Incidence Of Hodgkin Lymphoma Research Articles

Hodgkin's Lymphoma In Low-Income Countries: Experience Of Togo

While highly curable in developed countries, Hodgkin's lymphoma (HL), remains a significant challenge for resource-limited ones. This study aimed to describe the profile of HL in Togo. This was a retrospective, descriptive study conducted at the Clinical Hematology Department of the Campus University Hospital Center in Lomé, Togo. It focused on patient records diagnosed with HL between January 1, 2006, and December 31, 2022. Various variables such as age, gender, histological type of HL, Ann Arbor stage, prognostic classification, therapeutic protocol used, and patient outcomes were examined. The annual incidence of HL was 1.5 with a mean age of 38.7 years (range 12-63). Lymph node enlargement was the primary clinical sign (100%). Histologically, classical HL was found in 21 patients (87.5%). Staging was conducted for 16 (66.7%) patients, among whom 11 (66.7%) were at an advanced stage, and 6 (37.5%) had an unfavorable prognosis. The ABVD protocol was used in 13 patients (54.2%), receiving between 1 and 6 cycles. One patient achieved complete remission (4.1%), three deceased (12.5%), and 17 (71%) were lost to follow-up. Hodgkin's lymphoma prognosis remains unfavorable with low remission rates in Togo. Improving the technical facilities will ensure better management of this lymphoma.

Трудности диагностики лимфомы Ходжкина у ребенка с бронхиальной астмой

Hodgkin's lymphoma (HL) is a B-cell malignant lymphoproliferative disease. It is characterized by the presence of giant Reed-Berezovsky- Sternberg cells, which can be detected by microscopy of affected lymph nodes. The incidence of HL in the Russian Federation is 2.2 per 100,000 per year, and it ranks 26th among other malignancies worldwide. The disease has two peaks, occurring at the ages of 15–19 years and after 50 years. Men are slightly more commonly affected than women. Young patients with HL are predominantly women, while older patients are predominantly men. The etiology of HL remains unclear. Clinically, the disease is characterized by asymptomatic lymph node enlargement, intoxication, intermittent fever, and, in patients with massive mediastinal involvement, chest pain, cough, dyspnea, and symptoms of superior vena cava syndrome. The article discusses the prevalence, specifics of treatment, and association with allergic diseases, and describes a 13-year-old child with nodular sclerosis classic Hodgkin's lymphoma. KEYWORDS: Hodgkin's lymphoma, nodular sclerosis, allergic disease, asthma, lymphoproliferative disease, differential diagnosis. FOR CITATION: Belykh N.A., Chernenko A.P., Mikhaylova Yu.V., Piznyur I.V. Challenges in the diagnosis of Hodgkin lymphoma in a child with asthma. Russian Medical Inquiry. 2024;8(3):176–182 (in Russ.). DOI: 10.32364/2587-6821-2024-8-3-9.

Brentuximab Vedotin Combined with Chemotherapy in the Treatment of Pediatric Patients with R/R Hodgkin Lymphoma: Results of a Real World Setting Study

INTRODUCTION: Hodgkin Lymphoma (HL) is a familiar malignant lymphoma of the lymphatic system that accounts for 10% of all lymphoma diagnoses and 5% of lymphoma-related deaths. According to statistics, the incidence of HL in children and adolescents (0-19 years old) in China is about 1.78/million, and an average of 569 new cases are estimated annually from 2019 to 2021 . Brentuximab vedotin (BV) is an antibody-drug conjugates (ADC) that selectively delivers monomethyl auristatin E, an antimicrotubule agent, into CD30-expressing cells. Most of the data on the efficacy and safety of BV came from prospective and retrospective studies in adults or foreign children, and there are insufficient data in Chinese children. The purpose of this study is to explore the efficacy and safety of BV Combined with chemotherapy in Chinese pediatric patients with refractory and/or relapsed Hodgkin's lymphoma. METHODS: Retrospective analysis of clinical data of 9 children with refractory and/or relapsed Hodgkin's lymphoma from October 2021 to May 2023 at Beijing Children's Hospital, Capital Medical University. Patients were classified according to: clinical stage(Ann Arbor stage), huge tumor, huge tumor in the mediastinum, symptoms of B, and whether multiple lymph nodes were involved. Among them, the low-risk group was IA, ⅡA without giant tumor. The middle risk group was IB and ⅢA without huge tumor. High-risk groups were patients with stage ⅡB, ⅢB, Ⅳ or (each stage) with large tumors, or children with > 4 lymph node regions. All patients received BV in combination with chemotherapy for at least 2 cycles, and patients were assessed for remission response according to the Revised Response Criteria for Malignant Lymphoma at the end of every 2 cycles and followed up until July 20, 2023. RESULTS: Totally 32 cycles of chemotherapy were recorded, including 36 doses of BV administration(Table 1). The overall response rate of the children after 2 cycles of treatment was 100%, and the complete response rate was 88.89%. After remission, 2 cases (P1, P2) were treated with BV single drug 1.8mg/kg, Q3W for 6 months, and 3 cases (P3, P4, P7) were treated with radiotherapy. Two patients (P5, P6) received sequential chemotherapy, and two patients (P8, P9) were followed by programmed cell death 1(PD-1) antibody maintenance treatment for 6 months. After receiving PD-1 antibody for 6 months, 1 patient (P9) was transferred to BV monotherapy for maintenance, with 18 times planned. 2 cases (P1, P2) were then treated with autologous stem cell transplantation. None of the children developed disease progression during treatment. All patients successfully completed all planned dosage of BV, and serious adverse events were dominated by grade 3 or higher hematocrit, none of which interfered with normal treatment. Interpretation. BV had demonstrated the better efficacy and tolerable safety profile in the treatment of refractory and/or relapsed Hodgkin's lymphoma in children. CONCLUSIONS: BV has been approved by National Medical Products Administration in China since 2020, the clinical cases are mostly from adult lymphoma patients, and children data of in China is rare. In this study, we retrospectively reviewed and analyzed the data of BV combined chemotherapy in the treatment of refractory and relapsed Hodgkin lymphoma from single center, and found that the treatment response was rapid, continuousand safe. However, this study is a single-center retrospective study with a small sample size So We are conducting a prospective study of BV in first-line Hodgkin lymphoma children patients in China and aiming to generate more data for this specific population.

