Advances in the Treatment of Relapsed or Refractory Hodgkin's Lymphoma

Ramchandren, Radhakrishnan

doi:10.1634/theoncologist.2011-0258

Cited by 14 publications

(14 citation statements)

References 79 publications

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“…One reason may be improvement in the effectiveness of treatments for many malignancies, including advanced and personalized chemotherapy regimens [19, 20], aggressive surgical intervention [21], and autologous stem cell transplantation [22]. These medical advancements may provide longer disease free intervals and more curative treatments than previously described.…”

Section: Discussionmentioning

confidence: 99%

Pre-transplant malignancy: An analysis of outcomes after thoracic organ transplantation

Beaty¹,

George²,

Kilic³

et al. 2013

The Journal of Heart and Lung Transplantation

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Purpose: Pre-transplant malignancy (PTM) is a relative contraindication to organ transplantation. Studies examining the impact of PTM on outcomes after lung transplantation (LTx) or orthotopic heart transplantation (OHT) are limited. We evaluated the impact of PTM on outcomes after LTx and OHT. Methods: We retrospectively reviewed primary adult LTx and OHT recipients in the United Network for Organ Sharing database. Primary and secondary stratification were by PTM and tumor type, respectively. Matched cohorts (2:1) as well as multivariable Cox proportional hazards regression models evaluated mortality. Results: From 2000-2011, 13,613 adults underwent LTx and 19,817 adults underwent OHT. 740 (5.4%) LTx patients and 1,117 (5.6%) OHT patients had PTM. On unadjusted analysis, both LTx patients and OHT patients with PTM had similar 30 day, 1-year and 5-year survivals (p>0.05) compared to no PTM. These findings persisted after risk-adjustment. No tumor types were associated with increased mortality in LTx patients. Patients with leukemia/lymphoma/myeloma (LLM) had a significant increase in univariate mortality at 30 days (HR:1.82, p=0.04), 1-year (HR:1.93, p<0.001) and 5-years (HR:1.54, p=0.01) in OHT patients. Matched cohort analysis revealed comparable outcomes in LTx patients, but confirmed increased univariate 1-year mortality (HR:1.89, p=0.006) in OHT patients with LLM. Conclusions: In the largest study evaluating the effects of PTM on LTx and OHT, the incidence of PTM is 5.4% and 5.6%, respectively. In general, PTM does not increase mortality in either cohort. However, OHT patients with LLM have an increased hazard of mortality. Therefore, carefully selected patients with PTM should not be excluded from LTx or OHT.

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Section: Discussionmentioning

confidence: 99%

Pre-transplant malignancy: An analysis of outcomes after thoracic organ transplantation

Beaty¹,

George²,

Kilic³

et al. 2013

The Journal of Heart and Lung Transplantation

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“…25,26 It is active in relapsed/refractory classical HL regardless of subtype or degree of CD20 expression on RS cells. 27 Rationale of using rituximab in classic HL includes elimination of CD20 þ reactive B cells supporting RS cells, hence depriving malignant cells of survival signals and potentially increasing host immune responses. 28 Single-agent rituximab was associated with an objective response of 22% in nodular sclerosis histology.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

“…Inhibition of Akt in HL cell lines leads to apoptosis, suggesting that the PI3K-AktmTOR pathway has a role in growth and survival of RS cells. 27,40 Johnston et al 41 provided a proof-of-concept phase 2 trial enrolling 19 (84% had undergone prior auto-HCT) patients with relapsed HL showing an ORR of 47% and a median time-toprogression of 7.2 months (Table 1). Everolimus is also synergistic with other agents.…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

“…38,42,43 Immunomodulatory therapy Lenalidomide is an immunomodulatory agent with several mechanisms of action. 27 Limited data suggest that lenalidomide has modest clinical activity in relapsed/refractory HL (Table 1). A multicenter phase 2 study evaluated the efficacy of lenalidomide, in 38 patients with relapsed/refractory HL (87% had prior auto-HCT).…”

Section: Monoclonal Antibodiesmentioning

confidence: 99%

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Managing Hodgkin lymphoma relapsing after autologous hematopoietic cell transplantation: a not-so-good cancer after all!

Kharfan‐Dabaja

Hamadani

Sibai

et al. 2014

Bone Marrow Transplant

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Hodgkin lymphoma (HL) relapsing after an autologous hematopoietic cell transplant (HCT) poses a therapeutic challenge. In this setting, salvage chemotherapy (for example, gemcitabine-based, ifosfamide-containing and others) or immunotherapy (for example, brentuximab vedotin) is essential as a bridging-cytoreduction strategy to an allogeneic HCT. Myeloablative allogeneic hematopoietic cell transplantation in relapsed HL is associated with high rates of non-relapse mortality. In carefully selected patients with chemosensitive disease, allografting following lower-intensity conditioning regimens can provide durable disease control rates of about 25-35%. Promising early results with haploidentical and umbilical cord transplantation are noteworthy and are expanding this procedure to patients for whom HLA-matched related or unrelated donors are not available. Unfortunately, a significant number of HL patients relapsing after an autologous HCT are not candidates for allografting because of the presence of resistant disease, donor unavailability or comorbidities. Brentuximab vedotin is approved for HL relapsing after a prior autograft. Rituximab and bendamustine are also active in this setting, albeit with short durations of remission. Histone deacetylase inhibitors (for example, panobinostat, mocetinostat), mTOR inhibitors (for example, everolimus) and immunomodulatory agents (lenalidomide) have shown activity in phase II trials, but currently are not approved for this indication. Second autologous HCT are rarely performed but this approach should not be considered standard practice at this time. The need for effective agents for post autograft failures of HL largely remains unmet. Continuous efforts to ensure early referral of such patients for allogeneic HCT or investigational therapies are the key to improving outcomes of this not-so-good lymphoma.

