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The article "The impact of bleomycin deficit on survival in Hodgkin's lymphoma patients: A retrospective study" have presented the experience of AVD chemotherapy regimen in newly diagnosed Hodgkin's lymphoma (HL) in a single center in Brazil. Though being a small retrospective study, results from this study have provided the medical community a real-world data on HL in Brazil. ABVD has remained the standard of care for patients of newly diagnosed HL both in early and advance stages. Newer targeted molecules have also come for use in novel combinations with existing drugs. However, in a situation of temporary scarcity of bleomycin due to lack of supply during 2017 in Brazil led to use of incomplete ABVD regimen without bleomycin, i.e. AVD for HL. However, Soldi et al. utilized the opportunity to retrospectively study if the omission of bleomycin leads to subnormal treatment or unwarranted effects.
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Bleomicina , Enfermedad de Hodgkin , Enfermedad de Hodgkin/tratamiento farmacológico , Enfermedad de Hodgkin/mortalidad , Bleomicina/uso terapéutico , Bleomicina/administración & dosificación , Humanos , Estudios Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Vinblastina/uso terapéutico , Brasil/epidemiología , Doxorrubicina/uso terapéutico , Dacarbazina/uso terapéuticoRESUMEN
BACKGROUND: The outcomes of Hodgkin´s lymphoma (HL) in México have not been widely reported. Simplified and affordable treatments have been adopted in middle-income countries. AIM: The aim was to evaluate long-used therapies for HL in México in a long-term basis. METHODS: In a 34-year time period, 88 patients with HL were treated at a single institution in México. Patients were treated with adriamycin bleomycin vinblastine and dacarbazine (ABVD) or mechlorethamine, vincristine, procarbazine, and prednisone (MOPP). Relapsed or refractory patients were given ifosfamide, carboplatin, and etoposide (ICE) followed by autologous or allogeneic stem cell transplants. RESULTS: Thirty-seven women and 51 men were included; the median age was 29 years. Patients were followed for a mean of 128 mo. The 310-mo overall survival (OS) was 83% for patients treated with MOPP and 88% for those treated with ABVD. The OS of patients who received autologous stem cell transplantation was 76% (330 mo) vs 93% (402 mo) in those who did not. CONCLUSION: HL may be less aggressive in Mexican population than in Caucasians. Combined chemotherapy renders acceptable results, regardless of clinical stage.
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PURPOSE: Considering the increased cancer patient survivorship, the focus is now on addressing the impacts of treatment on quality of life. In young people, altered reproductive function is a major issue and its effects in young males are largely neglected by novel research. To improve clinician awareness, we systematically reviewed side effects of chemotherapy for Hodgkin lymphoma (HL) in young males. METHODS: The review was prospectively registered (PROSPERO N. CRD42019122868). Three databases (Medline via PUBMED, SCOPUS, and Cochrane Library) were searched for studies featuring males aged 13-51-years who underwent chemotherapy for HL using ABVD (Adriamycin® (doxorubicin), bleomycin, vinblastine, and dacarbazine) or BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) regimens. These chemotherapy regimens were compared against each other using sperm characteristics, FSH, and inhibin B levels to measure fertility levels. RESULTS: Data were extracted from five studies featuring 1344 patients. 6 months post-ABVD saw marked deterioration in sperm count, further reduced by more cycles (P = 0.05). Patients treated with BEACOPP rather than ABVD were more prone to oligospermia. Receiving fewer cycles of both regimens increased the likelihood of sperm production recovering. Patients treated with 6-8 cycles of BEACOPP did not recover spermiogenesis. CONCLUSIONS: ABVD and BEACOPP regimens significantly reduce fertility function to varying effects depending on treatment duration. ABVD temporarily causes significant reductions in male fertility, whereas BEACOPP's effects are more permanent. Therefore, clinicians should discuss fertility preservation with male patients receiving infertility-inducing gonadotoxic therapy. Further