German Hodgkin Study Group GHSG

Köln, Germany

German Hodgkin Study Group GHSG

Köln, Germany
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Halbsguth T.V.,University of Cologne | Halbsguth T.V.,German Hodgkin Study Group GHSG | Nogova L.,University of Cologne | Mueller H.,German Hodgkin Study Group GHSG | And 12 more authors.
Blood | Year: 2010

For older patients with early unfavorable or advanced stage Hodgkin lymphoma (HL) the prognosis is much worse than for younger HL patients. We thus developed a new regimen, BACOPP (bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone), to improve both tolerability and efficacy of treatment for older HL patients. Between 2004 and 2005, 65 patients with early unfavorable or advanced stage HL aged between 60 and 75 years were enrolled in this phase 2 trial. Treatment consisted of 6 to 8 cycles of BACOPP. Residual tumor masses were irradiated. Primary endpoints were feasibility as determined by adherence to protocol and overall response rate. Secondary endpoints included toxicity, freedom from treatment failure, and progression free and overall survival. For the final analysis 60 patients (92%) were eligible; 75% of treatment courses were administered according to protocol. World Health Organization grade 3/4 toxicities occurred in 52 patients. Fifty-one patients (85%) achieved complete remission, 2 (3%) partial remission, and 4 (7%) developed progressive disease. With a median observation time of 33 months, 18 patients died (30%), including 7 treatment-associated deaths. Three patients died before response assessment. Thus, the BACOPP regimen is active in older HL patients but is compromised by a high rate of toxic deaths. This trial was registered at www.clinicaltrials.gov as #NCT00284271. © 2010 by The American Society of Hematology.


Eichenauer D.A.,University of Cologne | Eichenauer D.A.,German Hodgkin Study Group GHSG | Borchmann P.,University of Cologne | Borchmann P.,German Hodgkin Study Group GHSG | And 2 more authors.
Leukemia and Lymphoma | Year: 2012

Hodgkin lymphoma (HL) is a malignancy of the lymphatic system with an incidence of 2-3/100 000/year in Europe and North America. The disease generally occurs in all age groups, but young adults are most often affected. Thus, adolescents aged 15 or 16 to 21 represent a relevant portion of patients. The optimum treatment for this age group is undefined. Both pediatric protocols such as OEPA (vincristine, etoposide, prednisone, adriamycin) or ABVE-PC (adriamycin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide) and adult regimens such as ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) or BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone) have been shown to be safe and active, resulting in long-term survival rates of 80% and more. However, a prospective comparison of pediatric and adult treatment strategies in terms of efficacy and other important questions such as treatment-related acute and long-term toxicity has not been undertaken so far. This review aims at shedding some light on potential treatment approaches for adolescents with HL and includes more recent analyses in this patient group. © 2012 Informa UK, Ltd.


Eichenauer D.A.,University of Cologne | Eichenauer D.A.,German Hodgkin Study Group GHSG | Engert A.,University of Cologne | Engert A.,German Hodgkin Study Group GHSG
European Journal of Haematology | Year: 2014

Hodgkin lymphoma (HL) is a B cell-derived lymphoid malignancy most often affecting young adults. More than 80% of HL patients achieve long-term remission after appropriate first-line treatment consisting of multiagent chemotherapy and/or radiotherapy (RT). In addition, approximately 50% of patients with disease recurrence remain relapse-free after salvage therapy with high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). However, patients with multiple relapses are mostly in a palliative situation, and novel drugs for this patient group are needed. Furthermore, novel less toxic but equally effective first-line and second-line approaches are required as therapy-related late sequelae represent a relevant cause of morbidity and mortality in HL survivors. Several antibodies and antibody-drug conjugates (ADC) targeting CD30 and CD20 have recently been evaluated in HL. Excellent response rates in heavily pretreated patients were observed with the ADC brentuximab vedotin directed against CD30. Thus, ongoing trials investigate brentuximab vedotin in different additional indications. One example is the first-line treatment of advanced HL where the drug is currently being evaluated in combination with variants of the first-line protocols ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone). Anti-CD20 antibodies given either as single agent or in combination with conventional chemotherapy have also been investigated and still undergo investigation in prospective studies including HL patients. This article reviews the available data on treatment approaches including antibodies and ADC in HL patients. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Eichenauer D.A.,University of Cologne | Eichenauer D.A.,German Hodgkin Study Group GHSG | Engert A.,University of Cologne | Engert A.,German Hodgkin Study Group GHSG
International Journal of Hematology | Year: 2012

