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1.
Crit Rev Oncol Hematol ; 157: 103175, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33321295

RESUMO

Second breast cancer (SBC) is the most common solid cancer among Hodgkin Lymphoma (HL) female survivors. We reviewed the related modifying risk factors, radiation-induced carcinogenesis, tumors characteristics, management specificities, prevention and surveillance modalities based on current evidence. The risk of developing SBC may be influenced essentially by the age at HL treatment, follow-up latency, dose of irradiation received and the extent of irradiated field. SBCs generally develop at younger age, they are often bilateral, and exhibit more aggressive biological features and worse prognosis. No firm answer about the benefits of breast surveillance is provided by literature, but compelling evidence tends toward a clinical benefit in early detection. Increasing awareness among health providers' care and current survivors as well as the implementation of screening measures is crucial. Great efforts are ongoing in individualizing treatment strategies for future HL patients and response-adapted approaches are holding promise in prevention of these second malignancies.


Assuntos
Neoplasias da Mama , Doença de Hodgkin , Segunda Neoplasia Primária , Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Feminino , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/terapia , Humanos , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Sobreviventes
2.
Medicine (Baltimore) ; 99(40): e22408, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019417

RESUMO

The epidemiology of lymphomas has changed since the use of antiretroviral therapy. The incidence of Non-Hodgkin Lymphomas (NHL) has significantly decreased in high income countries but not in low and middle-income countries where AIDS-related events remain high. This observational study describes the characteristics, infectious complications and main outcomes of patients diagnosed with HIV and lymphoma at the Instituto Nacional de Cancerología.All adults >18 years diagnosed with HIV and lymphoma from January 2010 to December 2017 were included. Information on HIV and lymphoma was collected, as well as the occurrence of co-infections at diagnosis and during therapy. Multiple regression was done with NHL patients to evaluate independent variables associated to death.One hundred fifty three patients were included: 127 patients with NHL (83%) and 26 (17%) with Hodgkin lymphoma (HL). Of the NHL, 49 (38%) were diffuse large B cell Lymphomas (DLBCL), 35 (27%) plasmablastic, 28 (23%) Burkitt, 10 (8%) primary DLBCL of Central Nervous system, 3 (2%) T-cell lymphomas, and 2 (2%) pleural effusion lymphoma. Most patients were diagnosed in an advanced stage: 70% of NHL had a high International Prognostic Index (IPI); 68% of patients had <200 cells/mm. Almost 25% of NHL patients had an opportunistic infection at lymphoma diagnosis. During chemotherapy, 60% of all patients presented with at least 1 serious non-opportunistic infectious complication, and 50% presented 2 or more infectious complications, mostly bacterial infections. Thirty six percent of NHL and 23% of HL died. After adjusting for confounders, the variables associated with death were IPI and lymphoma type.HIV positive patients with lymphoma in our institution are diagnosed with an advanced stage and a high burden of infections complications. Death remains high and the variables strongly associated with death are those related to lymphoma prognosis such as lymphoma type and IPI.


Assuntos
Infecções por HIV/epidemiologia , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/patologia , Linfoma não Hodgkin/epidemiologia , Linfoma não Hodgkin/patologia , Infecções Oportunistas/epidemiologia , Adulto , Feminino , Infecções por HIV/patologia , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Infecções Oportunistas/microbiologia , Estudos Retrospectivos
4.
Cancer Causes Control ; 31(6): 583-599, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32314107

RESUMO

PURPOSE: The purpose of this study was to investigate associations between pesticide exposures and risk of Hodgkin lymphoma (HL) using data from the North American Pooled Project (NAPP). METHODS: Three population-based studies conducted in Kansas, Nebraska, and six Canadian provinces (HL = 507, Controls = 3886) were pooled to estimate odds ratios and 95% confidence intervals for single (never/ever) and multiple (0, 1, 2-4, ≥ 5) pesticides used, duration (years) and, for select pesticides, frequency (days/year) using adjusted logistic regression models. An age-stratified analysis (≤ 40/ > 40 years) was conducted when numbers were sufficient. RESULTS: In an analysis of 26 individual pesticides, ever use of terbufos was significantly associated with HL (OR: 2.53, 95% CI 1.04-6.17). In age-stratified analyses, associations were stronger among those ≤ 40 years of age. No significant associations were noted among those > 40 years old; however, HL cases ≤ 40 were three times more likely to report ever using dimethoate (OR: 3.76 95% CI 1.02-33.84) and almost twice as likely to have ever used malathion (OR: 1.86 95% CI 1.00-3.47). Those ≤ 40 years of age reporting use of 5 + organophosphate insecticides had triple the odds of HL (OR: 3.00 95% CI 1.28-7.03). Longer duration of use of 2,4-D, ≥ 6 vs. 0 years, was associated with elevated odds of HL (OR: 2.59 95% CI 1.34-4.97). CONCLUSION: In the NAPP, insecticide use may increase the risk of HL, but results are based on small numbers.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Doença de Hodgkin/epidemiologia , Praguicidas , Adulto , Canadá/epidemiologia , Humanos , Kansas/epidemiologia , Nebraska/epidemiologia
5.
Ann Hematol ; 99(6): 1321-1330, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32333153

