Hdc and autologous pbsct appears to produce high response rate. Evaluation of recurrent infections and primary antibody deficiencies ewa schafer, md october 1, 2016. Hematopoietic stem cell transplantation for refractory or recurrent. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography. Early in the disease the lymphomas are more likely to be burkitts. Nonhodgkin lymphoma causes, risk factors, and prevention. In a study of chemosensitive hl patients in their first relapse, by schmitz et al. Risk factors affecting event free survival efs were. In ireland and northern ireland approximately 800 new cases of malignant lymphoma, hodgkin lymphoma hl and nonhodgkin.
This study, based on data from the australia and new zealand dialysis and transplant registry, determined the incidence and timing of risk factors for allograft loss due to recurrent glomerulonephritis in 1505 patients with biopsy. The swogled intergroup trial in this report was designed to evaluate in the multicenter prospective setting this tandem ahsct approach for patients with primary progressive or highrisk recurrent hl. From 2001 to 20 we have treated 11 patients pts suffering from relapsed or refractory hodgkin lymphomas. Lymphomas with recurrent chromosomal breakpoints activating multiple oncogenes, one of which being myc, are often referred to as dual hit or double hit dh lymphomas. Recurrent lymphoma infrequent with hiv, but prognosis. Bcell nonhodgkin lymphomas include burkitt lymphoma, chronic lymphocytic. Current challenges and novel treatment strategies in double. Risk factors and treatment of childhood and adolescent. Guidelines on diagnosis and treatment of malignant. The goal was to improve the 2year pfs in this unfavorable risk population from 45% in the earlier swog transplant study to 60%. Doctors will stage a tumor to signify how far the cancerous cells may have spread. Its molecular signature and clinical features resemble classical hodgkin lymphoma. The epsteinbarr virus ebv is the virus that causes mononucleosis, also known as mono, and it is associated with some types of nhl.
Patients with recurrent lymphoma can be successfully salvaged by the use of this combination regimen, especially if introduced early after relapse or preferably before progressive disease develops. Updated who classification of hematological neoplasms. Apr 21, 2011 those with primary refractory disease or at least 2 poor risk factorstime to relapse poor risk. Cycles were repeated every 4 weeks with reassessment of disease status made after 4 cycles. Nccn clinical practice guidelines in oncology nccn. The outcome of children, adolescents and young adults caya with poorrisk recurrent refractory lymphoma is dismal. Current challenges and novel treatment strategies in. Tandem autologous hematopoietic cell transplantation for. Patients subject to this analysis had refractory or poor risk relapsed hl defined as 1 primary refractory hl documented histologically, defined as active disease after frontline chemotherapy or a combined modality treatment program, or relapse within 3 months of its completion.
Factors that identify patients at low or high risk for recurrence would therefore. Primary mediastinal large bcell lymphoma springerlink. In many bcell lymphomas, chromosomal translocations are biologic and diagnostic hallmarks of disease. Recurrent glomerulonephritis after renal transplantation is a serious complication that can result in allograft loss. Pdf autologous stem cell transplantation for refractory. The swogled intergroup trial in this report was designed to evaluate in the multicenter prospective setting this tandem ahsct approach for patients with primary progressive or high risk recurrent hl. Cancer is named for the place where it originates, so a lymphoma that appears in another part of the body is still referred. In conclusion, our results appear to support the assumption that allohsct has curative potential in patients with poor risk lymphomas, most likely due to the lack of lymphoma involvement of the graft and the proven graftversuslymphoma effect. The disease is defined in terms of its microscopic appearance histology see the image below and the expression of cell surface markers immunophenotype. Lymphoma is a cancer of a part of the immune system called the lymph system. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
Pdf high dose chemotherapy and autologous stem cell. Guidelinesforthemanagementof non2hodgkinsandhodgkins. The nccn guidelines panel for cervical cancer screening endorses the following guidelines for the prevention and early detection of cervical cancer. Patients subject to this analysis had refractory or poorrisk relapsed hl defined as 1 primary refractory hl documented histologically, defined as active disease after frontline chemotherapy or a combined modality treatment program, or relapse within 3 months of its completion. Management of hodgkin lymphoma in relapse after autologous. Apr 11, 2002 the aim of our study was to evaluate the impact of an early intensification programme including chemotherapy cht, autologous stem cell transplantation asct and radiation therapy rt in. Trisomy 12 is seen in approximately 20% of cases of chronic lymphocytic leukemia cll and is associated with poor prognosis, whereas delq14 is seen in approximately 50% of cases and is also associated with a favorable prognosis. Guidelines on diagnosis and treatment of malignant lymphomas. Lowintermediate risk 2 poor prognostic factors highintermediate risk 3 poor prognostic factors high risk 4 or 5 poor prognostic factors follicular lymphoma international prognostic index flipi the ipi is useful for most lymphomas, but its not as helpful for follicular lymphomas, which tend to.
