Management Of Hodgkin Lymphoma Research Articles

Contemporary radiation therapy use in Hodgkin lymphoma

Radiation therapy assumes a pivotal role in Hodgkin lymphoma management, especially within combined modality therapy. It serves as a cornerstone in early-stage disease and in mitigating high-risk instances of local relapse in advanced stages. Over recent decades, radiation therapy has undergone significant advancements, notably alongside diagnostic imaging improvements, facilitating the reduction of radiation field size and dosage. This progress has notably led to minimized toxicity while upholding treatment efficacy.This comprehensive review extensively evaluates the indications and advancements in radiation therapy for Hodgkin lymphoma, with a primary focus on enhancing treatment efficacy while minimizing radiation-related toxicities. The exploration encompasses a detailed examination of various radiation fields, techniques and delivery modalities employed in Hodgkin lymphoma treatment, including intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and proton therapy. It delves into the intricacies of optimal dose selection and treatment planning strategies aimed at achieving maximal disease control while concurrently minimizing the risk of long-term side effects.

POSTER: HL-007 The Role of Interim Positron Emission Tomography (PET)/Computed Tomography (CT) Scans in the Management of Hodgkin Lymphoma: A Single-Center Study in a Developing Country

POSTER: HL-007 The Role of Interim Positron Emission Tomography (PET)/Computed Tomography (CT) Scans in the Management of Hodgkin Lymphoma: A Single-Center Study in a Developing Country

HL-007 The Role of Interim Positron Emission Tomography (PET)/Computed Tomography (CT) Scans in the Management of Hodgkin Lymphoma: A Single-Center Study in a Developing Country

HL-007 The Role of Interim Positron Emission Tomography (PET)/Computed Tomography (CT) Scans in the Management of Hodgkin Lymphoma: A Single-Center Study in a Developing Country

Very late relapse in Hodgkin lymphoma: Characterizing an understudied population

BackgroundVery late relapse (VLR) occurring >5 years after initial diagnosis is an uncommon event in the management of Hodgkin lymphoma (HL). Limited information regarding risk factors and optimal therapy is available. Patients and MethodsWe reviewed patients treated for HL at Princess Margaret Cancer Centre, Toronto, Ontario Canada between January 01, 1999 and 31 December 31, 2018. ResultsThirty-two patients experienced VLR. Median time to first relapse was 7.2 years. Most patients were treated with CMT both at initial diagnosis and relapse. Male gender (P = .04) and increased age at initial diagnosis (P = .008; HR 1.09 (95% CI: 1.02-1.15)) were identified as risk factors for inferior survival on univariate analysis. Stage, histology, treatment modality and risk assessment at diagnosis or relapse did not have a significant impact on survival outcomes. ASCT at first relapse had no impact on time to second progression (HR 1.72; 95% CI, 0.35-8.53; P = .51) or overall survival from first relapse (HR 1.55; 95% CI, 0.3-8.03; P = .6). ConclusionOur data aligns with the limited information available in VLR HL suggesting the negative impact of age and male gender on this rare event. Additionally, our data did not show benefit of ASCT at first relapse in terms of survival outcomes in this population, though this analysis is limited by small sample size. Further study of optimal therapy to prevent and treat VL in the era of novel agents is critical.

BEGEV salvage regimen in relapsed/refractory classical Hodgkin lymphoma: a real-life experience

