Tunisian adult’s Hodgkin lymphoma Study Group

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Published Oct 5, 2017
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Vol. 94 No. 11 (2016): Issue Nov 2016

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Ben Lakhal Raihane
Hdiji Sondos
Ben Youssef Yosra
Laariri Mohamed Adnène
Zriba Sami
Toumi Nabil
Mokrani Amina
Ezzaier Faten
Ladb Salwa
Frikha Hatem
Mesai Taha
Ben Salah Hanen
Tebra Sameh
Daoued Jamel
Bouaouina Noureddine
Maalej Monji
Frikha Mounir
Ben Ahmed Slim
Mezlini Amel
Ben Othmen Tarek
Msaddek Fehmi
Khelif Abderrahim
Elloumi Moez
Meddeb Balkis

Abstract

The Tunisian adult’s Hodgkin lymphoma (HL) Study Group was created in 1999.


It aimed to improve the management of this curable hematologic malignancy by standardizing the diagnosis, assessment of disease, treatment management and therapeutic evaluation in different Tunisian centers (Hematology, oncology and radiotherapy).Since 1998, four versions of the prospective national protocol for treating adult Hodgkin lymphoma have succeeded (MDH99, MDH2002, MDH2008, MDH2015). Each version was based on the results of the previous version and analyzed according to new data from the literature.


Due to this national study group, the number of patients lost to follow decreased significantly (30% before the creation of the group and only 3% for patients treated with MDH2008), the complete and uncertain response rates have improved (75% before the creation of the group and 92% in patients treated with MDH2008) with dramatically improved rates of overall survival from 57% to 90%.


On the other hand there was an improvement of toxic death rate (13% of toxic deaths in MDH2002 to 4.37% in the MDH2008) with a decrease of the respective rate of primary failure and relapse by 17% and 12.5% in MDH2002 against the 11.4% and 7.8% in the MDH2008. This resulted in an improvement in overall survival (90%) and event-free survival at 5 years (75%).


Now with the introduction of positron emission tomography in Tunisia, we hope yet to finalize the assessment of response and thus better adapt the treatment of this disease. Our objective remains the improvement of event-free survival rate to reach 80%.

Keywords:

Hodgkin lymphoma, Tunisian study group, Treatment, chemotherapy, radiotherapy, assessment, survival

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References

  1. Lister TA, Crowther D, Sutcliffe SB et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting.J Clin Oncol. 1989 Nov;7(11):1630-6.
  2. D.A.Eichenauer, A.Engert, M.André et al. Hodgkin's Lymphoma : ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann oncol. 2014; 25(sup): 70-75
  3. Ben lakhal R, Mseddi S, Laatiri M. A, Ladeb S, Frikha H, Daoued J, Ben salah, Bouaouina N.Traitement de la maladie de hodgkin de l'adulte en Tunisie.Tunis Med. 2004 ; 82(supN°3): 16-19.
  4. H. Tesch, V. Diehl, B. Lathan et al.Moderate dose escalation for advanced stage hodgkin's disease using the blemycin, etoposide adriamycin, cyclophosphamide, Vincristine, procarbazine and prednisone scheme and adjuvant radiotherapy: a study of the German Hodgkin's lymphoma study group. Blood.1998; 92: 60-67.
  5. C. Engel, M. Loeffler, S. Schmitz, H. Tesch, and V. Diehl.Acute hematologic toxicity and practicability of dose-intensified BEACOPP chemotherapy for advanced stage Hodgkin's disease. Ann Oncol 2000; 11 (9): 1105-1114.
  6. V Diehl, J Franklin, D Hasenclever et al. BEACOPP, a new dose-escalated and accelerated regimen, is least as affective as COPP/ABVD in patients with advanced-stage hodgkin's lymphoma: Interim report from a trial of the german Hodgkin's lymphoma study group. J clinOncol1998 ; 16(12) : 3810-3821
  7. Volker Diehl, Andrea Engert, Daniel Re. New strategies for the treatment of advanced stage hodgkin's lymphoma. HematolOncolClin North Am. 2007 Oct; 21(5):897-914
  8. Ben Lakhal R, Hdiji S, Laatiri MA, Ladeb S, Jeddi R, Aissaoui L, Ben Amor R, Msadek F, Frikha H, Toumi N, Daoud J, Bouaouina N, Belhadj Ali Z, Ben Abid H, Frikha M, Elloumi M, Khelif A, Meddeb B and Fenaux P.Hodgkin's Lymphoma (HL) in Tunisia Results of a 5 Year Prospective Multicenter Trial in 251 Pts. Blood (ASH Annual Meeting Abstracts) 2008; 112: 2597
  9. Hasenclever D, Diehl V. A pronostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med. 1998 Nov 19; 339(21):1506-14
  10. Engert A, Plutschow A, Eich HT et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med 2010; 363: 640-52.
  11. George A. Follows, Kirit M. Ardeshna, Solly F. Barrington et al. Guidelines for the first line management of classical Hodgkin Lymphoma. British journal of haematology, 2014, 166, 34-49.
  12. Engert A, Haverkamp H, Kobe C et al. Reduced-intensity chemotherapy and PETguided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 2012; 379:1791-1799.
  13. Andrew M. Evens, Irene Helenowski, Erika Ramsdale et al. A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcome and prognostic factors in modern era Blood 2012; 119: 692-695.
  14. Cheson BD1, Horning SJ, Coiffier B et al. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group.J ClinOncol. 1999; 17(4):1244.
  15. Sally F. Barrington, N. George Mikhaeel, LaleKostakoglu et al. Role of Imaging in the Staging and Response Assessment of Lymphoma: Consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J ClinOncol 2014; 32:3048-3058
  16. Bruce D. Cheson, Richard I. Fisher, Sally F. Barrington et al. Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification.J Clin Oncol 2014 ; 32:3059-3068