Significance of E-lesions in Hodgkin lymphoma and the creation of a new consensus definition:a report from SEARCH

The International Staging Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) seeks to provide an appropriate, universal differentiation between E-lesions and stage IV extranodal disease in Hodgkin lymphoma (HL). A literature search was performed through the PubMed and Google Scholar databases using the terms “Hodgkin disease,” and “extranodal,” “extralymphatic,” “E lesions,” “E stage,” or “E disease.” Publications were reviewed for the number of participants; median age and age range; diagnostic modalities used for staging; and the definition, incidence, and prognostic significance of E-lesions. Thirty-six articles describing 12 640 patients met the inclusion criteria. Most articles reported staging per the Ann Arbor (72%, 26/36) or Cotswolds modification of the Ann Arbor staging criteria (25%, 9/36), and articles rarely defined E-lesions or disambiguated “extranodal disease.” The overall incidence of E-lesions for patients with stage I-III HL was 11.5% (1330/11 602 unique patients). Available stage-specific incidence analysis of 3888 patients showed a similar incidence of E-lesions in stage II (21.2%) and stage III (21.9%), with E-lesions rarely seen with stage I disease (1.1%). E-lesions likely remain predictive, but we cannot unequivocally conclude that identifying E-lesions in HL imparts prognostic value in the modern era of the more selective use of targeted radiation therapy. A harmonized E-lesion definition was reached based on the available evidence and the consensus of the SEARCH working group. We recommend that this definition of E-lesion be applied in future clinical trials with explicit reporting to confirm the prognostic value of E-lesions.</p

A review of bottom-up and top-down emission estimates of hydrofluorocarbons (HFCs) in different parts of the world.

Hydrofluorocarbons (HFCs) are widespread alternatives for the ozone-depleting substances chlorofluorocarbons and hydrochlorofluorocarbons. They are used mainly as refrigerants or as foam-blowing agents. HFCs do not deplete the ozone layer, but they are very potent greenhouse gases, already contributing to global warming. Since 2019 HFCs are regulated under the Kigali Amendment to the Montreal Protocol, which demands reliable emission estimates to monitor the phase-down. Quantification of emissions is performed with two methods: bottom-up from product inventories or data on chemical sales; or top-down, inferred from atmospheric measurements by inverse modelling or interspecies correlation. Here, we review and compare the two methods and give an overview of HFC emissions from different parts of the world. Emission estimates reported by the different methods vary considerably. HFC emissions of developed countries (Annex I) are reported to the United Nations Framework Convention on Climate Change. These bottom-up estimates add up to only half of global emissions estimated from atmospheric data. Several studies with regional top-down estimates have shown that this gap is not owed to large-scale underreporting of emissions from developed countries, but mostly due to emissions from developing countries (non-Annex I). China accounts for a large fraction of the emissions causing the gap, but not entirely. Bottom-up and top-down estimations of emissions from other developing countries that could identify other large emitters are largely unavailable. Especially South America, West-, Central- and East-Africa, India, the Arabian Peninsula and Northern Australia are not well covered by measurement stations that could provide atmospheric data for top-down estimates

Initial cancer treatment and survival in children, adolescents, and young adults with Hodgkin lymphoma: A population‐based study

BackgroundHodgkin lymphoma (HL) is a treatable tumor affecting children, adolescents and young adults (AYAs; 15-39 years old). Population-based studies report worse survival for non-White children and AYAs but have limited data on individual therapeutic exposures. This study examined overall and HL-specific survival in a population-based cohort of patients while adjusting for sociodemographic factors and treatment.MethodsData for 4807 patients younger than 40 years with HL (2007-2017) were obtained from the California Cancer Registry. Individual treatment information was extracted from text fields; chemotherapy regimens were defined by standard approaches for pediatric and adult HL. Multivariable Cox models examined the influence of patient and treatment factors on survival.ResultsAt a median follow-up of 4.4 years, 95% of the patients were alive. Chemotherapy differed by age, with 70% of 22- to 39-year-olds and 41% of &lt;22-year-olds receiving doxorubicin, bleomycin, vinblastine, and dacarbazine (P &lt; .001). In multivariable models, older patients (22-39 vs &lt; 21 y; hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11-2.10), Black (vs White patients); HR, 1.90; 95% CI, 1.25-2.88), and Hispanic patients (HR, 1.45; 95% CI, 1.06-1.99) experienced worse survival; among those &lt; 21 y, Black race was associated with a 3.3-fold increased risk of death (HR, 3.26; 95% CI, 1.43-7.42).ConclusionsIn children and AYAs with HL, older age and non-White race/ethnicity predicted worse survival after adjustments for treatment data. Further work is needed to identify the biological and nonbiological factors driving disparities in these at-risk populations