PurposeOne of the most critical issues in the management of Hodgkin lymphoma (HL) patients who resulted as primary relapsed or refractory is to obtain a minimal disease status before autologous stem cell transplantation (ASCT). Finding a salvage regimen able to induce this status without severe toxicity would represent a major achievement in this setting.MethodsA single‐center retrospective study was conducted to assess effectiveness and safety of BEGEV (bendamustine, gemcitabine, and vinorelbine) regimen as first salvage setting prior to ASCT in HL patients.ResultsForty-three patients were treated in our institution between October 2017 and November 2020. Median age at BEGEV therapy was 35.0 years (range 17.2– 70.0), and the median time from frontline therapy to the first cycle of BEGEV was 79.5 days (range 4–2267). At the end of treatment, 31 patients achieved a complete response (CR), with an overall response rate of 76.7%. Forty-one patients harvested CD34+ cells and 35/43 (81.4%) patients underwent ASCT. With a median follow‐up of 22 months, 4 CR patients had disease relapse, yielding an estimated disease-free survival of 73.9% at 34 months. The estimated 2‐year progression-free survival was 66.7%. Response to first-line chemotherapy did not significantly influence prognosis.ConclusionsBEGEV regimen was well tolerated, and reversible haematological toxic effects were the most common adverse events. Real-life data on BEGEV regimen as first salvage setting showed a relevant rate of objective responses and a limited myelotoxicity with no impairment of a subsequent mobilization of peripheral blood stem cells.

A role of interim positron emission tomography/computed tomography scan in the management of Hodgkin lymphoma: A single-center study in a developing country

BACKGROUND: The Hodgkin lymphoma (HL) showed a good prognosis in Erbil city. However, a number of deaths were reported. The monitoring and treatment strategies of HL had improved in the last decade. AIMS: The aims of this study were to evaluate the prognostic value of interim positron emission tomography/computed tomography (PET/CT) scan in HL patients and predicting the survival outcome in addition to effect on progression-free survival (PFS) of HL patients. PATIENTS AND METHODS: A retrospective cross-sectional study was conducted in Nanakali Hospital in Erbil city, Kurdistan region, Iraq, through reviewing data of patients with HL from January 1, 2014, to December 31, 2019, on a sample of 75 HL patients. The diagnosis of HL was accomplished by the physician regarding lymph node biopsy by the World Health Organization criteria. The PET/CT scan was done after two treatment cycles. PET/CT of HL patients was done in a private center in Erbil city (Media Diagnostic Center). RESULTS: The mean overall survival duration of HL patients was 5.39 years with an overall survival rate of 92%, and the mean PFS duration of HL patients was 5.04 years with PFS rate of 76%. The mean overall survival of HL patients with positive interim PET/CT (4 years and rate 75%) was lower than the mean overall survival of HL patients with negative interim PET/CT (7.2 years and rate of 95.2%) with a significant difference (P < 0.001). CONCLUSIONS: The interim PET/CT scan is useful in prognosis of patients with HL and predicting overall survival and mortality.

Assessment and management of newly diagnosed classical Hodgkin lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance.

The management of Hodgkin lymphoma (HL) has undergone significant changes in recent years. Due to the predilection of HL to affect younger patients, balancing cure and treatment-related morbidity is a constant source of concern for physicians and patients alike. Positron emission tomography adapted therapy has been developed for both early and advanced stage HL to try and improve the outcome of treatment, while minimising toxicities. The aim of this review is to digest the plethora of studies recently conducted and provide some clear, evidence-based practice statements to simplify the management of HL.

Efficacy and toxicity of the treatment of children and adolescents with Hodgkin Lymphoma by GPOH-HD-2002 protocol

The reduction of long-term survival and fertility is still a problem in management of Hodgkin lymphoma in children and adolescents. These problems are partly solved by reduction of radiotherapy and changing procarbazine on etoposide and dacarbazine. We analyzed medical data of patients with HL < 18 years that were treated by modified OEPA-COPDAC protocol since 1.01.2012 to 01.12.2017. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. All patients despite gender didn't receive procarbazine. We analyzed data of 77 patients. Event-free survival (EFS) was 88% (95% CI 76.2-93.9%). EFS didn't differ between boys and girls 86.9% (95% CI 67.8-94.7%) and 88.7% (95% CI 67.3-96.1%) respectively ( р = 0,9). EFS was significantly higher in patients without E-lesions compared with patients with E-lesions 90.8% (95% CI 77.8-96.2) and 72.7% (95% CI 28.4-89.6) respectively (p = 0.04). We analyzed toxicity of 40 cycles OEPA and 44 cycles COPDAC. Toxicity was acceptable. In our study we didn't detect significant difference in EFS in boys and girls. Procarbazine can be safely changed on etoposide in OPPA and dacarbazine in COPP in boys and girls with HL. E-lesions is a risk factor of inferior EFS.

