Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

Meyer, Ralph M.; Hoppe, Richard T.

doi:10.1182/blood-2012-05-423236

Cited by 20 publications

(13 citation statements)

References 59 publications

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“…However, 2-5% and 5-10% of patients have a primary refractory disease, and 10-15% and 25-30% of patients experience relapse after conventional chemotherapy in early-stage HL and advanced-stage HL, respectively [1,2]. For these patients, several studies have demonstrated that autologous hematopoietic stem cell transplantation (HSCT) can prolong survival [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

et al. 2014

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on behalf of the Adult Lymphoma Working Group of the Japanese Society for Hematopoietic Cell TransplantationThe optimal treatment strategy with the use of hematopoietic stem cell transplantation (HSCT) for relapsed and refractory Hodgkin lymphoma (HL) remains unclear. We performed a retrospective analysis using registry data from the Japanese Society for Hematopoietic Cell Transplantation. Adult patients with HL who underwent a first autologous or a first allogeneic HSCT between 2002 and 2009 were included. Patients who underwent HSCT in first complete remission (CR) were excluded. Autologous and allogeneic HSCT were performed in 298 and 122 patients, respectively. For autologous HSCT, overall survival at 3 years (3yOS) was 70%, and sex, age, disease status, and performance status (PS) at HSCT were prognostic factors. OS was favorable even in patients who underwent autologous HSCT in disease status other than CR. For allogeneic HSCT, 3yOS was 43%, and sex and PS at HSCT were prognostic factors. Disease status at HSCT, previous autologous HSCT, and conditioning intensity did not affect OS. Moreover, graft-versus-host disease did not affect progression-free survival or relapse/progression rate. A first allogeneic HSCT without a previous autologous HSCT was performed in 40 patients. 3yOS was 45%, and was significantly inferior to that in patients who underwent their first autologous HSCT. This result was retained after the correction by the different patient characteristics according to the type of HSCT. In conclusion, autologous HSCT is effective in prolonging survival in patients with relapsed and refractory HL. Allogeneic HSCT might be beneficial even to relapsed HL after autologous HSCT, although establishing the role of allogeneic HSCT remains a challenge.

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Section: Introductionmentioning

confidence: 99%

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

et al. 2014

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“…Consolidation RT could be considered after transplantation in selected indications. 1 ASCT is standardly recommended as second transplant. In selected patients, RIC-allo could be considered as second transplant procedure.…”

Section: High-risk Groupmentioning

confidence: 99%

“…However, treatment failure occurs in approximately 10% of limited-stage disease. 1 In advanced-stage disease, up to 10% of patients will not reach complete remission (CR) and 20-30% of responders eventually relapse after treatment. 2 High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) has been clearly identified as a reference treatment in relapsing patients by two large randomized controlled studies which show improved freedom from treatment survival in the ASCT group compared to standard chemotherapy, and from registry studies which also show advantage for HDT in matched patients.…”

Section: Introductionmentioning

confidence: 99%

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

et al. 2013

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Key pre-salvage treatment risk factors that were almost consistently found to independently prognosticate outcome in Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant open-access paper. doi:10.3324/haematol.2012.072090 Manuscript received on January 15, 2013. Manuscript accepted on May 6, 2013 .beThe Hodgkin's Lymphoma Committee of the Lymphoma Study Association (LYSA) gathered in 2012 to prepare guidelines on the management of transplant-eligible patients with relapsing or refractory Hodgkin's lymphoma. The working group is made up of a multidisciplinary panel of experts with a significant background in Hodgkin's lymphoma. Each member of the panel of experts provided an interpretation of the evidence and a systematic approach to obtain consensus was used. Grades of recommendation were not required since levels of evidence are mainly based on phase II trials or standard practice. Data arising from randomized trials are emphasized. The final version was endorsed by the scientific council of the LYSA. The expert panel recommends a risk-adapted strategy (conventional treatment, or single/double transplantation and/or radiotherapy) based on three risk factors at progression (primary refractory disease, remission duration < 1 year, stage III/IV), and an early evaluation of salvage chemosensitivity, including 18 fluorodeoxy glucose-positron emission tomography interpreted according to the Deauville scoring system. Most relapsed or refractory Hodgkin's lymphoma patients chemosensitive to salvage should receive high-dose therapy and autologous stem-cell transplantation as standard. Efforts should be made to increase the proportion of chemosensitive patients by alternating non-cross-resistant chemotherapy lines or exploring the role of novel drugs. ABSTRACT © F e r r a t a S t o r t i F o u n d a t i o nN o c o m m e r c i a l u s e relapsing and refractory HL are primary refractoriness, short time to HL relapse, and advanced clinical stage at relapse. 2,12,13 The expert panel recommends using these robust prognostic factors to stratify patients into three risk groups (Table 1). There have been inconsistent reports of other predictive risk factors, sometimes with independent value, such as anemia, poor performance status (PS), presence of B symptoms, extranodal relapse, relapse in previous radiation field, age, or bulky disease, but the latter were not retained by the expert panel to serve in the risk group definition. 2,14,15 Primary refractoriness is defined either by progression at any time during chemotherapy or radiotherapy (RT) and up to three months after the end of treatment, and/or by persistence of a PET positive residual mass, using the quantitative 5-point scale Deauville score (DS) for PET interpretation. Using these criteria, a positive FDG-PET (i.e. DS 4 or 5) after 3-4 cycles of ABVD for supra-diaphragmatic HL, and after four cycles of BEACOP Pesc or ABVD for advanced HL, is considered as primary refractory disease...

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“…Therefore, the preferred treatment of HL patients with early-stage disease continues to be strongly debated in part because of the overarching goal of long-term OS with preserved quality of life. 37 New scientific advances have been sought to identify select, low-risk patients in whom radiation may be obviated and/or less chemotherapy delivered. The functional imaging modality, FDG-PET/CT, has been examined as a tool to direct when treatment should be deintensified or escalated based on interim results.…”

Section: Current Treatment Paradigms For Early-stage Hlmentioning

confidence: 99%

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Evens

Kostakoğlu

2014

Hematology

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Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

Cited by 20 publications

References 59 publications

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

The role of hematopoietic stem cell transplantation for relapsed and refractory Hodgkin lymphoma

Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

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