https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61940-5.pdf

Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial

M Bower, S Collins, C Cottrill, K Cwynarski, S Montoto, M Nelson, N Nwokolo, T Powles, J Stebbing, N Wales and A Webb, on behalf of the AIDS Malignancy Subcommittee Department of Oncology, Chelsea & Westminster Hospital, London, UK, HIV i-Base and UK-CAB, London, UK, St Bartholomew’s Hospital, London, UK, Royal Free Hospital, London, UK, Hammersmith Hospital, London, UK and Royal Sussex County Hospital, Brighton, UK

https://onlinelibrary.wiley.com/doi/pdf/10.1111/hiv.12136

British HIV Association guidelines for HIV-associated malignancies 2014

Hematopoietic growth factors: ESMO Clinical Practice Guidelines for the applications

Summary Background Several treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care—increased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP escalated ), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)—were not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy. Methods We searched the Cochrane Library, Medline, and conference proceedings for randomised controlled trials published between January, 1980, and June, 2013, that assessed overall survival in patients with advanced-stage Hodgkin's lymphoma given BEACOPP baseline , BEACOPP escalated , BEACOPP variants, ABVD, cyclophosphamide (mechlorethamine), vincristine, procarbazine, and prednisone (C[M]OPP), hybrid or alternating chemotherapy regimens with ABVD as the backbone (eg, COPP/ABVD, MOPP/ABVD), or doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (the Stanford V regimen). We assessed studies for eligibility, extracted data, and assessed their quality. We then pooled the data and used a Bayesian random-effects model to combine direct comparisons with indirect evidence. We also reconstructed individual patient survival data from published Kaplan-Meier curves and did standard random-effects Poisson regression. Results are reported relative to ABVD. The primary outcome was overall survival. Findings We screened 2055 records and identified 75 papers covering 14 eligible trials that assessed 11 different regimens in 9993 patients, providing 59 651 patient-years of follow-up. 1189 patients died, and the median follow-up was 5·9 years (IQR 4·9–6·7). Included studies were of high methodological quality, and between-trial heterogeneity was negligible (τ 2 =0·01). Overall survival was highest in patients who received six cycles of BEACOPP escalated (HR 0·38, 95% credibility interval [CrI] 0·20–0·75). Compared with a 5 year survival of 88% for ABVD, the survival benefit for six cycles of BEACOPP escalated is 7% (95% CrI 3–10)—ie, a 5 year survival of 95%. Reconstructed individual survival data showed that, at 5 years, BEACOPP escalated has a 10% (95% CI 3–15) advantage over ABVD in overall survival. Interpretation Six cycles of BEACOPP escalated significantly improves overall survival compared with ABVD and other regimens, and thus we recommend this treatment strategy as standard of care for patients with access to the appropriate supportive care. Funding None.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(13)70341-3.pdf

Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis

Long-term population-based survival data detailed by cancer subtype are important to measure the overall outcomes of malignancy managements. We provide net survival estimates at 1, 3, 5 and 10-year postdiagnosis on 37,549 hematological malignancy (HM) patients whose ages were >15 years, diagnosed between 1989 and 2004 and actively followed until 2008 by French population-based cancer registries. These are, to our knowledge, the first unbiased estimates of 10-year net survival in HMs detailed by subtypes. HMs were classified according to the International Classification of Diseases-Oncology 3. Net survival was estimated with the unbiased Pohar-Perme method. The results are reported by sex and age classes. The changes of these indicators by periods of diagnosis were tabulated and the trends of the net mortality rates over time since diagnosis graphed. In all, 5- and 10-year age-standardized net survivals after HMs varied widely from 81 and 76% for classical Hodgkin lymphoma (CHL) to 18 and 14% for acute myeloid leukemia (AML). Even in HMs with the most favorable prognoses, the net survival decreased between 5- and 10-year postdiagnosis. Women had better prognoses than men and age at diagnosis was an unfavorable prognostic factor for most HMs. In patients <55 years old, the net mortality rate decreased to null values 5-year postdiagnosis in AML and 10-year postdiagnosis in CHL, precursor non-HL, chronic myelogenous leukemia, diffuse large B-cell lymphoma and follicular lymphoma. The prognoses improved for various HMs over the study period. The obtained unbiased indicators are important to evaluate national cancer plans.