Flow cytometry for assessment of the tumor microenvironment in pediatric Hodgkin lymphoma.

The role of flow cytometry in diagnosis and management of Hodgkin lymphoma (HL) remains limited. As knowledge emerges of the tumor microenvironment in this disease, various methods are being evaluated in its study. This study examines the microenvironment using flow cytometry to assess differences between subtypes and clinicopathologic correlates. A retrospective cross-sectional study was performed analyzing the tumor immunophenotype, by flow cytometry, for 31 children with classical HL. Correlation was made with patient information, including outcome. The makeup of the tumor microenvironment varies across subtype of HL, with T cells predominating in nodular sclerosis (NS), and similar proportions of B and T cells in mixed cellularity (MC). CD4 cells predominate in NS, whereas CD8 more so in MC subtype. The rate of continuous complete remission is significantly higher in the MC subgroup. Last, the proportion of HLA-DR/CD38 copositive lymphocytes was an independent prognostic factor for relapse/refractoriness. This study indicates that flow cytometry can be used to examine the tumor microenvironment in HL and that percentage of HLA-DR/CD38 copositive lymphocytes may be a biomarker for relapse and refractoriness in pediatric HL.

Contemporary Management of Hodgkin Lymphoma and Chronic Lymphocytic Leukemia

Contemporary Management of Hodgkin Lymphoma and Chronic Lymphocytic Leukemia

Harnessing the immune system through programmed death-1 blockade in the management of Hodgkin lymphoma.

Immunotherapy is a rapidly evolving therapeutic option in the treatment of lymphoma. Neoplastic cells evade immune recognition through the programmed death (PD)-1/PD-ligand immune checkpoint pathway. Several novel agents have been developed to restore the immune system’s ability to recognize and destroy cancer cells. Nivolumab and pembrolizumab are two anti-PD-1 antibodies that have demonstrated success in the treatment of refractory Hodgkin lymphoma. Harnessing the immune system’s ability to target neoplastic cells, ideally without the use of cytotoxic chemotherapeutic agents, is one way in which these novel agents are changing the therapeutic landscape in the treatment of lymphomas. Here, we review the emerging data regarding checkpoint inhibitors in the management of Hodgkin lymphoma, the unique adverse effects encountered with the use of these agents, and a practical approach to the management of these adverse effects. Additionally, we discuss upcoming trials that will further assess the promising future developments of checkpoint inhibition in the treatment of not only Hodgkin lymphoma but also other B cell lymphomas and myeloma. These agents offer immense promise of a future where many lymphomas can be treated without the toxic effects of chemotherapeutic agents.

Positron Emission Tomography Scanning in the Management of Hodgkin Lymphoma Patients: A Single-Institution Experience.

