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Hematology (Amsterdam, Netherlands) Apr 2007We have evaluated the best method to assess the ovarian reserve and the ovarian protective effect of GnRH-analog (GnRH-a), in 29 women with Hodgkin's disease (HD)... (Comparative Study)
Comparative Study Randomized Controlled Trial
We have evaluated the best method to assess the ovarian reserve and the ovarian protective effect of GnRH-analog (GnRH-a), in 29 women with Hodgkin's disease (HD) treated with chemotherapy (CHT). The ovarian reserve was studied by measuring the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, antimullerian hormone (AMH) and the ultrasound antral follicular count (AFC). The patients were randomly treated with or without GnRH-a. At the time of study menstrual function was normal in 21 cases (72.4%), but absent in 8 (27.5%). Mean basal values of FSH, LH, AMH, inhibin B and AFC were normal in patients less than 30 years old and in the group treated four years or less before observation. AFC appeared to be the best marker of reduced ovarian reserve and a combination of AFC-AMH or inhibin B appeared the best predictor. In the GnRH-a group, no women had amenorrhoea, although ovarian reserve assessment was not significantly different from those who were not treated. The time-interval from CHT was the only significant predictor of ovarian function in GnRH-a treated patients. In conclusion, ovarian reserve evaluation, in young patients treated by CHT, can be performed by AFC. GnRH-a treatment does not have a protective effect, but could delay the development of ovarian failure.
Topics: Adolescent; Adult; Amenorrhea; Anti-Mullerian Hormone; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dacarbazine; Dexamethasone; Doxorubicin; Female; Follicle Stimulating Hormone; Glycoproteins; Hodgkin Disease; Humans; Infertility, Female; Inhibins; Luteinizing Hormone; Mechlorethamine; Ovarian Follicle; Ovary; Predictive Value of Tests; Prednisolone; Prednisone; Primary Ovarian Insufficiency; Procarbazine; Sensitivity and Specificity; Survivors; Testicular Hormones; Time Factors; Triptorelin Pamoate; Ultrasonography; Vinblastine; Vincristine
PubMed: 17454195
DOI: 10.1080/10245330600954072 -
Orvosi Hetilap Apr 2007Recently, in the diagnostics and treatment of Hodgkin's disease significant developments have occurred.
INTRODUCTION
Recently, in the diagnostics and treatment of Hodgkin's disease significant developments have occurred.
AIM
To summarize the clinical and histological data of patients with Hodgkin's disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months.
METHODS
Patients data was analyzed by using SPSS statistical software.
RESULTS
The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin's disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%).
CONCLUSION
The treatment results of our Hodgkin's disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Chemotherapy, Adjuvant; Cyclophosphamide; Dacarbazine; Disease Progression; Disease-Free Survival; Doxorubicin; Etoposide; Female; Follow-Up Studies; Hodgkin Disease; Humans; Hungary; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Prednisone; Procarbazine; Prognosis; Radiotherapy, Adjuvant; Remission Induction; Retrospective Studies; Survival Analysis; Treatment Outcome; Vinblastine; Vincristine
PubMed: 17416575
DOI: 10.1556/OH.2007.27884 -
International Journal of Clinical... Feb 2007Malignant fibrous histiocytoma (MFH) originates from primitive mesenchymal cells and has the capacity for dual differentiation into histiocytes and fibroblasts. MFH...