In the past decades, Hodgkin lymphoma (HL) has turned from an incurable disease to one with the most favorable prognosis among adult malignancies. This is due to the introduction of effective multi-agent chemotherapy and the optimization of radiation techniques. At present, 80-90 % of patients achieve long-term remission when receiving appropriate first-line treatment. Even in case of relapse, up to 50 % can be successfully salvaged with highdose chemotherapy and autologous stem cell transplantation. Thus, current studies do not necessarily aim at increasing treatment efficacy but rather focus on a possible reduction of acute and late toxicity by decreasing treatment intensity if possible. One promising strategy to spare therapy in good-risk patients is early response-adapted treatment stratification according to the result of interim positron emission tomography. The evaluation of novel drugs and the optimization of treatment for elderly HL patients and those with nodular lymphocyte-predominant HL are further aspects that are currently being addressed in ongoing trials. This review will give an overview on more recent clinical trials and discuss possible future strategies for the treatment of HL. © 2012 The Japanese Society of Hematology.


Eichenauer D.A.,University of Cologne | Eichenauer D.A.,German Hodgkin Study Group GHSG | Engert A.,University of Cologne | Engert A.,German Hodgkin Study Group GHSG
Mediterranean Journal of Hematology and Infectious Diseases | Year: 2011

Hodgkin lymphoma (HL) is a malignancy of the lymphatic system with an incidence of 2-3/100.000/year in developed countries. With modern multi-agent chemotherapy protocols optionally combined with radiotherapy (RT), 80% to 90% of HL patients achieve long-term remission and can be considered cured. However, current standard approaches bear a considerable risk for the development of treatment-related late effects. Thus, one major focus of current clinical research in HL is reducing the incidence of these late effects that include heart failure, infertility, chronic fatigue and therapy-related myelodysplastic syndrome/acute myeloid leukemia (t-MDS/t- AML). In previous analyses, t-MDS/t-AML after treatment for HL was associated with a poor prognosis. Nearly all patients died rapidly after diagnosis. However, more recent analyses indicated an improved outcome among patients with t-MDS/t-AML who are eligible for modern antileukemic treatment and allogeneic stem cell transplantation (aSCT). This article gives an overview of recent reports on the incidence and the treatment of t-MDS/t-AML after HL therapy and describes the efforts currently made to reduce the risk to develop this severe late effect.


Venkataraman G.,University of Chicago | Mirza M.K.,University of Chicago | Eichenauer D.A.,University of Cologne | Eichenauer D.A.,German Hodgkin Study Group GHSG | Diehl V.,German Hodgkin Study Group GHSG
British Journal of Haematology | Year: 2014

Classical Hodgkin lymphoma (cHL) is characterized by a paucity of neoplastic Hodgkin/Reed Sternberg (HRS) cells within a complex cellular milieu that is rendered immunologically incapable of reacting against CD30+HRS cells due to a plethora of immune escape mechanisms initiated by the neoplastic cells. Accounting for 25% of all lymphomas and nearly 95% of all Hodgkin lymphomas, patients with cHL are typically young adults. Besides traditional prognostic factors, such as the International Prognostic Index (IPI), newer imaging and ancillary biomarkers (CD68, Galectin-1 and plasma microRNA) have shown promise. Furthermore, the evolution of gene expression profiling (GEP) in recent years has enabled the development of several practically feasible GEP-based predictors with prognostic relevance. This review discusses the current status of clinical prognostication in cHL, the critical role of histological evaluation in light of several mimicking entities, and the relevance of tissue as well as serum biomarkers pertaining to immune escape mechanisms and recent GEP studies. © 2014 John Wiley & Sons Ltd.