RESUMO

Elderly Hodgkin lymphoma (HL) is an aggressive lymphoma subgroup with high 18F-FDG avidity at 18F-FDG-PET/CT but no shared criteria for PET/CT in treatment evaluation and prediction of outcome are available. The aim of our bicentric study was to investigate whether the metabolic baseline PET/CT parameters can predict treatment response and prognosis in elderly HL. We retrospectively included 123 patients who underwent baseline 18F-FDG-PET/CT and end of treatment PET/CT scans. The PET images were analyzed visually and semi-quantitatively by measuring the lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Survival curves were plotted according to the Kaplan-Meier method. At a median follow-up of 40 months, the median PFS and OS were 29 and 37 months. L-BP SUV R, L-L SUV R, MTV, and TLG were significantly higher in patients with no complete response compared with complete response group at end of treatment. Moreover, these parameters were demonstrated to be independent prognostic factors for PFS together with tumor stage, while only L-L SUV R and L-BP SUV R for OS. End of treatment PET/CT results using Deauville criteria were significantly correlated with outcome survival. End of treatment PET/CT results (using Deauville criteria) and semiquantitative baseline PET/CT parameters were significantly correlated with response to treatment and long-term outcome.


Assuntos
Fluordesoxiglucose F18 , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/epidemiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Prognóstico , Estudos Retrospectivos
6.
Cancer Radiother ; 24(3): 206-214, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32171674

RESUMO

PURPOSE: The aim of this study was to extensively describe the epidemiological, clinical and therapeutic outcomes of adolescents and young adults (AYA) population with classical Hodgkin Lymphoma (cHL). Then, a comparison between AYAs and adults and between the subgroups of AYAs treated with the same adult protocol was accomplished to further inform on optimal therapy approach of choice for adolescent patients. MATERIAL AND METHODS: In this mono-centric, retrospective study, we reviewed the medical records. We analyzed 112 consecutive North Tunisian patients, including 66 AYAs (15 to 39 years) and 46 adults (≥40years) affected by cHL treated from 2000 to 2015 at Salah Azaiez Institute. Then, we performed a comparative analysis between AYA and 46 adult patients and a subgroup analysis between adolescents and young adults. All patients were treated according to the national protocol for HL, edited by the Tunisian Society of Hematology. The treatment included chemotherapy and involved-field radiotherapy (RT) at a dose of 20 or 30 Grays (Gy) for responders and 36Gy for non-responders. RESULTS: AYA patients presented with adverse features with nodular sclerosis subtype (p=3.88×10-02) and mediastinal mass involvement (p=9.40×10-04). At a median follow-up of 51 and 32 months for AYAs and adults, respectively, no statistical difference in terms of 3 and 5-years overall survival (OS) and event-free survival (EFS) was shown. Using the Kaplan-Meier method, in AYAs, the ABVD regimen has an impact on 3-years EFS (p=4.63×10-02). The 36Gy RT was associated with the best 3-years EFS (p=9.24×10-03). Besides, AYA patients with advanced-stage had the worst 3-years OS (76%) (p=2.41×10-02). Although the adolescents and young adults shared similar clinical presentation, we noted that the adolescent group had the worst 3-years EFS (48%), but the best 3-years OS (91%). We identified 15% of primary refractory patients and a rate of toxicity of 5.3% in AYA. CONCLUSION: The treatment approach used is well tolerated by adult patients. However, the AYA patients and particularly adolescent subgroup had more advanced disease at diagnosis and should be treated more intensively in dedicated units. RT dose<36Gy and ABVD chemotherapy were associated with lower EFS in this population.


