Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: A systematic review and network meta-analysis
ABSTRACT Several treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care—increased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)—were not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy.
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- "Beyond this, availability of an improved ABVD platform allowing omission of consolidation radiotherapy may be advantageous in health-care settings where the availability of updated radiation delivery modalities is problematic (Terezakis & Kasamon , 2012). Given that access to novel agents to implement standard ABVD and the highly specialized supportive measures advocated by GHSG investigators to fully exploit survival benefit from escalated BEACOPP may not apply to all health-care systems worldwide (Skoetz et al, 2013), ABVD DD- DI may represent a sound and affordable option for high-risk patients with HL. "
ABSTRACT: We explored activity and safety of a dose-dense/dose-intense adriamycin, bleomycin, vinblastine and dacarbazine regimen (ABVDDD-DI ) in 82 patients with advanced Hodgkin Lymphoma. Patients entered a two-stage Bryant-Day Phase II study to receive six cycles of ABVDDD-DI without consolidation radiotherapy. Cycles were supported with granulocyte colony-stimulating factor and delivered every 21 d; drugs were administered on days 1 and 11 at the same doses of standard ABVD except for doxorubicin (35 mg/m(2) ; first four cycles only). Co-primary endpoints were complete response (CR) rate and severe acute cardiopulmonary toxicity; secondary endpoints were event-free (EFS) and disease-free survival (DFS). All patients received the four doxorubicin-intensified courses and 96% concluded all six cycles (82·3% within the intended 18 weeks). This translated into a 66·9% increase of received dose-intensity for doxorubicin and 31·8% for the other agents over standard ABVD. The CR rate was 95·1% (78/82) and 87·8% (72/82) achieved a metabolic CR after two cycles. Cardiopulmonary toxicity never exceeded grade 2 and affected 14·6% of patients. Most frequent toxicities were grade 4 neutropenia (10%) and anaemia (9%), grade 3 infection (17%) and grade 2 mucocutaneous changes (30%). Five-year EFS and DFS was 88·3% and 93·7%, respectively. ABVDDD-DI regimen was well-tolerated and ensured substantial CR and EFS rates without radiotherapy.British Journal of Haematology 03/2014; 166(1). DOI:10.1111/bjh.12862 · 4.96 Impact Factor
Canadian Journal of Physiology and Pharmacology 02/2014; 92(2):93-4. DOI:10.1139/cjpp-2013-0443 · 1.55 Impact Factor
- "Known as periwinkle tea in Jamaica, the well-known folk-use of rosy periwinkle led researchers to delve into its natural chemical properties in the 1950s. Scientific analysis of rosy periwinkle led to the discovery of 2 previously unknown compounds, vincristine and vinblastine, which have been subsequently developed into potent medicines to save lives from leukemia (Bucur et al. 2013) and Hodgkin's lymphoma (Skoetz et al. 2013), respec- tively. One final example is the recent publication by Cheng (Yale University, New Haven, Connecticut, USA), of a nonpurified product based on a traditional Chinese formula, and its ability to reduce chemotherapy-induced gastrointestinal toxicity (Lam et al. 2010). "
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ABSTRACT: Disease overview: Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 9,000 new patients annually and representing approximately 11% of all lymphomas in the United States. Diagnosis: HL is composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups under the designation of classical HL. Risk stratification: An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence are used to optimize therapy for patients with limited or advanced stage disease. Risk-adapted therapy: Initial therapy for HL patients is based on the histology of the disease, the anatomical stage and the presence of poor prognostic features. Patients with early stage disease are treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. Management of refractory disease: High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, palliative chemotherapy, non-myeloablative allogeneic transplant or participation in a clinical trial should be considered. © Am. J. Hematol. 87:1096–1103, 2012. VVC 2012 Wiley Periodicals, Inc.American Journal of Hematology 12/2012; 87(12):1096-1103. DOI:10.1002/ajh.23348 · 3.48 Impact Factor