VERY LATE RELAPSE >5 YEARS AFTER FIRST DIAGNOSIS OF HODGKIN LYMPHOMA: AN ANALYSIS OF THE GERMAN HODGKIN STUDY GROUP HD7-HD12 TRIALS
(Abstract release date: 05/19/16)
EHA Library. Bröckelmann P. 06/12/16; 135289; S795
Dr. Paul Bröckelmann
Contributions
Contributions
Abstract
Abstract: S795
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Hall A2
Background
Patients who are free of Hodgkin lymphoma (HL) for >5 years after first diagnosis are usually considered cured. Nevertheless, late relapses occur and biology, clinical characteristics, therapeutic approaches and prognosis are currently poorly understood.
Aims
Our study hence aimed at a comprehensive analysis of very late relapse (VLR) of HL.
Methods
We retrospectively analyzed 5149 patients of the GHSG HD7-HD12 trials, who were observed and relapse-free for >5 years after first diagnosis to estimate the incidence of VLR of HL. Cumulative incidence of VLR was calculated with death without preceding relapse considered as competing risk and compared between groups using Gray’s test. To investigate, whether VLR can be considered as new cases of HL, standardized incidence ratio (SIR) was estimated using age- and sex-specific reference values for the German population. Overall survival (OS) was estimated according to Kaplan-Meier from first diagnosis to death from any cause. Additionally, OS from date of relapse was estimated for patients with VLR and compared with a group of 487 patients from the respective trials having early relapse (≤5 years from first diagnosis). Patient characteristics and therapy at relapse were analyzed descriptively.
Results
With a median observation time of 10.3 years, a total of 169 relapses >5 years after first diagnosis were observed. In patients relapse-free for >5 years, cumulative incidences at 10, 15 and 20 years rose in a linear fashion and were 2.8%, 5.1% and 8.6%, respectively, with an SIR of 97.1 (95% CI: 83.0-112.9). VLR were more frequently observed in patients with early-stage favorable than early-stage unfavorable or advanced-stage disease at first diagnosis (15-year cumulative incidence 8.0% vs. 4.4% and 4.2%, respectively, p<0.001). OS was significantly worse in patients with VLR when compared to non-relapse survivors (10-year OS: 95.9% vs. 88.5%, HR: 2.4, 95% CI: 1.7-3.4, log-rank p<0.001). Compared to patients with early relapse, fewer patients with VLR were treated with autologous stem-cell transplantation (ASCT, 35% vs. 49%). Instead, they often received polychemotherapies such as BEACOPP (18% vs. 13%) or ABVD (15% vs. 11%). Compared to early relapse, we observed superior OS after VLR (HR: 0.5, 95% CI: 0.3-0.8, p<0.01) after adjustment for type of therapy and risk group at first diagnosis. In addition, relapse characteristics, changes in histologic subtype and risk factors for VLR will be presented.
Conclusion
Besides therapy-associated side effects, survivors after initially successful HL-therapy are at a 100-fold increased risk of re-occurrence of disease compared to German reference values. After modern risk-adapted treatment strategies especially in early-stage favorable HL, thorough regular follow-up is hence needed for timely detection. With adequate treatment, prognosis of VLR seems favorable when compared to early relapses.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Hodgkin's lymphoma, Late complications and outcome, Long-term follow-up, Relapse
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Hall A2
Background
Patients who are free of Hodgkin lymphoma (HL) for >5 years after first diagnosis are usually considered cured. Nevertheless, late relapses occur and biology, clinical characteristics, therapeutic approaches and prognosis are currently poorly understood.
Aims
Our study hence aimed at a comprehensive analysis of very late relapse (VLR) of HL.