Assuntos
Doença de Hodgkin/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Ciclofosfamida/administração & dosagem , Dacarbazina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/mortalidade , Doença de Hodgkin/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Mecloretamina/administração & dosagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Dosagem Radioterapêutica , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Tunísia/epidemiologia , Vimblastina/administração & dosagem , Vincristina/administração & dosagem , Adulto Jovem
7.
Future Oncol ; 16(9): 451-467, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32096658

RESUMO

Aim: Little is known about the association between specific primary lymph node (LN) sites and the risk of developing second primary cancers in Hodgkin lymphoma (HL) patients. Materials & methods: To fill this knowledge gap, we used the multiple primary standardized incidence ratio function of the SEER*stat program to explore such an association for multiple latency periods. Results: Several SPCs occurred at various time points following different primary LN presentations of HL. Conclusion: HL survivors may benefit from a tailored primary LN site-specific follow-up screening.


Assuntos
Doença de Hodgkin/epidemiologia , Doença de Hodgkin/patologia , Linfonodos/patologia , Segunda Neoplasia Primária/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Risco , Programa de SEER/estatística & dados numéricos
8.
Leuk Res ; 90: 106311, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32050133

RESUMO

INTRODUCTION: The optimal management of elderly patients (pts) with Hodgkin's lymphoma is not yet defined. The aims of the present study were: 1) to evaluate clinical and laboratory characteristics of elderly pts; 2) to indentify risk factors for unfavorable outcome. PATIENTS AND METHODS: The outcome of 182 pts ≥ 60 years (y) was retrospectively analyzed (median age, 67y). Mixed cellularity histology was diagnosed in 49.5 %, advanced stage of disease was in 68.7 % pts, CIRS > 3 in 35.7 %, ECOG PS ≥ 2 in 22.9 % (60-69y) of pts. Chemotherapy (CMT) alone was used in 69.2 % and combination of CMT and radiotherapy in 26.9 % of pts. Anthracycline-based CMT received 83.5 % of pts. The median follow-up was 4.5y. RESULTS: The overall response/complete remission rate was 85.6/70.7 %. The median progression free survival (PFS) and overall survival (OS) were 10y and 11.3y, respectively. Estimated 5-y PFS and 5-y OS were 65.7 % (in contrast to 98.2 % in pts < 60y; p < 0.001) and 70.5 % (99.4 % in pts < 60y; p < 0.001). Overall 70 (38.5 %) elderly pts died. The independent risk factors for a shorter OS included CIRS > 3, lymphopenia < 8 % and anthracycline-free CMT, for a shorter PFS anthracycline-free CMT and lymphopenia < 8 %. CONCLUSION: CIRS > 3, lymphopenia < 8 % and anthracycline-free chemotherapy appear to be significant for unfavorable outcome.


Assuntos
Doença de Hodgkin/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , República Tcheca/epidemiologia , Gerenciamento Clínico , Feminino , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Vigilância em Saúde Pública , Sistema de Registros , Resultado do Tratamento
9.
J Acquir Immune Defic Syndr ; 83(4): 345-349, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32097194

RESUMO

BACKGROUND: The incidence of HIV-associated Hodgkin lymphoma (HIV-HL) has not dropped in the era of widespread antiretroviral therapy (ART), and there have reportedly been shifts in the most prevalent variants encountered. In this study, factors of interest in cases of HIV-HL diagnosed before and after the widespread availability of ART in Johannesburg, South Africa, were compared. METHODS: All cases of HIV-HL diagnosed in 2007 and 2017 were extracted from the laboratory information system, and pertinent factors compared. RESULTS: The number of cases of HL increased significantly over the period assessed, but without a clear increase in the incidence of HIV-HL. As has been reported previously, the proportion of HIV-HL subclassified as the Nodular Sclerosis and Mixed Cellularity subtypes increased and decreased respectively over the period. The number of unclassifiable cases also increased significantly largely because of more frequent diagnosis in bone marrow (BM). BM involvement was highly prevalent at both timepoints (51.7% in 2007 vs 66.2% in 2017; P = 0.18), but was more frequently associated with multiple cytopenias in 2017. Despite significant ART upscaling, the median CD4 count was significantly lower in 2017 (242.5 cells/µL in 2007 vs 85.5 in 2017; P = 0.002). This particularly affected patients with BM involvement, and the median survival time was significantly shorter among BM+ patients diagnosed in 2017 as compared to those diagnosed in 2007. Notably, 40.8% of the patients with BM involvement diagnosed in 2017 died before the diagnosis was established. CONCLUSION: HIV-HL with BM involvement identifies a very high-risk subpopulation in the post-ART era.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Medula Óssea/patologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Doença de Hodgkin/complicações , Doença de Hodgkin/epidemiologia , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Fatores de Risco , África do Sul/epidemiologia
10.
Hematol Oncol ; 38(2): 153-161, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31953864