Unbiased estimates of long-term net survival of hematological malignancy patients detailed by major subtypes in France.

Background
There are two different international standards for the treatment of early unfavourable and advanced stage Hodgkin lymphoma (HL): chemotherapy with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) regimen and chemotherapy with ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) regimen.

Objectives
To provide an evidence-based answer regarding the advantages and disadvantages of chemotherapy including escalated BEACOPP compared to chemotherapy including ABVD.

Search methods
We searched for randomised controlled trials in MEDLINE, CENTRAL and conference proceedings (January 1985 to November 2010) and EMBASE (1985 to November 2008).

Selection criteria
We included randomised controlled trials examining chemotherapy including at least two cycles of escalated BEACOPP regimens compared to chemotherapy including at least four cycles of ABVD regimens as first-line treatment for patients with early unfavourable stage or advanced stage HL.

Data collection and analysis
Effect measures used were hazard ratios (HR) for overall survival (OS), progression-free survival (PFS) and freedom from first progression. Relative risks were used to analyse complete response rate, treatment-related mortality and adverse events. Two independent review authors extracted data and assessed quality of trials.

Main results
A total of 790 records were screened. Five eligible trials (four published, one ongoing), were identified. These trials included only adult patients (16 to 60 years of age). Four trials with 2868 patients were included in the meta-analyses: the HD9 and HD14 trials from Germany, the HD2000 and GSM-HD trials from Italy. All trials reported results for PFS and OS. PFS was statistically significantly longer for escalated BEACOPP: HR was 0.53 (95% confidence interval (CI) 0.44 to 0.64, I2 = 0%). There was no statistically significant difference in OS between the comparators: HR was 0.80 (95% CI 0.59 to 1.09, I2 = 0%). Three trials reported adverse events: the escalated BEACOPP regimens caused statistically significantly more haematological toxicities WHO grade III or IV (anaemia P < 0.00001, neutropenia P = 0.007, thrombocytopenia P < 0.00001), infections (P < 0.00001)) and occurrence of myeloid dysplastic syndrome (MDS) or acute myeloid leukemia (AML) (P = 0.05). There were no differences between both regimens for secondary malignancies, treatment-related mortality or infertility.

Authors' conclusions
This meta-analysis showed that adult patients between 16 and 60 years of age with early unfavourable or advanced stage HL benefited from chemotherapy including escalated BEACOPP regarding PFS, but there was no significant difference in OS. Longer follow-up and the inclusion of the EORTC 20012 trial will lead to a more definitive answer with respect to OS.

Comparison of chemotherapy including escalated BEACOPP versus chemotherapy including ABVD for patients with early unfavourable or advanced stage Hodgkin lymphoma.

This 13th biannual report of the Cochrane Hematological Malignancies Group highlights recently published randomized controlled trials (RCTs) in the field of hemato-oncology, covering the publication period from July 2010 to February 2011. Implications for clinical practice and methodological aspects are the main principles for selecting trials for this report. Studies were identified by an electronic search of MEDLINE using a broad search filter that covers all topics in hemato-oncology combined with a highly sensitive search filter for randomized trials (Cochrane Handbook for Systematic Reviews of Interventions). The electronic search of the OVID MEDLINE database was conducted on February 28, 2011. In this summary of key features of recent RCTs, we focus on multiple myeloma (MM). Of the 62 identified RCTs, 15 evaluated different treatment approaches in patients with MM. Five of these 15 trials are selected and presented in detail [three in long version (1–3) and two in short version (4,5)]. Three further RCTs of clinical importance are also presented in less detail (6–8).

/pdf/thirteenth-biannual-report-of-the-cochrane-haematological-3p2fdwkm94.pdf

Thirteenth Biannual Report of the Cochrane Haematological Malignancies Group—Focus on Multiple Myeloma

Monoclonal anti-CD20 antibodies for chronic lymphocytic leukaemia

Alemtuzumab for chronic lymphocytic leukaemia

The addition of hypomethylating agents into the armatorium against myelodysplastic syndromes (MDS) is commonly accepted as a promising new therapeutic option in this otherwise frustrating field. However, due to methodological aspects, it is still the subject of debate whether these compounds prolong

Meta-analysis on hypomethylating agents in myelodysplastic syndromes.

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