The world of lymphomas is broad, however, the causes of
the occurrence of cancers of the lymphatic system has not yet been adequately detected. There is still much to explore and much to learn. One way to adjust the appropriate therapies is to allow retrospective analyses. It is important to learn from experience.
Hodgkin’s lymphoma (HL) is one of the most common cancers in adolescents and young adults (AYA). In the absence of specific recommendations for this age group, AYA with HL can be treated according to pediatric or adult therapeutic strategies-with the same major challenge: maintaining optimal efficacy with less long-term toxicity and promoting treatment adherence. Adult strategies are mainly based on ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) with/without radiotherapy, whereas pediatric protocols include OEPA (vincristine, etoposide, prednisolone, doxorubicin) and COPDAC (cyclophosphamide, vincristine, prednisolone, dacarbazine) with radiotherapy for inadequate early response. Despite different treatment regimens, both approaches have demonstrated excellent efficacy, with 5-year overall survival rates exceeding 95% in patients younger than 25 years. However, there are very few studies comparing the outcomes of AYA with HL treated with a pediatric protocol with those of AYA treated with an adult protocol. This challenge has now been taken up by scientists from France [1].
From 2012 to 2018, 148 patients aged 15 to 25 years were treated for newly diagnosed HL. Of them, 71 were treated according to the adult strategy and 77 according to the pediatric EuroNet protocol. The primary objective of the study was to compare 5-year progression-free survival (PFS) by treatment group. Secondary objectives were to compare 5-year OS, interim PET response, cumulative doses of chemotherapy received, short-term toxicity profile, and number of hospitalization days. For both strategies, 5-year PFS was 100% in the localized stage and 78% in the advanced stage. Early response, as determined by interim PET, was associated with shorter PFS in both groups. A partial response at interim PET was observed in 21% of pediatric and 10% of adult patients, which was associated with a 5-year PFS of 68% and 44%, respectively, with no significant difference. In patients with negative intermediate PET, 5-year PFS was 90% in both groups.
However, pediatric protocols required more hospital days for total treatment than adult protocols (26 vs. 12 days), which may affect quality of life. Also, the risk of short-term steroid-related toxicities was higher with pediatric therapies. In contrast, that for late toxicity was higher in the adult regimens. These results justify a tailored therapeutic decision for each individual patient and underline the importance of treating these young patients in dedicated units that have professionals trained in the specificities of this age group.
Earlier start of therapy, better results?
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin’s lymphoma in adults. Although most patients have advanced disease, cure rates are over 60%. Those who do not respond to initial treatment usually have a poor treatment outcome. Currently, the optimal time between diagnosis and treatment (TDT) is not known. There are no standard TDT guidelines for DLBCL, and the data show a large median range (14 – 37 days). A retrospective study was therefore conducted to examine the effects of TDT on outcomes of patients treated under the Veterans Health Administration (VHA), the largest integrated health care system in the United States serving over 9 million veterans [2].
A total of 2448 patients were enrolled in this study. The median TDT was 19 days, median PFS was 46.8 months, and median OS was 54.1 months. Beim Vergleich des 2-Jahres-OS der Gruppe mit TDT ≤1 Woche mit allen anderen Gruppen gab es einen signifikanten Unterschied zugunsten des Überlebens in einer der Gruppen mit TDT >1 Woche. However, there was no significant difference when comparing the 1-3 weeks, 3–5 weeks, 5–7 weeks, and ≥7 weeks groups. The median PFS in the high-risk group was 7.2 months and the median OS was 11.2 months.
Congress: 64th Annual Meeting of the American Society of Hematology (ASH)
Literature:
- Lew-Derivry L, Brice P, Bigenwald C, et al: Should Adolescents and Young Adults with Hodgkin Lymphoma be Treated As Children or Adults? Abstract 727. 12/12/2022, ASH 2022.
- Souza GR, Kaur S, Boyle LD, et al: The Impact of Time from Diagnosis to Initiation of Chemotherapy on Survival of Patients with Diffuse Large B-Cell Lymphoma in the Veteran’s Health Administration. Abstract 852. 12/12/2022, ASH 2022.
InFo ONKOLOGIE & HÄMATOLOGIE 2023; 11(1): 24
