymphoma

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