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Halbsguth T.,German Hodgkin Study Group | Halbsguth T.,Universitatsklinikum Cologne | Borchmann P.,German Hodgkin Study Group | Borchmann P.,Universitatsklinikum Cologne
Onkologe | Year: 2010

Elderly patients with Hodgkin's lymphoma still have a relative poor prognosis especially in advanced stages. Due to the lack of large randomized studies, no evidence-based standard treatment can be defined. In routine practice patients with early stages disease are treated with a combined modality strategy of 2-4 cycles A(B)VD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy followed by involved-field radiation therapy. Patients with advanced stage disease are usually treated with 6-8 cycles of A(B)VD followed by radiotherapy to residual disease. A more aggressive regimen would be preferable but is frequently not feasible in this patient cohort due to comorbidities. Therefore, the aim of future studies is still to develop regimens with high anti-tumor efficacy but low toxicity. These studies require an elderly-specific design that takes comorbidities, innovative treatment approaches and quality of life issues during therapy and follow-up into account. Therefore, the GHSG (German Hodgkin Lymphoma Study Group) has initiated a phase I/II study to investigate the new immunomodulatory drug lenalidomide in combination with AVD in elderly patients with early unfavorable or advanced stage disease. © Springer-Verlag 2010.

Klimm B.,German Hodgkin Study Group | Franklin J.,University of Cologne | Stein H.,Berlin Reference Center for Lymphoma and Hematopathology | Eichenauer D.A.,German Hodgkin Study Group | And 5 more authors.
Journal of Clinical Oncology | Year: 2011

Purpose: To investigate the clinical characteristics and treatment outcome of patients with lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) compared with other histologic subtypes of Hodgkin's lymphoma (HL). Patients and Methods: From a total of 12,155 evaluable patients with biopsy-proven HL treated within the German Hodgkin Study Group trials HD4 to HD15, 10,019 patients underwent central expert pathology review. Eighty-four patients with LDCHL (< 1%) were identified and confirmed. The median follow-up time was 67 months. Results: Patients with LDCHL, compared with patients with other histologic subtypes, presented more often with advanced disease (74% v 42%, respectively; P < .001) and "B" symptoms (76% v 41%, respectively; P < .001). Other risk factors were also more frequent in patients with LDCHL. Complete remission or unconfirmed complete remission was achieved in 82% of patients with LDCHL compared with 93% of patients with other HL subtypes (P < .001), and more patients with LDCHL had progressive disease. At 5 years, progression-free survival (PFS) and overall survival (OS) were significantly lower in patients with LDCHL compared with patients with other HL subtypes (PFS, 71% v 85%, respectively; P < .001; OS, 83% v 92%, respectively; P = .0018). However, when analyzing the subgroup of patients who underwent treatment with intensified or dose-dense bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, patients with LDCHL (n = 39) had similar outcomes when compared with patients with other subtypes of HL (n = 3,564; P = .61). Conclusion: LDCHL has a different pattern from other HL subtypes with more clinical risk factors at initial diagnosis and significantly poorer prognosis. Patients with LDCHL should be treated with modern dose-intense treatment strategies. © 2011 by American Society of Clinical Oncology.

Boll B.,University of Cologne | Boll B.,German Hodgkin Study Group | Gorgen H.,German Hodgkin Study Group | Fuchs M.,University of Cologne | And 20 more authors.
Journal of Clinical Oncology | Year: 2013

Purpose Older patients with Hodgkin lymphoma (HL) account for approximately 20% of all HL patients. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy is regarded as standard of care in these patients. However, little is known on feasibility and efficacy of ABVD in this age group. Patients and Methods We analyzed the feasibility and efficacy of four cycles of ABVD in older patients age 60 to 75 years with early-stage HL who were treated within the German Hodgkin Study Group (GHSG) HD10 and HD11 trials; results were compared with those of younger patients treated within these trials. Results In total, 1,299 patients received four cycles of ABVD, and 117 of those patients were older than age 60 years (median, 65 years). In 14% of older patients, treatment was not administered according to protocol, mainly because of excessive toxicity. The mean delay of treatment was twice as high in the older patients (2.2 v 1.2 weeks). Fifty-nine percent of older patients achieved a relative dose-intensity of at least 80% compared with 85% of younger patients. Major toxicity (WHO grade 3 and 4), including leucopenia, nausea, infection, and others, was documented in 68% of older patients with a treatment-related mortality of 5%. Complete response was achieved in 89% of older patients, 3% had progressive disease, and 11% relapsed. At a median observation time of 92 months, 28% of the patients had died, and the 5-year progression-free survival estimate was 75% (95% CI, 66% to 82%). Conclusion In patients age ≥ 60 years with HL, four cycles of ABVD is associated with substantial dose reduction, treatment delay, toxicity, and treatment-related mortality. © 2013 by American Society of Clinical Oncology.

Boll B.,German Hodgkin Study Group | Boll B.,Universitatsklinikum Cologne | Borchmann P.,German Hodgkin Study Group | Borchmann P.,Universitatsklinikum Cologne | And 2 more authors.
Onkologe | Year: 2010

Experimental therapy strategies are currently restricted to patients with Hodgkin's lymphoma who relapse after high dose chemotherapy. Monoclonal antibodies, radio-immunoconjugates, immunotoxins, cellular therapeutics and small molecules, such as immunomodulatory substances, deacetylase inhibitors and m-TOR inhibitors have shown clinically relevant effectiveness. Currently ongoing clinical trials will yield an insight into the biology and provide novel, more effective and less toxic therapeutics for patients in all stages of Hodgkin's lymphoma. © Springer-Verlag 2009.

Sasse S.,University of Cologne | Sasse S.,German Hodgkin Study Group | Klimm B.,University of Cologne | Klimm B.,German Hodgkin Study Group | And 14 more authors.
Annals of Oncology | Year: 2012

Background: To evaluate long-term toxicity and efficacy of a combined modality strategy including extended-field radiotherapy (EF-RT) or involved-field radiotherapy (IF-RT), the German Hodgkin Study Group carried out a follow-up analysis in patients with early unfavorable Hodgkin's lymphoma (HL). Patients and methods: One thousand two hundred and four patients were randomized to four cycles of chemotherapy followed by either 30 Gy EF- or 30 Gy IF-RT (HD8 trial); 532 patients in each treatment arm were eligible. Results: At 10 years, no arm differences were revealed with respect to freedom from treatment failure (FFTF) (79.8% versus 79.7%), progression-free survival (79.8% versus 80.0%), and overall survival (86.4% versus 87.3%). Non-inferiority of IF-RT was demonstrated for the primary end point FFTF (95% confidence interval for hazard ratio 0.72-1.25). Elderly patients had a poorer outcome when treated with EF-RT. So far, 15.0% of patients in arm A and 12.2% in arm B died, mostly due to secondary malignancies (5.3% versus 3.4%) or HL (3.2% versus 3.4%). After EF-RT, there were more secondary malignancies overall (58 versus 45), especially acute myeloid leukemias (11 versus 4). Conclusion: Radiotherapy intensity reduction to IF-RT does not result in poorer long-term outcome but is associated with less acute toxicity and might be associated with less secondary malignancies. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology.

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