Malignant fibrous histiocytoma (MFH) originates from primitive mesenchymal cells and has the capacity for dual differentiation into histiocytes and fibroblasts. MFH occurring as a secondary malignancy following radio-chemotherapy is rare and its exact incidence is not yet known. Here we report a case of a 42-year-old man who developed MFH in his right knee over a period of more than 10 years after radio (44 Gy)-chemotherapy to treat Hodgkin's lymphoma. After the diagnosis the patient did not return and was lost to follow-up. This is a rare case with unusual presentation, and it highlights the importance of the awareness and prevention of such secondary tumors.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Neoplasms; Chemotherapy, Adjuvant; Dacarbazine; Doxorubicin; Histiocytoma, Malignant Fibrous; Hodgkin Disease; Humans; Male; Mechlorethamine; Muscle Neoplasms; Neoplasms, Radiation-Induced; Prednisone; Procarbazine; Radiotherapy, Adjuvant; Vinblastine; Vincristine
PubMed: 17380442
DOI: 10.1007/s10147-006-0624-z -
Biology of Blood and Marrow... Oct 2006Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however,...
Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however, more than half of these patients eventually relapse and die of their disease. We studied long-term outcomes and evaluated factors influencing progression-free survival (PFS) in 141 patients with PR REF or REL HL who underwent ASCT between 1985 and 2003. Median age at ASCT was 30 years (range, 7-60 years); 21 patients had PR REF, and 120 had REL HL. With a median follow-up of 6.3 years (range, 1-20 years), the probability of PFS at 5 and 10 years was 48% (95% confidence interval [CI], 39%-57%) and 45% (95% CI, 36%-54%) and that of overall survival (OS) was 53% (95% CI, 44%-62%) and 47% (95% CI, 37%-57%), respectively. Transplant-related mortality at 100 days was 1.4%. Among 45 5- to 20-year survivors, no late relapses of HL were observed. In multivariate analysis, 3 factors were independently predictive of poor PFS: chemoresistant disease (relative risk [RR], 2.9; 95% CI, 1.7-5.0), B-symptoms at pretransplantation relapse (RR, 2.1; 95% CI, 1.3-3.4), and presence of residual disease at the time of transplantation (RR, 2.3; 95% CI, 1.1-4.8). Patients with 0 or 1 of these 3 adverse factors (low-risk disease) had a 5-year PFS of 67% (95% CI, 55%-79%) compared with 37% (95% CI, 22%-52%) in those with 2 factors (intermediate-risk group) and 9% (95% CI, 0-20%) in those with all 3 factors (high-risk group) (P < .001). The rates of OS at 5 years were 71% (95% CI, 60%-82%), 49% (95% CI, 33%-65%) and 13% (95% CI, 0-27%) in the 3 groups, respectively (P < .001). ASCT is associated with durable PFS in appropriately selected patients with PR REF or REL HL. Using a simple prognostic model, we can identify patients with high-risk disease who have predictably unfavorable outcome after ASCT and require novel therapeutic approaches. A risk-adapted approach should be followed in determining treatment options for patients with PR REF and REL HL.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Marrow Transplantation; Child; Combined Modality Therapy; Dacarbazine; Doxorubicin; Female; Follow-Up Studies; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Peripheral Blood Stem Cell Transplantation; Prednisone; Procarbazine; Prospective Studies; Recurrence; Risk; Salvage Therapy; Transplantation, Autologous; Treatment Outcome; Tumor Burden; Vinblastine; Vincristine
PubMed: 17084370
DOI: 10.1016/j.bbmt.2006.06.006 -
Ai Zheng = Aizheng = Chinese Journal of... Aug 2006Currently, 60% patients with advanced Hodgkin's lymphoma could be cured by receiving standard treatments. The international prognostic factor project on advanced...
BACKGROUND & OBJECTIVE
Currently, 60% patients with advanced Hodgkin's lymphoma could be cured by receiving standard treatments. The international prognostic factor project on advanced Hodgkin's lymphoma has developed a concept of international prognostic score (IPS) based on seven adverse prognostic factors consisting of male sex, age 45 years or older, stage IV disease, leukocytosis, lymphocytopenia, low hemoglobin and low serum albumin for newly diagnosed advanced Hodgkin's lymphoma patients. This study was to explore the feasibility of the international prognostic score in advanced Hodgkin's lymphoma.
