Changes to This Summary (07/30/2013)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Updated statistics with estimated new cases and deaths for 2013 (cited American Cancer Society as reference 1).
Added Evens et al. as reference 5.
Added text to state that among 10,019 patients who underwent central expert pathology review for the German Hodgkin Study Group (GHSG), 84 patients were identified as having lymphocyte-depleted classical Hodgkin lymphoma (HL) (cited Klimm et al. as reference 3). Also added that these patients present with more advanced-stage HL and usually with B symptoms.
Added 2011 Swerdlow et al. as reference 9.
Added text to state that in a retrospective Surveillance, Epidemiology, and End Results (SEER) analysis, stage-specific survival was decreased by 30% to 60% in HL survivors compared with patients with de novo non-small cell lung cancer (cited Milano et al. as reference 23). Also revised text to state that in two case control studies of 479 patients who developed breast cancer after therapy for HL, cumulative absolute risks for developing breast cancer were calculated as a function of radiation therapy dose and the use of chemotherapy (cited 2012 Swerdlow et al. as reference 32). Also added text to state that these cohort studies show a continued increase in cumulative excess risk of breast cancer beyond 20 years of follow-up.
Added text to state that after six to eight cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), most men had testosterone levels within normal range; however, among women younger than 30 years, 82% recovered menses, but only 45% of women older than 30 years recovered menses (cited Behringer et al. and van der Kaaij et al. as references 42 and 44, respectively).
Added text to state that in the HD14 trial, the GHSG randomly assigned 1,528 patients with early unfavorable HL to either four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) plus 30 Gy of involved-field radiation therapy (IF-XRT) or two cycles of escalated BEACOPP followed by two cycles of ABVD plus 30 Gy of IF-XRT; with a median follow-up of 43 months, no difference was observed in overall survival (OS) (cited von Tresckow et al. as reference 14 and level of evidence 1iiA).
Added text to state that an indirect comparison for using ABVD alone is that the 94% OS seen for early unfavorable patients in the National Cancer Institute of Canada (NCIC) study at 11 years is equivalent to the survival seen in the GHSG's HD6, HD10, and HD11 trials using combined modality therapy at 11 years (cited Meyer et al. as reference 18). Also added that the NCIC study does demonstrate a 92% OS for ABVD alone at a median follow-up of 11.3 years; this would support the use of ABVD for patients with early unfavorable disease.
Revised text to state that patients are designated as having advanced favorable HL if they have clinical stage III or stage IV disease and three or fewer risk factors on the International Prognostic Index for HL, which corresponds to a freedom-from-progression at greater than 80% at 5 years with combination chemotherapy (cited Moccia et al. as reference 1).
Cited Gordon et al. as reference 10.
Revised text to state that patients are designated as having advanced unfavorable HL if they have clinical stage III or stage IV disease and four or more risk factors on the International Prognostic Index for HL, which corresponds to a freedom-from-progression at worse than 70% at 5 years with combination chemotherapy (cited Moccia et al. as reference 1).
Added text to state that in the GHSG HD15 trial, six cycles of escalated BEACOPP showed less toxicity and equivalent efficacy when compared with eight cycles of escalated BEACOPP or BEACOP delivered every 2 weeks (cited Engert et al. as reference 6 and level of evidence 1iiD).
Added text to state that a Cochrane meta-analysis of randomized, clinical trials comparing escalated BEACOPP and ABVD for early unfavorable HL or advanced-stage disease could identify no difference in OS (cited Bauer et al. as reference 10 and level of evidence 1iiA).
Added Chisesi et al. as reference 12.
Added Holmberg et al. as reference 15.
Added text to state that normalization of 18F-fluorodeoxyglucose–positron emission tomography–computed tomography (FDG-PET-CT) scans after reinduction therapy predicted a much better outcome after stem cell transplantation, with an event-free survival rate of 80% versus 29% in one phase II trial (cited 2012 Moskowitz et al. as reference 20 and level of evidence 3iiiDi). Also added that for patients at high risk of residual HL after stem cell transplant, a phase III study (the AETHERA trial [NCT01100502]) is evaluating the role of brentuximab vedotin.
Added text to state that phase II trials support responses in relapsing patients using brentuximab vedotin (cited 2012 Younes et al. and Chen et al. as references 28 and 29, respectively) and for bendamustine (cited 2013 Moskowitz et al. as reference 30 and level of evidence 3iiiDiv).
Added text to state that because of CD30 expression on malignant Reed-Sternberg cells of HL, but limited expression on normal cells, CD30 is a target for therapy and brentuximab vedotin is a chimeric antibody directed against CD30, which is linked to the microtubule-disrupting agent, monomethyl auristatin E. Also added that response rates around 75% are seen with complete remissions around 30% to 50% and median progression-free survival of 4 to 8 months (cited Gopal et al. and 2010 Younes et al. as references 32 and 33, respectively and level of evidence 3iiiDiv).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.