RESUMO

The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challenge. The aim of this study was to evaluate the impact of comorbidity assessment according to a standardized approach, the Cumulative Illness Rating Scale (CIRS), on prognosis in patients with classical HL aged 60 years and older. We studied 76 consecutive older adult patients with HL (median age 69 y, range 60-84) who had been treated in our institution between 1999 and 2018. Comorbidity was assessed at diagnosis according to CIRS. Anthracycline-containing chemotherapy with curative intent was administered in 59 (78%) patients. We identified 41 (54%) patients with at least one severe comorbidity rated on CIRS grade ≥ 3. Patients with severe comorbidity were more likely to have advanced-stage disease (P = .003), to have an International Prognostic Score (IPS) > 3 (P = .03), and to not receive anthracycline-containing chemotherapy (P = .008). The probability of overall survival (OS) at 3 years was 88% (95% CI, 71%-95%) in patients without severe comorbidities, while it was only 46% (95% CI, 29%-62%) in patients with a comorbidity CIRS grade ≥ 3 (P = .0001). The impact of comorbidity on prognosis was also evident when restricting the analysis to patients treated with anthracycline-containing therapy. The 3-year OS was 93% (95% CI, 76%-98%) (P = .004) in patients without severe comorbidity and 72% (95% CI, 47%-87%) in patients with severe comorbidity (P = .004). In a multivariate analysis, presence of comorbidity, but not age, was a significant factor for OS. Therefore, we conclude that a significant proportion of older adult patients with HL has severe comorbidity on the CIRS scale, which impacts more importantly than age on prognosis.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/patologia , Idoso , Idoso de 80 Anos ou mais , Bleomicina/uso terapêutico , Comorbidade , Dacarbazina/uso terapêutico , Doxorrubicina/uso terapêutico , Feminino , Seguimentos , Doença de Hodgkin/tratamento farmacológico , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Vimblastina/uso terapêutico
11.
BMC Cancer ; 20(1): 2, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31987032

RESUMO

BACKGROUND: The presence of comorbidity affects the care of cancer patients, many of whom are living with multiple comorbidities. The prevalence of cancer comorbidity, beyond summary metrics, is not well known. This study aims to estimate the prevalence of comorbid conditions among cancer patients in England, and describe the association between cancer comorbidity and socio-economic position, using population-based electronic health records. METHODS: We linked England cancer registry records of patients diagnosed with cancer of the colon, rectum, lung or Hodgkin lymphoma between 2009 and 2013, with hospital admissions records. A comorbidity was any one of fourteen specific conditions, diagnosed during hospital admission up to 6 years prior to cancer diagnosis. We calculated the crude and age-sex adjusted prevalence of each condition, the frequency of multiple comorbidity combinations, and used logistic regression and multinomial logistic regression to estimate the adjusted odds of having each condition and the probability of having each condition as a single or one of multiple comorbidities, respectively, by cancer type. RESULTS: Comorbidity was most prevalent in patients with lung cancer and least prevalent in Hodgkin lymphoma patients. Up to two-thirds of patients within each of the four cancer patient cohorts we studied had at least one comorbidity, and around half of the comorbid patients had multiple comorbidities. Our study highlighted common comorbid conditions among the cancer patient cohorts. In all four cohorts, the odds of having a comorbidity and the probability of multiple comorbidity were consistently highest in the most deprived cancer patients. CONCLUSIONS: Cancer healthcare guidelines may need to consider prominent comorbid conditions, particularly to benefit the prognosis of the most deprived patients who carry the greater burden of comorbidity. Insight into patterns of cancer comorbidity may inform further research into the influence of specific comorbidities on socio-economic inequalities in receipt of cancer treatment and in short-term mortality.


