Broeckelmann, Paul J., Sasse, Stephanie and Engert, Andreas (2018). Balancing risk and benefit in early-stage classical Hodgkin lymphoma. Blood, 131 (15). S. 1666 - 1679. WASHINGTON: AMER SOC HEMATOLOGY. ISSN 1528-0020
Full text not available from this repository.Abstract
With defined chemotherapy and radiotherapy (RT) and risk-adapted treatment, early-stage classical Hodgkin lymphoma (HL) has become curable in a majority of patients. Hence, a major current goal is to reduce treatment-related toxicity while maintaining long-term disease control. Patients with early-stage favorable disease (ie, limited stage without risk factors [RFs]) are frequently treated with 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (2xABVD) followed by 20-Gy involved-field or involved-site RT (IF/ISRT). In patients with early-stage unfavorable disease (ie, limited stage with RFs), 4 cycles of chemotherapy are usually consolidated with 30-Gy IF/ISRT. Compared with 4xABVD, 2 cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (2xBEACOPP(escalated)) followed by 2xABVD improved 5-year progression-free survival (PFS), with similar 5-year overall survival. Recently, treatment strategies based on [F-18] fluorodeoxyglucose positron emission tomography (PET) response were evaluated. In early-stage unfavorable HL, a majority of patients achieved a negative interim PET after 2xABVD and an excellent outcome after 4xABVD, whereas in those with a positive interim PET, 2xBEACOPP(escalated) improved 5-year PFS. Furthermore, a PET-guided RT approach was evaluated to decrease long-term toxicity. Although both the RAPID and H10 trials reported poorer disease control without RT, PET-guided omission of RT can constitute a valid therapeutic option in patients with an increased risk of RT-associated toxicity (eg, because of sex, age, or disease localization). Implementation of drugs such as the anti-CD30 antibody-drug conjugate brentuximab vedotin or the anti-programmed death 1 antibodies nivolumab or pembrolizumab might allow further reduction of overall mortality and improve quality of life in affected patients.
Item Type: | Journal Article | ||||||||||||||||
Creators: |
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URN: | urn:nbn:de:hbz:38-189389 | ||||||||||||||||
DOI: | 10.1182/blood-2017-10-772665 | ||||||||||||||||
Journal or Publication Title: | Blood | ||||||||||||||||
Volume: | 131 | ||||||||||||||||
Number: | 15 | ||||||||||||||||
Page Range: | S. 1666 - 1679 | ||||||||||||||||
Date: | 2018 | ||||||||||||||||
Publisher: | AMER SOC HEMATOLOGY | ||||||||||||||||
Place of Publication: | WASHINGTON | ||||||||||||||||
ISSN: | 1528-0020 | ||||||||||||||||
Language: | English | ||||||||||||||||
Faculty: | Unspecified | ||||||||||||||||
Divisions: | Unspecified | ||||||||||||||||
Subjects: | no entry | ||||||||||||||||
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Refereed: | Yes | ||||||||||||||||
URI: | http://kups.ub.uni-koeln.de/id/eprint/18938 |
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