Results of Treatment with Cyclophosphamide,Doxorubicin, Vincristine and Prednisone (CHOP) for Non-Hodgkin’s Aggressive Lymphoma Analyzed According to the International Prognostic Index

Abstract

Forty patients with aggressive (intermediate-grade and high-grade) non-Hodgkin’s lymphoma (NHL) were treated primarily with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy regimen, and then evaluated for prognostic features. Age, tumor stage, performance status, number of extranodal disease sites and serum concentrations of lactate dehydrogenase (LDH) were considered prognostic features. All the patients treated with the CHOP regimen were grouped into four risk categories, including low (L), low-intermediate (LI), high-intermediate (HI) and high (H) according to the International Prognostic Index. Twenty-one of 23 patients (91.3%) in the L plus LI risk groups and 5 of 17 patients (29.4%) in the H plus HI risk groups had complete response and the difference between these percentages was statistically significant (P<0.001). The overall survival rate (2 yr) of 23 patients in the L+LI risk group was 52.1% and of 17 patients in H+HI risk group was 11.7% and this difference was statistically significant (P<0.05). Our results indicated that the CHOP regimen is not effective in the HI+H risk groups of patients with aggressive NHL. New experimental approaches are needed for these patients.     

A New Subtype of Hodgkin’s Lymphoma, Syncytial Nodular Sclerosing: First Case Report of Primary Small Bowel Lymphoma

Introduction

Gastrointestinal lymphomas may arise as a component of systemic disease with GI involvement or primary neoplasm. The diagnosis of primary GI lymphoma requires the lack of peripheral or mediastinal lymphadenopathy, normal white blood cell count, and differential on the peripheral blood smear; tumor involvement must be predominantly in the GI tract, and no evidence of liver or spleen involvement. The small bowel accounts for approximately 9% of the GI lymphomas.

Case report

We describe a first case of primary small bowel Hodgkin’s lymphoma syncytial variant nodular sclerosing type. A 28-year-old man with history of long-term use of immuno-suppressive agent and steroid presents with partial obstructing abdominal-mass-causing anemia and lower gastrointestinal bleeding. The patient underwent colonoscopy because of progressive microcytic anemia. Colonoscopy revealed non-specific polyps that were non-bleeding. The patient continued to have symptoms of abdominal cramping and twitching sensation that led to serial of small bowel radiology studies which showed multiple filling defects and a partial small bowel obstruction. The patient underwent small bowel resection, which showed Hodgkin’s lymphoma syncytial variant type of nodular sclerosing.

Conclusion

This presentation is uncommon and, so far, there are less than ten cases reported with syncytial variant (SV) type of nodular sclerosing Hodgkin’s lymphoma (NSHD). All of which have presentation above the diaphragm and, to our knowledge, this represents the first case that primary SV type of NSHD originated from the small intestine.     

Optimal Therapy for Early-Stage Hodgkin’s Lymphoma: Risk Adapting,Response Adapting,and Role of Radiotherapy

Purpose of Review

The aim of this article is to discuss the current role of radiotherapy (RT) for early-stage Hodgkin’s lymphoma (HL) in the context of risk-adapted and response-adapted treatment strategy, and describe changes in RT technical approach.

Recent Findings

In low-risk patients, RT could be omitted but, at the price of a lower progression-free survival, and its role is still debated. Ongoing trials are combining new agents with chemotherapy alone or response-adapted combined modality therapy, and results are awaited. Modern RT incorporates lower doses and smaller fields, together with the implementation of sophisticated delivery techniques aimed to reducing the dose to critical structures such as the heart.

Summary

The role of RT for early-stage HL is still under debate, and new combinations are emerging; an individualized approach should be recommended, considering all RT technical opportunities to minimize toxicity while maintaining efficacy.