Assuntos
Neoplasias do Colo/epidemiologia , Doença de Hodgkin/epidemiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Retais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Sistema de Registros , Adulto Jovem
12.
J Allergy Clin Immunol ; 145(3): 868-876, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31730878

RESUMO

BACKGROUND: Immunodeficiency syndromes (acquired/congenital/iatrogenic) are known to increase Hodgkin lymphoma (HL) risk, but the effects of allergic immune dysregulation and corticosteroids are poorly understood. OBJECTIVE: We sought to assess the risk of HL associated with allergic disease (asthma, eczema, and allergic rhinitis) and corticosteroid use. METHODS: We conducted a case-control study using the United Kingdom Clinical Practice Research Datalink (CPRD) linked to hospital data. Multivariable logistic regression investigated associations between allergic diseases and HL after adjusting for established risk factors. Potential confounding or effect modification by steroid treatment were examined. RESULTS: One thousand two hundred thirty-six patients with HL were matched to 7416 control subjects. Immunosuppression was associated with 6-fold greater odds of HL (adjusted odds ratio [aOR], 6.18; 95% CI, 3.04-12.57), with minimal change after adjusting for steroids. Any prior allergic disease or eczema alone was associated with 1.4-fold increased odds of HL (aOR, 1.41 [95% CI, 1.24-1.60] and 1.41 [95% CI, 1.20-1.65], respectively). These associations decreased but remained significant after adjustment for steroids (aOR, 1.25 [95% CI, 1.09-1.43] and 1.27 [95% CI, 1.08-1.49], respectively). There was no effect modification by steroid use. Previous steroid treatment was associated with 1.4-fold greater HL odds (aOR, 1.38; 95% CI, 1.20-1.59). CONCLUSIONS: In addition to established risk factors (immunosuppression and infectious mononucleosis), allergic disease and eczema are risk factors for HL. This association is only partially explained by steroids, which are associated with increased HL risk. These findings add to the growing evidence that immune system malfunction after allergic disease or immunosuppression is central to HL development.


Assuntos
Doença de Hodgkin/epidemiologia , Doença de Hodgkin/imunologia , Hipersensibilidade Imediata/imunologia , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Hipersensibilidade Imediata/tratamento farmacológico , Masculino , Reino Unido , Adulto Jovem
13.
Cancer ; 126(3): 659-669, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31714589

RESUMO

BACKGROUND: An increased risk of metabolic syndrome has been reported for childhood cancer survivors and for adult survivors with certain cancer types. One previous study reported on the risk for diseases in the metabolic syndrome specifically among survivors of adolescent and young adult cancers. METHODS: The study comprised 11,822 five-year survivors of adolescent and young adult cancer (ages 15-39 years at diagnosis) who were diagnosed during the period from 1994 through 2009 in Denmark and a population-based comparison cohort of 76,024 individuals. The cohorts were linked to Danish nationwide registries for information on hospital contacts and purchase of prescription drugs related to metabolic syndrome, respectively. Standardized rate ratios (RRs) for hospital contacts (SHRRs) and prescriptions (SPRRs) with 95% CIs were calculated for diabetes, hyperlipidemia, and hypertension. RESULTS: Survivors had increased risks for hospital contacts and prescriptions for diabetes (SHRR, 1.21; 95% CI, 1.03-1.43; SPRR, 1.08; 95% CI, 0.96-1.23), hyperlipidemia (SHRR, 1.18; 95% CI, 1.00-1.40; SPRR, 1.16; 95% CI, 1.08-1.25), and hypertension (SHRR, 1.27; 95% CI, 1.15-1.41; SPRR, 1.25; 95% CI, 1.20-1.31). The highest risks for hospitalizations were among survivors of brain cancer (RR, 2.94 for diabetes) and Hodgkin lymphoma (RR, 2.40 for diabetes). Survivors of brain cancer and Hodgkin lymphoma were most likely to purchase prescription drugs for diseases in metabolic syndrome. CONCLUSIONS: Survivors of adolescent and young adult cancer are at increased risk of hospital contacts and purchase of prescription drugs for diseases in metabolic syndrome. Survivors at high risk should be followed closely to improve prevention, early detection, and management of these diseases to ultimately minimize the risk of cardiovascular diseases.