The addition of rituximab to anthracycline based chemotherapy improved response rates and survival. Genomic analyses identify recurrent alterations in immune. The exact cause of hodgkin lymphoma is not known, but the following factors may raise a persons risk of developing hodgkin lymphoma. By using tandem highdose chemotherapy, fitoussi et al. Definition, diagnosis, symptoms, causes, and treatment. Recurrent cancer is cancer that has reappeared, either in the organ or tissue that was originally affected or in a new location in the body. Patients with highgrade clinically aggressive lymphomas and transformed disease are an enriched population for socalled double hit lymphoma. The revised 2016 who classification of acute leukemias. Of the patients analyzed 71% were low risk, 22% were intermediate risk and 6%. Effect of the specific highdose chemotherapy regimen on outcome presented in part at the 2010 annual meeting of the american society of hematology and the 2012 annual meeting of the american society for blood and marrow transplantation, february 2012. How i treat relapsed and refractory hodgkin lymphoma blood. Pdf tandem autologous stem cell transplantation for. Amer wahed md, amitava dasgupta phd, dabcc, in hematology and coagulation, 2015. Jan 19, 2002 in conclusion, our results appear to support the assumption that allohsct has curative potential in patients with poor risk lymphomas, most likely due to the lack of lymphoma involvement of the graft and the proven graftversuslymphoma effect.
An intriguing subset is formed by the socalled double hit dh lymphomas that are defined by a chromosomal breakpoint affecting the myc8q24 locus in combination with another recurrent breakpoint, mainly a t14. Flow cytometric dna indexploidy testing additional assessment for hyperdiploidy and hypodiploidy together, these studies allow determination of the world health organization who all subtype and cytogenetic risk group. Number of risk factors ipi risk group all patients lowrisk 0,1. Genomic analyses identify recurrent alterations in immune evasion genes in diffuse large bcell lymphoma, leg type xiaolong alan zhou1,12, abner louissaint jr. The aim of our study was to evaluate the impact of an early intensification programme including chemotherapy cht, autologous stem cell transplantation asct and radiation therapy rt in. Dec 30, 2019 peripheral tcell lymphomas ptcl are a heterogeneous group of nonhodgkins lymphomas with poor clinical outcomes. And the pretransplantation disease status was the only significant prognostic factor in multivariate analysis. Esmo consensus conference on malignant lymphoma annals of. Rigorously, dh lymphoma is a rather imprecise term because, from the nomenclature point of view, it is neither restricted to bcell lymphomas eg, inv14positive tcell prolymphocytic leukemia may carry a myc. Primary highrisk group and sensitive relapse group had good prognosis, while refractory and resistance relapse group had poor prognosis. Effect of the specific highdose chemotherapy regimen on outcome. Current risk factors in the prognosis of childhood and adolescent burkitt lymphomaleukaemia include.
Purpose biologic heterogeneity is a feature of diffuse large bcell lymphoma dlbcl, and the existence of a subgroup with poor prognosis and phenotypic proximity to burkitt lymphoma is well known. Genomic analyses identify recurrent alterations in immune evasion genes in diffuse large bcell lymphoma, leg type. How i treat relapsed and refractory hodgkin lymphoma. The optimal chemotherapy for this lymphoma subtype has not been established.
Satwani p, jin z, martin pl, et al sequential myeloablative autologous stem cell transplantation and reduced intensity allogeneic hematopoietic cell transplantation is safe and feasible in children, adolescents and young adults with poorrisk refractory or recurrent hodgkin and nonhodgkin lymphoma. Nonhodgkin lymphomas begin when a type of white blood cell, called a t cell or b cell, becomes abnormal. Recurrent lymphoma infrequent with hiv, but prognosis remains poor 15th european aids conference, october 2124, 2015, barcelona mark mascolini recurrent hodgkin lymphoma hl or nonhodgkin lymphoma nhl proved infrequent after complete remission in a 32center german study 1. However, further studies are needed because of deaths due to the high rate of toxicity and recurrence. The cells even if only a few are likely to also be in adjacent lymph nodes, in the blood, and or in the bone marrow. Relapsed or refractory hodgkin lymphoma is a challenging problem for clinicians who treat hematologic malignancies. Clinical practice guidelines for the diagnosis and management. Pralatrexate showed efficacy and safety in recurrent or refractory ptcls. Autologous stem cell transplantation for refractory or poor risk relapsed hodgkins lymphoma. Conventional cytogenetics identifies some patients with rearrangements of myc and bcl2 andor bcl6 doublehit lymphomas who are increasingly treated with more intensive chemotherapy, but a more. Patients with mantlecell lymphoma relapsing after autologous stem. Minimal residual disease associated with mitochondrial dna in childhood bcell lymphoma purpose of study. Pralatrexate in patients with recurrent or refractory. Abstract disease overview hodgkin lymphoma hl is an uncommon.