Universal and Equitable Access to High-Cost Drugs in Uruguay. Results of 15 Years of Treatment of Non-Hodgkin Difusse Large B Cell Lymphoma (DLBCL) with Ritiximab in First Line Treatment in Uruguay

Introduction The Integrated National Health System (INHS) allows the worker or retiree and their families to have universal health coverage through a contribution proportional to their income, with the option of a public or private healthcare provider. This determines universal and equitable care coverage for the entire population. In 2004, with the arrival of the first high-cost drugs, rituximab and imatinib, healthcare providers had difficulties financially covering them. The National Resource Fund is a non-state public Entity created in 1980 to provide coverage for highly specialized medical techniques. It currently provides universal financial coverage to all residents linked to the INHS and encompasses almost all the coverage of patients nationwide. On January 1, 2005, financial coverage for high-cost drugs began with rituximab and imatinib under regulations that required strict diagnosis, treatment, and follow-up criteria. Non Hodgkin Lymphoma incidence in Uruguay is 11,53 cases per 100,000 men/year, and 7,9 cases per 100.000 women/year. Uruguay's population is estimated in 3,400,000. This study shows the results obtained with rituximab in DLBCL. Methods Analytical retrospective study of a historical cohort of consecutive patients with DLBCL who started first line treatment with chemo-immunotherapy with rituximab between January 1, 2005 and December 31, 2019. Follow-up was conducted until March 8, 2021. All patients signed informed consent. Results In the period considered, 1699 requests for rituximab treatment for patients with DLBCL were received, 1597 (94%) treatments were authorized. The results of the 1413 (89%) patients with onset of the disease are analyzed, 51,1% were from the capital city, Montevideo and 48,9% from other cities, 21% from public hospitals and 79% from private health system. Median age was 61 years (9-90), 4 patients < 18 years. Male patients 751 (53.2%) Regarding the characteristics of the disease, Ann Arbor stage was I in 223 (16.01%), II in 370 (26.56%), III in 326 (23.40%) and IV in 474 (34.03%) of the patients. IPI Score from 0 to 5 were 168 (12.03%), 390 (27.94%), 306 (21.92%), 412 (29.51%), 104 (7.45%), 16 (1.15%) respectively. The most frequent components of the IPI score were age >=60 (54.92%), elevated LDH (46.35%), and Ann Arbor stage III-IV (55.87%). B symptoms were present in 38.19% of the patients and Bulky disease in 479 patients (36%). HIV diagnosis was recorded in 2.05% of patients (n=29). CHOP with Rituximab was the treatment in 83.79% of the patients. With a median follow-up of 84.8 months, the median overall survival (OS) for the study population was 126.9 months (95% CI 102.6 - 138.3). The OS rate at 2 years was 72.75% (95%CI 70.37 - 75.01), at 3 years 69.14% (95%CI 66.69 - 71.50) and at 5 years 64.76% (95%CI 62.22 - 67.20) In the IPI univariate analysis, age > 60, Ann Arbor Stage III-IV, elevated LDH, and PS>=2 were associated with shorter survival time, but extra-nodal involvement greater than or equal to 2 was not. These prognostic associations were maintained when performing a multivariate analysis. Median OS according to the IPI for low-, low-intermediate, high-intermediate, and high-risk patients was 190.8, 138.2, 45.5, and 27.9 months, respectively. (p=0.00001). The 2 years OS for patients < 60 years was 77.86% (95% CI 74.48 - 80.92) while in those > 60 years was 68.56% (95% CI 65.21 - 71.73) (P<0.00001). Median OS was 114 months and 129 months for patients from public and private health system respectively (p=0.7) Discussion The results of OS and its relationship with the factors that make up the IPI are those expected according to the studies that determined that the use of rituximab associated with CHOP was the standard in DLBCL. Access to the medication was universal for the entire population of Uruguay, we found a lower-than-expected number of patients from the public health system. Conclusions The regulations provided the possibility of universal use of rituximab in DLBCL; the diagnosis, treatment and follow-up of these patients was standardized throughout the country. This is reflected in results comparable with international standards in the public and private health system. The survival results found in this study are those expected according to the reference works used in the design of the rituximab coverage regulations. Said regulation was the beginning of financial coverage by the National Resources Fund for other high-cost medicines.