Positron emission tomography (PET-CT) has become a valuable implement in the management of Hodgkin lymphoma (HL). However, since PET-CT is a relatively new imaging method, its capabilities have not been fully explored. The aim of the study was to evaluate the role of PET-CT at different points in HL management. The medical documentation of 47 HL patients treated at the Comprehensive Cancer Center in Białystok, Poland, was analyzed retrospectively. The study group consisted of 15 men and 32 women, aged 18-59 years, in HL clinical stages II-IV, treated either with chemotherapy or sequential chemoradiotherapy. In 65.2% of the patients who underwent post-chemotherapy PET-CT scanning before their qualification for adjuvant radiotherapy (RT), PET-CT was decisive in qualifying them for RT, by establishing whether or not metabolic partial remission (PR) had occurred. With regard to the achievement of partial or complete response (CR), computed tomography (CT) and PET-CT results correlated in 45.5% of the patients after the completion of chemotherapy, and in 18.7% after the completion of the entire treatment (chemotherapy or chemoradiotherapy). Among the patients from the advanced-stage group (stages III/IV stage and/or bulky HL), morphological PR in CT scans after two to three courses of chemotherapy was more often associated with a lack of metabolic CR in posttreatment PET-CT scanning (p = 0.022) than in other patients. Post-treatment PET-CT scanning was shown to be highly prognostic of a relapse-free follow-up (p < 0.0001) and superior to post-treatment CT imaging in relapse prediction (p < 0.0001). Compared to CT, PET-CT was more accurate in residual masses assessment. Notable ability of PET-CT in relapse-free follow-up prediction encourages to more common use of PET-CT in clinical practice. Further clinical research on the need for RT in patients with PR in CT parallel to CR in PET-CT is required.

Improving Survival of Patients With Hodgkin Lymphoma Over 4 Decades: Experience of the British National Lymphoma Investigation (BNLI) With 6834 Patients.

The management of Hodgkin lymphoma (HL) has changed markedly over the last 50 years. This is due to the expanding understanding about the biology of the disease, the development of increasingly efficacious multimodal treatment, and the recognition of how to reduce late effects. The British National Lymphoma Investigation (BNLI) was formed in the 1970s to coordinate UK research in the diagnosis and treatment of lymphoma. We describe the improvement in trial patient survival over 4 decades. This analysis is of data on 6834 patients with a de novo diagnosis of HL registered onto studies with BNLI oversight from January 1, 1970, to December 31, 2009. Patients were subdivided in 4 groups according to their decade of registration; 1970s, 1980s, 1990s, and 2000s. Because of the lengthy data collection period, there is a difference in duration of follow-up between decade groups, with median follow-up in the 1970s group of 28.2 years, 18.0 years in the 1980s group, 9.4 years in the 1990s group, and 5.4 years in the 2000s group. Comparison between data in all 4 groups is not possible beyond 13.4 years (maximum duration of follow-up in the 2000s group), and so a cutoff has been applied at 14 years. Data on overall survival, cause of death, primary treatment modality, and incidence of secondary malignancy were collected. Clear and statistically significant improvements in survival curves between the decades were present, with 10-year overall survival increasing from 62.4% in the 1970s to 89.6% in the 2000s. There was a suggestion that second malignancy and cardiac-related deaths have been reducing over time, but longer follow-up is needed for the later decades to confirm this trend. Results support existing registry data demonstrating that survival for HL has improved over the 4 decades analyzed. This data set is robust and validated, and it adds valuable understanding to the reasons behind the survival curves, which are a balance between efficacious therapies and decreased death related to cardiac conditions and second malignancies.

PET-scan in management of Hodgkin's lymphoma

La tomographie par emission de positons (TEP) utilisant le 2-deoxy-2[18F]fluoro-D-glucose (18-FDG) a acquis, depuis quelques annees, une place preponderante dans la prise en charge des lymphomes, et en particulier des lymphomes de Hodgkin(LH), hemopathies avides pour le FDG.La TEP, couplee ou non au scanner, permet de realiser une cartographie precise de l’atteinte tumorale.Les recommandations internationales ont recemment preconise que la TEP soit utilisee en routine dans le bilan [...]

Recent advances in the management of Hodgkin lymphoma.

Hodgkin lymphoma (HL) is a rare cancer of the immune system that typically affects lymph nodes and sometimes other organs. Although the majority of patients can be potentially cured with the use of multi-agent chemotherapy and radiotherapy, a proportion of them will relapse or develop resistant disease for which treatment options are limited. In recent years, new agents have been developed and tested in HL with encouraging results. Two classes of drugs stand out as highly active in advanced HL based on recent study results: antibody-drug conjugates and programmed death 1 inhibitors. Clinical trials in HL with these agents have been completed in the past several years and the results have recently become available. In this review, we discuss the recent advances in the management of HL with a focus on strategies to decrease toxicity and a review of the two drug classes that have the potential to change the landscape of treatment of this disease.

