Therapy of Hodgkin's lymphoma in clinical practice: A retrospective long-term follow-up analysis

Aquino,Sara; Clavio,Marino; Rossi,Edoardo; Vignolo,Luana; Miglino,Maurizio; Spriano,Mauro; Canepa,Letizia; Catania,Gioacchino; Pierri,Ivana; Bergamaschi,Micaela; Gonella,Roberta; Marani,Carlo; Racchi,Omar; Cavaliere,Marina; Goretti,Riccardo; Carbone,Federico; Bruzzone,Andrea; Tassara,Rodolfo; Carella,Angelo   Michele; Ghio,Riccardo; Gobbi,Marco

doi:10.3892/ol.2011.255

Therapy of Hodgkin's lymphoma in clinical practice: A retrospective long-term follow-up analysis

Authors:
- Sara Aquino
- Marino Clavio
- Edoardo Rossi
- Luana Vignolo
- Maurizio Miglino
- Mauro Spriano
- Letizia Canepa
- Gioacchino Catania
- Ivana Pierri
- Micaela Bergamaschi
- Roberta Gonella
- Carlo Marani
- Omar Racchi
- Marina Cavaliere
- Riccardo Goretti
- Federico Carbone
- Andrea Bruzzone
- Rodolfo Tassara
- Angelo Michele Carella
- Riccardo Ghio
- Marco Gobbi
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Affiliations: Department of Haematology and Oncology, University of Genoa, 16132 Genoa, Italy, Department of Haematology and Oncology, University of Genoa, 16132 Genoa, Italy, Department of Oncology, Villa Scassi Hospital, Genoa, Italy, Department of Internal Medicine, St. Paolo Hospital, Savona, Italy, Department of Internal Medicine, St. Corona Hospital, Pietra Ligure, Italy
Published online on: January 21, 2011 https://doi.org/10.3892/ol.2011.255
Pages: 289-295

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Abstract

Treatment of Hodgkin's lymphoma (HL) is perceived to be relatively straightforward. Consequently, patients are not usually referred to hemato-oncologically specialized centres and are treated locally instead. Comprehensive findings beyond prospective controlled trials are therefore lacking. Clinical data of 209 patients who had received a HL diagnosis were collected. A total of 7 patients received radiotherapy (RT) alone (3%), 75 (35%) were treated with a combination of chemotherapy (CT) and RT and 127 patients received CT alone [mainly doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD)]. Complete response (CR) following first-line treatment was achieved in 178 patients (85%) and in 195 (93%) after salvage treatment. Favorable disease (p=0.000359), limited-stage disease (p=0.0003), involvement of lymph nodes above the diaphragm (p=0.05) and absence of mediastinal bulky tumor involvement positively affected the CR rate following first-line treatment. Out of the 195 patients that achieved CR, 31 relapsed. Male gender (p=0.043) and age over 45 years (p=0.047) were significantly associated with an increased incidence of relapse. Age at diagnosis was the key factor affecting long-term outcome. The event-free survival (EFS) projected at 120 months was 80 and 57% for patients younger and older than 45 years, respectively (p=0.022). The overall survival (OS) projected at 120 months was 92 and 38% for patients younger and older than 45 years, respectively (p=0.00561). A second neoplasia was diagnosed in 8 patients. The development of a tumor in 4 cases (breast, lung and thyroid cancer) was likely RT-related. Only 1 patient not receiving RT developed acute myeloid leukemia. The EFS and OS of the 141 early-stage patients treated with CT + RT (n=62) or with CT alone (n=79) were not statistically different.