Correlation of Microvessel Density with Clinicothological Features of Hodgkin Lymphoma

BackgroundAngiogenesis is the process of new blood vessel growth that has an important role in tumor development. Microvessel density (MVD) assessment is one of the methods to assess angiogenesis. A high MVD is associated with a poor prognosis in various types of cancer including Hodgkin lymphoma (HL). Although, HL incidence is lower in developing countries, the death rate is higher in these regions. Moreover, this type of lymphoma is higher among young and reproductive people. The aim of this study was to determine the association between microvessel density and HL clinicopathological characteristics.MethodsThis was an observational analytic study with a cross-sectional method, conducted at the Anatomical Pathology Department/Dr. Mohammad Hoesin Palembang. The samples were paraffin blocks diagnosed as HL for period 2016-2021 and had complete clinicopathological data according to the criteria of this study. The slides were immunostained with antibody anti-CD34. One microvessel was determined by observing the endothelial morphology and CD34 expression in endothelial cytoplasm and/or cell membrane, then was evaluated and calculated by Image J. Data was statistically analyzed by STATA version 15.ResultsMajority HLs in this study were discovered in the age group of <45 years (71.00%), male (61.30%), nodal location (80.60%) and lymphocyte rich classical HL (LRCHL) subtype (51.60%). Although there was no significant association between MVD and the clinicopathological characteristics of HL, high MVD tend to occur in the age <45 years, male, nodal location, and LRCHL subtype.ConclusionThere was no significant association between microvessel density and HL clinicopathological characteristics.

Selected Articles from This Issue

Inflammatory and insulinemic pathways have been linked to prostate cancer; thus, health behaviors that activate these pathways may impact prostate cancer survivorship. In this study, Langlais and colleagues predicted biomarker levels of inflammation, hyperinsulinemia, and insulin resistance pathways from questionnaire data among 2,056 men with prostate cancer. The authors examined the scores in relation to risk of prostate cancer progression. Over a median of 6.4 years of follow-up, the most pro-inflammatory and pro-insulinemic behaviors following a prostate cancer diagnosis were associated with a 1.6- to 2.8-fold increased risk of prostate cancer progression. Limiting inflammation and insulin hypersecretion through diet and physical activity may improve prostate cancer survivorship.Testicular germ cell tumors (TGCTs), whose etiology is largely unknown, are believed to arise from primordial gonocytes with an altered DNA methylation reprogramming. Grasso and colleagues evaluated the association between 273 single-nucleotide polymorphisms (SNPs) from 28 DNA methylation-related genes and TGCT risk using summary statistics from the Genome Wide Association Study meta-analysis of the international Testicular Cancer Consortium on 10,156 TGCT cases and 179,683 controls. Four MTHFR SNPs, potentially affecting DNA methylation pattern, were associated with TGCT risk. This suggests that TGCT pathogenesis could be linked to folate cycle status, and this relation could be partly due to hereditary factors.In the United States (US), the incidence of Hodgkin lymphoma (HL) differs by ethnicity. In a large population-based case-control study, Graham and colleagues found that having a foreign-born mother (versus a US-born mother) was associated with an increased risk of early onset HL among non-Hispanic White individuals and a decreased risk among Hispanic individuals. In addition, sex, birthweight and parental age were also linked to risk of early onset HL. The findings suggest that the etiology of early onset HL is multi-faceted, and the observed disparity warrants further evaluation.This article describes the randomized transition from established cytology-based screening to primary HPV-based screening in Norway. This programmatic change required substantial modifications to existing infrastructure and screening protocols, affecting activity volumes, staff training, and changes in the data-flow and communication systems. Nygård and colleagues report a relative increase of 60% in the detection of cervical precancers and 40% in cancer using HPV-based screening as compared to the cytology-based screening. Introducing new screening technology gradually and in a controlled manner should be considered in both established and novel population-based cancer screening programs and specifically implementing HPV-based screening to advance the cervical cancer elimination.