PET Adapted Salvage Therapy for Advanced Hodgkin Lymphomas: Towards the Suppression of Positive Interim PET Unfavorable Prognosis? a Report of the Goelams Multicentric Phase 2 Trial LH2007

Introduction: Continuous improvement in the management of Hodgkin Lymphoma (HL) has brought to favorable outcome for the majority of patients. However, patients with advanced stages still present unsatisfactory results with ABVD. The GOELAMS group conducted a prospective multicentric phase 2 trial for advanced stage HL with front-line therapy by VABEM and early salvage therapy followed by ASCT in case of absence of complete metabolic response to test a global PET adapted strategy with early salvage (LH 2007 trial, NCT00920153).Patients & Methods: Patients with advanced stage according to prognostic system score (PSS>3) received VABEM in front-line and interim 18F-FDG PET restaging using visual analysis after 2 courses. In case of negative PET-2 patients continued their therapy with a third course. In case of positive interim PET they underwent early salvage therapy by platin, gemcitabine and dexamethasone combination followed by intensification in case of metabolic response.Results: 51 patients were included in the advanced arm. Median age was 40.5 years (range 18.2-64.8). Ann Arbor stage was IV in 35 (78%). B symptoms were observed in 44 (88%) patients; bulky disease in 22 (43%) of cases. The complete remission rate at the end of the strategy was 88% (n=45/51), with 34/37 patients in CR after 3 VABEM courses and 11/12 patients in CR after salvage therapy and ASCT. The metabolic complete response rate after 2 VABEM courses was 76% (37 above 49 assessable patients). The median follow up is 4.2 years (range: 0.02-5.8). Estimated 2-yrs EFS and OS (n=51) were respectively 82.3% (IC95% 72.5% to 93.5%) and 92.1% (IC95% 85% to 99.8%). 9 events occurred during the first 2 years and led to 4 deaths. The comparison by the one sample log-rank test of the observed EFS to a reference curve with a 2years EFS of 70% was statistcally significant (p=0.0004). No difference was observed in 2yrs-EFS and OS depending on interim PET-2 status. 2yrs-EFS and 2yrs-OS were respectively 83.7% (IC 95 72.6%-96.5%) and 97.2% (IC95 92.0%-100.0%) for PET-2 negative population vs 91.7% (IC 95 77.3%-100%) and 91.7% (IC95 77.3%-100.0%) for PET-2 positive population.Discussion & conclusion: VABEM is an efficient first line treatment choice for Advanced HL. We demonstrate here that a PET-guided strategy with early salvage therapy and intensification for interim PET-2 positive patients is safe and feasible and that this global strategy permits to obtain interesting results in a population of patients associated with poor prognosis. Finally, we suggest that salvage by non-cross-resistant drugs and intensification may erase the unfavourable prognostic of positive interim PET-2 status in HL. DisclosuresNo relevant conflicts of interest to declare.

Advances in the diagnosis and treatment of Hodgkin lymphoma and systemic anaplastic large cell lymphoma

Abstract Current management of Hodgkin lymphoma (HL) allows high cure rates to be achieved with initial therapy in both early-stage and advanced-stage disease. However, adverse events and the emergence of late effects are important issues for patients who respond well to frontline treatment. A further challenge in HL is the treatment of patients who are either refractory to, or relapse following, initial therapy. High-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT) is a potentially curative second-line treatment option for many patients with relapsed/refractory (R/R) HL. However, not all patients are candidates for HDCT/ASCT, and the frequency and duration of responses vary. For patients who fail HDCT/ASCT, current treatment options include further salvage chemotherapy, allogeneic transplantation or novel targeted therapies. Similar issues surround the management of R/R systemic anaplastic large cell lymphoma (sALCL), which is a rare and aggressive tumour. CD30 is strongly expressed in both HL and sALCL tumour cells and is a promising therapeutic target, as demonstrated by the activity of the novel antibody–drug conjugate brentuximab vedotin. New approaches to individualising and optimising patient management, including improved application of imaging, better prognostication through use of biomarkers and the potential use of new treatment combinations and agents targeting signalling pathways in malignant cells, may help to improve outcomes. The case studies included herein were presented at a symposium during the European Hematology Association (EHA) meeting in 2014. This publication aims to share clinical experiences and solutions to the management of HL and sALCL patients in very challenging disease settings.

