Current Oncology Reports

, Volume 2, Issue 2, pp 163–171 | Cite as

Hodgkin’s disease: Prognostic factors and short-course regimens

  • Nancy L. Bartlett
  • Sophia M. Arackal
Article

Abstract

Both topics discussed in this review, prognostic factors and short-course regimens for Hodgkin’s disease, have been the focus of recent research with the goal of developing tools and treatments that will result in the highest cure rates with the least long-term sequelae. A new “prognostic score” for advanced-stage Hodgkin’s disease and several potential prognostic factors, including soluble CD30, soluble interleukin-2 receptor, activated cytotoxic T-lymphocytes, and Epstein-Barr virus, are discussed. Preliminary reports of short-course chemotherapy regimens with and without radiotherapy for all stages of Hodgkin’s disease are summarized.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Carella AM, Pollicardo N, Pungolino E, et al.: Autologous stem cell transplantation as adjuvant treatment vs. no further therapy for poor-risk Hodgkin’s disease in first complete remission after MOPP/ABVD. Leuk Lymphoma 1995, 15(suppl 1):59–61.PubMedCrossRefGoogle Scholar
  2. 2.
    Carde P: Who are the high risk patients with Hodgkin’s disease? Leukemia 1996, 10(suppl 2):S62-S67.PubMedGoogle Scholar
  3. 3.
    Ferme C, Bastion Y, Brice P, et al.: Prognosis of patients with advanced Hodgkin’s disease: evaluation of four prognostic models using 344 patients included in the Group d’Études des Lymphomes de l’Adulte study. Cancer 1997, 80:1124–1133.PubMedCrossRefGoogle Scholar
  4. 4.
    Anonymous: A predictive model for aggressive Non-Hodgkin’s Lymphoma: The International Non-Hodgkin’s Lymphoma Prognostic Factors Project [see comments]. New Engl J Med 1993, 329:987–994.Google Scholar
  5. 5.
    Hasenclever D, Diehl V: A prognostic score for advanced Hodgkin’s disease. New Engl J Med 1998, 339:1506–1514. Report from the largest study of prognostic factors in advanced-stage Hodgkin’s disease, including data from more than 5000 patients. Collaborators developed a simple prognostic score based on seven clinical and patient characteristics at diagnosis. Importantly, no subset of patients had a 5-year freedom from progression less than 42%.PubMedCrossRefGoogle Scholar
  6. 6.
    Brice P: Prognostic factors in advanced Hodgkin’s disease: can they guide therapeutic decisions? New Engl J Med 1998, 339:1547–1549.PubMedCrossRefGoogle Scholar
  7. 7.
    Horning SJ, Hoppe RT, Breslin S, et al.: Brief chemotherapy (CT) (Stanford V) and involved field radiotherapy (RT) are highly effective for advanced Hodgkin’s disease (HD) [abstract]. Proc ASCO 1998, 17:16a.Google Scholar
  8. 8.
    Moskowitz CH, Yahalom J, Straus D, et al.: The use of Stanford V overcomes poor prognostic features in patients with advanced stage Hodgkin’s disease (HD) [abstract]. Blood 1998, 92(suppl 1):625a.Google Scholar
  9. 9.
    Radford JA, Rohatiner AZ, Dunlop DJ, et al.: Preliminary results of a four-centre randomized trial comparing weekly VAPEC-B (V) chemotherapy with the ChlVPP/EVA hybrid (H) regimen in previously untreated Hodgkin’s disease (HD) [abstract]. Proc ASCO 1997, 16:12a.Google Scholar
  10. 10.
    Noordijk EM, Carde P, Hagenbeek A, et al.: Combination of radiotherapy and chemotherapy is advisable in all patients with clinical stage I-II Hodgkin’s disease: six-year results of the EORTC-GPMC controlled clinical trials ‘H7-VF’, ‘H7-F’ and ‘H7-U’. Int J Radiat Oncol Biol Phys 1997, 39(suppl 1):173.CrossRefGoogle Scholar
  11. 11.
    Brice P, Bastion Y, Divine M, et al.: Analysis of prognostic factors after the first relapse of Hodgkin’s disease in 187 patients. Cancer 1996, 78:1293–1299.PubMedCrossRefGoogle Scholar
  12. 12.
    Brice P, Bouabdallah R, Moreau P, et al.: Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin’s disease: analysis of 280 patients from the French registry. Bone Marrow Transplant 1997, 20:21–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Horning SJ, Chao NJ, Negrin RS, et al.: High-dose therapy and autologous hematopoietic progenitor cell transplantation for recurrent or refractory Hodgkin’s disease: analysis of the Stanford University results and prognostic indices. Blood 1997, 89:801–813.PubMedGoogle Scholar
  14. 14.