Methods
We retrospectively analyzed 5149 patients of the GHSG HD7-HD12 trials, who were observed and relapse-free for >5 years after first diagnosis to estimate the incidence of VLR of HL. Cumulative incidence of VLR was calculated with death without preceding relapse considered as competing risk and compared between groups using Gray’s test. To investigate, whether VLR can be considered as new cases of HL, standardized incidence ratio (SIR) was estimated using age- and sex-specific reference values for the German population. Overall survival (OS) was estimated according to Kaplan-Meier from first diagnosis to death from any cause. Additionally, OS from date of relapse was estimated for patients with VLR and compared with a group of 487 patients from the respective trials having early relapse (≤5 years from first diagnosis). Patient characteristics and therapy at relapse were analyzed descriptively.
Results
With a median observation time of 10.3 years, a total of 169 relapses >5 years after first diagnosis were observed. In patients relapse-free for >5 years, cumulative incidences at 10, 15 and 20 years rose in a linear fashion and were 2.8%, 5.1% and 8.6%, respectively, with an SIR of 97.1 (95% CI: 83.0-112.9). VLR were more frequently observed in patients with early-stage favorable than early-stage unfavorable or advanced-stage disease at first diagnosis (15-year cumulative incidence 8.0% vs. 4.4% and 4.2%, respectively, p<0.001). OS was significantly worse in patients with VLR when compared to non-relapse survivors (10-year OS: 95.9% vs. 88.5%, HR: 2.4, 95% CI: 1.7-3.4, log-rank p<0.001). Compared to patients with early relapse, fewer patients with VLR were treated with autologous stem-cell transplantation (ASCT, 35% vs. 49%). Instead, they often received polychemotherapies such as BEACOPP (18% vs. 13%) or ABVD (15% vs. 11%). Compared to early relapse, we observed superior OS after VLR (HR: 0.5, 95% CI: 0.3-0.8, p<0.01) after adjustment for type of therapy and risk group at first diagnosis. In addition, relapse characteristics, changes in histologic subtype and risk factors for VLR will be presented.
Conclusion
Besides therapy-associated side effects, survivors after initially successful HL-therapy are at a 100-fold increased risk of re-occurrence of disease compared to German reference values. After modern risk-adapted treatment strategies especially in early-stage favorable HL, thorough regular follow-up is hence needed for timely detection. With adequate treatment, prognosis of VLR seems favorable when compared to early relapses.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Hodgkin's lymphoma, Late complications and outcome, Long-term follow-up, Relapse
Abstract: S795
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Hall A2
Background
Patients who are free of Hodgkin lymphoma (HL) for >5 years after first diagnosis are usually considered cured. Nevertheless, late relapses occur and biology, clinical characteristics, therapeutic approaches and prognosis are currently poorly understood.
Aims
Our study hence aimed at a comprehensive analysis of very late relapse (VLR) of HL.
Methods
We retrospectively analyzed 5149 patients of the GHSG HD7-HD12 trials, who were observed and relapse-free for >5 years after first diagnosis to estimate the incidence of VLR of HL. Cumulative incidence of VLR was calculated with death without preceding relapse considered as competing risk and compared between groups using Gray’s test. To investigate, whether VLR can be considered as new cases of HL, standardized incidence ratio (SIR) was estimated using age- and sex-specific reference values for the German population. Overall survival (OS) was estimated according to Kaplan-Meier from first diagnosis to death from any cause. Additionally, OS from date of relapse was estimated for patients with VLR and compared with a group of 487 patients from the respective trials having early relapse (≤5 years from first diagnosis). Patient characteristics and therapy at relapse were analyzed descriptively.
Results
With a median observation time of 10.3 years, a total of 169 relapses >5 years after first diagnosis were observed. In patients relapse-free for >5 years, cumulative incidences at 10, 15 and 20 years rose in a linear fashion and were 2.8%, 5.1% and 8.6%, respectively, with an SIR of 97.1 (95% CI: 83.0-112.9). VLR were more frequently observed in patients with early-stage favorable than early-stage unfavorable or advanced-stage disease at first diagnosis (15-year cumulative incidence 8.0% vs. 4.4% and 4.2%, respectively, p<0.001). OS was significantly worse in patients with VLR when compared to non-relapse survivors (10-year OS: 95.9% vs. 88.5%, HR: 2.4, 95% CI: 1.7-3.4, log-rank p<0.001). Compared to patients with early relapse, fewer patients with VLR were treated with autologous stem-cell transplantation (ASCT, 35% vs. 49%). Instead, they often received polychemotherapies such as BEACOPP (18% vs. 13%) or ABVD (15% vs. 11%). Compared to early relapse, we observed superior OS after VLR (HR: 0.5, 95% CI: 0.3-0.8, p<0.01) after adjustment for type of therapy and risk group at first diagnosis. In addition, relapse characteristics, changes in histologic subtype and risk factors for VLR will be presented.
