Search

CHALLENGES OF LONG-TERM FOLLOW UP FOR HODGKIN LYMPHOMA SURVIVORS. Challenge of Hodgkin lymphoma care is to obtain a high level of curability and minimize acute toxicities and long-term complications of chemotherapy and radiotherapy. A specific long-term multi-disciplinary follow-up should be organize with an important place of general practitioners. The follow-up concerns the risk of second cancer especially breast cancer and treatment-related cardiovascular diseases. In addition, a careful attention concerns some possible negative effects of the disease and treatments on psychosocial status and quality of life of Hodgkin lymphoma survivors., Competing Interests: H. Ghesquières déclare avoir participé à des interventions ponctuelles pour Gilead et Roche (activités de conseil et conférences), et pour BMS et AbbVie (conférences).

Competing Interests: H. Ghesquières déclare avoir participé à des interventions ponctuelles pour Gilead et Roche (activités de conseil et conférences), et pour BMS et AbbVie (conférences).

EPIDEMIOLOGY OF CLASSICAL HODGKIN LYMPHOMA. Classical Hodgkin lymphoma is a rare neoplasia but represents one of the most common cancers in adults younger than 40 years old. Epidemiology of Hodgkin lymphoma remains fascinating with specific incidence patterns depending of age, socio-economic status, histological subtypes and Epstein-Barr virus (EBV) tumor status. These findings are in favor of several diseases with different pathogenesis. A better understanding of biological specificities of some Hodgkin lymphoma subgroups such as those presenting by older patients might be helpful to improve treatment strategies and outcome. Currently, no causal agent has been identified. Some risk factors are described, especially genetic ones, but no specific screening or prevention procedure are currently indicated., Competing Interests: H. Ghesquières déclare avoir participé à des interventions ponctuelles pour Gilead et Roche (activités de conseil et conférences), et pour BMS et AbbVie (conférences).

Competing Interests: H. Ghesquières déclare avoir participé à des interventions ponctuelles pour Gilead et Roche (activités de conseil et conférences), et pour BMS et AbbVie (conférences).

DIAGNOSIS AND STAGING OF HODGKIN LYMPHOMA. Hodgkin lymphoma (HL) is composed of two distinct disease entities: classical HL (cHL) and nodular lymphocyte predominant HL (NLPHL). NLPHL is a rare entity with a specific therapeutic management. The subgroups of cHL are nodular sclerosis, mixed cellularity, lymphocyte depletion and lymphocyte-rich HL. The initial diagnosis of HL is made by a biopsy to analyze with accuracy the architecture of the lymph node. Most HL patients present with supradiaphragmatic lymphadenopathy. Initial staging is determined by positron emission tomography (PET) scan and bone marrow biopsy is now avoided of initial staging. This staging allows the definition of prognostic groups to determine a risk-adapted initial therapy to maintain a high level of curability and reduce long-term therapeutic side effects. Before initial treatment, cardiac ultrasound and pulmonary function tests are needed. The question of fertility preservation is important to address before treatment and for older patients the requirement of geriatric assessment., Competing Interests: H. Ghesquières déclare avoir participé à des interventions ponctuelles pour Gilead et Roche (activités de conseil et conférences), et pour BMS et AbbVie (conférences).

Hodgkin lymphoma affect about 1500 new patients annually in France and 60% of the patients presented a localized disease. HL is highly curable with chemotherapy such as ABVD and escalated BEACOPP and for limited stage, consolidation with involved-field or involved nodes radiation therapy. Treatment could be optimized using positron emission tomography (PET) scan performed after 2 cycles to identify early responders and PET2 positive patients who are at high risk of relapse. Hodgkin lymphoma is characterized a minority of malignant Hodgkin and Reed-Sternberg (HRS) cells and a predominance of inflammatory cells. HRS cells could be targeted by antibody drug conjugates targeting CD30 showing a strong efficacy for relapsed patients. Monoclonal antibodies that are directed against the immune checkpoints especially the PD-1- PD-L1/L2 axis showed also a significant activity for patients relapsing after brentuximab vedotin and autograft. These targeted drugs are currently testing in clinical trials in early phase of the disease., Competing Interests: H. Ghesquières déclare des liens ponctuels avec Mundipharma et Celgene (consultant), et avec Roche France (financement pour la recherche).

The clinical management of cancer in senior adult patients is based on the results of clinical trials which were performed in adults, generally younger adult patients. It is therefore difficult to assess the feasibility of such treatments, mainly chemotherapy, in older patients. The evaluation of health status is an important step in the decision making of cancer treatment in senior adults. In non Hodgkin lymphomas, the standard treatment remains chemotherapy with Rituximab. Specific protocols and treatment adaptation have been proposed in very old seniors. Surgery is a very efficient treatment in breast cancer, colorectal cancer and sometimes in non small cell lung cancer. Radiotherapy is important in the curative management of prostate cancer and in the multidisciplinary treatment of breast, colorectal and lung cancers. Chemotherapy is generally feasible in senior adults. However, Cisplatin is often too much toxic. Chemotherapy has a palliative impact in the treatment of metastatic prostate and breast cancers. It would be discussed in some high-risk groups of patients with breast and colorectal cancers. New targeted drugs are active in breast, colorectal cancers and in non Hodgkin lymphomas. Indications of treatment tailored on health status evaluation are discussed in the manuscript.