     

Incidence and Characteristics of Childhood Hodgkin’s Lymphoma in Greece: A Nationwide Study (Greece)

Objectives To estimate the incidence and epidemiological profile of childhood (0–14 years) Hodgkin’s lymphoma in Greece derived by the network of childhood Hematology–Oncology departments on the basis of all 95 newly diagnosed cases during a seven-year period. Methods Seventy-one of these cases were individually age and gender matched to an equal number of controls. Results The incidence of childhood Hodgkin Lymphoma reached a relatively high figure of 7.8 per million children-years, with an age distribution (2.2 for children 0–4; 6.3 for those 5–9 and 13.9 for those 10–14-years-old) and male to female ratio (1.7:1) similar to that reported from other cancer registries. Childhood Hodgkin’s lymphoma was more common among children living in less crowded quarters (odds ratio (OR): 6.5 and 95% confidence intervals (95% CI): 1.4–30.7), among those who have changed residence 60 to 18 months before the onset of the index disease (OR: 4.4, and 95% CI = 1.4–14.0), among those whose families owned a cat (OR: 5.5, 95% CI = 1.2–25.6) but not among those whose families owned a dog and marginally more common, among those with a history of infectious mononucleosis (OR: 5.0, 95% CI = 0.6–42.8). Conclusions Our results point to infectious agent(s) as playing an etiological role but do not allow discrimination among the delayed establishment of the herd immunity hypothesis, the population mixing hypothesis or that invoking transmission of the agent(s) from the non-human reservoir. The Childhood Hematology–Oncology Group. Maria Moschovi, Hematology–Oncology Unit, First Department of Pediatrics, Athens University Medical School, ‘Aghia Sophia’ General Children’s Hospital, Athens, Greece Fani Athanassiadou- Piperopoulou, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Greece Sophia Polychronopoulou, Department of Pediatric Hematology–Oncology, ‘Aghia Sophia’ General Children’s Hospital Athens, Greece Apostolos Pourtsidis, Department of Pediatric Hematology–Oncology, ‘Pan.&Agl. Kyriakou’ Children’s Hospital Athens, Greece Maria Kalmanti, Department of Pediatric Hematology–Oncology, University Hospital of Heraklion, Heraklion, Greece     

Adult Non Hodgkin’s Lymphoma Patients: Experience from a Tertiary Care Cancer Centre in North East India

There is paucity of data on non Hodgkin’s lymphoma (NHL) from our population in North-East India. Inthis retrospective study, patients were consecutively followed-up to see the clinic-pathological pattern of NHL,various responses, and pattern of relapses to first line treatment with chemotherapy. All patients in the presentstudy received standard regimen of cyclophosphamde, doxorubicin, vincristine, prednisolone (CHOP) with orwithout rituximab (R-CHOP) as per our institutional protocol as first line therapy. Our study has shown that,in our adult population, the majority of NHL cases present with stage II and stage III disease and extra nodalinvolvement, B-cell lymphomas and diffuse large cell lymphomas being the most common subtypes. Internationalprognostic index was a significant factor for varied responses to treatment. The majority of relapses after completeremission occurred in the first year.     

Clinicopathologic and Survival Characteristics of Childhood and Adolescent Non Hodgkin’s Lymphoma in Yazd,Iran

Background: Data regarding childhood and adolescent non Hodgkin lymphomas in Iran are limited. Theaim of this study was to assess the epidemiological and histomorphological features and survival of affectedpatients in our center. Materials and Methods: The clinicopathologic features and outcome of 44 children andadolescents with non Hodgkin lymphoma diagnosed during 2004-2012, were investigated retrospectively. Theinfluence of potential prognostic parameters in overall survival was investigated by log-rank test and Coxregression analysis. Results: The mean age at presentation was 13.8±6.16 years with a male predilection (M:F=3:1). Malignant lymphoma, not otherwise specified, diffuse large cell lymphoma and Burkitt lymphoma werethe three most common histological types observed. The tumors were 36.4% intermediate grade, 27.3% highgrade and 34.1% belonged to the malignant lymphoma not otherwise specified group. Immunohistochemistryfindings were available in 39 cases. Out of these cases 33 (84.6%) had B cell lineage, 4 (10.25%) T cell lineageand 2 (5.12%) of the cases belonged to miscellaneous group. 3 year and 5 year survivals were 48% and 30%respectively and median survival was 36 months (95%CI=21.7-50.3 months). Overall survival in patients withhigh grade tumors was 19.5 months, in the intermediate group,79 months , and for malignant lymphomas nototherwise specified it was 33.6 months (p value=0.000). Conclusions: The survival rate for children and adolescentswith non Hodgkin lymphomas at our center during 2004-2012 was at a low level.     

