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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.

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.

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.

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.

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