METHODS
We performed a retrospective review of 141 patients with untreated advanced Hodgkin's lymphoma in Cancer Center of Sun Yat-sen University between January 1980 and December 2004. IPS was defined as the number of adverse prognostic factors presented at diagnosis. The rates of failure free survival (FFS) and overall survival (OS) were estimated using the method of Kaplan-Meier and compared according to IPS by log-rank test. Cox proportional hazard model was used in multivariate analysis.
RESULTS
The 5-year FFS and OS for 141 advanced Hodgkin's lymphoma patients were 57.6%, 68.1% respectively. Estimated 5-year FFS was 67.7%, 63.2%, 61.8%, 34.9% for patients with 0-1, 2, 3, > or =4 of the adverse prognostic factors respectively. Estimated 5-year OS was 81.0%, 75.5%, 70.3%, 42.3% for patients with 0-1, 2, 3, > or =4 of the adverse prognostic factors respectively. The 5-year FFS for low risk patients with IPS=0-2 and high risk patients with IPS> or =3 were 65.4%, 48.9% respectively (log-rank test: P=0.012); the 5 year OS for patients with IPS=0-2 and IPS> or =3 were 78.4%, 57.1% respectively (log-rank test: P=0.004). Low risk patients with IPS=0-2 had superior overall survival than high risk patients with IPS> or =3 when treated with ABVD or MOPP. The FFS and OS of the advanced HL patients at high risk treated with ABVD were better than those treated with MOPP. Multivariate analysis demonstrated that B symptoms, extranodal disease and MOPP chemotherapy were independent adverse prognostic factors for FFS and OS.
CONCLUSIONS
The IPS shows good prognostic power in advanced HL. High risk advanced HL patients treated with MOPP have inferior survival than those treated with ABVD, thus we recommend patients to be treated with ABVD or more intensive regimen.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Child; Child, Preschool; Combined Modality Therapy; Cyclophosphamide; Dacarbazine; Disease-Free Survival; Doxorubicin; Feasibility Studies; Female; Follow-Up Studies; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Prednisone; Procarbazine; Prognosis; Proportional Hazards Models; Remission Induction; Retrospective Studies; Vinblastine; Vincristine; Young Adult
PubMed: 16965685
DOI: No ID Found -
Zhonghua Zhong Liu Za Zhi [Chinese... Mar 2006To evaluate whether involved-field (IF) radiotherapy is equally effective and less toxic in comparison with extended-field (EF) radiotherapy for patients with... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate whether involved-field (IF) radiotherapy is equally effective and less toxic in comparison with extended-field (EF) radiotherapy for patients with early-stage Hodgkin's disease (HD) who received combined modality therapy.
METHODS
The data of 88 early-stage HD patients treated with combined modality therapy were retrospectively reviewed. According to Ann Arbor classification, 12 patients (13.7%) had stage IA disease, 56 stage IIA (63.6%), and 20 IIB (22.7%). Forty-two (47.7%) patients underwent involved field radiotherapy (IF group), whereas the other 46 (52.3%) received extended field radiotherapy (EF group).
RESULTS
Of 6 patients who developed recurrence, 3 (7.1%) were in IF group and the other 3 (6.5%) in EF group. Only one patient's recurrence developed inside the radiation field in EF group. Three patients (7.2%) in IF group and 9 (19.5%) in EF group had WHO grade 1 and 2 leukopenia (P = 0.089). Overall survival rate at 1-, 2- and 3-year was 100.0%, 97.1%, and 97.1% in IF group versus 100.0%, 100%, and 95.8% in EF group (P = 0.86), respectively. Freedom from progression survival rate at 1-, 2- and 3-year was 97.6%, 94.8%, and 91.7% in IF group versus 97.8%, 93.2%, and 93.2% in EF group (P = 0.65), respectively.
