RESUMO
BACKGROUND: High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is a standard treatment for relapsed/refractory lymphoma patients. Yet, the widespread use of BEAM is hindered by carmustine accessibility. This study evaluates the efficacy and safety of PEAM (Cisplatin, Etoposide, Cytarabine, and Melphalan) versus BEAM in auto-HSCT for Hodgkin (HL) and non-Hodgkin lymphoma (NHL) patients. METHODS: We conducted a retrospective single-center study of adult lymphoma patients who received PEAM or BEAM pretransplant conditioning between January 2004 to December 2022, comparing efficacy and safety outcomes. RESULTS: Among 143 patients (median age of 33 years, 58% males), 55 had HL, and 88 had NHL. The overall response rate (ORR) was 86.7% for PEAM and 72.3% for BEAM, and the relapse rate (RR) was lower for PEAM than BEAM (22.9% vs 45.6%). Median time to relapse (TTR) and overall survival (OS) were not reached for either group. PEAM exhibited a shorter time to both neutrophil (NE) and platelet (PE) engraftment compared to BEAM (10 vs 12 days), with a more tolerable gastrointestinal (GI) toxicity profile. CONCLUSIONS: Both BEAM and PEAM showed similar outcomes, demonstrating comparable efficacy in terms of ORR, TTR, and OS for both HL and NHL patients. However, PEAM-conditioning was associated with a shorter time to engraftment and fewer GI adverse events.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Carmustina , Cisplatino , Citarabina , Transplante de Células-Tronco Hematopoéticas , Melfalan , Condicionamento Pré-Transplante , Transplante Autólogo , Humanos , Adulto , Masculino , Feminino , Carmustina/administração & dosagem , Carmustina/uso terapêutico , Estudos Retrospectivos , Citarabina/administração & dosagem , Citarabina/uso terapêutico , Melfalan/administração & dosagem , Melfalan/uso terapêutico , Condicionamento Pré-Transplante/métodos , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pessoa de Meia-Idade , Adulto Jovem , Doença de Hodgkin/terapia , Doença de Hodgkin/mortalidade , Etoposídeo/administração & dosagem , Linfoma/terapia , Linfoma/mortalidade , Adolescente , Linfoma não Hodgkin/terapia , Linfoma não Hodgkin/mortalidade , Resultado do TratamentoRESUMO
Hodgkin lymphoma (HL) is one of the most common lymphomas, with an incidence of 3 per 100,000 persons. Current treatment uses a cocktail of genotoxic agents, including adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), along with or without radiotherapy. This treatment regimen has proved to be efficient in killing cancer cells, resulting in HL patients having a survival rate of >90% cancer-free survival at five years. However, this therapy does not have a specific cell target, and it can induce damage in the genome of non-cancerous cells. Previous studies have shown that HL survivors often exhibit karyotypes characterized by complex chromosomal abnormalities that are difficult to analyze by conventional banding. Multicolor fluorescence in situ hybridization (M-FISH) is a powerful tool to analyze complex karyotypes; we used M-FISH to investigate the presence of chromosomal damage in peripheral blood lymphocytes from five healthy individuals and five HL patients before, during, and one year after anti-cancer treatment. Our results show that this anti-cancer treatment-induced genomic chaos that persists in the hematopoietic stem cells from HL patients one year after finishing therapy. This chromosomal instability may play a role in the occurrence of second primary cancers that are observed in 10% of HL survivors. This chapter will describe a protocol for utilizing M-FISH to study treatment-induced genome chaos in Hodgkin's lymphoma (HL) patients, following a brief discussion.
Assuntos
Doença de Hodgkin , Hibridização in Situ Fluorescente , Doença de Hodgkin/genética , Doença de Hodgkin/terapia , Humanos , Hibridização in Situ Fluorescente/métodos , Aberrações Cromossômicas/efeitos da radiação , Doxorrubicina/uso terapêutico , Genoma Humano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Instabilidade Cromossômica , Linfócitos/efeitos da radiação , Linfócitos/efeitos dos fármacos , Linfócitos/metabolismo , Bleomicina/uso terapêuticoRESUMO
Currently, there is limited data available comparing Primary Mediastinal Large B-cell Lymphoma (PMBL) and mediastinal Hodgkin disease, nodular sclerosis type (HDNS). This is a retrospective cohort study that compares the clinical features, histology through immunohistochemistry (IHC) and treatment outcomes of 19 cases of PMBL and 39 cases of HDNS diagnosed over 13 years at a single institution in San Juan, PR. Superior Vena Cava syndrome (SVCS) and elevated Lactate Dehydrogenase (LDH) levels were more frequently seen in the PMBL cohort. At the median follow-up visit, of 74 months, no significant difference was seen in overall survival or progression free survival between PMBL and HDNS. Almost all of the relapses in the PMBL group occurred within 12 months of diagnosis. Our data suggests that PMBL and HDNS differ in their clinical presentation and have a favorable prognosis.