    Lancet JE, Rapoport AP, Brasacchio R, et al.: Autotransplantation for relapsed or refractory Hodgkin’s disease: long-term follow-up and analysis of prognostic factors. Bone Marrow Transplant 1998, 22:265–271.PubMedCrossRefGoogle Scholar
  15. 15.
    von Wasielewski R, Mengel M, Fischer R, et al.: Classical Hodgkin’s disease: clinical impact of the immunophenotype. Am J Pathol 1997, 151:1123–1130.Google Scholar
  16. 16.
    Nadali G, Tavecchia L, Zanolin E, et al.: Serum level of the soluble form of the CD30 molecule identifies patients with Hodgkin’s disease at high risk of unfavorable outcome. Blood 1998, 91:3011–3016. Interesting report of a new biologic prognostic factor, soluble CD30, which in multivariate analysis was an independent predictor of poor prognosis in HD. Reports such as this should encourage the development of prognostic indices which combine both clinical and biologic markers.PubMedGoogle Scholar
  17. 17.
    Viviani S, Camerini E, Bonfante V, et al.: Soluble interleukin-2 receptors (sIL-2R) in Hodgkin’s disease: outcome and clinical implications. Br J Cancer 1998, 77:992–997.PubMedGoogle Scholar
  18. 18.
    Oudejans JJ, Jiwa NM, Kummer JA, et al.: Activated cytotoxic T cells as prognostic marker in Hodgkin’s disease. Blood 1997, 89:1376–1382.PubMedGoogle Scholar
  19. 19.
    Younes A, Oudejans JJ, van Diest PJ, et al.: Are activated cytotoxic T cells in Hodgkin’s disease biopsies a poor prognostic marker? Blood 1997, 90:890–891.PubMedGoogle Scholar
  20. 20.
    Murray PG, Billingham LJ, Hassan HT, et al.: Effect of Epstein-Barr virus infection on response to chemotherapy and survival in Hodgkin’s disease. Blood 1999, 94:442–447. The article compares the prognosis for 51 patients with detectable EBV in HD tissue versus 139 HD patients without detectable EBV. Two-year event-free survival rates were significantly better for EBV-positive patients. The authors discuss several possible explanations for this result.PubMedGoogle Scholar
  21. 21.
    Morente M, Piris M, Abraira V, et al.: Adverse clinical outcome in Hodgkin’s disease is associated with loss of retinoblastoma protein expression, high Ki67 proliferation index, and absence of Epstein-Barr virus-latent membrane protein 1 expression. Blood 1997, 90:2429–2436.PubMedGoogle Scholar
  22. 22.
    Brink A, Oudejans J, van den Brule A, et al.: Low p53 and high bcl-2 expression in Reed-Sternberg cells predicts poor clinical outcome for Hodgkin’s disease: involvement of apoptosis resistance. Mod Pathol 1998, 11:376–383.PubMedGoogle Scholar
  23. 23.
    Jiwa NM, Oudejans JJ, Bai MC, et al.: Expression of bcl-2 protein and transcription of the Epstein-Barr virus bcl-2 homologue BHRF-1 in Hodgkin’s disease: implications for different pathogenic mechanisms. Histopathology 1995, 26:547–553.PubMedCrossRefGoogle Scholar
  24. 24.
    Herbst H, Foss HD, Samol J, et al.: Frequent expression of interleukin-10 by Epstein-Barr virus-harboring tumor cells of Hodgkin’s disease. Blood 1996, 87:2918–2929.PubMedGoogle Scholar
  25. 25.
    Sarris AH, Kliche KO, Pethambaram P, et al.: Interleukin-10 levels are often elevated in serum of adults with Hodgkin’s disease and are associated with inferior failure-free survival. Ann Oncol 1999, 10:433–440.PubMedCrossRefGoogle Scholar
  26. 26.
    Christiansen I, Sundstrom C, Enblad G, Totterman TH: Soluble vascular cell adhesion molecule-1 (sVCAM-1) is an independent prognostic marker in Hodgkin’s disease. Br J Haematol 1998, 102:701–709.PubMedCrossRefGoogle Scholar
  27. 27.
    Beham-Schmid C, Heider KH, Hoefler G, Zatloukal K: Expression of CD44 splice variant v10 in Hodgkin’s disease is associated with aggressive behaviour and high risk of relapse. J Pathol 1998, 186:383–389.PubMedCrossRefGoogle Scholar
  28. 28.
    Hoppe RT: Hodgkin’s disease: Complications of therapy and excess mortality. Ann Oncol 1997, 8(suppl 1):S115-S118.CrossRefGoogle Scholar
  29. 29.
    Specht L, Gray RG, Clarke MJ, Peto R: Influence of more extensive radiotherapy and adjuvant chemotherapy on longterm outcome of early-stage Hodgkin’s disease: a metaanalysis of 23 randomized trials involving 3,888 patients. J Clin Oncol 1998, 16:830–843.PubMedGoogle Scholar
  30. 30.