Assuntos
Neoplasias Encefálicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doença de Hodgkin/epidemiologia , Síndrome Metabólica/epidemiologia , Adolescente , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Sobreviventes de Câncer , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/patologia , Criança , Dinamarca/epidemiologia , Feminino , Doença de Hodgkin/complicações , Doença de Hodgkin/patologia , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/patologia , Medição de Risco , Fatores de Risco , Adulto Jovem
14.
J Natl Cancer Inst ; 112(1): 63-70, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31070751

RESUMO

BACKGROUND: Adolescent women treated for Hodgkin lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children's Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25 years. METHODS: A discrete event simulation model was used to simulate the life histories of a cohort of 500 000 25-year-old women treated for HL at age 15 years. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), health-care costs, and the relative cost-utility (incremental cost-utility ratio [ICUR]) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled modeling of uncertainty evaluation. A publicly funded health-care payer perspective was adopted. RESULTS: Costs across the eight screening strategies ranged from $32 643 to $43 739, whereas QALYs ranged from 24.419 to 24.480. In an incremental cost-effectiveness analysis, annual mammography beginning at age 25 years was associated with an ICUR of $43 000/QALY gained, annual MRI beginning at age 25 years with a switch to annual mammography at age 50 years had an ICUR of $148 000/QALY, and annual MRI beginning at age 25 years had an ICUR of $227 222/QALY. Among all assessed surveillance strategies, the differences in life expectancy were small. CONCLUSIONS: Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Detecção Precoce de Câncer/economia , Doença de Hodgkin/epidemiologia , Radioterapia/efeitos adversos , Adolescente , Adulto , Tomada de Decisão Clínica , Análise Custo-Benefício , Árvores de Decisões , Feminino , Doença de Hodgkin/radioterapia , Humanos , Imagem por Ressonância Magnética/efeitos adversos , Mamografia/efeitos adversos , Modelos Teóricos , Vigilância em Saúde Pública , Anos de Vida Ajustados por Qualidade de Vida , Radioterapia/métodos
15.
Hematology Am Soc Hematol Educ Program ; 2019(1): 233-242, 2019 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-31808898

RESUMO

Hodgkin lymphoma (HL) in older patients, commonly defined as ≥60 years of age, is a disease for which survival rates have historically been significantly lower compared with younger patients. Older HL patients appear to have different disease biology compared with younger patients, including increased incidence of mixed cellularity histology, Epstein-Barr virus-related, and advanced-stage disease. For prognostication, several studies have documented the significance of comorbidities and functional status in older HL patients, as well as the importance of achieving initial complete remission. Collectively, selection of therapy for older HL patients should be based in part on functional status, including pretreatment assessment of activities of daily living (ADL), comorbidities, and other geriatric measures (eg, cognition, social support). Treatment of fit older HL patients should be given with curative intent, regardless of disease stage. However, attention should be paid to serious treatment-related toxicities, including risk of treatment-related mortality. Although inclusion of anthracycline therapy is important, bleomycin-containing regimens (eg, doxorubicin, bleomycin, vinblastine, dacarbazine) may lead to prohibitive pulmonary toxicity, and intensive therapies (eg, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are too toxic. Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, and dacarbazine to fit, untreated advanced-stage older HL patients was recently shown to be tolerable and highly effective. Therapy for patients who are unfit or frail because of comorbidities and/or ADL loss is less clear and should be individualized with consideration of lower-intensity therapy, such as brentuximab vedotin with or without dacarbazine. Altogether, therapy for older HL patients should be tailored based upon a geriatric assessment, and novel targeted agents should continue to be integrated into treatment paradigms.


Assuntos
Doença de Hodgkin/imunologia , Idoso , Comorbidade , Doença de Hodgkin/diagnóstico , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/patologia , Humanos , Estadiamento de Neoplasias , Recidiva
16.
Medicine (Baltimore) ; 98(45): e17641, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702615

RESUMO

The purpose of this study was to evaluate changes in the proportion of lymphoid neoplasm subtypes in South Korea. A total of 8615 cases of lymphoid neoplasms diagnosed in 1997-2016 at Samsung Medical Center in South Korea were classified according to the 2008 World Health Organization system. The total number and proportion of lymphoid neoplasms were compared between these two decades, with data from nationwide studies, and with other countries. To evaluate changes in the proportion of subtypes, crude rate of each subtype per 100 lymphoma patients during each decade and age adjusted rate were calculated. There were 3024 patients with lymphoid neoplasm in 1997-2006, and 5591 in 2007-2016, which represents an average increase of 1.85 times over the 20-year study period. Crude rate and age adjusted rate were increased in Hodgkin's lymphoma and mature B cell lymphoma while precursor lymphoid neoplasms and mature T cell lymphoma were decreased. Among B cell neoplasms, age adjusted rate of plasma cell neoplasm, follicular lymphoma, mantle cell lymphoma increased while there was no significant change in extranodal marginal zone lymphoma and Burkitt lymphoma. The increase in follicular lymphoma was due to the increases in nodal follicular lymphoma of low grade and duodenal-type follicular lymphoma. These results are consistent with the dynamics of causative factors, including socioeconomic factors, in Korea.