Assuntos
Doença de Hodgkin , Linfoma Difuso de Grandes Células B , Neoplasias do Mediastino , Humanos , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/terapia , Estudos Retrospectivos , Doença de Hodgkin/patologia , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/terapia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/terapia , Adulto Jovem , Idoso , Estudos de Coortes , Resultado do Tratamento , Seguimentos , Prognóstico , Adolescente , Síndrome da Veia Cava Superior/etiologia , Intervalo Livre de Progressão , Taxa de SobrevidaRESUMO
It is unclear whether muscle blood flow (MBF) is altered in long-term Hodgkin lymphoma (HL) survivors. We tested the hypothesis that 1) MBF response during mental stress (MS) is impaired in long-term HL survivors and 2) aerobic exercise training combined with local strength exercise (ET) restores MBF responses during MS in these survivors. Eighteen 5-year HL survivors and 10 aged-paired healthy subjects (HC) were studied. Twenty HL survivors were randomly divided into two groups: exercise-trained (HLT, n = 10) and untrained (HLUT, n = 10). Maximal aerobic capacity was evaluated by a cardiopulmonary exercise test and forearm blood flow (FBF) by venous occlusion plethysmography. MS was elicited by Stroop color and word test. ET was conducted for 4 mo, 3/wk for 60 min each session. The aerobic exercise intensity corresponded to anaerobic threshold up to 10% below the respiratory compensation point. The strength exercises consisted of two to three sets of chest press, pulley and squat exercises, 12-15 repetitions each exercise at 30-50% of the maximal voluntary contraction. Baseline was similar in HL survivors and HC, except peak oxygen consumption (peak VÌo2, P = 0.013) and FBF (P = 0.006) that were lower in the HL survivors. FBF responses during MS were lower in HL survivors (P < 0.001). ET increased peak VÌo2 (11.59 ± 3.07%, P = 0.002) and FBF at rest (33.74 ± 5.13%, P < 0.001) and during MS (24 ± 5.31%, P = 0.001). Further analysis showed correlation between the changes in peak VÌo2 and the changes in FBF during MS (r = 0.711, P = 0.001). In conclusion, long-term HL survivors have impaired MBF responses during MS. ET restores MBF responses during MS.NEW & NOTEWORTHY Long-term Hodgkin lymphoma (HL) survivors have impaired muscle blood flow responses during mental stress and decreased maximal aerobic capacity. Supervised aerobic exercise training combined with local strength exercises restores muscle blood flow responses during mental stress and maximal aerobic capacity in these survivors. These findings provide evidence of safety and effectiveness of exercise training in HL survivors. Moreover, they highlight the importance of exercise training in the treatment of this set of patients.
Assuntos
Sobreviventes de Câncer , Tolerância ao Exercício , Doença de Hodgkin , Músculo Esquelético , Consumo de Oxigênio , Fluxo Sanguíneo Regional , Treinamento Resistido , Humanos , Doença de Hodgkin/fisiopatologia , Doença de Hodgkin/terapia , Masculino , Feminino , Adulto , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/fisiopatologia , Pessoa de Meia-Idade , Exercício Físico , Fatores de Tempo , Antebraço/irrigação sanguínea , Terapia por Exercício/métodos , Aptidão CardiorrespiratóriaRESUMO
Advances in treatment have reduced mortality from Hodgkin lymphoma; therefore, greater attention should be focused on minimizing the late effects. A variety of risk-adapted treatment regimens exist that prioritize disease presentation but not patient-specific comorbidities. Herein, we describe a patient with sickle cell disease diagnosed with Hodgkin lymphoma and the considerations made in treatment planning to minimize therapy-related acute toxicity and late effects that overlap with the patient's preexisting sickle cell disease complications.