Nivolumab in treatment of relapsed Hodgkin lymphoma

The incidence of Hodgkin lymphoma (HL) relapses is 8-30 % and depend on disease stage, presence of unfavorable prognostic factors and treatment programme. Modern second-line treatment programmes are based on gemcitabine and carboplatin with following autologous stem cell transplantation and can reach many-year overall survival in 70 % of patients. For increasing treatment efficacy of relapsed HL monoclonal antibodies (brentuximab vedotin) and checkpoint inhibitors (nivolumab) are supplemented. Nowadays it makes an assessment of immunochemotherapy efficacy in patients with relapsed HL, determines long-term effects of treatment. Nevertheless, preliminary results allow to find a significant therapeutic advantages of immunochemotherapy with following autologous stem cell transplantation above standard polychemotherapy.

Incidence, mortality, risk factors, and trends for Hodgkin lymphoma: a global data analysis

BackgroundHodgkin lymphoma is a lymphatic malignancy commonly found in cervical lymph nodes. This study evaluated the worldwide incidence, mortality, associated risk factors, and temporal trends of Hodgkin lymphoma by sex, age, and country.MethodsThe age-standardised Hodgkin lymphoma incidence and mortality were retrieved from the GLOBOCAN, CI5 volumes I-XI, WHO mortality database, the NORDCAN and SEER Program. The age-standardised prevalence of smoking, alcohol drinking, obesity, and hypertension was also extracted for each country. Trends were tested using Average Annual Percentage Change (AAPC) from Joinpoint regression analysis.ResultsThe Hodgkin lymphoma incidence and mortality were 0.98 and 0.26 per 100,000 in 2020. A higher incidence was observed in high-income countries, while higher mortality was found in low-income countries. Incidence and mortality were associated with GDP per capita, prevalence of smoking, obesity, and hypertension at the population level. Despite the decreasing mortality trend, there was an increasing incidence, especially among females, younger population, and subjects from Asian countries.ConclusionsThere was an increasing trend in Hodgkin lymphoma incidence, especially among subjects who were female, younger population, and from Asian countries. Further studies are needed to investigate the reasons for these epidemiologic trends.

Global patterns of Hodgkin lymphoma incidence and mortality in 2020 and a prediction of the future burden in 2040.

Our study examines global patterns of Hodgkin lymphoma (HL) in 2020 and predicts the future incidence and mortality burden in 2040 using IARC's GLOBOCAN estimates of the number of new cases and deaths of HL in 185 countries. A total of 83 000 new cases of HL and 23 000 deaths from HL were estimated in 2020. In general, incidence and mortality rates were consistently higher in males (50% more cases and deaths than females) across world regions and countries. Incidence rates varied markedly by world region, at least 10-fold in both sexes, with the highest incidence rates observed in Southern Europe. Mortality exhibited an inverse pattern compared to incidence, with rates elevated in Western Asia and Northern Africa. The number of HL incident cases is predicted to rise to around 107 000 cases (a 30% increase) by 2040 due to demographic changes, assuming global rates in 2020 remains unchanged. The findings provide a baseline and impetus for developing strategies that aim to reduce the burden of HL in future decades.

Связь активности Солнца и дыма с трендами гемобластозов в России

ematological malignancies, which include leukemia, Hodgkin's lymphoma (HL), non-Hodgkin's lymphomas (NHL) and multiple myeloma, amount 6.6% of the global incidence of malignant ne-oplasms, and 4.7% in Russia. A significant number of studies indicate the involvement of envi-ronmental factors in the occurrence of hematological malignancies. The role of electromagnetic waves in the origin of NHL is indicated by data on the increased risk of developing them in occu-pations associated with electricity. Leukemia in children is positively associated with vehicle smoke. There are indications of a role in the emergence of HL of tobacco smoke. Previously, the authors established a links between the incidence of NHL and leukemia in cohorts of young chil-dren with the activity of the Sun, and in leukemia a correlation with the smoke of forest fires was also found. In this work has been investigated the relations between the trends in the incidence of hematological malignancies in the population of Russia in 1993-2018 with smoke and solar activity. There was a tendency towards an increase in the incidence of hematological malignancies (p<0.001) by 2.8% per year. The incidence of leukemia (p=0.004), NHL (p<0.001), and multiple myeloma (p<0.001) significantly increased. This trend is presumably related to the increase in the number of cars in the country. The incidence of HL, on the contrary, is characterized by a downward trend (p=0.019). A link was found between the activity of the Sun and the incidence of leukemia (r=0.708, p=0.010, lag 2 years), NHL (r=0.689, p=0.013, lag 2 years), multiple myeloma (r=0.657, p=0.020, lag 2 years) and LH (r=0.606, p=0.037, lag 7 years). The data obtained sug-gest a significant contribution of smoke and solar activity to the occurrence of hematological ma-lignancies in children and adults. Based on the role of environmentally related oxidative stress in oncogenesis, it is recommended for the prevention of hematological malignancies to consume a sufficient amount of vitamins, regularly include in the diet fresh vegetables, fruits, foods to stimulate autophagy and Transfer Factor.