Assuntos
Doença de Hodgkin/epidemiologia , Linfoma de Células B/epidemiologia , Linfoma de Células T/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
17.
Br J Haematol ; 187(5): 573-587, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31566730

RESUMO

The treatment of Hodgkin lymphoma (HL) is one of early success. However, disease-free survival (DFS) does not reflect latent organ injury and its impact on health status and well-being beyond 5 years. In fact, we are at a crossroads, in terms of needing individualized approaches to maintain DFS, while minimizing late effects and preserving health-related quality of life (HRQoL). Premature morbidity and mortality translate to a high societal cost associated with the potential number of productive life years ahead in this population who are young at diagnosis. The discordance between short-term lymphoma-free survival and long-term health and HRQoL creates a "survivorship gap" which can be characterized for individuals and for subgroups of patients. The current review delineates contributors to compromised outcomes and health status in child and adolescent (paediatric) HL and frames the survivorship gap in terms of primary and secondary prevention. Primary prevention aims to titrate therapy. Secondary prevention entails strategies to intervene against late effects. Bridging the survivorship gap will be attained with enhanced knowledge of and attention to biology of the tumour and microenvironment, host genetic factors, HRQoL and sub-populations with disparate outcomes.


Assuntos
Doença de Hodgkin/terapia , Sobrevivência , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Criança , Preservação da Fertilidade/métodos , Doença de Hodgkin/epidemiologia , Humanos , Morbidade , Prevenção Primária/métodos , Qualidade de Vida , Medição de Risco/normas , Terapia de Salvação/métodos , Prevenção Secundária/métodos
18.
J Hematol Oncol ; 12(1): 107, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640759

RESUMO

BACKGROUND: Hodgkin lymphoma (HL) is an uncommon B cell lymphoma. We assessed the global, regional, and national burden of HL from 1990 to 2017, by gender, age, and social-demographic index (SDI). METHODS: Data on HL, including incidence, mortality, and disability adjusted life-years (DALY), from 1990 to 2017 were obtained from the 2017 Global Burden of Disease study. Estimated annual percentage changes (EAPCs) were calculated to assess incidence rate, mortality, and DALY trends. RESULTS: HL incidences increased by 38.66%, from 72,937 in 1990 to 101,133 in 2017, while the age-standardized incidence rate (ASIR) was relatively stable. ASIR decreased in the low SDI regions (EAPC = - 2.58; 95% CI, from - 2.66 to - 2.49) and was stable in the other four SDI regions. Incidence showed a bimodal distribution with peak values in patients aged 20-39 years and patients aged 60 years or higher. The number of death cases and DALYs were stable. The age-standardized death rate decreased by 2.36% (95% CI, from - 2.43% to - 2.30%) per year. The annual age-standardized DALY rate decreased by 2.29% (95% CI, from - 2.36% to - 2.21%). The incidence and mortality in male subjects was higher than that in female subjects. The incidence in male and female subjects aged 15-30 years old was close, whereas the biggest difference existed in patients aged < 10 years old and 45-75 years old between genders. CONCLUSION: Globally, incidence of HL was stable, while mortality and DALY rate of HL had been decreasing from 1990 to 2017. Compared with lower and decreasing ASIR in the low SDI region, ASIR in the high SDI region was always high, indicating the need for HL treatment improvement and the establishment of more targeted and specific strategies in high SDI countries to reduce the incidence of HL.


Assuntos
Carga Global da Doença/tendências , Doença de Hodgkin/epidemiologia , Doença de Hodgkin/mortalidade , Adulto , Idoso , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
19.
BMJ Open ; 9(9): e029228, 2019 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-31542744

