Hodgkin lymphoma treatment with ABVD in the US and the EU: neutropenia occurrence and impaired chemotherapy delivery.

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2010-08-19

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Abstract

BACKGROUND: In newly diagnosed patients with Hodgkin lymphoma (HL) the effect of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD)-related neutropenia on chemotherapy delivery is poorly documented. The aim of this analysis was to assess the impact of chemotherapy-induced neutropenia (CIN) on ABVD chemotherapy delivery in HL patients. STUDY DESIGN: Data from two similarly designed, prospective, observational studies conducted in the US and the EU were analysed. One hundred and fifteen HL patients who started a new course of ABVD during 2002-2005 were included. The primary objective was to document the effect of neutropenic complications on delivery of ABVD chemotherapy in HL patients. Secondary objectives were to investigate the incidence of CIN and febrile neutropenia (FN) and to compare US and EU practice with ABVD therapy in HL. Pooled data were analysed to explore univariate associations with neutropenic events. RESULTS: Chemotherapy delivery was suboptimal (with a relative dose intensity < or = 85%) in 18-22% of patients. The incidence of grade 4 CIN in cycles 1-4 was lower in US patients (US 24% vs. EU 32%). Patients in both the US and the EU experienced similar rates of FN across cycles 1-4 (US 12% vs. EU 11%). Use of primary colony-stimulating factor (CSF) prophylaxis and of any CSF was more common in the US than the EU (37% vs. 4% and 78% vs. 38%, respectively). The relative risk (RR) of dose delays was 1.54 (95% confidence interval [CI] 1.08-2.23, p = 0.036) for patients with vs. without grade 4 CIN and the RR of grade 4 CIN was 0.35 (95% CI 0.12-1.06, p = 0.046) for patients with vs. without primary CSF prophylaxis. CONCLUSIONS: In this population of HL patients, CIN was frequent and FN occurrence clinically relevant. Chemotherapy delivery was suboptimal. CSF prophylaxis appeared to reduce CIN rates.

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10.1186/1756-8722-3-27

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Schwenkglenks, Matthias, Ruth Pettengell, Thomas D Szucs, Eva Culakova and Gary H Lyman (2010). Hodgkin lymphoma treatment with ABVD in the US and the EU: neutropenia occurrence and impaired chemotherapy delivery. J Hematol Oncol, 3. p. 27. 10.1186/1756-8722-3-27 Retrieved from https://hdl.handle.net/10161/4389.

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Lyman

Gary Herbert Lyman

Adjunct Professor in the Department of Medicine

Dr. Gary Lyman is Adjunct Professor of Medicine in the Division of Medical Oncology, Department of Internal Medicine at Duke University School of Medicine . He is a nationally and internationally recognized authority on comparative effectiveness and health services and outcomes research. Lyman research has been funded by the National Cancer Institute, the National Heart Lung and Blood Institute, the American Society of Clinical Oncology along with industry grants related to supportive cancer care. Dr Lyman has published some 700 research articles in in the professional medical literature. 

Personal Statement
I have been extremely privileged to work with some of the worlds best biostatisticians and clinical trialists over the years including a postdoctoral fellowship with Professor Marvin Zelen, chair of Biostatistics at the Harvard School of Public Health and as a Visiting Professor with Professor Stuart Pocock at the the London School of Hygiene and Tropical Medicine and Professor Doug Altman at the Oxford Centre for Health Statistics as well as many others now in the Division of Public Health Sciences at the Fred Hutchinson Cancer Research Center. It has been very humbling and a true honor to work with and learn from such professionals. These wonderful colleagues have made it possible for me to be listed among the top 1% of most highly cited investigators by Web of Science for the past 7 years with nearly 97,000 professional citations.  Thank you all. https://en.wikipedia.org/wiki/Gary_Herbert_Lyman

Dr Lyman’s research interests include:
Personalized Medicine and Cancer Supportive Care: In addition to the conduct of randomized controlled trials of new cancer diagnostic, prognostic, treatment and supportive care approaches, Dr Lyman’s research interests include the personalized management of early-stage breast cancer and supportive care of patients receiving cancer chemotherapy, most notably those at risk for febrile neutropenia and venous thromboembolism. Based on clinical trial results, Dr Lyman is actively involved in the development and validation of clinical risk models for patient selection and targeted intervention and preventive strategies. Dr Lyman is co-PI on an NCI on comparative effectiveness of cancer pharmacogenomics grant to discover and validate new genomic tools for guiding more personalized cancer treatments and on an NHLBI trial of thromboprophylaxis in high risk ambulatory patients receiving cancer chemotherapy.

Evidence synthesis, clinical practice guidelines and health policy: Dr Lyman conducts systematic reviews and meta-analyses of major clinical issues in support of clinical practice guidelines. Dr Lyman chairs several guidelines for the American Society of Clinical Oncology including those on antiemetics, venous thromboembolism, sentinel node biopsy in patients with breast cancer and cutaneous melanoma and on weight based dosing of chemotherapy. Dr Lyman also conducts analyses of large population studies of clinical outcomes associated with of current cancer patient management in a real world setting with a particular focus on cancer management in the elderly patient with cancer. Dr Lyman leads several decision simulation studies for improved clinical decision making and cost-effectiveness analysis of new and novel therapies based on results of clinical trials, systematic reviews and population studies. He serves as an advisor on new oncologic agents to the US FDA. Dr Lyman also serves as Editor-in-Chief of Cancer Investigation and on the editorial boards of several prestigious research journals.


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