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No universal gold standard chemotherapy exists for the treatment of older (≥60 years) patients with classical Hodgkin lymphoma (cHL). To evaluate the current curative treatment strategies used in the Nordic countries, we collected data from patients diagnosed in Sweden, Denmark and Norway during the years 2000 to 2021. We included 1569 patients: 704 (45%) Swedish, 671 (43%) Danish, and 194 (12%) Norwegian. Of these, 671 (43%) received doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), 123 (8%) received doxorubicin, vinblastine, and dacarbazine (AVD), 465 (31%) received cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and 212 (13%) received other chemotherapy (single agent or combination). Eighty-two (5%) patients lacked information on first-line regimen. In multivariable analyses of overall survival (OS), treatment with AVD was associated with improved survival compared to ABVD, whereas there was a trend toward inferior survival among patients receiving CHOP or other regimens. For progression-free survival (PFS), multivariable analysis likewise demonstrated significantly improved outcome with AVD relative to ABVD, whereas outcomes for the CHOP group were comparable to ABVD. Outcome for patients receiving other regimens tended to be poorer. Collectively, outcome for AVD with respect to both OS and PFS was at least equal to ABVD and often superior to CHOP. By omitting bleomycin, treatment-related toxicity is known to be reduced in AVD compared to ABVD. Based on our findings, AVD is a preferable chemotherapy option in older patients with cHL and should rightly be considered as backbone in treatment with novel drugs.

Objective: Retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancer is a complex procedure associated with postoperative complications and long-term morbidity, best performed by experienced surgeons at high-volume centers. This study evaluates surgical outcomes of RPLND in a centralized population-based cohort.

Methods: This is a retrospective analysis of a prospective multicenter cohort of all RPLNDs in Sweden between 2018 and 2022. 217 patients (175 nonseminomas and 42 seminomas) underwent unilateral or bilateral primary RPLND or post-chemotherapy RPLND. Primary outcomes were complications, loss of ejaculation, and histopathology.

Results: Intraoperative complications occurred in 8% of unilateral and 0% of bilateral templates in primary RPLND, and in 0 and 8% in post-chemotherapy RPLND, most commonly renal injury. Postoperative complications rate was significantly higher with bilateral templates in post-chemotherapy RPLND (49% vs 18%, p < 0.01). Clavien-Dindo >= IIIb complications occurred in 2 (primary) and 3% (post-chemotherapy), respectively. Loss of ejaculation was numerically more common after bilateral templates (primary: 60% vs 31%, p = 0.07; post-chemotherapy: 53% vs 38%, p = 0.09). Viable cancer was found in 95% of seminomas and 52% of nonseminomas for primary RPLND and in nonseminoma post-chemotherapy RPLND, 11% viable cancer, 50% teratoma, and 39% benign nodes. Robotic surgery did not increase complications or loss of ejaculation.

Conclusions: RPLND demonstrated low complication rates and rare serious events. Bilateral templates were associated with increased loss of ejaculation. Robotic surgery was safe, and prior chemotherapy did not preclude laparoscopy. Post-chemotherapy RPLND showed more teratoma and viable cancer, and fewer benign findings than previously reported.

Background

Accreditation of cancer centres aims to deliver high-quality, person-centered care and underscores the integration with education, research, and innovation. Over the past decade, cancer centres in the Nordic countries have engaged in accreditation processes through the Organisation of European Cancer Institutes (OECI).

Objective

This study provides an overview of a rapidly evolving landscape, highlighting strengths, revealing opportunities and defining areas for improvement.

Methods

All cancer centres in Denmark, Finland, Norway, and Sweden that had completed accreditation by the OECI were eligible for the study. Strengths, gaps, and areas for improvement were identified through systematic analysis of accreditation applications, evaluation reports, and improvement plans.

Results

Ten cancer centres that had completed the OECI accreditation process were included. Accreditation reports showed 79–95% affirmative scores across standards. High levels of maturity were observed for standards within prevention and early detection, diagnosis and treatment, and education and training. In contrast, gaps were identified in governance, quality systems, multidisciplinarity, patient partnership, and research. Areas for improvement were centre-specific, though recurrent actions related to access to quality dashboards, patient involvement, patient pathways, clinical trials and systematic evaluation of research performance.

Conclusion

Accredited cancer centres have become an increasingly important component of cancer control efforts in the Nordic countries. The quality benchmarks and improvement points identified serve as a foundation for collaborative development of cancer centres services and infrastructures.

Studies on mantle cell lymphoma (MCL) emphasize that patients with progression of disease (POD) <= 24 months have inferior prognosis compared to patients with later POD. This population-based study assessed the impact of POD on overall survival (OS) by timing of progression and first-line treatment. A total of 1186 MCL patients diagnosed 2006-2018 were identified in the Swedish lymphoma register. POD was defined as progressive disease after first-line treatment or relapse following initial response. Hazard ratios (HRs) with 95% confidence intervals (CIs), comparing all-cause mortality among patients with and without POD, were estimated with Cox regression. An illness-death model was used to quantify the impact of timing of progression on OS, conditional on the timepoint of POD/PF (progression-free). Patients were followed for up to 10 years following treatment (median 3.7 years). BR, Nordic MCL2, and R-CHOP/R-CHOP-like treatment were administered to 33%, 30%, and 14% of patients. Almost half (48%, n = 572) of patients experienced POD, with consequently higher mortality, regardless of timing and treatment (adjusted HR = 7.56, 95% CI: 6.32-9.05). Importantly, even for patients with POD after 6-10 years, mortality was more than two-fold increased (HR = 2.67, 95% CI: 1.05-6.79). On the absolute scale, a survival difference persisted for progression occurring up to 9 years after primary treatment. Especially early but also late progression (well beyond the 24-month mark) has a large negative impact on survival in MCL. These results highlight the need for improved first-line, including maintenance therapies to sustain remission and optimize outcomes for MCL patients.