CONCLUSION
Compared with extended-field radiotherapy, involved-field radiotherapy is equally effective and less toxic for patient with early-stage Hodgkin's disease treated with combined modality therapy.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Dacarbazine; Doxorubicin; Female; Follow-Up Studies; Hodgkin Disease; Humans; Leukopenia; Lymphatic Irradiation; Lymphatic Metastasis; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Prednisone; Procarbazine; Recurrence; Retrospective Studies; Survival Rate; Vinblastine; Vincristine
PubMed: 16875611
DOI: No ID Found -
Annals of Hematology Oct 2006
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dexamethasone; Disease-Free Survival; Doxorubicin; Etoposide; Female; Follow-Up Studies; Humans; Leucovorin; Lymphoma; Male; Mechlorethamine; Methotrexate; Middle Aged; Prednisone; Procarbazine; Retrospective Studies; Time Factors; Vincristine
PubMed: 16838163
DOI: 10.1007/s00277-006-0138-9 -
Journal of Clinical Oncology : Official... Jun 2006To compare the clinical presentation, response to treatment, and long-term outcome of Hodgkin's lymphoma (HL) presenting in adolescents and young adults.
PURPOSE
To compare the clinical presentation, response to treatment, and long-term outcome of Hodgkin's lymphoma (HL) presenting in adolescents and young adults.
PATIENTS AND METHODS
The British Columbia Cancer Agency Lymphoid Cancer database was used to identify adolescents (16 years to 21 years) and young adults (22 years to 45 years) receiving primary treatment for HL between 1981 and 2004. All patients were treated using adult protocols.
RESULTS
The study population included 259 adolescents and 890 young adults. There were no significant differences in histologic subtypes, sex, stages, or presence of B symptoms or bulky disease between adolescents and adults. Equal proportions of adolescents and adults were treated with radiation alone (38% v 35%), chemotherapy alone (13% v 15%), or combined-modality programs (49% v 50%). There was no difference in progression-free survival (PFS) or overall survival (OS) between adolescents and adults, with 10-year PFS rates of 77% versus 80% (P = .67) and 10-year OS rates of 91% versus 89% (P = .42). In limited stage disease, 10-year PFS was 89% for adolescents and 89% for adults and OS 96% and 96%, respectively. In advanced stage disease, 10-year PFS was 71% for adolescents and 75% for adults and OS 88% and 86%, respectively. Actuarial risk of second malignancy for adolescents and adults was not different (P = .68).
CONCLUSION
Adolescents and young adults with HL have similar baseline characteristics and achieve similar outcomes when treated with the same protocols. The use of adult treatment protocols is a safe and effective strategy for treating adolescents with HL.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; British Columbia; Chemotherapy, Adjuvant; Dacarbazine; Disease-Free Survival; Doxorubicin; Female; Hodgkin Disease; Humans; Incidence; Male; Mechlorethamine; Medical Record Linkage; Neoplasm Staging; Neoplasms, Second Primary; Prednisone; Procarbazine; Prospective Studies; Radiotherapy, Adjuvant; Registries; Risk Assessment; Survival Analysis; Treatment Outcome; Vinblastine; Vincristine
PubMed: 16735704
DOI: 10.1200/JCO.2005.04.5823 -
Ai Zheng = Aizheng = Chinese Journal of... Apr 2006Reactive thymic hyperplasia following chemotherapy for malignant tumors is likely to be misdiagnosed as tumor residue or relapse, therefore, leads to unnecessary...
BACKGROUND & OBJECTIVE
Reactive thymic hyperplasia following chemotherapy for malignant tumors is likely to be misdiagnosed as tumor residue or relapse, therefore, leads to unnecessary treatment. This study was to analyze the clinical features of reactive thymic hyperplasia following chemotherapy for childhood malignant lymphoma.
