KEP: Cancer Epidemiology
We aim to improve the understanding of determinants of risk and prognosis of cancer, with a special focus on malignant lymphomas and cancers arising after organ transplantation, as well as to characterize issues of cancer survivorship. The overall goal is to provide a better basis for primary prevention of cancer, prediction of risk and prognosis, and cancer rehabilitation.
Our research is based on linkages of large national health care registers enriched with clinical data from national cancer quality registers as well as a large bi-national case-control study of malignant lymphomas (the SCALE study). We collaborate with other research groups at KEP, other units at the Karolinska Institutet (CCK, MEB, IMM), researchers at other Swedish Universities (Uppsala, Lund), as well as internationally within the Nordic countries (the Nordic expert group on post-transplant malignancies) and within the InterLymph consortium.
Young people with Hodgkin lymphoma have low relapse risk
Based on a Nordic cohort of >2,500 patients with classical Hodgkin lymphoma (HL) at ages 18-49 years of age 2000-2013, we investigated relapse risks and loss in expectation of lifetime at different milestones during follow-up. Five-year overall survival was 95% (95% CI 94;96). Five-year risk of relapse was 13.4% (95% CI 12.1;14.8) overall but decreased to 4.2% (95% CI 3.8;4.6) among patients who stayed even-free during the first two years from diagnosis. Relapse risk for patients treated with 6-8 courses of BEACOPP was comparable to that of patients treated with 6-8 courses of ABVD despite more adverse risk criteria among BEACOPP treated patients. In summary, real-world data on young HL patients from the Nordic countries show excellent outcomes, with a particularly favorable outlook for patients reaching even-free survival at 2 years, supporting limited relapse-oriented clinical follow-up.
Estimated 5-year relapse risk conditional on reaching event free survival milestones. The x-axis represents the event-free survival (EFS) milestone reached, and the y-axis shows the estimated risk of a relapse in the 5 years from the EFS milestone onward. eg, In all patients, the 5-year relapse probability measured from diagnosis onward was 10%. The 5-year relapse risk of patients who reached 2 years of EFS was 3.6% and decreased to 1.2% for patients who reached 5 years of EFS. (A) The 5-year relapse risk estimates were calculated and stratified by (B) age at diagnosis, (C) stage, (D) calendar period of diagnostic year, and (E) sex, (F) treatment for advanced stage patients
Cardiovascular risk after Hodgkin lymphoma
Treatment for Hodgkin lymphoma saves lives, but also leads to additional, treatment-related diseases. Here, the authors calculated the excess risk of diseases of the circulatory system (DCS) experienced by HL patients, compared with the risk expected for patients who have not had HL. Looking at patients diagnosed between 1985-2013, they found that incidence of treatment-related DCS decreased from 1985 through 1994, but leveled off after that. Patients treated since 2000 have elevated risk of a treatment-related DCS for up to 10 years. Less toxic treatment, or better prevention strategies, would be worth pursuing.
Pregnancy after Hodgkin lymphoma
Hodgkin lymphoma affects young adults and is today a curable disease with intensive chemotherapy. In this recent article, published in Journal of Clinical Oncology, we have investigated the childbearing potential in survivors after Hodgkin lymphoma. We show that in the absence of relapse, contemporarily treated women have an improved childbearing potential with calendar time and women treated today give birth to the same degree as matched comparators.
Diffuse Large B-cell Lymphoma
The impact of prognosis by comorbidity
Comorbidity impacts overall survival among patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. In this recent article, published in Journal of Internal Medicine, we have examined the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. We demonstrate that comorbidity is associated with inferior DLBCL outcome, mainly due to a lower likelihood of receiving treatment with curative intent. Among patients treated with curative intent, comorbidity only increased the risk of other-cause death, resulting in inferior overall but not lymphoma-specific survival. This demonstrates a need for effective treatments with a more tolerable toxicity profile for comorbid patients in particular, and optimization of comorbid conditions in parallel with DLBCL treatment.
Loss in expectation of life after Diffuse Large B-cell Lymphoma
Survival has improved among patients with diffuse large B-cell lymphoma (DLBCL) with the addition of anti-CD20 antibody therapy. In this article, published in the Americal Journal of Hematology, we illustrate recent gains and remaining unmet needs in DLBCL by measuring changes in loss in expectation of life over time. Despite improvements following the introduction of rituximab, continued large losses of life among young high-risk patients with primary refractory disease and early relapse as the most important challenges of current DLBCL practice.
|Elsa Brånvall||Doktorand, Forskarstuderande|
|Sara Ekberg||Forskarstuderande, Statistiker|
|Karin Ekström Smedby||Forskare|
|Sara Harrysson||Doktorand, Forskarstuderande|
|Renata Zelic||Doktorand, Forskarstuderande|