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1	Diehl V: Hodgkin’s disease, from pathology specimen to cure. N Engl J Med. 357:1968–1971. 2007.
2	Hasenclever D and Diehl V: A prognostic score for advanced Hodgkin’s disease. N Engl J Med. 339:1506–1514. 1998.
3	Canellos GP, Anderson JR, Propert KJ, et al: Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 327:1478–1484. 1992.
4	Duggan DB, Petroni GR, Johnson JL, et al: Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an intergroup trial. J Clin Oncol. 21:607–614. 2003.
5	Gobbi PG, Levis A, Chisesi T, et al; Intergruppo Italiano Linfomi. ABVD versus modified stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin’s lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi. J Clin Oncol. 23:9198–9207. 2005.PubMed/NCBI
6	Diehl V, Franklin J, Pfreundschuh M, et al: Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. Standard and increased-dose BEACOPP. N Eng J Med. 348:2386–2395. 2003.
7	Diehl V and Fuchs M: Early, intermediate and advanced Hodgkin’s lymphoma: modern treatment strategies. Ann Oncol. 18(Suppl 9): 71–79. 2007.
8	Bonadonna G, Bonfante V, Viviani S, Di Russo A, Villani F and Valagussa P: ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin’s disease: long-term results. J Clin Oncol. 22:2835–2841. 2004.PubMed/NCBI
9	Koontz BF, Kirkpatrick JP, Clough RW, et al: Combined-modality therapy versus radiotherapy alone for treatment of early-stage Hodgkin’s disease: cure balanced against complications. J Clin Oncol. 24:605–611. 2006.
10	Engert A, Franklin J, Eich HT, et al: Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin’s lymphoma: final results of the GHSG HD7 trial. J Clin Oncol. 25:3495–3502. 2007.PubMed/NCBI
11	Fermè C, Eghbali H, Meerwaldt JH, et al: Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. EORTC-GELA H8 Trial. N Engl J Med. 357:1916–1927. 2007.
12	Olweny CL and Ziegler JL: Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med. 358:742–759. 2008.
13	Laskar S, Gupta T, Vimal S, et al: Consolidation radiation after complete remission in Hodgkin’s disease following six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy: is there a need? J Clin Oncol. 22:62–68. 2004.
14	Straus DJ, Portlock CS, Qin J, et al: Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II, and IIIA nonbulky Hodgkin disease. Blood. 104:3483–3489. 2004. View Article : Google Scholar
15	Meyer RM, Gospodarowicz MK, Connors JM, et al: Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin’s lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol. 23:4634–4642. 2005.PubMed/NCBI
16	Gospodarowicz MK and Meyer RM: The management of patients with limited-stage classical Hodgkin lymphoma. ASH 2006 Educational Book. pp. 255–258. 2006, PubMed/NCBI
17	Canellos GP, Abramson JS, Fisher DC and LaCasce AS: Treatment of favourable, limited-stage Hodgkin’s lymphoma with chemotherapy without consolidation by radiation therapy. J Clin Oncol. 28:1611–1615. 2010.
18	Viviani S, Di Nicola M, Bonfante V, et al: Long-term results of high-dose chemotherapy with autologous bone marrow or peripheral stem cell transplant as first salvage treatment for relapsed or refractory Hodgkin lymphoma: a single institution experience. Leuk Lymphoma. 51:1251–1259. 2010. View Article : Google Scholar
19	Zinzani PL, Tani M, Molinari AL, Stefoni V, Zuffa E, Alinari L, Gabriele A, Bonifazi F, Salvucci M, Tura S and Baccarani M: Ifosfamide, epirubicin and etoposide regimen as salvage and mobilizing therapy for relapsed/refractory lymphoma patients. Haematologica. 87:816–821. 2002.PubMed/NCBI
20	Clavio M, Garrone A, Pierri I, Michelis GL, Balocco M, Albarello A, Varaldo R, Canepa P, Miglino M, Ballerini F, Canepa L and Gobbi M: Ifosfamide, epirubicin, etoposide (IEV) and autologous peripheral blood progenitor cell transplant: a feasible and effective salvage treatment for lymphoid malignancies. Oncol Rep. 14:933–940. 2005.
21	Santoro A, Magagnoli M, Spina M, Pinotti G, Siracusano L, Michieli M, Nozza A, Sarina B, Morenghi E, Castagna L, Tirelli U and Balzarotti M: Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica. 92:35–41. 2007.PubMed/NCBI
22	Hoppe RT: Hodgkin’s disease: complications of therapy and excess mortality. Ann Oncol. 8(Suppl 1): 115–118. 1997.
23	Jaffe ES, Lee Harris N, Stein H and Vardiman JW: World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of Haematopoietic and Lymphoid Tissues. IARC Press; Lyon: 2001
24	Brusamolino E, Bacigalupo A, Barosi G, et al: Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up. Haematologica. 94:550–565. 2009.
25	Provencio M, Salas C, Millan I, Cantos B, Sanchez A and Bellas C: Late relapses in Hodgkin Lymphoma: a clinical and immunochemistry study. Leuk Lymphoma. 51:1686–1691. 2010. View Article : Google Scholar : PubMed/NCBI
26	Walker A, Schoenfeld ER, Lowman JT, Mettlin CJ, MacMillan J and Grufferman S: Survival of the older patient compared with the younger patient with Hodgkin’s disease. Influence of histologic type, staging, and treatment. Cancer. 65:1635–1640. 1990.
27	Diaz-Pavon JR, Cabanillas F, Majlis A and Hagemeister FB: Outcome of Hodgkin’s disease in elderly patients. Hematol Oncol. 13:19–27. 1995.
28	Gallamini A: Positron emission tomography scanning: a new paradigm for the management of Hodgkin’s lymphoma. Haematologica. 95:1046–1048. 2010.
29	Olcese F, Clavio M, Rossi E, et al: The addition of radiotherapy to chemotherapy does not improve outcome of early stage Hodgkin’s lymphoma patients: a retrospective long-term follow-up analysis of a regional Italian experience. Ann Hematol. 88:855–861. 2009.
30	Ghalibafian M, Beaudre A and Girinsky T: Heart and coronary artery protection in patients with mediastinal Hodgkin lymphoma treated with intensity-modulated radiotherapy: dose constraints to virtual volumes or to organs at risk? Radiother Oncol. 87:82–88. 2008.
31	Travis LB: Evaluation of the risk of therapy-associated complications in survivors of Hodgkin lymphoma. Hematology Am Soc Hematol Educ Program. 2007.192–196