Current epidemiological thinking is that classic Hodgkin lymphoma (cHL) comprises multiple aetiologically distinct disease entities that may in part be defined by either histological subtype or the presence of Epstein-Barr virus (EBV) in the malignant cells, or by both. This study aimed to advance our understanding of epidemiological differences between cHL subtypes, in particular EBV-positive and EBV-negative cHL. We retrospectively collected and EBV-typed 1992 cHL primary tumour tissues from among all 2811 patients diagnosed with incident HL in Denmark in the period 1990 through 2010 'Hodgkin lymphoma in Denmark' [HOLYDAN] project. Based on characteristics of retrieved samples combined with additional information from national registers, we projected nationwide age-, sex-, histology- and EBV-specific cHL incidence rates. The analyses demonstrated age- and sex-dependent variation in histology- and EBV-tumour status-specific cHL incidence rates, details of which yielded new aetiological clues. cHL incidence increased markedly around the age of puberty, irrespective of histological subtype and EBV status. The incidence of all subtypes of cHL increased with age after age 50 years, with the exception of EBV-negative nodular sclerosis cHL in females, which therefore showed a single peak in incidence and was higher than in males among young adults. These results were obtained in a small homogeneous population and might, therefore, only apply to rich, industrialised, Western populations. Nevertheless, we propose that puberty creates an immunological host environment conducive to cHL development irrespective of EBV status and histology, and that age-related decline in immune function facilitates the development of both EBV-positive and EBV-negative cHL.

BACKGROUND: World-wide consensus is lacking regarding patient selection and timing of high-dose chemotherapy (HDCT) with autologous stem-cell support in males with germ cell cancer (GCC). However, within the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) guidelines are harmonised. Our aim was to evaluate survival and toxicity in HDCT-treated GCC-patients within SWENOTECA.

METHODS: In total, 7322 GCC patients were diagnosed between 2011-2021 in Sweden and Norway, among which 80 (∼1.1%) patients were treated with HDCT. Indications for HDCT were: Delayed tumour-marker decline during primary/intensified primary treatment (n = 45), progressive disease (n = 29), or relapse (n = 25). The HDCT-regimen consisted of two cycles of carboplatin/etoposide.

RESULTS: The 5-year overall survival (5-yr OS) and progression-free survival (5-yr PFS) after HDCT was 55% and 43%, respectively. Indication delayed tumour-marker decline: 5-yr OS:75%, 5-yr PFS:53%, indication progressive disease 5-yr OS:29%, 5-yr PFS:18%, indication relapse 5-yr OS:61%, 5-yr PFS:58%. Four (5%) died due to HDCT-related complications, none within the delayed tumour-marker decline group. Grade 3-4 infections were seen in n = 69, 86%.

CONCLUSION: HDCT-treatment according to the SWENOTECA-programme was feasible and associated with promising OS. Early intensification to HDCT for patients with delayed tumour-marker decline during primary-treatment was safe and led to 5-yr OS of 75% with no toxic deaths.

Introduction

Patients with multiple myeloma (MM) and chronic lymphocytic leukaemia (CLL) are burdened by immunodeficiency due to treatment and underlying disease. Infection-related mortality remains a significant concern for patients' overall survival (OS).

Methods

This Swedish, population-based study examined incidence of infections and OS in patients with MM or CLL between January 2010 and December 2021, using Swedish Cancer Registry data.

Results

Overall, 15,766 patients were included (MM: 8532; CLL: 7234); the majority were male (MM: 57%; CLL: 62%); median age was 71 years (range: 19–100 [MM]; 23–102 [CLL]). The proportion with a Charlson Comorbidity Index ≥ 5 was 37% (MM) and 25% (CLL). At least one infection was reported in 66% (MM; n = 5618) and 50% (CLL; n = 3618), with a median follow-up of 3.3 and 4.8 years, respectively. Pneumonia was the most common bacterial infection (21% for both), while herpes zoster was the most common specified viral infection (MM: 2.6%; CLL: 3.5%). Median OS (95% confidence interval) among these patients was 4.7 (4.6–4.9) and 9.7 (9.3–10.2) years, respectively. Infection (any) was the underlying/contributing cause of death for 1251/4822 (26%) deceased patients (MM) and 835/2571 (33%) (CLL). Higher comorbidity, prior infection and prophylaxis were associated with increased infection risk, while age, female sex and more recent diagnosis were associated with reduced risk.

Conclusions

This study demonstrates high mortality rates among patients with MM and CLL, due to underlying malignancy and high infection burden. This emphasises the need for optimised anticancer treatments and infection control strategies.

The tick-borne bacterium Neoehrlichia (N.) mikurensis causes latent infections that can become symptomatic when B-cell defenses are compromised. We investigated the prevalence of N. mikurensis in two cohorts of Swedish patients: a prospective cohort (n = 186) evaluated for lymphoma and a retrospective cohort (n = 198) diagnosed with seven lymphomas. Samples were tested for N. mikurensis by PCR. Nine of 116 patients (7.8%) diagnosed with lymphoma in the prospective cohort, and 7/198 (3.5%) in the retrospective cohort had a concomitant N. mikurensis infection. Indolent lymphomas, particularly marginal zone lymphoma (9.3%), were frequently coupled with N. mikurensis infection. Males had higher risk of having lymphoma and N. mikurensis infection. N. mikurensis was diagnosed in 3.2% of patients without lymphoma, making it the most common infectious differential diagnosis for possible lymphoma. This emerging pathogen should therefore be considered as a differential diagnosis for patients with suspected lymphoma in N. mikurensis-endemic regions.