Salvage Radiotherapy in Patients With Relapsed and Refractory Hodgkin’s Lymphoma: A Retrospective Analysis From the German Hodgkin Lymphoma Study Group

Josting, Andreas; Nogová, Lucia; Franklin, Jeremy; Glossmann, Jan-Peter; Eich, Hans Theodor; Sieber, M.; Schober, Thomas; Boettcher, Heinz-Dietrich; Schulz, Ulrich; Müller, Rolf-Peter; Diehl, Volker; Engert, Andreas

doi:10.1200/jco.2005.05.022

Cited by 123 publications

(84 citation statements)

References 25 publications

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“…Indeed, the proportion of patients achieving long-term disease control after RT alone is too low. 36 The expert panel recognizes two potential indications of RT (in addition to palliation of incurable HL). Firstly, TBI can be included in the conditioning regimen prior to ASCT for patients at high risk of relapse and who have not been previously irradiated (see below).…”

Section: Radiotherapymentioning

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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Section: Radiotherapymentioning

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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“…In 2005, Josting et al reported the most comprehensive series of salvage radiotherapy alone in 100 patients with primary progressive or relapsed HL. 38 With a median observation time of 52 months, 5-year FF2F and OS for all patients were 28% and 51%, respectively, and for patients with limited stage at progression/relapse, 22% and 55%, respectively.…”

Section: Graft-versus-lymphomamentioning

confidence: 89%

Therapies for Relapsed Hodgkin Lymphoma: Transplant and Non-Transplant Approaches Including Immunotherapy

Bartlett¹

2005

Hematology

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Autologous stem cell transplant remains the standard of care for relapsed Hodgkin lymphoma (HL). Approximately 50% of patients with chemo-sensitive relapse will be cured with this approach. The optimal pretransplant salvage regimen is controversial, but less toxic combinations seem to be equivalent to more aggressive approaches. For patients with chemorefractory disease at relapse and those failing autologous transplant, the long-term prognosis remains poor. New approaches such as reduced-intensity allogeneic transplant, monoclonal antibodies targeting the CD30 antigen, Epstein-Barr virus (EBV)-specific cytotoxic T-lymphocytes, and bortezomib are under investigation, but preliminary results are disappointing. New therapies are needed for patients with relapsed HL.During the last decade, the questions regarding the treatment of relapsed Hodgkin lymphoma (HL) have changed. There is no longer a need to address treatment of relapse after primary radiotherapy, as this approach to HL has virtually disappeared. In addition, controversy surrounding the optimal timing (first vs second relapse) of autologous stem cell transplantation (auto-SCT) after failure of primary chemotherapy (CT) has largely subsided. Results of a large randomized trial from the German Hodgkin Study Group (GHSG) and European Group for Blood and Marrow Transplantation (EBMT) published in 2002 and updated at the American Society of Clinical Oncology (ASCO) 2005 meeting showed freedom from treatment failure was significantly better for patients undergoing transplant compared to non-transplant salvage, regardless of whether they relapsed early (< 12 months) or late following primary chemotherapy. 1,2Novel approaches to the primary treatment of HL and additional options for the treatment of relapsed disease have resulted in new questions.• Should patients who receive chemotherapy alone for early stage disease and have a localized relapse at the site(s) of initial disease receive radiotherapy (RT) or high-dose therapy and transplant at the time of first relapse? • What options are available for patients relapsing after aggressive first-line regimens such as dose-escalated BEACOPP? • Given the marked decrease in mortality following allogeneic transplant with reduced intensity conditioning (RIC), are there circumstances where this approach would be favored over autologous stem cell transplantation? • How should newer agents with activity in HL, such as vinorelbine and gemcitabine, be incorporated into treatment of relapsed disease?Unfortunately, studies are not yet available to answer these questions completely. This review will summarize the recent literature regarding treatment of relapsed HL including prognostic factors, pre-transplant salvage regimens, advances and long-term follow-up of auto-SCT, use of RIC with allogeneic transplant (RIC-allo), and the continued search for new drugs including an active monoclonal antibody for HL. Prognostic FactorsMany prognostic factors have been described for patients relapsing after first-line chemotherapy includi...

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“…The presence of B symptoms, advanced stage (III/IV) at relapse, Karnofsky of < 90% were identified as poor prognostic factors for those patients (Josting, Nogova et al 2005).…”

Section: Role Of Radiotherapy For Rr-hlmentioning

confidence: 99%

Therapy for Relapsed and Refractory Pediatric Hodgkin Lymphoma

Fernández¹,

Alarcón²

2012

Hodgkin's Lymphoma

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Salvage Radiotherapy in Patients With Relapsed and Refractory Hodgkin’s Lymphoma: A Retrospective Analysis From the German Hodgkin Lymphoma Study Group

Abstract: SRT offers an effective treatment for selected subsets of patients with relapsed or refractory HD.

Cited by 123 publications

References 25 publications

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

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

Therapies for Relapsed Hodgkin Lymphoma: Transplant and Non-Transplant Approaches Including Immunotherapy

Therapy for Relapsed and Refractory Pediatric Hodgkin Lymphoma

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