OSTEONECROSIS AS A TREATMENT COMPLICATION IN HODGKIN LYMPHOMA PATIENTS: AN ANALYSIS OF THE GERMAN HODGKIN STUDY GROUP (GHSG)
(Abstract release date: 05/19/16)
EHA Library. Borchmann S. 06/10/16; 135142; S109
Mr. Sven Borchmann
Contributions
Contributions
Abstract
Abstract: S109
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:30 - 12:45
Location: Hall A2
Background
Hodgkin Lymphoma (HL) is one of the best curable hematological malignancies. Therefore, a major focus for future improvements in the treatment of this disease will be a reduction of short- and long-term side effects. Osteonecrosis (ON) has been reported as an infrequent but sometimes debilitating late effect of HL therapy in a few case report series.
Aims
The aim of the present study is to provide a detailed analysis of ON as a late effect after multimodality treatment for HL.
Methods
A total of 12,083 patients treated within the GHSG trials HD10-15 and HD18 between 05/98 and 07/14 were evaluated. During the trial duration and prolonged follow-up, complications and late effects of trial participants are registered. Using a trial-database-aided search for ON and related symptoms as well as manual chart review, 66 incident cases of osteonecrosis were identified. Detailed information on patient characteristics, localizations, interventions and outcomes were collected. Risk factors for ON after HL therapy were analyzed by multivariate logistic regression.
Results
The cumulative incidence of ON was 0.16% [CI: 0.08-0.30] in early (favorable or unfavorable) stage HL (n=10) and 0.93% [CI: 0.71-1.21] in advanced stage HL (n=54). The majority of ON cases were male (75%). A total of 66 patients had a total of 140 ON. Most patients had more than one area affected (71%) and the most commonly affected location was the femoral head (73%). Most patients with available information needed surgical intervention (54%) and had continuing symptoms despite treatment (66%), including inability to walk and severe pain. Joint-saving interventions were attempted and successful in 6 of 8 patients. The first ON event occurred within the first 3 years after HL diagnosis in 83% of cases. Peak incidence was observed in the second year after diagnosis with 41% of cases occurring between 12 and 24 months after therapy. In a multivariate logistic regression including all patients, male gender (OR 2.1; CI: 1.2-3.7) and advanced stage (OR 3.9; CI: 2.3-6.9) were identified as risk factors for ON. Because ON was a very rare complication in early stage HL, the following results focused on survivors of advanced stage HL. The median cumulative prednisone dose in ON cases after advanced stage HL was 8,400mg (range: 3,920-10,800) versus 7,350mg (range: 0-16,800) in not affected patients. In a multivariate logistic regression model including only patients with advanced stage HL, young age (OR 0.7 for each additional 10 years of age; CI: 0.5-0.9) and a higher cumulative dose of prednisone during therapy (OR 1.3 for each additional 1gr; CI: 1.1-1.5) were identified as additional risk factors. Nodal pain after alcohol ingestion (p=0.78), radiotherapy (p=0.29), a large mediastinal tumor (p=0.13), international prognostic score (IPS) (p=0.09) and body-mass-index (BMI) (p=0.99) were evaluated as potential risk factors but did not significantly influence the risk for ON.
Conclusion
We provide the largest and most comprehensive analysis of ON after HL therapy performed so far. ON after HL therapy, despite being an infrequent event, often leads to significant disease burden in affected patients and sometimes has dramatic effects on mobility and quality of life. The described risk factors and peak incidence timeframe could be helpful in order to identify patients at high risk for ON. Early evaluation of these often young patients is recommended in case of symptoms suggestive of ON. This might help to identify affected patients early and attempt bone and joint saving interventions whenever possible. High prednisone doses were identified as a risk factor for ON and future modifications of HL therapy leading to a decrease in the cumulative corticosteroid dose might be able to decrease the incidence of ON after HL therapy in the future.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Complications, Hodgkin's disease, Hodgkin's lymphoma, Osteonecrosis
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:30 - 12:45
Location: Hall A2
Background
Hodgkin Lymphoma (HL) is one of the best curable hematological malignancies. Therefore, a major focus for future improvements in the treatment of this disease will be a reduction of short- and long-term side effects. Osteonecrosis (ON) has been reported as an infrequent but sometimes debilitating late effect of HL therapy in a few case report series.
Aims
The aim of the present study is to provide a detailed analysis of ON as a late effect after multimodality treatment for HL.
Methods
A total of 12,083 patients treated within the GHSG trials HD10-15 and HD18 between 05/98 and 07/14 were evaluated. During the trial duration and prolonged follow-up, complications and late effects of trial participants are registered. Using a trial-database-aided search for ON and related symptoms as well as manual chart review, 66 incident cases of osteonecrosis were identified. Detailed information on patient characteristics, localizations, interventions and outcomes were collected. Risk factors for ON after HL therapy were analyzed by multivariate logistic regression.
