Faculty Bibliography

Although Hodgkin lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only 50 % of these patients will be effectively salvaged with conventional therapies. The prognosis is particularly poor for those patients with chemotherapy refractory disease, who are unable to obtain even transient disease control, and for patients who relapse following high dose chemotherapy and autologous stem cell transplant. In this review, we summarize the most recent updates on the management of patients with relapsed HL, the role of novel therapies such as brentuximab vedotin, and an overview of promising new agents currently under investigation. We also discuss the role of consolidation strategies such as high-dose chemotherapy and autologous stem cell transplant, and reduced-intensity allogeneic hematopoietic stem cell transplant, and the need for new strategies in the elderly patient population.

Although most patients with Hodgkin lymphoma (HL) are cured with primary therapy, patients with primary refractory disease or relapse after initial treatment have poor outcomes and represent an unmet medical need. Recent advances in unraveling the biology of HL have yielded a plethora of novel targeted therapies. This review provides an overview of the data behind the hype generated by these advances and addresses the question of whether or not clinically these targeted therapies offer hope for patients with HL.

BACKGROUND CONTEXT: Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been common practice. However, the effect of predonation on pre-incision hematocrit has not been studied. This study aims to determine if pre-donation of autologous blood leads to a lower pre-incision hematocrit. PURPOSE: To compare the effects of autologous blood donation on preincisional hematocrit levels. STUDY DESIGN/SETTING: Retrospective cohort study of prospective randomized trial. PATIENT SAMPLE: Patients (ages 10-21) undergoing posterior spinal fusion in a prospective, randomized controlled trial in which 125 patients were randomized to TXA, EACA, or Saline for surgery from January 2009 to January 2011. Of the 125 patients that enrolled in the study, 28 patients donated blood and 62 patients did not donate blood. 35 patients were omitted as the autologous blood donation status was not clearly documented in the medical record. OUTCOME MEASURES: Primary outcome measure was the pre-incisional hematocrit of patients immediately prior to surgery. METHODS: This is a retrospective review of data from a prospective, randomized controlled trial in which 125 patients were randomized to TXA, EACA, or Saline for surgery from January 2009 to January 2011. As part of the prospective study, all patients had a complete blood count (CBC) drawn just prior to incision. Of the 125 patients that enrolled in the study, 28 patients donated blood and 62 patients did not donate blood. 35 patients were omitted as the autologous blood donation status was not clearly documented in the medical record. Patient demographics and CBC values were compared between groups using a T-test. Statistical significance was achieved at P<0.05. RESULTS: Pre-donation patients (n528) had an average age of 15.662.2and were 75% female (21F, 7M) which was comparable to non-donation patients (n562) who had a mean age of 15.0 +/- 2.3 and were 82% female (51F, 11M) (p=0.259, p=0.425 respectively). However, pre-donation!

Recent advances in Hodgkin lymphoma research are expected to prelude a promising new treatment era for patients and their treating physicians. Scientific investigations over the last few years have provided new insights into risk stratification, and, simultaneously, a plethora of novel targeted therapies are emerging for patients with relapsed and refractory disease. These novel therapies will be tested primarily in high-risk patients because 75% of the patients are cured with conventional therapies. The challenges, as Hodgkin lymphoma therapy moves forward, will be using these biologic insights to identify the patients who may benefit earlier in treatment from these novel agents, and tailoring the therapy to the tumor biology of the patient. These dual aims are intertwined; as our therapeutic arsenal increases, these biologic determinants of risk may themselves inform the design of therapies and the choice of treatments for high-risk patients. Clin Cancer Res; 19(11); 2797-803. (c)2013 AACR.