Increased Production of B-Cell Activating Cytokines and Altered Peripheral B-Cell Subset Distribution during HIV-Related Classical Hodgkin Lymphoma.

Simple SummaryPatients with HIV are at high risk of developing Hodgkin’s lymphoma. This is potentially due to alterations in blood circulating B-lymphocytes and their activating cytokines. We analyzed the distribution of circulating B-lymphocytes and the level of the activating cytokines IL6, IL10 and BAFF in 38 patients with HIV-related Hodgkin’s lymphoma during a 2-year follow-up. We also compared their characteristics at diagnosis with (1) pre-diagnosis serum samples and (2) samples from control HIV-infected subjects without lymphoma. We found an increase in activating cytokines in cases compared to controls. The level of activating cytokines increased in advanced lymphoma. It decreased over time during follow-up. B-lymphocytic count was similar between patients and controls, but their subset distribution differed. There was an overrepresentation of naive B-lymphocytes over memory B-lymphocytes in HIV-associated Hodgkin lymphoma patients, more pronounced in those with advanced lymphoma. Follow-up showed an increase in B-lymphocytic count with an even greater proportion of naive B-cells. Together this suggests that in HIV-infected patients, Hodgkin lymphoma is associated with an altered blood distribution of B-lymphocytic subsets and an increased production of activating cytokines. This environment may contribute to the process of tumorigenesis.Classical Hodgkin Lymphoma incidence increases in HIV-1-infected patients (HIV-cHL). HIV infection is associated with higher B-cell activation. Here, in 38 HIV-cHL patients from the French cohort ANRS-CO16 Lymphovir, we examined longitudinally over 24 months the serum levels of the B-cell activating cytokines IL10, IL6, and BAFF, and blood distribution of B-cell subsets. Fourteen HIV-cHL patients were also compared to matched HIV-infected controls without cHL. IL10, IL6, and BAFF levels were higher in HIV-cHL patients than in controls (p < 0.0001, p = 0.002, and p < 0.0001, respectively). Cytokine levels increased in patients with advanced-stage lymphoma compared to those with limited-stage (p = 0.002, p = 0.03, and p = 0.01, respectively). Cytokine levels significantly decreased following HIV-cHL diagnosis and treatment. Blood counts of whole B-cells were similar in HIV-cHL patients and controls, but the distribution of B-cell subsets was different with higher ratios of naive B-cells over memory B-cells in HIV-cHL patients. Blood accumulation of naive B-cells was more marked in patients with advanced cHL stages (p = 0.06). During the follow-up, total B-cell counts increased (p < 0.0001), and the proportion of naive B-cells increased further (p = 0.04). Together the results suggest that in HIV-infected patients, cHL is associated with a particular B-cell-related environment that includes increased production of B-cell-activating cytokines and altered peripheral distribution of B-cell subsets. This B-cell-related environment may fuel the process of tumorigenesis.

Clinically Undetected Hodgkin Lymphoma Diagnosed Initially on Bone Marrow Biopsy: A Large Retrospective Observational Study from a Tertiary Care Center

Abstract Introduction Hodgkin lymphoma (HL) involving the bone marrow (BM) is relatively rare with an incidence ranging from 4% to 18%. The incidence of primary HL of marrow is 0.25%. To the best of our knowledge, the present study is the largest study on HL diagnosed initially on marrow biopsy. Objective To establish diagnostic criteria based on clinicopathological and histological features in HL diagnosed first on the marrow. Materials and Methods This was a retrospective study done from January 2012 to December 2020 that included 36 cases of HL diagnosed initially on BM. Based on the presence of large mononuclear or binucleate Reed–Sternberg (RS)-like cells in a polymorphous inflammatory background, HL was suspected and immunohistochemistry (IHC) with CD15 and CD30 was done. Correlation with subsequent lymph node biopsies was done, wherever possible. Results Fever (94.4%) was the most common symptom, followed by loss of weight (66.7%). Twenty-one cases (58.4%) had uni/bicytopenia and 15 cases (41.6%) had pancytopenia. Only one case showed suspicious mononuclear RS cells on aspirates and the rest of the cases were diagnosed on trephine biopsy alone. Trephine imprints showed variable cellularity in 13 (36%) cases. Diffuse involvement was seen in 24 cases (66.7%), and focal nodular aggregates were seen in 12 cases (33.3%). Out of 36 cases, 26 cases (19 cases on marrow and 7 cases on lymph node) were confirmed as HL with IHC. Immunophenotype of the RS cells on the marrow was CD30+/CD15+ in (6/29) (20.7%) cases, CD30+/CD15− in (7/29) (24.1%) cases and CD30−/CD15+ in (6/29) (20.7%) cases. Seven cases (26.9%) were diagnosed on subsequent lymph node biopsy as mixed cellularity HL with IHC confirmation. Marrow fibrosis was seen in 16 cases (44.4%), and granulomas were seen in 8 cases (22.2%). Conclusion In cases presenting with long-standing fever and cytopenias, HL must always be suspected, even if there are no palpable lymph nodes. Bone marrow biopsy is preferable over aspiration in such cases and IHC plays a major role in diagnosing the cases.