Biologic agents in the management of Hodgkin lymphoma.

The advent of biologic approaches for the treatment of solid tumors and hematologic malignancies has been a major accomplishment in oncology and a rapidly growing field of clinical and translational research in cancer therapeutics. Classical Hodgkin lymphoma (HL) is no exception. Although the investigation of biologic therapies in HL started decades ago, it has only recently flourished, largely because of the development of new monoclonal antibody drug conjugates and checkpoint inhibitors. Biologic therapies represent a potent treatment option that have produced durable remissions even in patients who have had multiple relapses or with refractory disease. This article reviews 8 major classes of biologic approaches that have been investigated in HL: monoclonal antibodies, immunotoxins, antibody-drug conjugates, radioimmunotherapy, adoptive immunotherapy, immunomodulators, chimeric antigen receptor T cells, and checkpoint inhibitors. An armamentarium of biologic therapies for HL that are well tolerated and potentially more effective is expected to be available in the near future.

Beyond PET/CT in Hodgkin lymphoma: a comprehensive review of the role of imaging at initial presentation, during follow-up and for assessment of treatment-related complications

ObjectiveThe purpose of this article is to provide a comprehensive review of the role of imaging modalities other than PET/CT in the management of Hodgkin lymphoma (HL). PET/CT is the imaging modality of choice in the management of Hodgkin’s lymphoma (HL). However, imaging modalities other than PET/CT such as plain radiographs, ultrasound, CT, MRI and nuclear imaging can help in various stages of clinical management of HL, including the initial workup and post-treatment surveillance. Both CT and MRI help in detecting recurrences, treatment-related pulmonary, cardiovascular and abdominal complications as well as second malignancies. Familiarity with expected post-treatment changes and complications on surveillance images can help radiologists guide patient management. The purpose of this article is to provide a comprehensive review of the role of imaging modalities other than PET/CT in the management of Hodgkin lymphoma (HL).Main Messages• Surveillance of HL patients is usually performed with plain radiographs and CT.• Follow-up imaging can depict normal post-treatment changes or treatment-related complications.• Imaging is important for the timely detection of second malignancies in HL patients.

Expert Radiation Oncologist Interpretations of Involved-Site Radiation Therapy Guidelines in the Management of Hodgkin Lymphoma

Recently, involved-site radiation therapy (ISRT) guidelines have been developed and published to replace the previous concept of involved-field radiation therapy for patients with lymphoma. However, these ISRT guidelines may be interpreted in different ways, posing difficulties for prospective clinical trials. This study reports survey results regarding interpretation of the ISRT guidelines. Forty-four expert lymphoma radiation oncologists were asked to participate in a survey that included 7 different cases associated with 9 questions. The questions pertained to ISRT contouring and asked respondents to choose between 2 different answers (no "correct" answer) and a third write-in option allowed. Fifty-two percent of those surveyed responded to the questionnaire. Among those who responded, 72% have practiced for >10 years, 46% have treated >20 Hodgkin lymphoma cases annually, and 100% were familiar with the ISRT concept. Among the 9 questions associated with the 7 cases, 3 had concordance among the expert radiation oncologists of greater than 70%. Six of the questions had less than 70% concordance (range, 56%-67%). Even among expert radiation oncologists, interpretation of ISRT guidelines is variable. Further guidance for ISRT field design will be needed to reduce variability among practicing physicians.