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• W2168678052 abstract "incidenceThe crude incidence of Hodgkin's lymphoma (HL) in the European Union is 2.3 and the mortality is 0.4 cases/100 000/year. Young adults aged 20–40 years are most often affected; however, a second incidence peak is seen in individuals aged 55 and older. Slightly more men than women are diagnosed with HL. Histologically, classical HL (cHL) accounting for ∼95% of all HL cases is distinguished from nodular lymphocyte-predominant HL (NLPHL) representing ∼5% of all HL cases.diagnosisPathological diagnosis should be made according to the World Health Organization (WHO) classification from a sufficiently large surgical specimen or excisional lymph node biopsy to provide enough material for fresh frozen and formalin-fixed samples.In cHL, the presence of Hodgkin and Reed–Sternberg (HRS) cells is disease-defining while the detection of lymphocyte predominant (LP) cells is required for the diagnosis of NLPHL. The immunophenotype of the malignant cells in cHL and NLPHL differs significantly. In contrast to HRS cells that stain consistently positive for CD30 and CD15, occasionally positive for CD20 and negative for CD45, LP cells are characterised by the expression of CD20 and CD45 but they lack CD15 and CD30.staging and risk assessmentThe diagnostic work-up is shown in Table 1. The medical history including the presence of B symptoms (fever, drenching night sweats, unexplained weight loss >10% of total body weight over 6 months) and other disease-related symptoms such as fatigue, pruritus and alcohol-induced pain, as well as the results of a physical examination, should be recorded [1.Cheson B.D. Fisher R.I. Barrington S.F. et al.Recommendations for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma—the Lugano classification.J Clin Oncol. 2014; (in press)Crossref Scopus (2598) Google Scholar].Table 1Diagnostic work-up in Hodgkin's lymphomaDiagnosis Lymph node biopsy (or a biopsy from another organ with suspected affection)Staging and risk stratification Medical history and physical examination X-ray of the chest Contrast-enhanced CT scan of neck, chest and abdomen PET Full blood cell count and blood chemistry HBV, HCV and HIV screeningPre-treatment examinations ECG Echocardiography Pulmonary function test Reproductive counselling (in younger patients) Serum pregnancy test (in younger female patients)CT, computed tomography; PET, positron emission tomography; HBV, hepatitis B; HCV, hepatitis C; HIV, human immunodeficiency virus; ECG, electrocardiography. Open table in a new tab Chest X-ray and a contrast-enhanced computed tomography (CT) scan of neck, chest and abdomen are mandatory. In addition, a baseline positron emission tomography (PET) should be carried out according to the recommendations for staging and response assessment in lymphoma whenever this diagnostic tool is available [1.Cheson B.D. Fisher R.I. Barrington S.F. et al.Recommendations for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma—the Lugano classification.J Clin Oncol. 2014; (in press)Crossref Scopus (2598) Google Scholar, 2.Barrington S.F. Mikhaeel N.G. Kostakoglu L. et al.The role of imaging in the staging and response assessment of lymphoma: consensus of the ICML Imaging Working Group.J Clin Oncol. 2014; (in press)Crossref Scopus (980) Google Scholar].Given the high sensitivity of PET/CT for bone marrow involvement, a bone marrow biopsy is no longer indicated in patients undergoing PET/CT evaluation [III, B] [1.Cheson B.D. Fisher R.I. Barrington S.F. et al.Recommendations for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma—the Lugano classification.J Clin Oncol. 2014; (in press)Crossref Scopus (2598) Google Scholar, 2.Barrington S.F. Mikhaeel N.G. Kostakoglu L. et al.The role of imaging in the staging and response assessment of lymphoma: consensus of the ICML Imaging Working Group.J Clin Oncol. 