Hodgkin Lymphoma in People Living with HIV.

Simple SummaryHodgkin lymphoma (HL) is a non-AIDS defining neoplasm, but people living with HIV (PLWH) have between a 5- and 26-fold higher risk of developing it than the general population. Epstein-Barr virus is present in almost all HIV-related HL cases, and plays an important role in its etiopathogenesis. Despite the aggressive characteristics, the prognosis of HL affecting PLWH is similar to that of the general population if patients are treated following the same recommendations. Administration of cART concomitantly with chemotherapy is highly recommended. However, this combination may be challenging due to drug–drug interactions and overlapping toxicity. Thus, interdisciplinary collaboration between hemato-oncologists and HIV specialists is crucial for the optimal treatment of both lymphoma and HIV infection.Despite widespread use of combined antiretroviral therapy (cART) and increased life expectancy in people living with HIV (PLWH), HIV-related lymphomas (HRL) remain a leading cause of cancer morbidity and mortality for PLWH, even in patients optimally treated with cART. While the incidence of aggressive forms of non-Hodgkin lymphoma decreased after the advent of cART, incidence of Hodgkin lymphoma (HL) has increased among PLWH in recent decades. The coinfection of Epstein–Barr virus plays a crucial role in the pathogenesis of HL in the HIV setting. Currently, PLWH with HRL, including HL, are treated similarly to HIV-negative patients and, importantly, the prognosis of HL in PLWH is approaching that of the general population. In this regard, effective cART during chemotherapy is strongly recommended since it has been shown to improve survival rates in all lymphoma subtypes, including HL. As a consequence, interdisciplinary collaboration between HIV specialists and hemato-oncologists for the management of potential drug–drug interactions and overlapping toxicities between antiretroviral and antineoplastic drugs is crucial for the optimal treatment of PLWH with HL. In this article the authors review and update the epidemiological, clinical and biological aspects of HL presenting in PLWH with special emphasis on advances in prognosis and the factors that have contributed to it.

Racial and ethnic disparities in pediatric cancer incidence among children and young adults in the United States by single year of age.

Incidence rates of pediatric cancers in the United States are typically reported in 5-year age groups, obscuring variation by single year of age. Additionally, racial and ethnic variation in incidence is typically presented in broad categories rather than by narrow age ranges. The Surveillance, Epidemiology, and End Results (SEER) 18 data (2000-2017) were examined to calculate frequencies and age-adjusted incidence rates among individuals aged birth to 39 years. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were estimated as the measure of association for rate comparisons by race and Hispanic origin overall and by single year of age. Several histologic types showed substantial variation in race/ethnicity-specific and overall rates by single year of age. Overall, Black children and young adults experienced substantially decreased incidence of acute lymphoid leukemia (IRR, 0.52; 95% CI, 0.49-0.55) compared to Whites, and this decreased incidence was strongest at ages 1 through 7 years and 16 through 20 years. Hispanic individuals experienced decreased overall incidence of Hodgkin lymphoma (IRR, 0.50; 95% CI, 0.48-0.52) and astrocytoma (IRR, 0.54; 95% CI, 0.52-0.56) and increased risk of acute lymphoblastic leukemia (IRR, 1.46; 95% CI, 1.42-1.51) compared to non-Hispanic Whites, and the increased risk was strongest at ages 10 through 23 years. Substantial decreased risk across many tumor types was also observed for Asian/Pacific Islanders and American Indian/Alaska Natives. Examination of incidence rates for pediatric cancers by narrow age groups may provide insights regarding etiological differences in subgroups. Additionally, variation in age-specific incidence rates by race and ethnicity may enable hypothesis generation on drivers of disparities observed.

Incidence and survival of Hodgkin lymphoma patients treated at a national cancer center in a middle-income country from 1999-2018: A report of 1,382 cases.

