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Specific Therapy for Lymphomas
Published in Tariq I Mughal, John M Goldman, Sabena T Mughal, Understanding Leukemias, Lymphomas, and Myelomas, 2017
Tariq I Mughal, John M Goldman, Sabena T Mughal
Many efforts are currently devoted to improving on the results achieved by treatment with ABVD, which of course has been a significant advance from the historical treatment with MOPP. Newer combinations such as the seven-drug combination known as Stanford V (mechlorethamine, daunorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisolone), developed at Stanford, California, USA, and the BEACOPP regimen (bleomycin, etoposide, daunorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), developed by the German Hodgkin Lymphoma Study Group (GHLSG), have resulted in better results, particularly in high-risk patients, and further studies are in progress. Current studies carried out by GHLSG, comparing ABVD with BEACOPP suggest a better outcome with the latter, but there have been concerns about an increased risk of treatment-related (secondary) leukemia, and further studies are in progress.
Hodgkin lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2014
Beate Klimm, Dennis A. Eichenauer, Andreas Engert
Different study groups tried to improve these rates by developing new regimens with additional drugs and by increasing dose intensity and dose density with the support of colony-stimulating factors and modern antibiotics. These new approaches include multi-drug regimens such as Stanford V, MEC, VAPEC-B, ChlVPP/EVA and BEACOPP.40–42
Extranodal lymphomas in patients with HIV infection
Published in Franco Cavalli, Harald Stein, Emanuele Zucca, Extranodal Lymphomas, 2008
Michele Spina, Umberto Tirelli
The GICAT has reported the final results of a prospective phase II study to determine the feasibility of a 12-week chemotherapy with classical Stanford V regimen and adjuvant radiotherapy in 59 patients. Overall, 89% of the patients had an objective response, with CR and PR rates of 81% and 8%, respectively. The estimated 3-year OS, DFS, and time-to-progression rates are 51%, 68%, and 60%, respectively.75
Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review
Published in Expert Review of Hematology, 2020
Mehul Dalal, Jatin Gupta, Kim Price, Athanasios Zomas, Harry Miao, Ajibade Ashaye
The aim of this SLR was to assess the published evidence for the efficacy and safety of treatments for newly-diagnosed advanced-stage HL. Specifically, the front-line treatments for HL, ABVD and BEACOPP, with and without RT, in addition to the newly approved therapy A+AVD. This SLR was conducted according to PRISMA guidelines, however, there were some limitations. The same efficacy outcomes were not reported for all included studies and treatment regimens were not always consistent between trials, with some involving different cycles of treatment. This review focused primarily on 5-year OS and PFS rates as these were the most commonly reported. However, not all studies assessed these specific outcomes, and some reported values at different time-points, limiting comparisons between studies. A particular focus was Stage IV disease or extra-nodal involvement, however, subgroup analyses for these populations were not reported for most studies. Inclusion criteria were largely consistent across studies included in the SLR. Most studies included patients aged ≥18–60 years, with the exception of a small number of studies that also included patients aged >60 years. The focus of this SLR was to assess the efficacy and safety of current standard of care frontline therapies used in the treatment of patients with advanced HL and therefore other therapies such as Stanford V and COPP are discussed briefly. Additionally, results of a Phase II study investigating BEACOPP backbone plus brentuximab vedotin have been presented; however, this therapy has not been described in detail as results from the Phase III trial (HD21) are pending.
Novel agents positively impact chemotherapy and transplantation in Hodgkin lymphoma
Published in Expert Review of Hematology, 2019
Parastoo B. Dahi, Craig H. Moskowitz, Sergio A. Giralt, Hillard M. Lazarus
Selection of treatment for classical Hodgkin lymphoma (cHL) is usually based upon disease stage and prognostic factors. Initial treatment for patients who have early-stage disease (stage I-II) and favorable risk (absence of: bulky disease, B symptoms, ESR ≥ 50 mm/hr, >3 nodal sites of disease) includes chemotherapy alone (ABVD: Adriamycin® (doxorubicin), bleomycin, vinblastine, dacarbazine; or Stanford V: doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone), or, combined modality therapy with chemotherapy plus consolidative radiation therapy (RT) [3,6,7]. For unfavorable, early-stage cHL, combined modality therapy can be considered [8,9]. In a multicenter study, 1,064 patients randomly were assigned to four cycles of chemotherapy followed by extended-field (EF) or involved-field (IF) radiotherapy. At a median observation time of 54 months, the 5-year overall survival (OS) was 91% and freedom from treatment failure (FFTF) was 83%. Radiotherapy volume size reduction from EF to IF after two cycles of chemotherapy produced similar results and less toxicity in patients with early-stage unfavorable HL [8,10].
Upfront autologous hematopoietic stem cell transplantation in patients with high-risk stage III to IV Hodgkin lymphoma: a multicenter retrospective cohort study
Published in Hematology, 2019
Li Gao, Xixi Xiang, Cheng Zhang, Lei Gao, Tonghua Yang, Sanbin Wang, Bin Li, Shifeng Lou, Yao Liu, Xi Zhang
Staging of HL is essential for the optimal choice of therapy. Patients with advanced-stage HL commonly receive a more prolonged course of combination chemotherapy, and most patients can be cured [2]. However, nearly 30% of these patients are not cured and show either primary refractoriness or relapse [6]. To improve the outcome of these patients, some studies have tried other chemotherapy regimens. Some clinical trials have compared the Stanford V regimen to ABVD and reported similar response rates, similar adverse events, and similar failure-free and overall survival [15,16]. Additionally, the GHSG developed a standard-dose and an escalated-dose BEACOPP for patients with advanced-stage HL [17]. Some studies revealed better tumor control, PFS and OS for escalated BEACOPP [7–9]. However, severe adverse events are more frequent in patients receiving BEACOPP than in ABVD-treated patients [10]. One randomized study showed that compared with ABVD, treatment with BEACOPP resulted in better initial tumor control, but the long-term clinical outcome did not significantly differ because ASCT was sufficiently effective [7]. This plan prevents all patients from receiving intensive initial treatment such as escalated BEACOPP [7]. Presently, ABVD remains the most commonly used treatment for patients with advanced-stage HL [6,11].