RESUMO

OBJECTIVES: Hodgkin's lymphoma (HL) is the the most common cancer in teenagers and young adults. This nationwide study conducted over a 25-year period in the UK investigates variation in HL incidence by age, sex, region and deprivation to identify trends and high-risk populations for HL development. DESIGN: Population-based cohort study. SETTING: Clinical Practice Research Datalink (CPRD) electronic primary care records linked to Hospital Episode Statistics and Index of Multiple Deprivation data were used. PARTICIPANTS: Data on 10 million individuals in the UK from 1992 to 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: Poisson models were used to explore differences in HL incidence by age, sex, region and deprivation. Age-specific HL incidence rates by sex and directly age-standardised incidence rates by region and deprivation group were calculated. RESULTS: A total of 2402 new cases of HL were identified over 78 569 436 person-years. There was significant variation in HL incidence by deprivation group. Individuals living in the most affluent areas had HL incidence 60% higher than those living in the most deprived (incidence rate ratios (IRR) 1.60, 95% CI 1.40 to 1.83), with strong evidence of a marked linear trend towards increasing HL incidence with decreasing deprivation (p=<0.001). There was significant regional variation in HL incidence across the UK, which persisted after adjusting for age, sex and deprivation (IRR 0.80-1.42, p=<0.001). CONCLUSIONS: This study identified high-risk regions for HL development in the UK and observed a trend towards higher incidence of HL in individuals living in less deprived areas. Consistent with findings from other immune-mediated diseases, this study supports the hypothesis that an affluent childhood environment may predispose to development of immune-related neoplasms, potentially through fewer immune challenges interfering with immune maturation in early life. Understanding the mechanisms behind this immune dysfunction could inform prevention, detection and treatment of HL and other immune diseases.


Assuntos
Doença de Hodgkin/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Reino Unido/epidemiologia
20.
Rev. cuba. hematol. inmunol. hemoter ; 35(3): e1027, jul.-set. 2019. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093279

RESUMO

Introducción: El linfoma de Hodgkin ha pasado de ser una enfermedad fatal a una de las neoplasias con mayores posibilidades de curación. Objetivo: Caracterizar el comportamiento del linfoma de Hodgkin en los pacientes adultos. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo parcial que incluyó 75 pacientes adultos con linfoma de Hodgkin atendidos en el Instituto de Hematología e Inmunología entre enero de 1987 hasta enero de 2017. Resultados: El 64 por ciento de los pacientes fueron del sexo masculino; predominó el color de piel blanco (85,3 por ciento) y el grupo de 18 a 38 años fue el más frecuente (68 por ciento). Prevalecieron los pacientes sin comorbilidades (65,3 por ciento) y con buen validismo (93,3 por ciento). El 52 por ciento de los pacientes estaba en estadio III al diagnóstico; predominó el grupo pronóstico de avanzado favorable 61.3 por ciento. La variedad histológica más frecuente fue la esclerosis nodular con 48 pacientes y el esquema empleado con mayor frecuencia fue ABVD, con el que se logró 92 por ciento de remisión completa. El 20 por ciento de los pacientes fallecieron y el 18,7 por ciento recayeron. La sobrevida global a los 2, 5 y 10 años fue de 93 por ciento, 83 por ciento y 80 por ciento, respectivamente. La sobrevida libre de enfermedad a los 5 y 10 años fue de 82 por ciento y 73 por ciento, respectivamente. Conclusiones: La sobrevida global y la sobrevida libre de enfermedad de los pacientes fueron altas. Los pacientes tratados con la combinación de quimioterapia y radioterapia mostraron significativamente una mejor supervivencia global(AU)


Introduction: Hodgkin's lymphoma has evolved to be one of the cancers with highest possibilities of cure. Objective: To characterize the behavior of the Hodgkin's lymphoma disease in adult patients. Methods: An observational, descriptive and retrospective study was carried out. It included 75 adult patients with Hodgkin's lymphoma attended in the Institute of Hematology and Immunology since January 1987 to January of 2017. Results: 64 percent of the patients were male; the white color of skin and the group from 18 to 38 years predominated, with 85.3 percent and 68 percent respectively. Patients without comorbidity prevailed, and those who had a good status performance, representing the 65.3 percent and 93.3 percent respectively. The 52 percent of patients were in stage III at diagnosis, the group with advanced favorable disease was predominant, with 61.3 percent of the cases. The most frequent histological type was nodular sclerosis with 48 patients; and ABVD protocol was used more often, achieving 92 percent of complete remission. Twenty percent of the patients died and 18.7 percent relapsed. The overall survival of the patients at 2, 5 and 10 years was 93 percent, 83 percent and 80 percent respectively. The progression-free survival at of 5 and 10 years was 82 percent and 73 percent respectively. Conclusions: The overall survival and the progression-free survival of patients were high, and patients treated with the combination of chemotherapy and radiotherapy showed a significantly better overall survival(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Doença de Hodgkin/epidemiologia , Análise de Sobrevida , Saúde do Adulto , Epidemiologia Descritiva , Estudos Retrospectivos , Intervalo Livre de Progressão
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