e19523 Background: Hodgkin lymphoma (HL) is classically described as a malignancy with a good prognosis and bimodal pattern. We aim to describe the incidence and survival of HL patients treated at the National Cancer Institute (NCI) in Peru. Methods: We evaluated the database at the NCI Epidemiology Department in Peru from 1999-2018. The international classification of diseases (ICD)-10 codes C810-C813, C817, C819 and ICD for Oncology (version 3) codes 96503-96533, 96573-96593, 96533-96553, 96573, 99903 were used to classify both nodal and extra-nodal HL. The estimate of overall survival (OS) curves was performed by the Kaplan-Meier method, and the difference was computed by the log-rank test. Results: During the study period 12,092 patients with lymphoma were found, of which 1,382 (11.4%) were HL. The median age was 24 years (range 2-88). Male patients were 62.4%. Patients of ≤14 years were 32.9%, with the most frequent 5-year interval group those aged 5-9 years-old representing 16.7% of patients. The adolescent and young adults (AYA) (15-39 years) group represented 38.4%. A total of 1,360 (98.4%) were classified as nodal HL. The classification according to the subtypes was as follows: 1,148 (83.1%) were one of the five subtypes [classical HL (cHL) and nodular lymphocyte-predominant HL (NLPHL)], 196 (14.2%) were HL, not otherwise specified, and 38 (2.7%) were HL without pathological confirmation. The classifiable 1,148 patients were categorized as follows: 1,107 patients (96.4%) were cHL and 41 (3.6%) were NLPHL. The cHL patients were classified as mixed cellularity HL (MCHL) in 52.3%, nodular sclerosis HL (NSHL) in 36.7%, lymphocyte-rich HL (LRHL) in 8.1%, and lymphocyte-depleted HL (LDHL) in 2.9%. The whole classifiable cohort (n = 1,148) showed a trimodal pattern. The MCHL subtype was most frequent in the 5-9 years group and in the 60-64 years group. The NSHL subtype was most frequent in the 20-24 years group. The median 5-year OS of the entire cohort (n = 1,382) was 86.3% (95%CI, 83.9-88.5). The OS according to the interval age groups were as follows: for the 0-14 years group the 5-yr OS was 94.9% (95%CI, 91.8-96.8), for the 15-39 years was 84% (95%CI, 79.5-87.68), for the 40-64 years group was 82.5% (95%CI, 75.2-87.8), and for the ≥65 years group was 58.6% (95%CI, 43.4-71.1). The OS according to age range showed a statistically significant difference p &lt; 0.01. Conclusions: In our study, patients with HL are younger compared to those in developed countries. The most frequent 5-year interval group is the 5-9 years group. HL incidence had a trimodal pattern. Extra-nodal presentation was extremely rare. NLPHL was also rare. The most frequent subtype was MCHL, however, in AYA patients the most frequent subtype was NSHL. Better OS was seen in the 0-14 year group, this being statistically significant compared to the older groups. Worse OS was observed in patients aged 65 and older.

Mortality Trend of Hodgkin Lymphoma in Ecuador from 2000 to 2019

Introduction. Globally, the incidence of Hodgkin lymphoma (HL) increased from 1990 to 2017, presenting two incidence peaks regarding age, at 20–39 years, and 60 years or more. However, there is limited information about the mortality of this disease in the Ecuadorian population. This study aims to present the mortality trend of HL in Ecuador from 2000 to 2019. Methods. We performed an observational study, reporting the crude death rates by HL in the Ecuadorian population from 2000 to 2019, and its mortality trend analysis. Data were extracted from governmental databases published by the Ecuadorian National Institute of Statistics and Census (INEC). Results. From 2000 to 2019, INEC registered 862 deaths of patients with HL. From them, 355 (41.18%) were female, and 699 (81.09%) resided in urban areas, with an average age of 54.61 years. During the period studied, the mortality rates by HL in Ecuador presented a significant increasing trend (p=0.037), in which 2019 and 2018 were the years with the highest death rate (0.38 by 100,000 inhabitants), whereas 2001 and 2007 had the lowest death rate (0.20 by 100,000 inhabitants). Regarding age, we found a bimodal distribution of cases with two peaks in the 2nd and 7th decades of life. Conclusion. In this study, we found the highest mortality rate of HL in 2018 and 2019, with a significant increasing trend since 2000. Regarding age, we found two highest mortality peaks, which correspond to the 2nd and 7th decades of life, similar to other studies in the region.

Hodgkin Lymphoma in Nigeria: Prevalence, Mechanisms of Tumorigenesis and Diagnosis

Hodgkin lymphoma (HL) is an uncommon neoplasm where tumor stems from a certain kind of leukocytes known as B-cell. This lymphoid malignancy involves outlying lymph gland which may extend to tissues. Research estimates 40% of patients are diagnosed from constitutive signs while early detection is a challenge. The Hodgkin Reed-Stenberg cells is established as the hallmark of Hodgkin lymphoma but multiple underlying mechanisms are involved. Hodgkin lymphoma spreads across different regions with limitations of effective control, hence there is a need to fully understand its tumorigenesis and diagnosis. We reviewed the multiphase deregulated signalling pathways and several interactions amongst cells, these characteristics can proffer new breakthrough to target therapeutics either through direct inhibition of affected signalling pathways or Hodgkin Reed-Stenberg cells associated with diverse cellular infiltrates within the lymph cell. HL incidence in Nigeria is similar to the incidence in other regions but there is a higher death rate in Nigeria. Nigeria bears the second highest burden of HIV globally which contributes to incidence of HL. Also, Epstein-Barr virus increases the risk of the disease, which is also prevalent in Nigeria. Lymphomas are associated with higher cancer-related deaths especially in HIV-infected persons with 2.5times lower 2-year survival chance compared to HIV-uninfected persons and late stage of lymphoma was also a contributing factor to the survival outcomes. Hence, to reduce the burden of the disease, an understanding of the aetiology, epidemiology, and biochemical mechanisms of the lymphoma is needed which are herein reviewed.