Safety and Preliminary Efficacy of Vorinostat With R-EPOCH in High-risk HIV-associated Non-Hodgkin's Lymphoma (AMC-075)

Introduction

Vorinostat (VOR), a histone deacetylase inhibitor, enhances the anti-tumor effects of rituximab (R) and cytotoxic chemotherapy, induces viral lytic expression and cell killing in Epstein-Barr virus-positive (EBV⁺) or human herpesvirus-8-positive (HHV-8⁺) tumors, and reactivates latent human immunodeficiency virus (HIV) for possible eradication by combination antiretroviral therapy (cART).

Plasma kinetics of a cholesterol-rich microemulsion (LDE) in patients with Hodgkin’s and non-Hodgkin’s lymphoma and a preliminary study on the toxicity of etoposide associated with LDE

Background: Neoplastic diseases are often associated with low plasma low-density lipoprotein (LDL) cholesterol and diminished LDL clearance due to upregulation in cancer cells of the receptors that internalize the lipoprotein. Thus, it is possible to use LDL or cholesterol-rich microemulsions (LDE) that bind to LDL receptors as carriers of antineoplastic agents to concentrate those drugs into cancer tissues. Our aim was to determine whether LDL cholesterol concentration plus LDE increased clearance occur in lymphomas. Patients and methods: The LDE labeled with [³ H]-cholesteryl oleate was injected into four Hodgkin’s and 12 non-Hodgkin’s lymphoma patients and into 16 healthy control subjects and the LDE plasma residence time (RT) was determined from sequential plasma samples. Two volunteers with relapsed/refractory lymphoma were treated with 300 mg/m² body surface etoposide associated with LDE in six cycles at 3-week intervals. Results: The LDL cholesterol was lower in lymphoma patients than in controls (94±52 and 115±16 mg/dL, p=0.0362, respectively). The LDE RT was 49% smaller in lymphoma patients than in controls (RT=21.9 and 45.7 h; p=0.0134), with positive correlation between RT and LDL cholesterol. LDE-etoposide showed no considerable toxicity in all cycles in the two treated patients and the disease remained stable during the treatment. Conclusions: Our results suggest that lymphomas overexpress LDL receptors that make room for using LDE as drug-targeting vehicle and that the LDE-etoposide preparation is suitable for patient use.     

Impact of first- and second-line treatment for Hodgkin’s lymphoma on the incidence of AML/MDS and NHL—experience of the German Hodgkin’s Lymphoma Study Group analyzed by a parametric model of carcinogenesis

BackgroundUsing a parametric carcinogenesis model, we disentangle the superimposing effects of primary and relapse therapies of Hodgkin's disease on secondary neoplasias.Patients and methodsWe analyze eight randomized trials of the German Hodgkin's lymphoma study group [5357 individuals, 67 secondary acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) and 97 secondary non-Hodgkin’s lymphoma (NHL)]. Primary therapies were divided into four groups: radiotherapy alone, moderately dosed COPP/ABVD-like chemotherapies for intermediate and advanced stages and BEACOPP escalated.ResultsFor secondary AML/MDS, the hazards after primary therapies are proportional (maximum at 3.4 years), while the hazard after relapse therapy is more peaked (maximum at 1.8 years). Intermediate and advanced stage chemotherapy resulted in a cumulative risk of 1.5%, while the risk after BEACOPP escalated is higher (4.4%, P = 0.004) and comparable with that after relapse therapy (4.5%). For secondary NHL, there are no differences in cumulative risk between the primary therapies (2.9%), while the risk after relapse therapy is increased (6.6%, P = 0.002).ConclusionsBEACOPP escalated moderately increases the risk of secondary AML/MDS but not NHL. No differences were found between other chemotherapies of advanced stages and intermediate stages. Secondary AML/MDS occurs faster after relapse treatment than after primary treatment.     