high-quality studies are required to more adequality describe the risk to fertility by chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Fertilidad/efectos de los fármacos , Enfermedad de Hodgkin/tratamiento farmacológico , Infertilidad Masculina/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/efectos adversos , Bleomicina/farmacología , Bleomicina/uso terapéutico , Ciclofosfamida/efectos adversos , Ciclofosfamida/farmacología , Ciclofosfamida/uso terapéutico , Dacarbazina/efectos adversos , Dacarbazina/farmacología , Dacarbazina/uso terapéutico , Doxorrubicina/efectos adversos , Doxorrubicina/farmacología , Doxorrubicina/uso terapéutico , Etopósido/efectos adversos , Etopósido/farmacología , Etopósido/uso terapéutico , Humanos , Masculino , Prednisona/efectos adversos , Prednisona/farmacología , Prednisona/uso terapéutico , Procarbazina/efectos adversos , Procarbazina/farmacología , Procarbazina/uso terapéutico , Vinblastina/efectos adversos , Vinblastina/farmacología , Vinblastina/uso terapéutico , Vincristina/efectos adversos , Vincristina/farmacología , Vincristina/uso terapéuticoRESUMEN
Resumen ANTECEDENTES: El linfoma de Hodgkin ocupa el cuarto lugar de las neoplasias que aparecen durante el embarazo. En realidad, éste no tiene repercusiones en la historia natural de la enfermedad, pero dificulta el tratamiento. CASO CLÍNICO: Paciente de 18 años, con 35 semanas de embarazo; ingresó al servicio de Ginecología Oncológica por aumento de volumen en la región axilar derecha, con dolor a la palpación profunda. Durante la exploración se observó un ganglio móvil de 3 x 3.5 cm en el lado derecho de la región axilar y adenopatía inguinal izquierda, menor de 1 cm. La ecografía reportó la mama derecha con una masa sólida, homogénea, de bordes nítidos, de 38 x 35 mm y volumen de 20.84 cc; el Doppler color evidenció aumento de la vascularización. La lesión se estadificó en BIRADS 3. Se decidió finalizar el embarazo por cesárea, con nacimiento de un varón sano, de 2900 g, Apgar 8/9. De la biopsia se extrajeron ocho ganglios linfáticos axilares. La inmunohistoquímica confirmó un proceso linfoproliferativo, compatible con linfoma de Hodgkin clásico, con celularidad mixta CD30+ y KI67 50%. Se le indicó quimioterapia con protocolo ABVD en 6 ciclos, sin necesidad de radioterapia. A seis meses de la cirugía su evolución fue satisfactoria, con ausencia de ganglios palpables, sin recidiva ni reacción fallida a los medicamentos. CONCLUSIÓN: El linfoma de Hodgkin concomitante con el embarazo es excepcional; los signos de la enfermedad pueden confundirse fácilmente con otras alteraciones, incluso pasar inadvertidas. El feto, al exponerse a radiación menor a 100 mGy, tiene menos posibilidades de malformaciones.
Abstract BACKGROUND: Hodgkin lymphoma during pregnancy accounts for 4th place in the neoplasms. Pregnancy has no impact on the natural history of the disease; however, it hinders treatment, which is individualized from a clinical evaluation and based on staging. CLASSIC CASE: Patient 18 years of age, with pregnancy of 35 weeks gestation, who is referred to the external consultation of Oncology Gynecology by increased volume in right axillary region with deep palpation pain. During its examination presence of 3 x 3.5 cm mobile node, on the right side of the axillary region, and left inguinal adenopathy >1 cm. The ultrasound reported right breast with solid mass, homogeneous, sharp edges, 38 x 35 mm and volume of 20.84 cc, doppler color with increased vascularity, is staged as BIRADS 3. Cesarean section was performed, with male birth, weight; 2900 g Apgar 8/9 without incident report. In the periareolar excisional biopsy, eight axillary lymph nodes were removed. Immunohistochemistry confirmed a classic LH-compatible lymphoproliferative process with CD30+, KI67 50% mixed cellularity. The hematology service decides management based on chemotherapy with ABVD protocol in 6 blocks, without radiotherapy. Currently it is evolving smoothly after six months of surgery, there was no corroborate of palpable nodes, and so far treatment, without reports of relapses or reaction to medications. CONCLUSION: Hodgkin´s lymphoma in pregnancy is exceptional, the signs of the disease are easily confused with other pathologies or even go unnoticed. The fetus, when exposed to radiation less than 100 mgy, is less likely to malform.