Assuntos
Anemia Falciforme , Doença de Hodgkin , Humanos , Doença de Hodgkin/complicações , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/terapia , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Medição de RiscoRESUMO
El linfoma de Hodgkin (LH) se debe a la transformación clonal de células originadas en los linfocitos B, lo que genera las células binucleadas patognomónicas de Reed-Sternberg. El LH es una enfermedad de células B con una distribución bimodal, con mayor incidencia en la adolescencia y la tercera década de la vida y un segundo pico en personas mayores de 55 años. Las células del LH clásico habitualmente sufren una reprogramación de la expresión génica, ya que pierden la expresión de la mayoría de los genes típicos de las células B y han adquirido la expresión de múltiples genes que son típicos de otros tipos de células del sistema inmunitario. El algoritmo de tratamiento dependerá si se trata de LH clásico o de predominio linfocítico, si es un estadio temprano con marcadores de pronóstico desfavorables o no, el esquema inicial de manejo y si existe enfermedad voluminosa, entre las variables más relevantes.Hodgkin's lymphoma (HL) is due to the clonal transformation of cells originating from B lymphocytes, generating the pathognomonic binucleate Reed-Sternberg cells. HL is a B cell disease with a bimodal distribution, with higher incidence in adolescence and the third decade of life, showing a second peak in people over 55 years of age. Classic Hodgkin lymphoma cells routinely undergo gene expression reprogramming, as they lose the expression of most of the typical B-cell genes and acquire the expression of multiple genes that are typical of other types of cells in the immune system. The treatment algorithm will depend on whether it is classic or predominantly lymphocytic HL, if it is early stage with unfavorable prognostic markers or not, the initial management regimen, and whether there is bulky disease, among the most relevant variables.
Assuntos
Consenso , Doença de Hodgkin , Fatores Etários , Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transformação Celular Neoplásica/patologia , Doença de Hodgkin/genética , Doença de Hodgkin/patologia , Doença de Hodgkin/terapia , Humanos , Imunoterapia/métodos , Linfoma Relacionado a AIDS/etiologia , México , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico , Células de Reed-Sternberg/patologiaRESUMO
Introducción: El trasplante autólogo de progenitores hematopoyéticos es una terapéutica aplicable en determinadas situaciones a pacientes con Linfoma de Hodgkin. Objetivo: Evaluar la respuesta al trasplante autólogo de progenitores hematopoyéticos en los pacientes con Linfoma de Hodgkin. Métodos: Se realizó un estudio de 60 pacientes con Linfoma de Hodgkin trasplantados en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, entre 1991 y 2018. Se estimó el porcentaje de respuesta a los tres meses, la supervivencia global y la supervivencia libre de enfermedad a los cinco años. Resultados: La tasa de respuesta a los tres meses fue de 82,7 por ciento. La supervivencia global y libre de enfermedad a los cinco años fue de 94,7 por ciento y 51,7 por ciento, respectivamente. La mortalidad temprana relacionada con el trasplante fue de 5 por ciento. Conclusiones: La aplicación del trasplante autólogo de progenitores hematopoyéticos constituyó una alternativa terapéutica válida. La baja mortalidad temprana evidenció una realización del procedimiento con un perfil de seguridad satisfactorio(AU)
Introduction: Autologous hematopoietic stem cell transplantation is an applicable therapy in certain situations to patients with Hodgkin's Lymphoma. Objective: To evaluate the response to autologous hematopoietic stem cell transplantation in patients with Hodgkin's Lymphoma. Methods: A study of 60 patients with Hodgkin lymphoma transplanted at Hermanos Ameijeiras Clinical and Surgical Hospital was carried out from 1991 to 2018. The percentage of response at three months, overall survival and disease-free survival period were estimated at five years. Results: The response rate at three months was 82.7 percent. Overall and disease-free survival at five years was 94.7 percent and 51.7 percent, respectively. Early transplant-related mortality was 5 percent. Conclusions: The use of autologous hematopoietic stem cell transplantation was a valid therapeutic alternative. The low early mortality evidenced that the procedure was performed with a satisfactory safety profile(AU)
Assuntos
Humanos , Transplante Autólogo/mortalidade , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/terapia , Estudos RetrospectivosRESUMO
The treatment of classic Hodgkin lymphoma (HL) is a success in onco-hematology. Despite the high cure rate of HL with initial therapy, 5-10% of patients are primary refractory and 10-20% will eventually relapse. The standard treatment for these patients is salvage chemotherapy and autologous stem cell transplantation (ASCT). Only about half of these patients will benefit from this procedure. The prognosis of relapsed refractory (rr) HL has improved with the introduction of effective drugs. With these options available, identification of reliable risk factors is important to guide treatment over the course of disease. Different variables including performance status, anemia, B symptoms, laboratory abnormalities, treatment intensity before ASCT, response to therapy, and duration of remission, have been analyzed to determine risk for progression-free survival (PFS) and overall survival (OS) after ASCT. This review will discuss the publications analyzing these factors, the validated risk scores useful to identify patients at high risk of progression after ASCT, and will describe future perspectives.