Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials
Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials
Treatment intensification to maximize disease control and reduced intensity approaches to minimize the risk of late sequelae have been evaluated in newly diagnosed Hodgkin lymphoma. The influence of these interventions on the risk of secondary malignant neoplasms, progression-free survival and overall survival is reported in the meta-analysis herein, based on individual patient data from 9498 patients treated within 16 randomized controlled trials for newly diagnosed Hodgkin lymphoma between 1984 and 2007. Secondary malignant neoplasms were meta-analyzed using Peto’s method as time-to-event outcomes. For progression-free and overall survival, hazard ratios derived from each trial using Cox regression were combined by inverse-variance weighting. Five study questions (combined-modality treatment vs. chemotherapy alone; more extended vs. involved-field radiotherapy; radiation at higher doses vs. radiation at 20 Gy; more vs. fewer cycles of the same chemotherapy protocol; standard-dose chemotherapy vs. intensified chemotherapy) were investigated. After a median follow-up of 7.4 years, dose-intensified chemotherapy resulted in better progression-free survival rates (P=0.007) as compared with standard-dose chemotherapy, but was associated with an increased risk of therapy-related acute myeloid leukemia/myelodysplastic syndromes (P=0.0028). No progression-free or overall survival differences were observed between combined-modality treatment and chemotherapy alone, but more secondary malignant neoplasms were seen after combined-modality treatment (P=0.010). For the remaining three study questions, outcomes and secondary malignancy rates did not differ significantly between treatment strategies. The results of this meta-analysis help to weigh up efficacy and secondary malignancy risk for the choice of first-line treatment for Hodgkin lymphoma patients. However, final conclusions regarding secondary solid tumors require longer follow-up.
1748-1757
Eichenauer, Dennis A.
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Becker, Ingrid
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Monsef, Ina
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Chadwick, Nicholas
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de Sanctis, Vitaliana
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Federico, Massimo
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Fortpied, Catherine
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Gianni, Alessandro M.
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Henry-Amar, Michel
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Hoskins, Peter
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Johnson, Peter
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Luminari, Stefano
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Bellei, Monica
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Pulsoni, Alessandro
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Sydes, Matthew R.
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Valagussa, Pinuccia
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Viviani, Simonetta
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Engert, Andreas
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Franklin, Jeremy
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October 2017
Eichenauer, Dennis A.
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Becker, Ingrid
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Monsef, Ina
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Chadwick, Nicholas
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de Sanctis, Vitaliana
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Federico, Massimo
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Fortpied, Catherine
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Gianni, Alessandro M.
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Henry-Amar, Michel
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Hoskins, Peter
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Johnson, Peter
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Luminari, Stefano
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Bellei, Monica
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Pulsoni, Alessandro
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Sydes, Matthew R.
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Valagussa, Pinuccia
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Viviani, Simonetta
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Engert, Andreas
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Franklin, Jeremy
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Eichenauer, Dennis A., Becker, Ingrid, Monsef, Ina, Chadwick, Nicholas, de Sanctis, Vitaliana, Federico, Massimo, Fortpied, Catherine, Gianni, Alessandro M., Henry-Amar, Michel, Hoskins, Peter, Johnson, Peter, Luminari, Stefano, Bellei, Monica, Pulsoni, Alessandro, Sydes, Matthew R., Valagussa, Pinuccia, Viviani, Simonetta, Engert, Andreas and Franklin, Jeremy
(2017)
Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials.
Haematologica, 102 (10), .
(doi:10.3324/haematol.2017.167478).
Abstract
Treatment intensification to maximize disease control and reduced intensity approaches to minimize the risk of late sequelae have been evaluated in newly diagnosed Hodgkin lymphoma. The influence of these interventions on the risk of secondary malignant neoplasms, progression-free survival and overall survival is reported in the meta-analysis herein, based on individual patient data from 9498 patients treated within 16 randomized controlled trials for newly diagnosed Hodgkin lymphoma between 1984 and 2007. Secondary malignant neoplasms were meta-analyzed using Peto’s method as time-to-event outcomes. For progression-free and overall survival, hazard ratios derived from each trial using Cox regression were combined by inverse-variance weighting. Five study questions (combined-modality treatment vs. chemotherapy alone; more extended vs. involved-field radiotherapy; radiation at higher doses vs. radiation at 20 Gy; more vs. fewer cycles of the same chemotherapy protocol; standard-dose chemotherapy vs. intensified chemotherapy) were investigated. After a median follow-up of 7.4 years, dose-intensified chemotherapy resulted in better progression-free survival rates (P=0.007) as compared with standard-dose chemotherapy, but was associated with an increased risk of therapy-related acute myeloid leukemia/myelodysplastic syndromes (P=0.0028). No progression-free or overall survival differences were observed between combined-modality treatment and chemotherapy alone, but more secondary malignant neoplasms were seen after combined-modality treatment (P=0.010). For the remaining three study questions, outcomes and secondary malignancy rates did not differ significantly between treatment strategies. The results of this meta-analysis help to weigh up efficacy and secondary malignancy risk for the choice of first-line treatment for Hodgkin lymphoma patients. However, final conclusions regarding secondary solid tumors require longer follow-up.
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Accepted/In Press date: 19 July 2017
e-pub ahead of print date: 14 September 2017
Published date: October 2017
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Local EPrints ID: 415087
URI: http://eprints.soton.ac.uk/id/eprint/415087
ISSN: 0390-6078
PURE UUID: 989ec058-ee21-432d-9475-36957f4c9366
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Date deposited: 25 Oct 2017 16:30
Last modified: 16 Mar 2024 03:00
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Contributors
Author:
Dennis A. Eichenauer
Author:
Ingrid Becker
Author:
Ina Monsef
Author:
Nicholas Chadwick
Author:
Vitaliana de Sanctis
Author:
Massimo Federico
Author:
Catherine Fortpied
Author:
Alessandro M. Gianni
Author:
Michel Henry-Amar
Author:
Peter Hoskins
Author:
Stefano Luminari
Author:
Monica Bellei
Author:
Alessandro Pulsoni
Author:
Matthew R. Sydes
Author:
Pinuccia Valagussa
Author:
Simonetta Viviani
Author:
Andreas Engert
Author:
Jeremy Franklin
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