2014; (in press)Crossref Scopus (980) Google Scholar, 3.El-Galaly T.C. d'Amore F. Mylam K.J. et al.Routine bone marrow biopsy has little or no therapeutic consequence for positron emission tomography/computed tomography-staged treatment-naive patients with Hodgkin lymphoma.J Clin Oncol. 2012; 30: 4508-4514Crossref PubMed Scopus (200) Google Scholar]. However, bone marrow biopsy must be carried out if PET/CT is not available.Full blood cell count, erythrocyte sedimentation rate (ESR) and blood chemistry including C-reactive protein, alkaline phosphatase, lactate dehydrogenase, liver enzymes and albumin are obligatory. Screening for hepatitis B, hepatitis C and human immunodeficiency virus (HIV) is compulsory [II–III, A].Staging is carried out according to the Ann Arbor classification in consideration of defined clinical risk factors. After completion of staging, patients are allocated to three categories (limited, intermediate and advanced stages). Table 2 illustrates the European Organisation for Research and Treatment of Cancer/Lymphoma Study Association and the German Hodgkin Study Group definitions of limited, intermediate and advanced stages [II–III, A].Table 2Definition of Hodgkin's lymphoma risk groups according to the European Organisation for Research and Treatment of Cancer /Lymphoma Study Association and the German Hodgkin Study GroupTreatment groupEORTC/LYSAGHSGLimited stagesCS I–II without risk factors (supra-diaphragmatic)CS I–II without risk factorsIntermediate stagesCS I–II with ≥1 risk factors (supra-diaphragmatic)CS I, CS IIA with ≥1 risk factors;CS IIB with risk factors C/D, but not A/BAdvanced stagesCS III–IVCS IIB with risk factors A/B, CS III/IVRisk factors(A) Large mediastinal mass(A) Large mediastinal mass(B) Age ≥50 years(B) Extranodal disease(C) Elevated ESR(C) Elevated ESR(D) ≥4 nodal areas(D) ≥3 nodal areasElevated ESR: >50 mm/h without B symptoms, >30 mm/h with B symptoms.Large mediastinal mass: more than one-third of the maximum horizontal chest diameter.B symptoms: fever, night sweat, unexplained weight loss >10% over 6 months.EORTC: European Organisation for Research and Treatment of Cancer; LYSA: Lymphoma Study Association; GHSG: German Hodgkin Study Group; CS: clinical stage; ESR: erythrocyte sedimentation rate. Open table in a new tab To identify patients at increased risk for acute and/or long-term complications, cardiac and pulmonary function tests should be carried out before the start of treatment.Since chemotherapy and radiotherapy (RT) can potentially cause permanent fertility damage, reproductive counselling must be offered to young patients of both genders before treatment.treatment of cHLlimited-stage patientsCombined modality treatment consisting of a brief chemotherapy followed by RT was shown to result in superior tumour control compared with RT alone [I, A] [4.Engert A. Franklin J. Eich H.T. 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. 2007; 25: 3495-3502Crossref PubMed Scopus (198) Google Scholar, 5.Fermé C. Eghbali H. Meerwaldt J.H. et al.Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease.N Engl J Med. 2007; 357: 1916-1927Crossref PubMed Scopus (343) Google Scholar] (Figure 1).Currently, two or three cycles of adriamycin/bleomycin/vinblastine/dacarbazine (ABVD) (Table 3) followed by involved-field RT (IFRT) is considered standard of care for limited-stage HL. A large multicentre trial in which patients were randomly assigned to either two or four cycles of ABVD followed by either 20 or 30 Gy IFRT showed similar freedom from treatment failure (FFTF) and overall survival (OS) rates for all treatment groups. Thus, the least toxic approach consisting of two cycles of ABVD followed by 20 Gy IFRT appears to be sufficient for limited-stage HL [I, A] [6.Engert A. Plutschow A. Eich H.T. et al.Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma.N Engl J Med. 2010; 363: 640-652Crossref PubMed Scopus (679) Google Scholar]. However, the current RT guidelines of the International Lymphoma Radiation Oncology Group (ILROG) recommend involved-site RT (ISRT) after chemotherapy in limited stages although this recent strategy has not yet been validated in a prospective study [7.Specht L. Yahalom J. Illidge T. et al.Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the International Lymphoma Radiation Oncology Group (ILROG).Int J Radiat Oncol Biol Phys. 2014; 89: 854-862Abstract Full Text Full Text PDF PubMed Scopus (379) Google Scholar].Table 3The adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) regimenAdriamycin25 mg/m2i.v.Days 1 + 15Bleomycin10 mg/m2i.v.Days 1 + 15Vinblastine6 mg/m2i.v.Days 1 + 15Dacarbazine375 mg/m2i.v.Days 1 + 15Recycle: day 29. Open table in a new tab The question of whether RT can be omitted in patients with complete metabolic response at interim PET is currently a matter of debate and cannot be fully answered to date. Several randomised trials addressing this issue have been initiated in recent years. Emerging data consistently demonstrate a progression-free survival advantage also for patients with a complete metabolic response at interim PET when treatment with combined modality approaches is applied. A population that can be safely treated with chemotherapy alone could not yet be defined [8.Raemaekers J.M. André M.P. Federico M. et al.Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 Trial.J Clin Oncol. 2014; 32: 1188-1194Crossref PubMed Scopus (298) Google Scholar, 9.Radford J. Barrington S. Counsell N. et al.Involved field radiotherapy versus no further treatment in patients with clinical stages IA and IIA Hodgkin lymphoma and a ‘negative’ PET scan after 3 cycles ABVD. Results of the UK NCRI RAPID trial.Blood. 2012; 120 (ASH Annual Meeting Abstracts): 547Crossref Google Scholar]. Therefore, interim PET-guided treatment in limited-stage HL is not recommended outside clinical studies.intermediate-stage patientsIntermediate-stage HL is usually treated with combined modality approaches.Four cycles of ABVD followed by 30 Gy IFRT is widely considered standard for intermediate-stage HL [I, A] [5.Fermé C. Eghbali H. Meerwaldt J.H. et al.Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease.N Engl J Med. 2007; 357: 1916-1927Crossref PubMed Scopus (343) Google Scholar]. In patients ≤60 years who are eligible for a more intensive treatment, this standard is challenged by a protocol consisting of two cycles of bleomycin/etoposide/adriamycin/cyclophosphamide/vincristine/procarbazine/prednisone in escalated dose (BEACOPPescalated) (Table 4) followed by two cycles of ABVD and 30 Gy IFRT. After a median follow-up of 43 months, FFTF with this protocol was superior in comparison with four cycles of ABVD followed by 30 Gy IFRT. An advantage in OS could not be shown [I, B–C] [10.von Tresckow B. Plütschow A. Fuchs M. et al.Dose-intensification in early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD14 trial.J Clin Oncol. 2012; 30: 907-913Crossref PubMed Scopus (225) Google Scholar]. Although no results of a prospective study addressing this issue are available to date, the ILROG guidelines recommend ISRT instead of IFRT after chemotherapy in intermediate stages [7.Specht L. Yahalom J. Illidge T. et al.Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the International Lymphoma Radiation Oncology Group (ILROG).Int J Radiat Oncol Biol Phys. 2014; 89: 854-862Abstract Full Text Full Text PDF PubMed Scopus (379) Google Scholar].Table 4The bleomycin/etoposide/adriamycin/cyclophosphamide/vincristine/ procarbazine/ prednisone in escalated dose (BEACOPPescalated) regimenBleomycin10 mg/m2i.v.Day 8Etoposide200 mg/m2i.v.Days 1–3Adriamycin35 mg/m2i.v.Day 1Cyclophosphamide1250 mg/m2i.v.Day 1Vincristine1.4 mg/m2 (maximum: 2 mg)i.v.Day 8Procarbazine100 mg/m2p.o.Days 1–7Prednisone40 mg/m2p.o.Days 1–14G-CSFs.c.From day 8Recycle: day 22.G-CSF, granulocyte colony-stimulating factor. Open table in a new tab The question of whether RT is dispensable in intermediate-stage patients with complete metabolic response at interim PET is unanswered. Trials addressing this issue are ongoing.advanced-stage patientsAdvanced-stage HL is usually treated with chemotherapy alone. Additional RT is confined to patients with residual disease after chemotherapy.Patients ≤60 years are treated with either six to eight cycles of ABVD followed by localised RT of residual lymphoma larger than 1.5 cm or six cycles of BEACOPPescalated followed by localised RT of PET-positive residual lymphoma larger than 2.5 cm [I, A] [11.Canellos G.P. Niedzwiecki D. Johnson J.L. Long-term follow-up of survival in Hodgkin's lymphoma.N Engl J Med. 2009; 361: 2390-2391Crossref PubMed Scopus (31) Google Scholar, 12.Engert A. Haverkamp H. Kobe C. et al.Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial.Lancet. 2012; 379: 1791-1799Abstract Full Text Full Text PDF PubMed Scopus (466) Google Scholar]. Several trials randomly comparing ABVD and BEACOPPescalated have shown a superior tumour control with BEACOPPescalated [13.Federico M. Luminari S. Iannitto E. et al.ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial.J Clin Oncol. 2009; 27: 805-811Crossref PubMed Scopus (221) Google Scholar, 14.Viviani S. Zinzani P.L. Rambaldi A. et al.ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned.N Engl J Med. 2011; 365: 203-212Crossref PubMed Scopus (321) Google Scholar, 15.Carde P.P. Karrasch M. Fortpied C. et al.ABVD (8 cycles) versus BEACOPP (4 escalated cycles => 4 baseline) in stage III-IV high-risk Hodgkin lymphoma (HL): first results of EORTC 20012 Intergroup randomized phase III clinical trial.J Clin Oncol. 2012; 30 (ASCO Meeting Abstracts): 8002Crossref Google Scholar]. A recent network meta-analysis including 9993 patients also indicated a significantly better OS with BEACOPPescalated when compared with ABVD. The survival advantage was 10% at 5 years [16.Skoetz N. Trelle S. Rancea M. et al.Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis.Lancet Oncol. 2013; 14: 943-952Abstract Full Text Full Text PDF PubMed Scopus (143) Google Scholar]. However, given the relevant acute toxicity of BEACOPPescalated, appropriate surveillance and supportive care must be available when this protocol is used. In patients >60 years, the BEACOPP regimen should not be given, as an increased rate of treatment-related mortality has been observed in this age group [II, A] [17.Ballova V. Rüffer J.U. Haverkamp H. et al.A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly).Ann Oncol. 2005; 16: 124-131Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar]. Thus, ABVD represents the standard regimen for older HL patients who are fit enough for treatment with multi-agent chemotherapy.Retrospective analyses have indicated that early interim PET might be a good predictor for treatment failure in patients with advanced HL receiving ABVD chemotherapy [18.Hutchings M. Loft A. Hansen M. et al.FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma.Blood. 2006; 107: 52-59Crossref PubMed Scopus (638) Google Scholar, 19.Gallamini A. Hutchings M. Rigacci L. et al.Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study.J Clin Oncol. 2007; 25: 3746-3752Crossref PubMed Scopus (694) Google Scholar]. Therefore, ongoing trials aim at guiding treatment on the basis of early interim PET which is used to distinguish between patients who can potentially be cured with reduced therapy and patients who require standard or even more intensive treatment. However, given a lack of mature prospective data, treatment stratification on the basis of early interim PET cannot be considered standard as yet and further evidence from randomised trials is necessary.relapsed diseaseFor most patients with refractory or relapsed HL, the treatment of choice consists of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) [II, A] [20.Linch D.C. Winfield D. Goldstone A.H. et al.Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial.Lancet. 1993; 341: 1051-1054Abstract PubMed Scopus (927) Google Scholar, 21.Schmitz N. Pfistner B. Sextro M. et al.Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial.Lancet. 2002; 359: 2065-2071Abstract Full Text Full Text PDF PubMed Scopus (906) Google Scholar]. High-risk patients may benefit from tandem ASCT [III, B] [22.Morschhauser F. Brice P. Fermé C. et al.Risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation for first relapse/refractory Hodgkin's lymphoma: results of the prospective multicenter H96 trial by the GELA/SFGM study group.J Clin Oncol. 