Oral Extranodal Non Hodgkin’s Lymphoma: Series of Forty Two Cases in Malaysia

Background: Lymphoma is a malignant neoplasm of lymphoid tissue classified into Hodgkin’s and non-Hodgkin’s types. It mostly affects lymph nodes although a considerable proportion of Non-Hodgkin’s casesoccur in extranodal sites. Materials and Methods: Selected cases diagnosed as non-Hodgkin’s lymphoma (NHL)during the period of 1980 to 2012 were retrieved from the archives of the Oral Pathology Diagnostic Laboratory,Faculty of Dentistry, University of Malaya. The sections from the formalin-fixed paraffin embedded tissue blockswere stained with H&E as well as with LCA, CD20, and CD3. Results: The mean age was 41.6 years with amale: female ratio of 1.3:1. Out of the forty two cases, nineteen were Malays, eighteen were Chinese, followedby Indians (3) and Indonesians (2). The most common site of involvement was the mandible (22.2%), followedby the maxilla and palate (19.4% each). Most of the lesions presented as a painless progressive swelling. Onlythirty six cases were further subdivided into B or T cell types. The majority were B-cell type (26 cases), of these 6cases were Burkitt’s lymphomas. Only ten cases were T-cell lymphoma, with three cases of NK/T-cell lymphoma.Conclusions: In this series of 42 patients diagnosed as extranodal non-Hodgkin’s lymphoma, the lesions appearedas painless swellings, mostly in men with the mandible as the most frequent site of involvement. Majority wereB-cell lymphomas with Malays and Chinese being equally affected whereas lymphomas were rare in the Indianethnicity. T-cell lymphomas were found to be common in the Chinese ethnic group.     

Lorlatinib for Previously Treated ALK-Positive Advanced NSCLC: Primary Efficacy and Safety From a Phase 2 Study in People’s Republic of China

IntroductionLorlatinib was found to have activity in ALK-positive NSCLC in a global phase 1 and 2 study. We report an ongoing phase 2 study in Chinese patients with ALK-positive advanced or metastatic NSCLC.MethodsOpen-label, dual-cohort study (NCT03909971); patients had progressive disease after ALK tyrosine kinase inhibitor treatment (cohort 1: previous crizotinib; cohort 2: one ALK tyrosine kinase inhibitor other than crizotinib [±prior crizotinib]), more than or equal to one unirradiated extracranial target lesion, and Eastern Cooperative Oncology Group performance status of 0 to 2. Patients received oral lorlatinib 100 mg once daily in continuous 21-day cycles. Primary end point: objective response in cohort 1 by independent central radiology (ICR) according to Response Evaluation Criteria in Solid Tumors version 1.1. Analyses were based on patients receiving more than or equal to one dose.ResultsAt data cutoff (August 10, 2020), 109 patients were enrolled (cohort 1: n = 67; cohort 2: n = 42). A total of 47 patients in cohort 1 (70.1%, 95% confidence interval [CI]: 57.7–80.7, p < 0.0001; primary end point) and 20 patients in cohort 2 (47.6%, 95% CI: 32.0–63.6, secondary end point) achieved objective response by ICR. Median progression-free survival was not reached in cohort 1 and was 5.6 months in cohort 2. In patients with brain lesions at baseline, 29 of 36 patients in cohort 1 (80.6%, 95% CI: 64.0–91.8) and 10 of 21 patients in cohort 2 (47.6%, 95% CI: 25.7–70.2) achieved objective intracranial response by ICR. Hypercholesterolemia (92.7%) and hypertriglyceridemia (90.8%) (cluster terms) were common treatment-related adverse events (TRAEs). Nine patients (8.3%) had serious TRAEs; one permanently discontinued from treatment because of TRAEs.ConclusionsLorlatinib was found to have a robust and durable response and high intracranial objective response in previously treated Chinese patients with ALK-positive NSCLC.     