Results
The cumulative incidence of ON was 0.16% [CI: 0.08-0.30] in early (favorable or unfavorable) stage HL (n=10) and 0.93% [CI: 0.71-1.21] in advanced stage HL (n=54). The majority of ON cases were male (75%). A total of 66 patients had a total of 140 ON. Most patients had more than one area affected (71%) and the most commonly affected location was the femoral head (73%). Most patients with available information needed surgical intervention (54%) and had continuing symptoms despite treatment (66%), including inability to walk and severe pain. Joint-saving interventions were attempted and successful in 6 of 8 patients. The first ON event occurred within the first 3 years after HL diagnosis in 83% of cases. Peak incidence was observed in the second year after diagnosis with 41% of cases occurring between 12 and 24 months after therapy. In a multivariate logistic regression including all patients, male gender (OR 2.1; CI: 1.2-3.7) and advanced stage (OR 3.9; CI: 2.3-6.9) were identified as risk factors for ON. Because ON was a very rare complication in early stage HL, the following results focused on survivors of advanced stage HL. The median cumulative prednisone dose in ON cases after advanced stage HL was 8,400mg (range: 3,920-10,800) versus 7,350mg (range: 0-16,800) in not affected patients. In a multivariate logistic regression model including only patients with advanced stage HL, young age (OR 0.7 for each additional 10 years of age; CI: 0.5-0.9) and a higher cumulative dose of prednisone during therapy (OR 1.3 for each additional 1gr; CI: 1.1-1.5) were identified as additional risk factors. Nodal pain after alcohol ingestion (p=0.78), radiotherapy (p=0.29), a large mediastinal tumor (p=0.13), international prognostic score (IPS) (p=0.09) and body-mass-index (BMI) (p=0.99) were evaluated as potential risk factors but did not significantly influence the risk for ON.
Conclusion
We provide the largest and most comprehensive analysis of ON after HL therapy performed so far. ON after HL therapy, despite being an infrequent event, often leads to significant disease burden in affected patients and sometimes has dramatic effects on mobility and quality of life. The described risk factors and peak incidence timeframe could be helpful in order to identify patients at high risk for ON. Early evaluation of these often young patients is recommended in case of symptoms suggestive of ON. This might help to identify affected patients early and attempt bone and joint saving interventions whenever possible. High prednisone doses were identified as a risk factor for ON and future modifications of HL therapy leading to a decrease in the cumulative corticosteroid dose might be able to decrease the incidence of ON after HL therapy in the future.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Complications, Hodgkin's disease, Hodgkin's lymphoma, Osteonecrosis
Abstract: S109
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:30 - 12:45
Location: Hall A2
Background
Hodgkin Lymphoma (HL) is one of the best curable hematological malignancies. Therefore, a major focus for future improvements in the treatment of this disease will be a reduction of short- and long-term side effects. Osteonecrosis (ON) has been reported as an infrequent but sometimes debilitating late effect of HL therapy in a few case report series.
Aims
The aim of the present study is to provide a detailed analysis of ON as a late effect after multimodality treatment for HL.
Methods
A total of 12,083 patients treated within the GHSG trials HD10-15 and HD18 between 05/98 and 07/14 were evaluated. During the trial duration and prolonged follow-up, complications and late effects of trial participants are registered. Using a trial-database-aided search for ON and related symptoms as well as manual chart review, 66 incident cases of osteonecrosis were identified. Detailed information on patient characteristics, localizations, interventions and outcomes were collected. Risk factors for ON after HL therapy were analyzed by multivariate logistic regression.
Results
The cumulative incidence of ON was 0.16% [CI: 0.08-0.30] in early (favorable or unfavorable) stage HL (n=10) and 0.93% [CI: 0.71-1.21] in advanced stage HL (n=54). The majority of ON cases were male (75%). A total of 66 patients had a total of 140 ON. Most patients had more than one area affected (71%) and the most commonly affected location was the femoral head (73%). Most patients with available information needed surgical intervention (54%) and had continuing symptoms despite treatment (66%), including inability to walk and severe pain. Joint-saving interventions were attempted and successful in 6 of 8 patients. The first ON event occurred within the first 3 years after HL diagnosis in 83% of cases. Peak incidence was observed in the second year after diagnosis with 41% of cases occurring between 12 and 24 months after therapy. In a multivariate logistic regression including all patients, male gender (OR 2.1; CI: 1.2-3.7) and advanced stage (OR 3.9; CI: 2.3-6.9) were identified as risk factors for ON. Because ON was a very rare complication in early stage HL, the following results focused on survivors of advanced stage HL. The median cumulative prednisone dose in ON cases after advanced stage HL was 8,400mg (range: 3,920-10,800) versus 7,350mg (range: 0-16,800) in not affected patients. In a multivariate logistic regression model including only patients with advanced stage HL, young age (OR 0.7 for each additional 10 years of age; CI: 0.5-0.9) and a higher cumulative dose of prednisone during therapy (OR 1.3 for each additional 1gr; CI: 1.1-1.5) were identified as additional risk factors. Nodal pain after alcohol ingestion (p=0.78), radiotherapy (p=0.29), a large mediastinal tumor (p=0.13), international prognostic score (IPS) (p=0.09) and body-mass-index (BMI) (p=0.99) were evaluated as potential risk factors but did not significantly influence the risk for ON.