2008; 26: 5980-5987Crossref PubMed Scopus (125) Google Scholar].Salvage regimens such as dexamethasone/high-dose Ara-C/cisplatin (DHAP), ifosfamide/gemcitabine/vinorelbine (IGEV) or ifosfamide/carboplatin/etoposide (ICE) are given to reduce the tumour burden and mobilise stem cells before high-dose chemotherapy and ASCT [II–III, A] [23.Josting A. Rudolph C. Reiser M. et al.Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease.Ann Oncol. 2002; 13: 1628-1635Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar, 24.Santoro A. Magagnoli M. Spina M. et al.Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma.Haematologica. 2007; 92: 35-41Crossref PubMed Scopus (185) Google Scholar, 25.Moskowitz C.H. Nimer S.D. Zelenetz A.D. et al.A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: analysis by intent to treat and development of a prognostic model.Blood. 2001; 97: 616-623Crossref PubMed Scopus (364) Google Scholar].A subset of low-risk patients relapsing after primary treatment with two cycles of chemotherapy followed by RT can be successfully salvaged with a second, more intensive conventional chemotherapy such as BEACOPPescalated [IV, B–C] [26.Sieniawski M. Franklin J. Nogová L. et al.Outcome of patients experiencing progression or relapse after primary treatment with two cycles of chemotherapy and radiotherapy for early-stage favorable Hodgkin's lymphoma.J Clin Oncol. 2007; 25: 2000-2005Crossref PubMed Scopus (45) Google Scholar].In some patients with localised late relapse, salvage RT alone appears to be sufficient [IV, B–C] [27.Josting A. Nogová L. Franklin J. et al.Salvage radiotherapy in patients with relapsed and refractory Hodgkin's lymphoma: a retrospective analysis from the German Hodgkin Lymphoma Study Group.J Clin Oncol. 2005; 23: 1522-1529Crossref PubMed Scopus (108) Google Scholar].The use of the antibody-drug conjugate brentuximab vedotin represents an option in patients failing ASCT. After a pivotal phase II study including 102 HL patients with relapse after ASCT had revealed an overall response rate (ORR) of 75% with single-agent brentuximab vedotin, the drug was recently approved for the treatment of such patients [III, B] [28.Younes A. Gopal A.K. Smith S.E. et al.Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma.J Clin Oncol. 2012; 30: 2183-2189Crossref PubMed Scopus (1155) Google Scholar]. Alternatively, patients can be enrolled in clinical trials evaluating novel agents.Reduced-intensity conditioning allogeneic stem cell transplantation (RIC-aSCT) can be considered in young, chemo-sensitive patients in good general condition who relapse after high-dose chemotherapy and ASCT [III, C] [29.Sureda A. Canals C. Arranz R. et al.Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma. Results of the HDR-ALLO study—a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation.Haematologica. 2012; 97: 310-317Crossref PubMed Scopus (162) Google Scholar]. However, RIC-aSCT is not a standard approach in HL and should be conducted within clinical trials whenever possible.In patients with multiple relapses who have no other treatment options, acceptable remission rates, satisfying quality of life and prolonged survival can be achieved by palliative single-agent chemotherapy with gemcitabine or bendamustine and/or regional RT [30.Santoro A. Bredenfeld H. Devizzi L. et al.Gemcitabine in the treatment of refractory Hodgkin's disease: results of a multicenter phase II study.J Clin Oncol. 2000; 18: 2615-2619Crossref PubMed Scopus (203) Google Scholar, 31.Moskowitz A.J. Hamlin Jr, P.A. Perales M.A. et al.Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma.J Clin Oncol. 