Broeckelmann, Paul J., Goergen, Helen, Kohnhorst, Charlotte, Von Tresckow, Bastian, Moccia, Alden, Markova, Jana, Meissner, Julia, Kerkhoff, Andrea, Ludwig, Wolf-Dieter, Fuchs, Michael, Borchmann, Peter and Engert, Andreas (2017). Late Relapse of Classical Hodgkin Lymphoma: An Analysis of the German Hodgkin Study Group HD7 to HD12 Trials. J. Clin. Oncol., 35 (13). S. 1444 - 1455. ALEXANDRIA: AMER SOC CLINICAL ONCOLOGY. ISSN 1527-7755

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Abstract

Purpose Clinical characteristics, therapeutic approaches, and prognosis of late relapse (LR) in patients with classic Hodgkin lymphoma (cHL) are poorly understood. We performed a comprehensive analysis of LR of Hodgkin lymphoma (LR-HL). Methods To estimate the incidence of LR-HL, we retrospectively analyzed 6,840 patients with cHL included in the German Hodgkin Study Group trials HD7 to HD12. Patients who experienced a relapse >5 years into remission were compared with patients in continued remission for >5 years and with those who experienced a relapse <= 5 years after first diagnosis. Results With a median observation time of 10.3 years, 141 incidences of LR-HL were observed. Cumulative incidences at 10, 15, and 20 years rose linearly and were 2.5%, 4.3%, and 6.9%, respectively. The standardized incidence ratio for HL with respect to age-and sex-matched German reference data was 84.5 (95% CI, 71.2 to 99.7). LR-HL was more frequently observed in patients with early-stage favorable than unfavorable or advanced stage at first diagnosis (15-year cumulative incidence, 5.3% v 3.9% and 3.9%, respectively; P =.01). Overall survival from first diagnosis was worse after LR compared with nonrelapse survivors (10-year estimate, 95.8% v 86.1%; hazard ratio, 2.5; 95% CI, 1.7 to 3.5; P<.001). In patients with LR-HL, survival was better compared with 466 patients with earlier relapse (hazard ratio, 0.6; 95% CI, 0.4 to 0.9, P =.01). Forty-four percent and 49% of patients with LR-HL and earlier relapse, respectively, received stem cell transplantations. Conclusion Apart from treatment-associated adverse effects, survivors after initially successful therapy for cHL are at an 85-fold risk for recurrence of disease compared with the general German population. After risk-adapted treatment strategies, especially in early-stage favorable HL, regular clinical follow-up is recommended for timely detection of LR-HL. With adequate treatment, prognosis of LR-HL is better compared with early relapses. (C) 2017 by American Society of Clinical Oncology

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Broeckelmann, Paul J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goergen, HelenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kohnhorst, CharlotteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Von Tresckow, BastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moccia, AldenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Markova, JanaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meissner, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kerkhoff, AndreaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludwig, Wolf-DieterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fuchs, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Borchmann, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Engert, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-232780
DOI: 10.1200/JCO.2016.71.3289
Journal or Publication Title: J. Clin. Oncol.
Volume: 35
Number: 13
Page Range: S. 1444 - 1455
Date: 2017
Publisher: AMER SOC CLINICAL ONCOLOGY
Place of Publication: ALEXANDRIA
ISSN: 1527-7755
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
INVOLVED-FIELD RADIOTHERAPY; NON-INFERIORITY TRIAL; BURKITTS-LYMPHOMA; FINAL ANALYSIS; OPEN-LABEL; CHEMOTHERAPY; DACARBAZINE; RECURRENCE; INTENSITY; BLEOMYCINMultiple languages
OncologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/23278

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