Hodgkin’s lymphoma

Quality of life in adolescent and young adult Hodgkin’s lymphoma survivors

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , , , ,

Ye.G. Arshanskaya1,2, S.V. Semochkin2,3, and A.G. Rumyantsev2,3

1 S.P. Botkin City Clinical Hospital, Moscow, Russian Federation

2 Federal Clinical-and-Research Center of Pediatric Hematology, Oncology, and Immunology n.a. Dmitriy Rogachev, Moscow, Russian Federation

3 N.I. Pirogov Russian National Research Medical University, RF Ministry of Health, Moscow, Russian Federation

ABSTRACT

Background. Deterioration of quality of life (QoL) and late complications of antitumor therapy for Hodgkin’s lymphoma (HL) are the important medical issues, since they mostly relate to young patients with a high life-expectancy.

Objective. The study was to compare QoL of HL survivors versus healthy young adults.

Methods. 56 (22 males and 34 females) HL survivors with a median age of 27.5 (range 22–41) were evaluated. For the purpose of comparison, 94 (44 males and 50 females) healthy subjects with a median age of 28.0 (range 22–46) were enrolled into the study of QoL. All HL survivors were treated in our hospital according to the modified pediatric protocol DAL-HD-90 in 1997–2007. QoL was assessed using the Short Form 36 (SF-36) which enabled generating 8 separate scales and 2 final scores (0 = worst possible health, 100 = best possible health). All survivors were in complete remission of HL for ³ 5 years.

Results. The HL survivors had the lower scores than the normal controls according to all scales and SF-36. Statistically significant differences were found in: general health — 53.4 (95 %CI 47.8–59.1) vs. 72.3 (68.8–75.8; p < 0,001), vitality — 54.7 (50.4–59.1) vs. 72.2 (69.3–75.2; p < 0.001), and mental health — 57.4 (53.5–61.4) vs. 71.7 (68.6–74.8; p < 0.001). The patients at the age ³ 18.5 years (ROC-curves; p = 0.047) at the time of HL diagnosis had poorer QoL when compared to younger patients with respect to: general health — 48.3 (41.3–55.2) vs. 60.9 (51.6–70.2; p = 0.027): vitality — 50.3 (44.7–55.9) vs. 61.1 (51.6–70.2; p = 0.013). The patients with the unfavorable events including relapse (n = 6) and second malignancy (n = 2) showed the lowest scores of QoL, especially in physical role performance [34.4 (2.6–71.3) vs. 79.7 (77.8–89.6; p = 0.002)] and emotional role performance [25.0 (7.5–57.5) vs. 77.8 (67.1–88.4; p < 0.001)]. Duration of remission, age at the QoL evaluation, gender, therapy intensity (2, 4, or 6 cycles of primary chemotherapy plus radiotherapy), Ann-Arbor stages, bulky disease, current married status, and education levels showed no significant influence on the QoL parameters.

Conclusion. Long-term HL survivors had poorer physical and mental QoL than the general population of young adults. The age at the time of LH diagnosis ³ 18.5 years was associated with significantly reduced QoL. The relapsed HL and second malignancies were mostly associated with the deterioration of physical and emotional role functioning that may indicate uncertainty of patients about future well-being.

Keywords: Hodgkin’s lymphoma, quality of life, adolescents, young adults, DAL-HD-90, SF-36

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Determination of B-cell clonality in Hodgkin’s lymphoma

EXPERIMENTAL STUDIES , , ,

Yu.V. Sidorova, N.V. Ryzhikova, S.Yu. Smirnova, E.E. Nikulina, B.V. Biderman, A.M. Kovrigina, T.N. Moiseeva, N.N. Sharkunov, and A.B. Sudarikov

Hematology Research Center, Moscow, Russian Federation

ABSTRACT

B-cell origin of Hodgkin’s lymphoma was demonstrated using microdissection and single cell PCR of Reed-Sternberg and Hodgkin cells (R. Kuppers et al., 1994). We assessed B-cell clonality in the biopsy samples of 35 patients with Hodgkin’s lymphoma without microdissection. B-cell clonality was evaluated using PCR amplification by IGH (FR1, FR2, FR3) and IGK (Vk-Jk, Vk/intron-Kde) gene rearrangements with multiplex BIOMED-2 primer sets and subsequent fragment analysis using ABI PRISM 3130 Genetic Analyzer (Applied Biosystems). Clonality was found in 11 out of 35 (31,5 %) formalin fixed paraffin-embedded (FFPE) lymph node specimens from patients with Hodgkin’s lymphoma. In 11 cases when both FFPE and fresh frozen samples were available, we observed the similar results with the specimens of both types. No correlation was found between the presence of B-cell clones and age, histological type of Hodgkin lymphoma, type of tumor cell growth (syncytial or diffuse), number of eosinophils in tissues, or CD20/CD15 expression on the surface of tumor cells. The high incidence of B-cell clonality determined in Hodgkin’s lymphoma biopsy samples makes the B-cell clonality assay unsuitable for differential diagnosis between Hodgkin’s lymphoma and B-cell lymphomas.