Individuals with HGV-RNA are at High Risk of B Cell Non - Hodgkin’s Lymphoma Development

Lymphoma is a common hematological malignancy. Hepatitis viruses, especially hepatitis B and hepatitis C, are ‍known risk factors for development of non-Hodgkin lymphomas. However, there are a number of patients with ‍hepatitis in whom no virus can be identified and it was therefore postulated that there may be other agents which ‍may be causing hepatitis. Many new hepatitis viruses have indeed been identified and proposed to have possible ‍roles in pathogenesis of many disorders. Hepatitis G virus (HGV) is an example of a newly detected hepatitis virus. ‍Whethere there is a correlation between infection and development of non-Hodgkin’s lymphoma is of interest. ‍Therefore an appraisal of the prevalence of HGV RNA among patients with B cell non-Hodgkin’s lymphoma ‍comparing with healthy control subjects was performed. According to the literature review, three reports covering ‍247 cases of non Hodgkin’s lymphoma were recruited. The overall prevalence of HGV RNA positivity was found to ‍be 7.2 % (18/247). Of the three reports, only two had complete data on the prevalence in both patients with B cell ‍non - Hodgkin’s lymphoma and healthy control subjects andwere used for further metanalysis study, covering 178 ‍cases and 355 healthy subjects. The overall antibody positive rate in the patients and healthy subjects were 8.4 % ‍(15/178) and 0.8 % (3/355), respectively, with an odds ratio is 10.8. According to this study, it can be seen that ‍individuals who are HGV RNA positive may be at very high risk of B cell non-Hodgkin’s lymphoma development.     

Efficacy of carbon-ion radiotherapy and high-dose chemotherapy for patients with unresectable Ewing’s sarcoma family of tumors

Background

Treatment for unresectable Ewing’s sarcoma family of tumors (ESFT) is a formidable challenge because of its high tendency for local and distant failure. Recently, carbon-ion radiotherapy (CIRT) has been applied to unresectable bone and soft tissue sarcoma. Additionally, high-dose chemotherapy (HDC) with stem cell rescue has been used to improve the survival of patients with relapsed ESFT. Here we report our experience with CIRT and HDC in the treatment of unresectable ESFT.

Methods

Five unresectable ESFT patients including 4 who underwent CIRT and HDC and one who underwent CIRT from 1999?2009 were retrospectively studied. After neoadjuvant chemotherapy, CIRT was conducted at the National Institute of Radiological Sciences in Chiba as local therapy. Consecutively, we employed HDC including busulfan, melphalan, and thiotepa with stem cell rescue.

Results

Two patients showed tumor shrinkage after CIRT, including 1 patient who achieved partial response. No severe acute toxicity related to CIRT was observed. Local failure was observed in only 1 patient at 22 months after CIRT. Four patients conducted HDC with stem cell rescue after CIRT and 1 patient suffered from veno-occlusive disease just after HDC. Distant failure was observed in 3 patients after completion of the treatment.

Conclusions

CIRT and HDC for unresectable ESFT patients show favorable local control, with unsatisfactory results for distant control.     