2013; 31: 456-460Crossref PubMed Scopus (154) Google Scholar]. As brentuximab vedotin has also been approved for the treatment of HL patients with disease recurrence after at least two lines of treatment who are not candidates for high-dose chemotherapy followed by ASCT, its use can also be considered in this patient group.treatment of NLPHLstage IA without risk factors30 Gy IFRT alone is the standard treatment for stage IA NLPHL patients without risk factors [III, A] [32.Nogová L. Reineke T. Eich H.T. et al.Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin's lymphoma: a retrospective analysis from the German Hodgkin Study Group (GHSG).Ann Oncol. 2005; 16: 1683-1687Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar].other stagesUsually, NLPHL is treated identically to cHL in all stages except for stage IA without risk factors [33.Nogová L. Reineke T. Brillant C. et al.Lymphocyte-predominant and classical Hodgkin's lymphoma: a comprehensive analysis from the German Hodgkin Study Group.J Clin Oncol. 2008; 26: 434-439Crossref PubMed Scopus (172) Google Scholar]. As the malignant LP cells of NLPHL consistently express CD20, addition of an anti-CD20 antibody may improve treatment efficacy [V, C]. However, prospective data on this issue are not yet available.relapsed NLPHL patientsEven more importantly than in cHL, a renewed biopsy should be obtained in patients with suspected NLPHL relapse before salvage therapy is initiated, since transformation into aggressive non-Hodgkin's lymphoma must be excluded. According to newer analyses, transformation rates appear to be substantially higher than previously reported [IV, A] [34.Biasoli I. Stamatoullas A. Meignin V. et al.Nodular, lymphocyte-predominant Hodgkin lymphoma: a long-term study and analysis of transformation to diffuse large B-cell lymphoma in a cohort of 164 patients from the Adult Lymphoma Study Group.Cancer. 2010; 116: 631-639Crossref PubMed Scopus (125) Google Scholar, 35.Al-Mansour M. Connors J.M. Gascoyne R.D. et al.Transformation to aggressive lymphoma in nodular lymphocyte-predominant Hodgkin's lymphoma.J Clin Oncol. 2010; 28: 793-799Crossref PubMed Scopus (128) Google Scholar].Localised NLPHL relapses can be effectively treated with rituximab alone [III, B] [36.Schulz H. Rehwald U. Morschhauser F. et al.Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG).Blood. 2008; 111: 109-111Crossref PubMed Scopus (139) Google Scholar].Patients with more advanced disease at relapse often require a more aggressive salvage therapy possibly combined with an anti-CD20 antibody. However, prospective data on the use of high-dose chemotherapy followed by ASCT are not available yet.Given the lack of CD30 on the malignant LP cells in NLPHL, brentuximab vedotin does not represent a treatment option in this entity.response evaluationInterim response evaluation by contrast-enhanced CT should be carried out after completion of chemotherapy/before RT in limited and intermediate stages and after four cycles of chemotherapy as well as before RT in advanced stages. Retrospective studies including advanced-stage and relapsed patients, respectively, have shown that interim PET appears to be a useful tool to identify poor-risk individuals [18.Hutchings M. Loft A. Hansen M. et al.FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma.Blood. 2006; 107: 52-59Crossref PubMed Scopus (638) Google Scholar, 19.Gallamini A. Hutchings M. Rigacci L. et al.Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study.J Clin Oncol. 2007; 25: 3746-3752Crossref PubMed Scopus (694) Google Scholar, 37.Moskowitz A.J. Yahalom J. Kewalramani T. et al.Pretransplantation functional imaging predicts outcome following autologous stem cell transplantation for relapsed and refractory Hodgkin lymphoma.Blood. 2010; 116: 4934-4937Crossref PubMed Scopus (191) Google Scholar]. However, interim PET-guided treatment cannot be considered standard and should be restricted to clinical trials except for the decision of whether patients with advanced HL receiving BEACOPPescalated require RT [12.Engert A. Haverkamp H. Kobe C. et al.Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial.Lancet. 