FocusonLymphoma(HodgkinandTCellCJmMBhoma):AnUpdateFromthe2011ASHMeetingRanjanaH.Advani,MDProfessorofMedicineDivisionofOncologyStanfordUniversitySchoolofMedicineMember,StanfordCancerInstituteStanford,CalifomiaOverallGoalToprovideasummaryandexpertanalysisofnewdataonHodgkinIymphomaandT-cellymphomasThisactivitymayipncludeqiscussionofinvestigationa/agentsnotapprovedbytheUSFoodandDrugAdministrationjorUse问功eUnitedStates.GeneExpressionProfilingforRiskStratificationinHL“70%ofpatientswithadvancedHLhavelong-termsurvivalwithinitialtherapy“30%withadvancedHLwilprogress一10%-15?%ofthesewilldiedespiteSecond-linetreatment“InternationalPrognosticIndex一Toolusedtoidentifypatientswithhigh-riskdisease一Consistsof7factors一High-riskdiseaseisdefinedasaScore4ScottDW,etalBlood2011;118:abstr430.GeneExpressionProfilingforRiskStratificationinHL(cont)*Hypothesis:Biologicalfactors,measuredbygeneexpressionprofilinginparaffin-embeddedtissueSamples,mightpredictoverallsurvival(O3)*SampleswereobtainedfromtheECOG2496trialandthepredictivemodelforOSwasvalidatedinanindependentdatasetAtmedianfollow-upof5.3years,36(12%)ofthe293patientshaddied*51genesweredifferentiallyexpressedwithrespecttoOS,includinggenesthatarepartofmacrophage,cytotoxic/NKcellandapoptosissignaturesScottDW,etalBlood2011:118:abstr430.O0SBasedonRiskScoreTrainingCohortValidationCohort五1.0pn日1.0Lowriskscore(n81)言0.8菖0.8口口袁o6High-riskscore(ns以3)言k主:High-iskscore(n=49)万0.4E0.4E不目央下0.2&0.22P.0001&P.006一.火-0.0TTT0.0+T一一051015051015Time(y)Timey)ScottDW,etalBlood2011:118:abstr430【“GeneExpressionProfilingforRisk“StratificationinHL(cont),Themodelidentifiedahigh-riskgroup(39%)一Estimated5-yearO0Swas77%inthehigh-riskgroupvs96%inthelow-riskgroup(P60y一Treatedinstudiesbetween1993and200750%hadadVanced-stage|disease*35%didnotcompleteplannedtreatment一115/754patientshaddocumentedrelapse/progressionovermedianobservationtimeof6years一50%receivedacurativetreatmentforrelapseddisease(includingABVD,BEACOPP,HDC/SCT)BolB,etalBlood2011;118:abstr2.RelapsedHLinElderlyPatients(cont)“*CRorunconfirmedCRinabout55%ofpatients-Inthissubgroup,mediansurvivalafterfirstrelapse/progressionwas2years*Survivalwasbetterafterconventionaltreatmentforrelapse/progressionthanlafterHDC/SCT一2.5yearsdifferenceinmediansurvivalafterfirstrelapseorprogression*Overall,mediansurvivalafterfirstrelapse/progressionwasonly11monthsBB,etalBlood2011;118:abstr92.Reduced-IntensityChemotherapyandPET-GuidedRadiotherapyinAdvancedHL“2126newlydiagnosedpatientswithadvancedHL,ages18-60,randomizedona3-armstudy一705patientsweretreatedwith8cyclesofescalated-BEACOPP:,71I1with6-cyclesofescalatedBEACOPP,and710with8cyclesofBEACOPP-14-Attheendoftreatment,patientswitharesidualmass2.5cmreceivedRTifPETwaspositive-Medianfollow-upwas48monthsEngertAetalBlood2011;118:abstr589.【Reduced-IntensityChemotherapyandPET-GuidedRadiotherapyinAdvancedHL(cont)*6cyclesofescalatedBEACOPPweremoreeffectiveandlesstoxicthan8cyclesofescalatedBEACOPP一Deathrate:4.6%VS7.5%;differencewasmainlyduetomoreacutetoxicityandsecondaryneoplasmswith8cyclesofBEACOPP一CRrate:94.2%Vs90.1%(P=.001)一Freedomfromtreatmentfailureat5years:89.3%vs84.4%一0Sat5years:95.3%vs91.9%*Only11%ofpatientshadPET-positivediseaseandreceivedRT,comparedwith71%inpriorHD9studyEngertAetalBlood2011;118:abstr589.