Population-based Assessment of Hospitalizations for Neutropenia from Chemotherapy in Older Adults with Non-Hodgkin’s Lymphoma (United States)

Objective To study neutropenia hospitalization (NH) incidence and risk factors in a population-based sample of older adults with non-Hodgkin’s lymphoma (NHL) and evaluate the validity of inferences from Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases. Methods NHL cases receiving first-course chemotherapy were identified from Iowa SEER-Medicare. Survival methods evaluated NH risk factors. Medical record and Medicare claims data on chemotherapy and NH were compared. Results Of 761 subjects, 165 (21.7%, 95% CI: 18.8, 24.6) were hospitalized for neutropenia. Of those hospitalized, 41% were hospitalized in cycle 1 and 22% in cycle 2. Significant multivariable risk factors for NH were diffuse large cell histology, renal disease, Charlson comorbidity index, and anthracycline chemotherapy but not patient age. Medicare and medical records agreed on month of chemotherapy initiation 95% of the time and chemotherapy type 95% of the time. ICD-9 code 288.0 sensitivity for NH was 80%. Conclusions Neutropenia hospitalizations were common in the first 2 chemotherapy cycles, especially among older adults with comorbidity. Findings conflict with a prior medical records study in which age was a risk factor for NH and dose intensity a negative confounder. Valid inferences about age effects on chemotherapy toxicity require more clinical detail than is available in administrative data.     

The course of anxiety and depression for patients with Hodgkin’s lymphoma or diffuse large B cell lymphoma: a longitudinal study of the PROFILES registry

Purpose

The purpose of this study is to prospectively assess anxiety and depression among patients with Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). Also, to compare its prevalence with a normative population, identify subgroups with more anxiety and depression, and assess its impact on health-related quality of life (HRQoL).

Methods

The population-based Eindhoven Cancer Registry was used to select patients diagnosed with HL or DLBCL from 1999 to 2010, 489 responded (T1). The HADS was completed four times (T1–T4), with a 1-year interval. Linear mixed-models were used to assess the course of anxiety and depression and identify high-risk subgroups.

Results

Both anxiety and depression were reported more often by patients compared to the normative population (p?p?DLBCL patients reported higher anxiety scores, whereas older DLBCL patients reported higher depression scores over time (p?Conclusion More HL and DLBCL patients experience anxiety and depression compared to their counterparts in the general population and it did not improve in time.

Implication for Cancer Survivors

Clinicians should be aware that former lymphoma patients with anxiety and depression have a deteriorated global health status/HRQoL and refer patients to suitable aftercare when necessary.     

Phase II Study on Safety and Efficacy of Yadanzi® (Javanica oilemulsion injection) Combined with Chemotherapy for Patientswith Gastric Cancer

Objective: To investigate the efficacy and safety of Yadanzi® (Javanica oil emulsion injection) combined withchemotherapy for treatment of patients with advanced gastric cancer. Methods: From January 2011 to December2012, we recruited 75 patients with advanced gastric cancer, who received javanica oil emulsion injectiontogether with chemotherapy. After two cycles of treatment, efficacy and safety of the combined therapies wereevaluated. Results: Overall response rate of 75 patients after treatment was 85.3% (CR+PR+SD). Treatmentrelated side effects were recorded. No treatment related death occurred. Conclusions: Javanica oil emulsioninjection combined with chemotherapy could be considered as a safe and effective regimen in treating patientswith advanced gastric cancer. Further randomized clinical trials should be conducted to confirm whether theaddition of Yadanzi® to chemotheraphy could be associated with reduced toxicity, enhanced tolerability andimproved quality of life for patients with advanced gastric cancer.     

Hodgkin’s lymphoma involving extranodal sites:potential association with HIV infection and the implications for clinical management

正We commend Li et al.[1]for their article Clinical characteristics of the patients with Hodgkin’s lymphoma involving extranodal sites (published in the Chinese Journal of Cancer in July 2012). We agree that in comparison with extranodal non-Hodgkin’s lymphoma(NHL), the incidence of extranodal Hodgkin’s lymphoma(HL) is much rarer and thus described much less     

Clinical Safety and Efficacy of Kanglaite® (Coix Seed Oil) Injection Combined with Chemotherapy in Treating Patients with Gastric Cancer

Objective: To observe efficacy and side effects, as well as the impact on quality of life, of Kanglaite® (CoixSeed Oil) injections combined with chemotherapy in the treatment of advanced gastric cancer patients. Method:A consecutive cohort of 60 patients were divided into two groups: the experimental group receiving Kanglaite®Injection combined with chemotherapy and the control group with chemotherapy alone. After more than twocourses of treatment, efficacy, quality of life and side effects were evaluated. Results: The response rate andKPS score of experimental group were significantly improved as compared with those of the control group(P<0.05). In addition, gastrointestinal reactions and bone marrow suppression were significantly lower than inthe control group (P<0.05). Conclusions: Kanglaite® Injection enhanced efficacy and reduced the side effects ofchemotherapy, improving quality of life of gastric cancer patients; use of Kanglaite® injections deserves to befurther investigated in randomized control clinical trails.     