2012; 379: 1791-1799Abstract Full Text Full Text PDF PubMed Scopus (466) Google Scholar].Final staging should be carried out after completion of treatment. Physical examination, laboratory analyses and contrast-enhanced CT are mandatory. In addition, PET should be carried out at final staging according to the guidelines for staging and response assessment in lymphoma whenever this diagnostic tool is available [1.Cheson B.D. Fisher R.I. Barrington S.F. et al.Recommendations for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma—the Lugano classification.J Clin Oncol. 2014; (in press)Crossref Scopus (2598) Google Scholar, 2.Barrington S.F. Mikhaeel N.G. Kostakoglu L. et al.The role of imaging in the staging and response assessment of lymphoma: consensus of the ICML Imaging Working Group.J Clin Oncol. 2014; (in press)Crossref Scopus (980) Google Scholar].prognosisWith modern treatment strategies, 80%–90% of HL patients achieve permanent remission and can be considered cured.personalised medicineIn HL, personalised treatment based on certain genetic features as known for some malignancies is not established.Treatment intensity is chosen according to the clinical stage and the presence or absence of clinical risk factors (as described in the staging and risk assessment section). The use of risk-adapted therapy has led to excellent cure rates in HL patients irrespective of the stage at diagnosis.Prospective studies evaluating interim PET-guided strategies have been initiated, with the aim to discriminate between low-risk patients who may be sufficiently treated with reduced-intensity approaches and high-risk patients who require standard or even intensified treatment. In patients with limited and intermediate stages, the goal is to define a group of patients with complete metabolic response after chemotherapy not requiring consolidating RT. In advanced HL, it has been shown that RT is dispensable in patients without PET-positive residual lymphoma larger than 2.5 cm after BEACOPPescalated chemotherapy. Ongoing trials in advanced HL evaluate whether it is possible to modify the intensity of chemotherapy based on the result of early interim PET. However, no mature data addressing this issue are available to date.follow-upHistory, physical examination and laboratory analysis including full blood cell count, ESR and blood chemistry should be carried out every three months for the first half year, every 6 months until the fourth year and once per year thereafter [V, B].Additional evaluation of thyroid function (thyroid-stimulating hormone) after irradiation of the neck at one, two and at least five years is recommended. Furthermore, testosterone and oestrogen levels should be monitored, particularly in younger patients who had intensive chemotherapy.CT scans and previously pathologic radiographic tests must be carried out once to confirm the remission status." @default.
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• W2168678052 title "Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up" @default.
• W2168678052 cites W1914654455 @default.
• W2168678052 cites W1972497571 @default.
• W2168678052 cites W1973535185 @default.
• W2168678052 cites W1978054534 @default.
• W2168678052 cites W1979066583 @default.
• W2168678052 cites W1997194652 @default.
• W2168678052 cites W2006625003 @default.
• W2168678052 cites W2010746974 @default.
• W2168678052 cites W2034218339 @default.
• W2168678052 cites W2060178495 @default.
• W2168678052 cites W2094431983 @default.
• W2168678052 cites W2101873015 @default.
• W2168678052 cites W2108618573 @default.
• W2168678052 cites W2108824619 @default.
• W2168678052 cites W2118169390 @default.
• W2168678052 cites W2119147717 @default.
• W2168678052 cites W2119843363 @default.
• W2168678052 cites W2122654415 @default.
• W2168678052 cites W2125790189 @default.
• W2168678052 cites W2127055058 @default.
• W2168678052 cites W2131452371 @default.
• W2168678052 cites W2131900456 @default.
• W2168678052 cites W2137965731 @default.
• W2168678052 cites W2140801657 @default.
• W2168678052 cites W2141082026 @default.
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