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The role of Ann Arbor staging in determining treatment intensity after achieving a negative positron emission tomography (PET) has not been established in classical Hodgkin lymphoma (cHL). Patients with stage I-IV cHL, received three cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and an interim PET scan (PET3). PET3-negative patients received no further therapy. PET3-positive patients received three additional cycles of ABVD plus involved-field radiation therapy or salvage chemotherapy, if refractory to ABVD, and were re-evaluated by PET scan (PET6). Study endpoints were 3-year progression-free survival (PFS) and overall survival (OS) rates. Two hundred and thirty-nine patients with early-stage and 138 with advanced-stage were evaluable. Overall, 260 patients (70%) were PET3-negative and had higher 3-year PFS (90% vs. 65%; P < 0·0001) and OS (98% vs. 92%; P = 0·007) rates than PET3-positive patients. All PET3-negative patients, regardless of disease stage at diagnosis, achieved similarly good PFS (90-91%; P = 0·76) and OS (97-99%). The only independent prognostic factor for PFS was PET3-negativity (Hazard ratio 3·8; 95% confidence interval 2·4-6·3; P < 0·0001). This study suggests that cHL patients who achieve a negative PET3 following ABVD have an excellent outcome, regardless of stage at diagnosis. An appropriately powered, phase III trial will be necessary to confirm these findings.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/tratamiento farmacológico , Tomografía de Emisión de Positrones/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Bleomicina/farmacología , Bleomicina/uso terapéutico , Dacarbazina/farmacología , Dacarbazina/uso terapéutico , Doxorrubicina/farmacología , Doxorrubicina/uso terapéutico , Femenino , Enfermedad de Hodgkin/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Supervivencia , Vinblastina/farmacología , Vinblastina/uso terapéutico , Adulto JovenRESUMEN
Abstract Background: Reports dealing with clinical outcomes of classical Hodgkin's lymphoma in low- to middle-income countries are scarce and response to therapy is poorly documented. This report describes the characteristics and clinical outcomes of patients with classical Hodgkin's lymphoma from a single institution in Latin America. Method: A retrospective study was conducted over ten years of patients with classical Hodgkin's lymphoma treated at a referral center. Progression-free and overall survival rates were estimated by Kaplan-Meier analysis. The univariate Cox regression model was used to estimate associations between important variables and clinical outcomes. Main results: One hundred and twenty-eight patients were analyzed. The mean age was 28.5 years. The five-year progression-free and overall survival were 37.3% and 78.9%, respectively. Of the whole group, 55 (43%) were primary refractory cases. Only 39/83 (47%) patients with advanced disease vs. 34/45 (75.6%) in early stages (p-value = 0.002) achieved complete remission. Those with advanced disease had a five-year overall survival of 68.7% vs. 91.8% for early disease (p-value = 0.132). Thirty-one patients relapsed (24.2%) and 20 (64.5%) received a transplant. The hazard ratio for progression with bone marrow infiltration was 2.628 (p-value = 0.037). For death, an International Prognostic Score ≥4 had a hazard ratio of 3.355 (p-value = 0.050) in univariate analysis. Two-thirds of classical Hodgkin's lymphoma patients diagnosed at advanced stages had a low progression-free survival but an overall survival similar to high-income countries. Conclusion: Patients diagnosed with classical Hodgkin's lymphoma in Northeastern Mexico had a significantly low progression-free survival rate and presented with advanced disease, underscoring the need for earlier diagnosis and improved contemporary therapeutic strategies in these mainly young productive-age Hodgkin's lymphoma patients.
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Vincristina , Bleomicina , Enfermedad de Hodgkin , Doxorrubicina , Tasa de Supervivencia , Dacarbazina , América LatinaRESUMEN
BACKGROUND: Reports dealing with clinical outcomes of classical Hodgkin's lymphoma in low- to middle-income countries are scarce and response to therapy is poorly documented. This report describes the characteristics and clinical outcomes of patients with classical Hodgkin's lymphoma from a single institution in Latin America. METHOD: A retrospective study was conducted over ten years of patients with classical Hodgkin's lymphoma treated at a referral center. Progression-free and overall survival rates were estimated by Kaplan-Meier analysis. The univariate Cox regression model was used to estimate associations between important variables and clinical outcomes. MAIN RESULTS: One hundred and twenty-eight patients were analyzed. The mean age was 28.5 years. The five-year progression-free and overall survival were 37.3% and 78.9%, respectively. Of the whole group, 55 (43%) were primary refractory cases. Only 39/83 (47%) patients with advanced disease vs. 34/45 (75.6%) in early stages (p-value=0.002) achieved complete remission. Those with advanced disease had a five-year overall survival of 68.7% vs. 91.8% for early disease (p-value=0.132). Thirty-one patients relapsed (24.2%) and 20 (64.5%) received a transplant. The hazard ratio for progression with bone marrow infiltration was 2.628 (p-value=0.037). For death, an International Prognostic Score ≥4 had a hazard ratio of 3.355 (p-value=0.050) in univariate analysis. Two-thirds of classical Hodgkin's lymphoma patients diagnosed at advanced stages had a low progression-free survival but an overall survival similar to high-income countries. CONCLUSION: Patients diagnosed with classical Hodgkin's lymphoma in Northeastern Mexico had a significantly low progression-free survival rate and presented with advanced disease, underscoring the need for earlier diagnosis and improved contemporary therapeutic strategies in these mainly young productive-age Hodgkin's lymphoma patients.