Clinical features of AIDS patients with Hodgkin’s lymphoma with isolated bone marrow involvement: report of 12 cases at a single institution

Objective

To study the main clinical and histopathological features of 12 patients with Hodgkin’s lymphoma (HL) diagnosed primarily from bone marrow (BM) involvement.

Methods

We included 12 acquired immunodeficiency syndrome (AIDS) patients with HL assisted in the F. J. Muñiz Infectious Diseases Hospital since January 2002 to December 2013. The diagnosis of HL with primary BM involvement in patients was confirmed by clinical, histopathological, and immunohistochemical findings.

Results

All patients presented “B” symptoms and pancytopenia. All of them had stage IV neoplasm disease because of BM infiltration. The median of CD4⁺ T-cell counts was 114 cells/μL, and mixed cellularity (MC) was the most frequent histopathological subtype of 92% cases.

Conclusion

When other causes are excluded, BM biopsy should be performed in AIDS patients with “B” symptoms and pancytopenia to evaluate BM infiltration by atypical lymphocytes.KEYWORDS : Acquired immunodeficiency syndrome (AIDS), Hodgkin’s lymphoma (HL), bone marrow (BM)     

Risk of second breast cancer in female Hodgkin’s lymphoma survivors: a meta-analysis

Background

Women treated for Hodgkin??s lymphoma (HL) have an elevated risk of developing second breast cancer (SBC) compared with the general population. We planned this meta-analysis to quantify the long-term risk of SBC and analyze the contributing risk factors among HL survivors.

Methods

According to predefined selection criteria, literature search identified 34 studies that were included in the analyses.

Results

After eliminating overlapping or duplicate data, 957 incidences of SBC were encountered in 24,505 females with HL over a median follow-up of 14.9?years. The medians: age at the diagnosis of HL, age at diagnosis of SBC, and latency since HL treatment to the development of SBC were 23.7, 35.0, and 17.7?years, respectively. The pooled relative risk (RR) of SBC was 8.23 (95% CI, 5.43-12.47, I ² ?=?96%), with a median absolute excess rate of 22.9 per 10,000 person-years. The RR was found inversely related to age at diagnosis of HL with the highest rate (68.7; [95%CI, 28.08-168.11], I ² ?=?79%), occurred in young patients (?? 15?years old), where the RR in older women (?? 40?years old) was not significant (0.55; [95% CI, 0.09-3.52]). Analysis of RR by 5-year increments since the treatment of HL showed that the risk was highest after 15?C19?years of latency (13.87; [95% CI, 7.91-24.30], I ² ?=?89%). Analysis of the effect of treatment modalities showed that the RR rates were (4.70; [95% CI, 3.28-6.75], I ² ?=?74%), (5.65; [95%CI, 2.94-10.88], I ² ?=?91%), and (1.19; [95% CI, 0.50-2.82], I ² ?=?65%), for radiotherapy (RT) only, combined RT and chemotherapy (CT), and CT only, respectively. To investigate the demonstrated heterogeneity, meta-regression analysis was performed when feasible. In most such analyses, the natural logarithm of RR was inversely associated with age at HL diagnosis.

Conclusions

We conclude that, the current meta-analysis provided the most recent comprehensive estimate of the risk of SBC in a broad-range of HL survivors. Younger age at diagnosis proved to be a dominant risk factor. The obtained results would serve providing breast cancer screening recommendations for HL survivors.