Risk assessment in the management of newly diagnosed classical Hodgkin lymphoma

Abstract

Treatment of Hodgkin lymphoma is associated with 2 major types of risk: that the treatment may fail to cure the disease or that the treatment will prove unacceptably toxic. Careful assessment of the amount of the lymphoma (tumor burden), its behavior (extent of invasion or specific organ compromise), and host related factors (age; coincident systemic infection; and organ dysfunction, especially hematopoietic, cardiac, or pulmonary) is essential to optimize outcome. Elaborately assembled prognostic scoring systems, such as the International Prognostic Factors Project score, have lost their accuracy and value as increasingly effective chemotherapy and supportive care have been developed. Identification of specific biomarkers derived from sophisticated exploration of Hodgkin lymphoma biology is bringing promise of further improvement in targeted therapy in which effectiveness is increased at the same time off-target toxicity is diminished. Parallel developments in functional imaging are providing additional potential to evaluate the efficacy of treatment while it is being delivered, allowing dynamic assessment of risk during chemotherapy and adaptation of the therapy in real time. Risk assessment in Hodgkin lymphoma is continuously evolving, promising ever greater precision and clinical relevance. This article explores the past usefulness and the emerging potential of risk assessment for this imminently curable malignancy.

Hodgkin Lymphoma Outcome: A Retrospective Study from 3 Tertiary Centers in Saudi Arabia

“…Furthermore, the estimated 5-year FFTF was 71% for advancedstage HL; this is similar to most recent clinical trials in which a 5-year failure-free survival rate of 73% was observed [6,29,34,[36][37][38]. However, a superior FFTF outcome was observed on CT imaging in patients who received consolidation radiotherapy post chemotherapy for residual disease (n = 90) compared to those who did not receive radiotherapy (86 vs. 65%, p < 0.003).…”

Hodgkin lymphoma in children and adolescents: improving the therapeutic index

“…At the present time there are no validated integral biomarkers that can be utilized for risk stratification or as surrogate markers of outcome. Whereas a wide range of biomarkers providing information on H/RS cells, the microenvironment and host polymorphisms and mutations, 23 have been studied in adults with HL, limited information is available specifically in pediatric HL. Comprehensive molecular characterization of childhood HL may help to further refine disease classification and improve our assessment of early response.…”

Five-year follow-up of brentuximab vedotin combined with ABVD or AVD for advanced-stage classical Hodgkin lymphoma

“…[4][5][6] In multisystemic, severe forms of this disease, targeted treatments with the BRAF inhibitors, vemurafenib and dabrafenib, have been efficiently used in BRAF-mutated patients. [7][8][9] In wild-type (WT) BRAF patients, cobimetinib, a MEK inhibitor, has also been used with success.…”

“…The methods for obtaining the BRAF status were described elsewhere. 4 Among them, 88 (66%) were found to carry a BRAF V600E mutation. The other 45 patients were considered as WT BRAF patients.…”

“…[1][2][3][4][5][6] However, treatment of patients with advanced-stage disease with optimal chemotherapy, such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), fails to cure as many as 15% to 25% of patients, necessitating secondary intensified treatment, which incurs major toxicity and is only successful in ;50% of patients. 1,7,8 Genuine improvement in these outcomes will require identification of novel effective agents that can be integrated with standard chemotherapy during primary treatment.…”