Conclusion
We provide the largest and most comprehensive analysis of ON after HL therapy performed so far. ON after HL therapy, despite being an infrequent event, often leads to significant disease burden in affected patients and sometimes has dramatic effects on mobility and quality of life. The described risk factors and peak incidence timeframe could be helpful in order to identify patients at high risk for ON. Early evaluation of these often young patients is recommended in case of symptoms suggestive of ON. This might help to identify affected patients early and attempt bone and joint saving interventions whenever possible. High prednisone doses were identified as a risk factor for ON and future modifications of HL therapy leading to a decrease in the cumulative corticosteroid dose might be able to decrease the incidence of ON after HL therapy in the future.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Complications, Hodgkin's disease, Hodgkin's lymphoma, Osteonecrosis
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 12:30 - 12:45
Location: Hall A2
Background
Hodgkin Lymphoma (HL) is one of the best curable hematological malignancies. Therefore, a major focus for future improvements in the treatment of this disease will be a reduction of short- and long-term side effects. Osteonecrosis (ON) has been reported as an infrequent but sometimes debilitating late effect of HL therapy in a few case report series.
Aims
The aim of the present study is to provide a detailed analysis of ON as a late effect after multimodality treatment for HL.
Methods
A total of 12,083 patients treated within the GHSG trials HD10-15 and HD18 between 05/98 and 07/14 were evaluated. During the trial duration and prolonged follow-up, complications and late effects of trial participants are registered. Using a trial-database-aided search for ON and related symptoms as well as manual chart review, 66 incident cases of osteonecrosis were identified. Detailed information on patient characteristics, localizations, interventions and outcomes were collected. Risk factors for ON after HL therapy were analyzed by multivariate logistic regression.
Results
The cumulative incidence of ON was 0.16% [CI: 0.08-0.30] in early (favorable or unfavorable) stage HL (n=10) and 0.93% [CI: 0.71-1.21] in advanced stage HL (n=54). The majority of ON cases were male (75%). A total of 66 patients had a total of 140 ON. Most patients had more than one area affected (71%) and the most commonly affected location was the femoral head (73%). Most patients with available information needed surgical intervention (54%) and had continuing symptoms despite treatment (66%), including inability to walk and severe pain. Joint-saving interventions were attempted and successful in 6 of 8 patients. The first ON event occurred within the first 3 years after HL diagnosis in 83% of cases. Peak incidence was observed in the second year after diagnosis with 41% of cases occurring between 12 and 24 months after therapy. In a multivariate logistic regression including all patients, male gender (OR 2.1; CI: 1.2-3.7) and advanced stage (OR 3.9; CI: 2.3-6.9) were identified as risk factors for ON. Because ON was a very rare complication in early stage HL, the following results focused on survivors of advanced stage HL. The median cumulative prednisone dose in ON cases after advanced stage HL was 8,400mg (range: 3,920-10,800) versus 7,350mg (range: 0-16,800) in not affected patients. In a multivariate logistic regression model including only patients with advanced stage HL, young age (OR 0.7 for each additional 10 years of age; CI: 0.5-0.9) and a higher cumulative dose of prednisone during therapy (OR 1.3 for each additional 1gr; CI: 1.1-1.5) were identified as additional risk factors. Nodal pain after alcohol ingestion (p=0.78), radiotherapy (p=0.29), a large mediastinal tumor (p=0.13), international prognostic score (IPS) (p=0.09) and body-mass-index (BMI) (p=0.99) were evaluated as potential risk factors but did not significantly influence the risk for ON.
Conclusion
We provide the largest and most comprehensive analysis of ON after HL therapy performed so far. ON after HL therapy, despite being an infrequent event, often leads to significant disease burden in affected patients and sometimes has dramatic effects on mobility and quality of life. The described risk factors and peak incidence timeframe could be helpful in order to identify patients at high risk for ON. Early evaluation of these often young patients is recommended in case of symptoms suggestive of ON. This might help to identify affected patients early and attempt bone and joint saving interventions whenever possible. High prednisone doses were identified as a risk factor for ON and future modifications of HL therapy leading to a decrease in the cumulative corticosteroid dose might be able to decrease the incidence of ON after HL therapy in the future.
Session topic: First-line treatment of Hodgkin Lymphoma
Keyword(s): Complications, Hodgkin's disease, Hodgkin's lymphoma, Osteonecrosis
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