Intensified treatment of patients with early stage, unfavourable Hodgkin lymphoma: long-term follow-up of a randomised, international phase 3 trial of the German Hodgkin Study Group (GHSG HD14)

Gillessen, Sarah; Plütschow, Annette; Fuchs, Michael; Marková, Jana; Greil, Richard; Topp, Max S.; Meißner, Julia; Zijlstra, Josée M.; Eichenauer, Dennis A.; Bröckelmann, Paul J.; Diehl, Volker; Borchmann, Peter; Engert, Andreas; Tresckow, Bastian von

doi:10.1016/s2352-3026(21)00029-6

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…For stage I/II with high risk, HD14 proved that patients could reduce recurrence when receiving 2-cycle escalated BEACOPP (eBEACOPP) (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone) combined with two-cycle ABVD compared with four-cycle ABVD. 26 But it caused more adverse effects at the same time. Advanced HL can choose ABVD or BEACOPP as their first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

Nomogram model and risk score predicting overall survival and guiding clinical decision in patients with Hodgkin’s lymphoma: an observational study using SEER population-based data

Liang

Zhang

et al. 2022

BMJ Open

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IntroductionThis study developed a prognostic nomogram of Hodgkin lymphoma (HL) for purpose of discussing independent risk factors for HL patients with Surveillance, Epidemiology and End Results (SEER) database.MethodsWe collected data of HL patients from 2010 to 2015 from the SEER database and divided it into two cohorts: the training and the verification cohort. Then the univariate and the multivariate Cox regression analyses were conducted in the training, the verification as well as the total cohort, after which the intersection of variables with statistical significance was taken as independent risk factors to establish the nomogram. The predictive ability of the nomogram was validated by the Concordance Index. Additionally, the calibration curve and receiver operating characteristic curve were implemented to evaluate the accuracy and discrimination. Finally, we obtained 1-year, 3-year and 5-year survival rates of HL patients.Results10 912 patients were eligible for the study. We discovered that Derived American Joint Committee on Cancer (AJCC) Stage Group, lymphoma subtype, radiotherapy and chemotherapy were four independent risk factors affecting the prognosis of HL patients. The 1-year, 3-year and 5-year survival rates for high-risk patients were 85.4%, 79.9% and 76.0%, respectively. It was confirmed that patients with stage I or II had a better prognosis. Radiotherapy and chemotherapy had a positive impact on HL outcomes. However, patients with lymphocyte-depleted HL were of poor prognosis.ConclusionsThe nomogram we constructed could better predict the prognosis of patients with HL. Patients with HL had good long-term outcomes but novel therapies are still in need for fewer complications.

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Section: Discussionmentioning

confidence: 99%

Nomogram model and risk score predicting overall survival and guiding clinical decision in patients with Hodgkin’s lymphoma: an observational study using SEER population-based data

Liang

Zhang

et al. 2022

BMJ Open

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Section: Discussionmentioning

confidence: 99%

“…Additionally, the role of RT has been challenged by the results of the RATHL trial 35 in advanced HL, which included stage IIA patients with adverse features, and recent findings of noninferiority of chemotherapy-alone with 2 1 2 intensified treatment in GHSG HD14. 36 Within classifications of disease stage, variations in disease and patient factors still could influence relapse risk. For instance, in post hoc analysis of the RAPID trial, baseline maximum tumor diameter (MTD) was prognostic of subsequent relapse in patients who had achieved complete metabolic response.…”

Section: Age and Sexmentioning

confidence: 99%

Informing radiotherapy decisions in stage I/IIa Hodgkin lymphoma: modeling life expectancy using radiation dosimetry

Jones¹,

Candio²,

Shakir

et al. 2022

Blood Advances

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In recent randomized trials, omitting consolidative radiotherapy (RT) in early-stage Hodgkin lymphoma (ESHL) increased relapses. However, decades of follow-up are required to observe whether lower initial disease control is compensated by reduced risk of late effects. Extrapolation beyond trial follow-up is therefore necessary to inform current treatment decisions. To this end, we developed a microsimulation model to estimate lifetime quality-adjusted life years (QALYs) after combined modality treatment (CMT) or chemotherapy-alone for stage I/IIa ESHL. For CMT, the model included risks of breast and lung cancer, coronary heart disease, and ischemic stroke. Comparative outcomes were assessed for a clinically relevant range of example patients differing by age, sex, smoking status, and representative organs at risk (OAR) radiation doses informed by the RAPID trial. Analysis was performed with and without a 3.5% discount rate on future health. Smoking status had a large effect on optimal treatment choice. CMT was superior for nearly all never smoker example patients regardless of age, sex, and OAR doses. At a maximum, CMT produced a 1.095 (95% CI: 1.054-1.137) gain in undiscounted QALYs for a 20-year-old male never smoker with unilateral neck disease. In contrast, current smokers could substantially gain from chemotherapy-alone treatment. Again at a maximum, a 20-year-old male current smoker with bilateral neck and whole mediastinum involvement gained 3.500 (95% CI: 3.400 to 3.600) undiscounted QALYs with chemotherapy-alone treatment. Overall, CMT was more favorable the younger the patient, when future health discounting was included, and in never smokers.

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“…There is no general recommendation for antiviral prophylaxis in patients with first line therapy of Hodgkin’s lymphoma (treated with ABVD or BEACOPPesc) according to study protocols [ 93 , 94 ]. Still the risk of VZV reactivation may be elevated, partly due to corticosteroid exposure (Table 5 ).…”

Section: Patient Groupsmentioning

confidence: 99%

Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus

et al. 2022

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Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 “Antiviral prophylaxis in patients with solid tumours and haematological malignancies” focusing on herpes simplex virus and varicella zoster virus.

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Intensified treatment of patients with early stage, unfavourable Hodgkin lymphoma: long-term follow-up of a randomised, international phase 3 trial of the German Hodgkin Study Group (GHSG HD14)

Cited by 20 publications

References 18 publications

Nomogram model and risk score predicting overall survival and guiding clinical decision in patients with Hodgkin’s lymphoma: an observational study using SEER population-based data

Nomogram model and risk score predicting overall survival and guiding clinical decision in patients with Hodgkin’s lymphoma: an observational study using SEER population-based data

Informing radiotherapy decisions in stage I/IIa Hodgkin lymphoma: modeling life expectancy using radiation dosimetry

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