Von Tresckow B.,University of Cologne | Von Tresckow B.,German Hodgkin Study Group GHSG | Engert A.,University of Cologne | Engert A.,German Hodgkin Study Group GHSG
Current Opinion in Oncology | Year: 2013

PURPOSE OF REVIEW: Despite the advances in the treatment of Hodgkin Lymphoma, patients with refractory disease still have a poor prognosis. Hodgkin Lymphoma can be refractory at first diagnosis or might become refractory later in the course of treatment. Both situations represent a therapeutic challenge. RECENT FINDINGS: Intensified chemotherapy with BEACOPP escalated has been evaluated in early unfavourable and advanced Hodgkin Lymphoma and led to an improved tumour control and reduced rates of refractory disease. Furthermore, there is growing evidence for the role of tandem autologous transplant in breaking refractory disease. For patients relapsing after autologous transplant, more recent analyses have reported outcome and defined risk factors. The antibody drug conjugate brentuximab vedotin is a new, highly effective therapeutic option for these patients. Dose-reduced allogeneic transplant is a therapeutic alternative for patients relapsing after autologous transplant, but induction of a remission is the prerequisite for a successful allogeneic transplant. Brentuximab vedotin has been evaluated as a bridge to allogeneic transplant for patients refractory to conventional treatment. SUMMARY: Recent therapeutic advances have improved the prognosis of Hodgkin Lymphoma by prevention or successful treatment of refractory disease. The use of new drugs such as brentuximab vedotin will hopefully further increase the cure rates. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Eichenauer D.A.,University of Cologne | Eichenauer D.A.,German Hodgkin Study Group GHSG | Boll B.,University of Cologne | Boll B.,German Hodgkin Study Group GHSG | Diehl V.,German Hodgkin Study Group GHSG
Expert Opinion on Pharmacotherapy | Year: 2014

Introduction: Hodgkin lymphoma (HL) is a lymphoid malignancy with an incidence of 2-3/100,000/year. Young adults are most often affected. Due to the development of highly active multi-agent chemotherapy protocols and the optimization of radiotherapy (RT) fields and doses, HL has become one of the malignancies with the highest cure rates. As treatment efficacy can hardly be improved, the major goal of clinical HL research consists in decreasing therapy-associated acute and long-term toxicity. To this end, treatment stratification based on interim positron emission tomography and the implementation of targeted drugs such as the antibody-drug conjugate brentuximab vedotin are currently being evaluated in prospective trials. Areas covered: This article reviews recent randomized Phase III and larger Phase II trials including HL patients. Expert opinion: In early stage HL, excellent results are achieved with a brief chemotherapy followed by involved-field RT. Patients with advanced HL should receive six to eight cycles of chemotherapy optionally followed by localized RT. In relapsed disease, high-dose chemotherapy followed by autologous stem cell transplantation represents the standard of care for most patients. The use of novel drugs and imaging tools that currently undergo evaluation may optimize HL treatment. © 2014 Informa UK, Ltd.


Burkle C.,German Hodgkin Study Group GHSG | Borchmann P.,German Hodgkin Study Group GHSG
Onkologe | Year: 2016

Hodgkin lymphoma is the most frequent hematologic neoplasia in young adults. Most patients (>80 %) can be healed with risk-adapted chemo- and/or radiotherapy. The staging into early favorable, early unfavorable, and advanced stages depends on tumor burden and other risk factors. A thorough and complete diagnosis is important for risk classification. State-of-the-art first-line therapies for early favorable and early unfavorable Hodgkin lymphoma are combined radiochemotherapies: In early favorable stages with two cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and in early unfavorable with two cycles of BEACOPPesc (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, procarbazine) therapy followed by two cycles of ABVD. In advanced stages, radiotherapy after six cycles of BEACOPPesc therapy depends on residual metabolic activity after chemotherapy. With curative intent, first choice in relapse is high-dose chemotherapy. The special needs of young adults with cancer must be taken into consideration. © 2016, Springer-Verlag Berlin Heidelberg.


Josting A.,German Hodgkin Study Group GHSG
Expert Review of Hematology | Year: 2010

Depending on stage and risk factor profile, up to 95% of patients with Hodgkin lymphoma at first presentation reach complete remission after the initial standard treatment including radiotherapy, combination chemotherapy or combined modality therapy. Patients who relapse after first complete remission can achieve a second complete remission and long-term disease-free survival with salvage treatment including radiotherapy for localized relapse in previously nonirradiated areas, conventional salvage chemotherapy, or high-dose chemotherapy with stem cell transplantation. In general, risk-adapted treatment strategies are used in the treatment of patients with Hodgkin lymphoma. Adequate staging of newly diagnosed patients enables optimal treatment planning, which is of particular importance for finding a balance between treatment efficacy and toxicity. In this review, an overview is given of the current knowledge of clinical and biological risk factors and the role of imaging modalities during and after treatment. © 2010 Expert Reviews Ltd.

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