The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

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
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.
0390-6078
1748-1757
Eichenauer, Dennis A.
883fcdcf-2f67-4f83-b184-29f3be3243c1
Becker, Ingrid
61de2d85-1d62-4f92-8574-0978721089f4
Monsef, Ina
c3921be9-6991-495c-9bbd-741fe14a5639
Chadwick, Nicholas
c73a1506-690b-4ca2-8fe5-bd39eca75ade
de Sanctis, Vitaliana
2789059a-7725-450f-87f4-d9ff11d4d9b3
Federico, Massimo
619243d1-85a2-4d50-8a7a-c1807595d7c5
Fortpied, Catherine
0dae2cfc-31a4-4198-b8b4-51aa4138ae33
Gianni, Alessandro M.
df286fb6-97dc-415f-be21-5918bb827f22
Henry-Amar, Michel
b0da9816-3755-476e-84b6-427ffc6ae62a
Hoskins, Peter
814142f5-3f2d-43a6-9b64-8fb534b3ec99
Johnson, Peter
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Luminari, Stefano
41774511-cdfa-402c-8366-eec89b6c2679
Bellei, Monica
6021a68d-f678-4b84-a529-85a3d33481dd
Pulsoni, Alessandro
7ac8f4ba-98fe-4bbc-a6a5-babf9493bd78
Sydes, Matthew R.
6d7141c4-3171-43e8-b1e5-c93e6b7c7d3e
Valagussa, Pinuccia
2141fc28-6661-486f-810b-c53e83a9376a
Viviani, Simonetta
c29c623f-b0da-478e-93bb-44d734ca3049
Engert, Andreas
2d0c8512-a80b-45c4-ba2f-56668f064667
Franklin, Jeremy
9c13ce89-6ad6-4c67-a2e9-061046fee8ea
Eichenauer, Dennis A.
883fcdcf-2f67-4f83-b184-29f3be3243c1
Becker, Ingrid
61de2d85-1d62-4f92-8574-0978721089f4
Monsef, Ina
c3921be9-6991-495c-9bbd-741fe14a5639
Chadwick, Nicholas
c73a1506-690b-4ca2-8fe5-bd39eca75ade
de Sanctis, Vitaliana
2789059a-7725-450f-87f4-d9ff11d4d9b3
Federico, Massimo
619243d1-85a2-4d50-8a7a-c1807595d7c5
Fortpied, Catherine
0dae2cfc-31a4-4198-b8b4-51aa4138ae33
Gianni, Alessandro M.
df286fb6-97dc-415f-be21-5918bb827f22
Henry-Amar, Michel
b0da9816-3755-476e-84b6-427ffc6ae62a
Hoskins, Peter
814142f5-3f2d-43a6-9b64-8fb534b3ec99
Johnson, Peter
3f6068ce-171e-4c2c-aca9-dc9b6a37413f
Luminari, Stefano
41774511-cdfa-402c-8366-eec89b6c2679
Bellei, Monica
6021a68d-f678-4b84-a529-85a3d33481dd
Pulsoni, Alessandro
7ac8f4ba-98fe-4bbc-a6a5-babf9493bd78
Sydes, Matthew R.
6d7141c4-3171-43e8-b1e5-c93e6b7c7d3e
Valagussa, Pinuccia
2141fc28-6661-486f-810b-c53e83a9376a
Viviani, Simonetta
c29c623f-b0da-478e-93bb-44d734ca3049
Engert, Andreas
2d0c8512-a80b-45c4-ba2f-56668f064667
Franklin, Jeremy
9c13ce89-6ad6-4c67-a2e9-061046fee8ea

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), 1748-1757. (doi:10.3324/haematol.2017.167478).

Record type: Article

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.

Text
1748.full - Version of Record
Download (631kB)

More information

Accepted/In Press date: 19 July 2017
e-pub ahead of print date: 14 September 2017
Published date: October 2017

Identifiers

Local EPrints ID: 415087
URI: http://eprints.soton.ac.uk/id/eprint/415087
ISSN: 0390-6078
PURE UUID: 989ec058-ee21-432d-9475-36957f4c9366
ORCID for Peter Johnson: ORCID iD orcid.org/0000-0003-2306-4974

Catalogue record

Date deposited: 25 Oct 2017 16:30
Last modified: 22 Nov 2021 02:42

Export record

Altmetrics

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: Peter Johnson ORCID iD
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

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×