METHODS
Clinical data of 13 children with reactive thymic hyperplasia following chemotherapy for malignant lymphoma, treated from Mar. 1999 to Mar. 2004, were retrospectively analyzed. Of the 13 cases, 5 were Hodgkin's disease (HD), and 8 were non-Hodgkin's lymphoma (NHL). All patients received computed tomography (CT) to evaluate the therapeutic effect. When a new thymic mass emerged, positive electron tomography/computed tomography (PET/CT) was performed to identify its quality.
RESULTS
At diagnosis, 10 patients had mediastinal involvement. Reactive thymic hyperplasia occurred following the completion of chemotherapy in 9 cases, or during the maintenance of chemotherapy in 4 cases. CT showed that the longest diameters of the new mediastinal masses were 2.2-6.0 cm (mean 3.7 cm). The interval from last chemotherapy cycle to the occurrence of thymic hyperplasia was 2-12 months (mean 4 months). PET/CT was performed to 5 cases, and showed no vital tumors in the mediastinum. Three cases were misdiagnosed as tumor residue or relapse, and received second-line therapy. All patients were followed-up for 1-6 years (median 4 years), and none suffered tumor relapse.
CONCLUSIONS
Reactive thymic hyperplasia may occur following intensive chemotherapy for childhood malignant lymphoma. It should not be misdiagnosed as malignant tumors and overtreated.
Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Child; Child, Preschool; Dacarbazine; Disease-Free Survival; Doxorubicin; Etoposide; Female; Follow-Up Studies; Hodgkin Disease; Humans; Ifosfamide; Lymphoma, Non-Hodgkin; Male; Mechlorethamine; Mediastinal Neoplasms; Positron-Emission Tomography; Prednisone; Procarbazine; Thymus Hyperplasia; Tomography, X-Ray Computed; Vinblastine; Vincristine
PubMed: 16613683
DOI: No ID Found -
Blood Jun 2006From 1989 to 1996, 533 eligible patients with stage IIIB/IV Hodgkin lymphoma (HL) were randomly assigned to receive 6 cycles of hybrid MOPP/ABV (mechlorethamine,... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
Long-term results and competing risk analysis of the H89 trial in patients with advanced-stage Hodgkin lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte (GELA).
From 1989 to 1996, 533 eligible patients with stage IIIB/IV Hodgkin lymphoma (HL) were randomly assigned to receive 6 cycles of hybrid MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone/Adriamycin [doxorubicin], bleomycin, vinblastine; n = 266) or ABVPP (doxorubicin, bleomycin, vinblastine, procarbazine, prednisone; n = 267). Patients in complete remission (CR) or partial response of at least 75% after 6 cycles received 2 cycles of consolidation chemotherapy (CT) (n = 208) or subtotal nodal irradiation (RT) (n = 210). A better survival probability was observed after ABVPP alone: the 10-year overall survival (OS) estimates were 90% for ABVPP x 8, 78% for MOPP/ABV x 8, 82% for MOPP/ABV with RT, and 77% for ABVPP x 6 with RT (P = .03); and the 10-year disease-free survival (DFS) estimates were 70%, 76%, 79%, and 76%, respectively (P = .09). The 10-year DFS estimates for patients treated with consolidation CT or RT were 73% and 78% (P = .07), and OS estimates were 84% and 79%, respectively (P = .29). These results showed that RT was not superior to consolidation CT after a doxorubicin-induced CR in patients with advanced HL. An analysis of competing risks identified age more than 45 years as a significant risk factor for death, relapse, and second cancers. Prospective evaluation of late adverse events may improve the management of patients with HL.
Topics: Adolescent; Adult; Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Disease-Free Survival; Doxorubicin; Evaluation Studies as Topic; Female; Hodgkin Disease; Humans; Longitudinal Studies; Lymphatic Irradiation; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Neoplasms, Second Primary; Prednisolone; Prednisone; Procarbazine; Recurrence; Retrospective Studies; Risk Factors; Vinblastine; Vincristine
PubMed: 16478882
DOI: 10.1182/blood-2005-11-4429