    Santoro A, Bonfante V, Viviani L, et al.: Subtotal nodal (STNI) vs. involved field (IFRT) irradiation after 4 cycles of ABVD in early stage Hodgkin’s disease (HD) [abstract]. Proc ASCO 1996, 15:415. Preliminary results of a pilot study of four cycles of ABVD plus involved-field versus extended-field RT. This study showed no difference in outcome based on the extent of RT, and its regimen has been widely adopted "off-protocol" as an alternative to extended-field RT in good-prognosis early-stage patients.Google Scholar
  31. 31.
    Brusamolino E, Baio A, Lunghi F, et al.: Treatment of earlystage Hodgkin’s disease with four cycles of ABVD followed by limited radiotherapy: analysis of efficacy and long-term toxicity. Ann Oncol 1999, 10(suppl 3):161.Google Scholar
  32. 32.
    Klasa RJ, Connors JM, Fairey R, et al.: Treatment of early stage Hodgkin’s disease: improved outcome with brief chemotherapy and radiotherapy without staging laparotomy. Ann Oncol 1996, 7(suppl 3):21.Google Scholar
  33. 33.
    Colonna P, Jais JP, Desablens B, et al.: Mediastinal tumor size and response to chemotherapy are the only prognostic factors in supradiaphragmatic Hodgkin’s disease treated by ABVD plus radiotherapy: ten-year results of the Paris-Ouset France 81/12 trial, including 262 patients. J Clin Oncol 1996, 14:1928–1935.PubMedGoogle Scholar
  34. 34.
    Tesch H, Sieber M, Ruffer JU, et al.: Two cycles of ABVD plus radiotherapy is more effective than radiotherapy alone in early stage HD: Results of the HD7 trial of the GHSG. Ann Oncol 1999, 10(suppl 3):73.Google Scholar
  35. 35.
    Radford JA, Cowan RA, Ryder WDJ, et al.: Four weeks of neo-adjuvant chemotherapy significantly reduces the progression rate in patients treated with limited field radiotherapy for clinical stage (CS) IA/IIA Hodgkin’s disease: results of a randomized pilot study. Ann Oncol 1996, 7(suppl 3):21.Google Scholar
  36. 36.
    Horning SJ, Hoppe RT, Breslin S, et al.: Very brief (8 week) chemotherapy (CT) and low dose (30 GY) radiotherapy (RT) for limited stage Hodgkin’s disease (HD): preliminary results of the Stanford-Kaiser G4 study of Stanford V+RT [abstract]. Blood 1999, 94:387a.Google Scholar
  37. 37.
    Pavlovsky S, Schvartzman E, Lastiri F, et al.: Randomized trial of CVPP for three versus six cycles in favorable-prognosis and CVPP versus AOPE plus radiotherapy in intermediateprognosis untreated Hodgkin’s disease. J Clin Oncol 1997, 15:2652–2658.PubMedGoogle Scholar
  38. 38.
    Wasserman TH, Petroni GR, Millard FE, et al.: Sequential chemotherapy (etoposide, vinblastine, and doxorubicin) and subtotal lymph node radiation for patients with localized Hodgkin’s disease and unfavorable prognostic features: a phase II Cancer and Leukemia Group B study (9051). Cancer 1999, 86:1590–1595.PubMedCrossRefGoogle Scholar
  39. 39.
    Sieber M, Rueffer U, Tesch H, et al.: Rapidly alternating COPP+ABV+IMEP (CAI) is equally effective as alternating COPP+ABVD (CA) for Hodgkin’s disease: final results of two randomized trials for intermediate (HD5 protocol) and advanced (HD6 protocol) stages [abstract]. Blood 1997, 90(suppl 1):586a.Google Scholar
  40. 40.
    Bartlett NL, Rosenberg SA, Hoppe RT, et al.: Brief chemotherapy, Stanford V, and adjuvant radiotherapy for bulky or advanced-stage Hodgkin’s disease: a preliminary report. J Clin Oncol 1995, 13:1080–1088. Initial report of a 12-week chemotherapy regimen and limited RT in unfavorable HD designed to minimize the cumulative dose of alkylating agents, anthracyclines, and bleomycin. With short follow-up, results compare favorably with longer regimens, particularly in bulky stage II patients.PubMedGoogle Scholar
  41. 41.
    Horning SJ, Rosenberg SA, Hoppe RT: Brief chemotherapy (Stanford V) and adjuvant radiotherapy for bulky or advanced Hodgkin’s disease: an update. Ann Oncol 1996, 7(suppl 4):105–108.PubMedGoogle Scholar
  42. 42.
    Verbergh E, Zachee P, Vandenberghe P, et al.: Stanford V regimen in bulky or advanced-stage Hodgkin’s disease. Ann Oncol 1999, 10(suppl 3):153.Google Scholar
  43. 43.
    Horning SJ, Bennett JM, Bartlett NL, et al.: Twelve weeks of chemotherapy (Stanford V) and involved field radiotherapy (RT) are highly effective for bulky and advanced stage Hodgkin’s disease (HD): a limited institution ECOG pilot study [abstract]. Blood 1996, 88(suppl 1):673a.Google Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • Nancy L. Bartlett
    • 1
  • Sophia M. Arackal
    • 1
  1. 1.Division of Medical OncologyWashington University School of MedicineSt. LouisUSA

Personalised recommendations