Global and regional incidence, mortality and disability-adjusted life-years for Epstein-Barr virus-attributable malignancies, 1990-2017.

ObjectiveTo determine the global and regional burden of Epstein-Barr virus (EBV)-attributed malignancies.DesignAn international comparative study based on the Global Burden of Disease (GBD) Study estimates.SettingGlobal population by age, sex, region, demographic index and time.Methods and outcome measuresThe burden of EBV-attributed Burkitt lymphoma (BL), Hodgkin lymphoma (HL), nasopharyngeal carcinoma (NPC) and gastric carcinoma (GC) was estimated in a two-step process. In the first step, the fraction of each malignancy attributable to EBV was estimated based on published studies; this was then applied to the GBD estimates to determine the global and regional incidence, mortality and disability-adjusted life-years (DALYs) for each malignancy by age, sex, geographical region and social demographic index (SDI) from 1990 to 2017.ResultsThe combined global incidence of BL, HL, NPC and GC in 2017 was 1.442 million cases, with over 973 000 deaths. An estimated 265 000 (18%) incident cases and 164 000 (17%) deaths were due to the EBV-attributed fraction. This is an increase of 36% in incidence and 19% in mortality from 1990. In 2017, EBV-attributed malignancies caused 4.604 million DALYs, of which 82% was due to NPC and GC alone. The incidence of both of these malignancies was higher in high and middle-high SDI regions and peaked in adults aged between 50 and 70 years. All four malignancies were more common in males and the highest burden was observed in East Asia.ConclusionsThis study provides comprehensive estimates of the burden of EBV-attributed BL, HL, NPC and GC. The overall burden of EBV-related malignancies is likely to be higher since EBV is aetiologically linked to several other malignancies not included in this analysis. Increasing global population and life expectancy is expected to further raise this burden in the future. The urgency for developing an effective vaccine to prevent these malignancies cannot be overstated.

Hodgkin lymphoma.

Hodgkin lymphoma (HL) is a B cell lymphoma characterized by few malignant cells and numerous immune effector cells in the tumour microenvironment. The incidence of HL is highest in adolescents and young adults, although HL can affect elderly individuals. Diagnosis is based on histological and immunohistochemical analyses of tissue from a lymph node biopsy; the tissue morphology and antigen expression profile enable classification into one of the four types of classic HL (nodular sclerosis, mixed cellularity, lymphocyte-depleted or lymphocyte-rich HL), which account for the majority of cases, or nodular lymphocyte-predominant HL. Although uncommon, HL remains a crucial test case for progress in cancer treatment. HL was among the first systemic neoplasms shown to be curable with radiation therapy and multiagent chemotherapy. The goal of multimodality therapy is to minimize lifelong residual treatment-associated toxicity while maintaining high levels of effectiveness. Recurrent or refractory disease can be effectively treated or cured with high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation, and prospective trials have demonstrated the potency of immunotherapeutic approaches with antibody-drug conjugates and immune checkpoint inhibitors. This Primer explores the wealth of information that has been assembled to understand HL; these updated observations verify that HL investigation and treatment remain at the leading edge of oncological research.

A 12-Year Comparative Analysis of Hodgkin and Non-Hodgkin Lymphomas in Lebanon: Trend Characteristics and 10-Year Projections.

Background Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are two common malignancies worldwide and in Lebanon. Analysis of their trends plays a crucial role to better understand their origins and risk factors. This study will probe incidences of both types of lymphomas from 2005 to 2016, aiming to compare between the two malignancies according to age and sex and plot projections until 2026.MethodsHL and NHL cases from 2005 to 2016 were collected from the National Cancer Registry of Lebanon. Data was stratified according to age and sex. Age-specific and age-standardized incidence rates were analysed using joinpoint regression; 10-year projections were predicted based on logarithmic models.ResultsBetween 2005 and 2016, NHL was significantly more common than HL. NHL was higher in both genders. HL showed a bimodal age distribution while NHL peaked in elderly patients. NHL incidence rates in males increased significantly from 2005 to 2014 while HL incidence rates showed an insignificant rise. Over the next 10 years, NHL and HL cases are expected to increase in Lebanon.ConclusionHL and NHL are on the rise in Lebanon. Extensive research into the main factors contributing to these lymphomas is crucial in the fight against them. More efforts must be done by the government and health organizations to better control the disease.