Conclusion
Besides therapy-associated side effects, survivors after initially successful HL-therapy are at a 100-fold increased risk of re-occurrence of disease compared to German reference values. After modern risk-adapted treatment strategies especially in early-stage favorable HL, thorough regular follow-up is hence needed for timely detection. With adequate treatment, prognosis of VLR seems favorable when compared to early relapses.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Hodgkin's lymphoma, Late complications and outcome, Long-term follow-up, Relapse
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:30 - 08:45
Location: Hall A2
Background
Patients who are free of Hodgkin lymphoma (HL) for >5 years after first diagnosis are usually considered cured. Nevertheless, late relapses occur and biology, clinical characteristics, therapeutic approaches and prognosis are currently poorly understood.
Aims
Our study hence aimed at a comprehensive analysis of very late relapse (VLR) of HL.
Methods
We retrospectively analyzed 5149 patients of the GHSG HD7-HD12 trials, who were observed and relapse-free for >5 years after first diagnosis to estimate the incidence of VLR of HL. Cumulative incidence of VLR was calculated with death without preceding relapse considered as competing risk and compared between groups using Gray’s test. To investigate, whether VLR can be considered as new cases of HL, standardized incidence ratio (SIR) was estimated using age- and sex-specific reference values for the German population. Overall survival (OS) was estimated according to Kaplan-Meier from first diagnosis to death from any cause. Additionally, OS from date of relapse was estimated for patients with VLR and compared with a group of 487 patients from the respective trials having early relapse (≤5 years from first diagnosis). Patient characteristics and therapy at relapse were analyzed descriptively.
Results
With a median observation time of 10.3 years, a total of 169 relapses >5 years after first diagnosis were observed. In patients relapse-free for >5 years, cumulative incidences at 10, 15 and 20 years rose in a linear fashion and were 2.8%, 5.1% and 8.6%, respectively, with an SIR of 97.1 (95% CI: 83.0-112.9). VLR were more frequently observed in patients with early-stage favorable than early-stage unfavorable or advanced-stage disease at first diagnosis (15-year cumulative incidence 8.0% vs. 4.4% and 4.2%, respectively, p<0.001). OS was significantly worse in patients with VLR when compared to non-relapse survivors (10-year OS: 95.9% vs. 88.5%, HR: 2.4, 95% CI: 1.7-3.4, log-rank p<0.001). Compared to patients with early relapse, fewer patients with VLR were treated with autologous stem-cell transplantation (ASCT, 35% vs. 49%). Instead, they often received polychemotherapies such as BEACOPP (18% vs. 13%) or ABVD (15% vs. 11%). Compared to early relapse, we observed superior OS after VLR (HR: 0.5, 95% CI: 0.3-0.8, p<0.01) after adjustment for type of therapy and risk group at first diagnosis. In addition, relapse characteristics, changes in histologic subtype and risk factors for VLR will be presented.
Conclusion
Besides therapy-associated side effects, survivors after initially successful HL-therapy are at a 100-fold increased risk of re-occurrence of disease compared to German reference values. After modern risk-adapted treatment strategies especially in early-stage favorable HL, thorough regular follow-up is hence needed for timely detection. With adequate treatment, prognosis of VLR seems favorable when compared to early relapses.
Session topic: Relapsed Hodgkin Lymphoma & Primary Mediastinal Large B-Cell Lymphoma (PM-DLBCL)
Keyword(s): Hodgkin's lymphoma, Late complications and outcome, Long-term follow-up, Relapse
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