These include burkitt lymphoma, lymphomas occurring after an organ transplant, and, rarely, other lymphomas in people who are otherwise healthy. To overcome this poor prognosis, we designed an approach to maximize an allogeneic graft vs lymphoma effect in the setting of low disease burden. Recurrent chronic upper and lower respiratory tract infections gi infections with the use of high dose igg replacement therapy invasive infections have decreased causes of death pulmonary disease malignancy b cell lymphomas gastric cancer autoimmune complications liver disease infection. Nonhodgkin lymphoma causes, risk factors, and prevention 1. Pdf autologous stem cell transplantation for refractory or. Several small series suggest that lymphomas bearing three mycbcl2bcl6 or four mycbcl2bcl6ccnd1 concurrent rearrangements may fare even worse than doublehit lymphomas, but with small numbers and lack of uniform treatment protocols, it is difficult to draw conclusions regarding definitive differences in clinical outcomes 18,20. Hodgkin lymphoma formerly, hodgkin disease is a potentially curable lymphoma with distinct histology, biologic behavior, and clinical characteristics. Mcp 125 hematopoietic stem cell transplantation hodgkins and. Lymphomas in patients with hiv infection may occur early in the course of the disease, possibly being the aids. Lymphoma is the most common form of hematological malignancy, or blood cancer, in the developed world. Comparing the difference between manual and com puterised. For lymphoma patients, recurrence is a common concern. Clinical practice guidelines for the diagnosis and.
Hodgkin lymphoma originating from the germinal center, and it represents a heterogeneous group of diseases with variable outcomes that are differentially characterized by clinical features, cell of origin coo, molecular features, and most recently, frequently recurring mutations. Infections occur frequently in patients with lymphomas. Children and adolescents with bcell lymphoma bcl have a high event free survival efs, however, high risk children with recurrent or refractory disease have an overall low efs with poor prognosis. Advanced recurrent or refractory hodgkin lymphomas hls have a dismal prognosis and are in general treated palliatively. Efficacy of an early intensification treatment integrating. Allogeneic hematopoetic stemcell transplantation for. Peripheral tcell lymphomas ptcl are a heterogeneous group of nonhodgkins lymphomas with poor clinical outcomes. Evaluation of recurrent infections and primary antibody.
Survival rates and factors that affect prognosis outlook. Transplantation in the treatment of hodgkin lymphoma. Tandem autologous stem cell transplantation for patients with primary refractory or poor risk recurrent hodgkin lymphoma. Univariate analysis has shown that the following factors are also associated with reduced survival and increased risk of disease progressionref44. Autologous stem cell transplantation for refractory or. American cancer society, american society for colposcopy and cervical pathology, and american society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer. Which factors are associated with poor outcomes in. Primary mediastinal bcell lymphoma pmbcl is a relatively rare lymphoma subtype affecting mainly young adults. The standard management of these patients should include the use of salvage chemotherapy followed by autologous stem cell transplant asct in patients who are chemotherapy sensitive. Lymphoma is a type of blood cancer, and as such is rarely localized to one tumor. Autologous stem cell transplantation for refractory or poor. Diagnosis and treatment of malignant lymphomas diagnosis and treatment.
High dose chemotherapy and autologous stem cell transplantation for poor risk and recurrent nonhodgkins lymphoma. Doublehit bcell lymphomas blood american society of. Autologous stem cell transplantation for refractory or poorrisk relapsed hodgkins lymphoma. People between the ages of 15 and 40 and people older than 55 are more likely to develop hodgkin lymphoma. Cutaneous diffuse large bcell lymphomas dlbcls are aggressive lymphomas with a poor prognosis. New active treatments are needed to salvage this category of patients. Lowintermediate risk 2 poor prognostic factors highintermediate risk 3 poor prognostic factors high risk 4 or 5 poor prognostic factors follicular lymphoma international prognostic index flipi the ipi is useful for most lymphomas, but its not as helpful for follicular lymphomas, which tend to be slower growing. Satwani p, jin z, martin pl, et al sequential myeloablative autologous stem cell transplantation and reduced intensity allogeneic hematopoietic cell transplantation is safe and feasible in children, adolescents and young adults with poor risk refractory or recurrent hodgkin and nonhodgkin lymphoma.
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