Keywords: Hodgkin’s lymphoma, B-cell clonality, PCR, immunoglobulin gene rearrangements.

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International prognostic score in advanced Hodgkin’s lymphoma

LYMPHOID TUMORS , , , ,

K.D. Kaplanov1, A.L. Shipaeva1, V.A. Vasil’yeva1, E.G. Gemdjian2, I.V. Matveeva1, L.S. Tregubova1, T.U. Klitochenko1, K.V. Demidenko1, O.B. Kalashnikova1, G.U. Vyskub1, O.E. Golubeva1, O.V. Levina1, V.A. Orlov1, and E.A. Demina3

1 Volgograd Regional Oncology Clinic #1, Volgograd, Russian Federation

2 Hematology Research Center, RF Ministry of Health, Moscow, Russian Federation

3 N.N. Blokhin Russian Cancer Research Center, RAMS, Moscow, Russian Federation

ABSTRACT

Since chemotherapy of Hodkgin’s lymphoma was introduced in early 60s, it has undergone fundamental changes that were associated with dramatic improvement in the disease prognosis. Currently, the various intensive modifications of original BEACOPP, such as BEACOPP-14 and escalate BEACOPP, are among the most widely used for treatment of advanced Hodkgin’s lymphoma.

Initially, the International Prognostic Score (IPS) was developed for patients treated with MOPP and MOPP-ABVD protocols. We suggest that due to the well-known changing value of the various prognostic signs with protocols of different intensity, the significance of IPS for BEACOPP-based therapy should be reconsidered.

One hundred seventy two patients with advanced Hodgkin’s lymphoma were included in our trial. All these patients were treated at the Hematology department of Volgograd Regional Oncology Clinic #1. Treatment options were as follows: 64 (37%), 84 (49%), and 24 (14%) patients received intensive BEACOPP-based, standard BEACOPP, or ABVD therapy, respectively. The final data presented are related to the period up to June 30, 2012.

We retrospectively evaluated the treatment outcomes for each IPS group. To distinguish the most significant prognostic signs from all six IPS factors, we studied the impact of each factor on treatment efficacy.

The greatest difference in overall 3- and 4-year survival was observed between the groups of patients with IPS 0–1 and ³ 2; for IPS 0–1, 3- and 4-year overall survival rate was 93%; for IPS ³ 2, 3- and 4-year overall survival rate was 81% and 75%, respectively (p = 0.05). 3-year overall survival was significantly negatively affected by such factors as age over 45 (70% versus 87%, relative risk (RR) = 3.95% CI: 1.7–7, p = 0.01) and albumin level < 40 g/L (79% versus 88%, RR= 2.8, 95% CI: 1.2–6.8, p = 0.02). Overall 3-year survival rate in males (n = 91) and females (n = 81) was 80% and 88%, respectively (p = 0.09). We found no effect on overall and freedom-from-treatment-failure survival (FFTF) of such factors as hemoglobin levels, lymphocyte count, leukocytes count, and IV stage disease. With respect to overall survival, multivariate analysis showed the greatest significance of age (relative risk, RR =3.6, 95% CI: 1.8–7, p = 0.001) and albumin level (OR = 2.6, 95% CI: 1.1–6, p = 0.036).

Keywords: Hodgkin’s lymphoma, international prognostic score (IPS), advanced stages, overall survival (OS), freedom-from-treatment-failure survival (FFTFS), BEACOPP, ABVD

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Hodgkin’s lymphoma and male fertility disorders

REVIEWS , , ,

A.А. Vinokurov

Federal Clinical-and-Research Center of Pediatric Hematology, Oncology, and Immunology n.a. Dmitriy Rogachev, Moscow, Russian Federation

ABSTRACT

This literature review is focused on the mechanisms of the impact that cytotoxic drugs cause in male reproductive cells and the rate of infertility induced by the various regimens of combined chemotherapy for Hodgkin’s lymphoma. The specific endocrine abnormalities associated with antitumor treatment are described in detail and, also, routine and experimental methods for fertility preservation in cancer patients are presented.

Keywords: Hodgkin’s lymphoma, male infertility, sperm cryopreservation, male fertility preservation.

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REFERNCES

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Hodgkin’s lymphoma and a “new old” bendamustine

DIAGNOSIS AND TREATMENT OF LYMPHOID TUMORS , , ,

S.S. Shklyaev, and V.V. Pavlov

Medical Radiological Research Center, RF Ministry of Health, Obninsk, Russian Federation

ABSTRACT

Hodgkin’s lymphoma is a malignant tumor that eventually turned from a fatal incurable to successfully curable disease after primary treatment in the vast majority of cases. However, the prognosis for patients with refractory and relapsed disease is not infrequently dismal and life-threatening, especially if the tumor continues progressing after high-dose chemotherapy with autologous stem cell transplantation or, in some instances, even after allogeneic stem cell grafting. Bendamustine is a “new old” cytostatic agent that can be effectively applied for treating this group of patients. Our literature review highlights a variety of relevant options in treatment of Hodgkin’s lymphoma using bendamustine.

Keywords: Hodgkin’s lymphoma, refractory and relapsed disease, treatment, bendamustine.

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