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“…Sajnos a primeren refrakter és korán relabáló betegek kezelése továbbra is kihívást jelent, számukra a nagy dózisú kezelés autológ heamopoeticus őssejt-szupportációval, valamint az újszerű, célzott terápiás lehetőségek (brentuximab vedotin, PD-1-gátlók [programozott sejthalál-1]) jelenthetnek terápiás lehetőséget [3,4].…”

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Pulmonalis eltérések Hodgkin-lymphomában

et al. 2016

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A Hodgkin-lymphoma kezelése a hematológia sikertörténetei közé tartozik. A korszerű kombinált kemo-és radioterápiának köszönhetően a betegek jelentős része túlél, így előtérbe kerülnek a kezelések mellékhatásai, amelyek a betegek későbbi életminőségét és élettartamát befolyásolhatják. A szerzők a Hodgkin-lymphoma tüdőben előfordu-ló megjelenési formáit és a kezelés következtében kialakuló pulmonalis eltéréseket, szövődményeket elemzik -saját eseteik példáján. A Hodgkin-lymphoma tüdőérintettsége gyakrabban másodlagos, primer pulmonalis érintettség igen ritkán fordul elő. A szerzők saját betegeik vizsgálata során tüdőérintettséget összesen az esetek 8-12%-ában észleltek. A kezelés rövid és hosszú távú pulmonalis mellékhatásait egyrészt az immunszuppresszióval összefüggésben lévő infekciók, másrészt a jelenleg első vonalbeli standard kezelés részét képező bleomycin, illetve a mellkasi irradiáció okozta pneumonitis és fibrosis jelentik. A Hodgkin-lymphoma pulmonalis megjelenése egyrészt diagnosztikai és differenciáldiagnosztikai nehézségeket jelenthet, stádiumot és ennek következtében kezelést módosíthat, másrészt a kialakuló mellékhatások a későbbi élettartamot és életminőséget jelentősen meghatározzák, így felismerésük döntő fontosságú. Orv. Hetil., 2016, 157(5), 163-173.Kulcsszavak: Hodgkin-lymphoma, tüdőérintettség, bleomycin, mellkasi irradiáció, második daganat Pulmonary alterations in Hodgkin lymphomaMost of Hodgkin lymphoma patients survive due to combined chemo/radiotherapy. Improved survival brings longterm side effects to the front, which may determine the patients' subsequent quality of life and expected lifetime. This manuscript aims to analyze lung manifestations of Hodgkin lymphoma and treatment related pulmonary complications, demonstrated with own cases. The lung involvement in Hodgkin lymphoma is often secondary, and primary pulmonary involvement is very rare. The authors found 8-12% of lung involvement among their patients. Side effects of treatment consist of pulmonary infections in conjuction with immunosuppression, while on the other hand bleomycin and chest irradiation as part of current standard of care induced pneumonitis and fibrosis are reported. The pulmonary involvement in Hodgkin lymphoma may cause differential diagnostic difficulty. Lung involvement could modify stage and consequently treatment, and the development of side effects might determine later quality of life and expected lifetime. Therefore, identification of lung involvement is crucial.Keywords: Hodgkin lymphoma, lung involvement, bleomycin, chest irradiation, second tumor Jóna, Á., Illés, Á., Szemes, K., Miltényi, Zs. [Pulmonary alterations in Hodgkin lymphoma]. Orv. Hetil., 2016, 157(5), 163-173. (Beérkezett: 2015 elfogadva: 2015. december 3.) ÖSSZEFOGLALÓ KÖZLEMÉNY Rövidítések ABVD = adriamycin, bleomycin, vinblastin, dacarbazin; ARDS = akut respirációs distressz szindróma; AVD = adriamycin, vincristin, dacarbazin; BEACOPP = bleomycin, etoposid, doxorubicin, cyclophosphamid, vincristin, procarbazin, prednison; BEA...

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Advances in the Treatment of Relapsed or Refractory Hodgkin's Lymphoma

Abstract: ABSTRACT

Cited by 14 publications

References 79 publications

Pre-transplant malignancy: An analysis of outcomes after thoracic organ transplantation

Pre-transplant malignancy: An analysis of outcomes after thoracic organ transplantation

Managing Hodgkin lymphoma relapsing after autologous hematopoietic cell transplantation: a not-so-good cancer after all!

Pulmonalis eltérések Hodgkin-lymphomában

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