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BMJ Case Reports May 2014Hodgkin's lymphoma complicating chronic ulcerative colitis is extremely rare. We report a case of extranodal Hodgkin's lymphoma involving rectosigmoid in a patient of...
Hodgkin's lymphoma complicating chronic ulcerative colitis is extremely rare. We report a case of extranodal Hodgkin's lymphoma involving rectosigmoid in a patient of chronic ulcerative colitis on long-term azathioprine. A 67-year-old man presented with extensive ulcerative colitis, on follow-up since September 2005. He received long-term steroids, mesalamine and azathioprine. Serial surveillance colonoscopic examinations and colonic biopsies were performed. Surveillance colonoscopy performed 8 years after the onset of disease showed multiple deep ulcers and nodular masses involving the rectum and sigmoid colon. Histological examination of rectosigmoid biopsies showed classic Hodgkin's disease. Azathioprine was withdrawn. He received mechlorethamine, vincristine, procarbazine and prednisone (MOPP) chemotherapy protocol and was planned for total colectomy in follow-up. We believe patients with ulcerative colitis on long-term azathioprine should be on vigil for development of lymphomas by protocol surveillance colonoscopic examinations and biopsies. The risk of lymphoma in such patients is small and outweighs the benefits of long-term azathioprine therapy.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Azathioprine; Colitis, Ulcerative; Hodgkin Disease; Humans; Immunosuppressive Agents; Male; Mechlorethamine; Prednisone; Procarbazine; Rectal Neoplasms; Sigmoid Neoplasms; Vincristine
PubMed: 24849639
DOI: 10.1136/bcr-2013-203354 -
British Journal of Cancer Jan 1992The peak incidence of Hodgkin's disease occurs during the reproductive age, and its association with pregnancy is at a rate of between 1:1,000-1:6,000. We studied the... (Comparative Study)
Comparative Study
The peak incidence of Hodgkin's disease occurs during the reproductive age, and its association with pregnancy is at a rate of between 1:1,000-1:6,000. We studied the effects of Hodgkin's Disease on the course and survival of 48 women who had Hodgkin's Disease and who were pregnant, and compared their outcome with non-pregnant matched women who were of similar stage of disease, age at diagnosis, and calenderic year of treatment. Twenty-year survival of pregnant women with Hodgkin's Disease was not different from that of their matched controls. Pregnant women with Hodgkin's Disease had similar distribution of stages to the controls.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Birth Weight; Case-Control Studies; Cesarean Section; Combined Modality Therapy; Delivery, Obstetric; Female; Follow-Up Studies; Gestational Age; Hodgkin Disease; Humans; Hydrocephalus; Infant, Newborn; Mechlorethamine; Prednisone; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome; Procarbazine; Vincristine
PubMed: 1733434
DOI: 10.1038/bjc.1992.21 -
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... Dec 2007The treatment strategies of Hodgkin's lymphoma (HL) are different according to clinical stage and risk factors, yet the optimal treatment strategy remains unclear. This...
BACKGROUND & OBJECTIVE
The treatment strategies of Hodgkin's lymphoma (HL) are different according to clinical stage and risk factors, yet the optimal treatment strategy remains unclear. This study was to analyze the treatment results and prognostic factors of stage IA HL.
METHODS
According to prognosis, 97 patients with stage IA HL were divided into 3 groups: 7 (7.2%) in very favorable (VF) group, 72 (74.2%) in favorable (F) group, and 18 (18.6%) in unfavorable (UF) group. Short-term treatment outcome and long-term survival were analyzed. The prognosis was analyzed with Cox regression model.
RESULTS
Median follow-up time was 65 months. After radiotherapy or radiochemotherapy, 90 patients (92.8%) achieved complete remission (CR). The 5-and 10-year overall survival (OS) rates were 87.7% and 76.3%; the 5-and 10-year disease-free survival (DFS) rates were 79.4% and 74.5%. The 5-and 10-year OS rates were 100% and 100% in VF group, 88.9% and 88.4% in F group, 78.1% and 39.1% in UF group (P=0.292). The 5-and 10-year DFS rates were 100% and 87.2% in VF group, 86.3% and 71.8% in F group, 73.6% and 34.5% in UF group (P=0.032). Cox analysis showed that pathologic type (P=0.056) and tumor relapse (P=0.011) influenced OS, and the response to primary treatment (P=0.024) influenced DFS. The relapse rate was 18.6%û there was no significant difference between the patients received radiotherapy alone and those received radiochemotherapy (Chi(2)=0.072, P=0.788). The occurrence rate of secondary malignancies was 5.2%, including 2 cases of non-Hodgkin's lymphoma. All the 12 patients who died had received radiotherapy alone.
CONCLUSIONS
More than 90% of stage IA HL patients can achieve CR with radiotherapy alone or chemoradiotherapy. The long-term OS and DFS of the patients who received radiochemotherapy are better than those of the patients who received radiotherapy alone. The pathologic type, response to primary treatment and tumor relapse may be independent prognostic factors of stage IA HL.
Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Combined Modality Therapy; Cyclophosphamide; Disease-Free Survival; Doxorubicin; Female; Follow-Up Studies; Hodgkin Disease; Humans; Lymphatic Metastasis; Male; Mechlorethamine; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Prednisone; Procarbazine; Radiotherapy, High-Energy; Remission Induction; Retrospective Studies; Survival Rate; Vincristine; Young Adult
PubMed: 18076802
DOI: No ID Found -
Blood May 1991The outcome of treatment for a first relapse of Hodgkin's disease after primary chemotherapy was analyzed in 80 patients. They were divided into four groups: group 1 (n...
The outcome of treatment for a first relapse of Hodgkin's disease after primary chemotherapy was analyzed in 80 patients. They were divided into four groups: group 1 (n = 24) had initially been treated with three cycles of (mechlorethamine, vincristine, prednisone, and procarbazine [MOPP]) and wide-field irradiation therapy; group 2 (n = 25) had six cycles of MOPP; group 3 (n = 15) and group 4 (n = 16) both initially received MOPP/ABVD (MOPP plus doxorubicin, bleomycin, vinblastine, and dacarbazine) or MOPP/ABV hybrid, but group 3 received conventional salvage regimens whereas group 4 was treated with high-dose chemotherapy and autologous bone marrow transplantation as salvage therapy (n = 16). Freedom from second failure (FF2F) was used as the major endpoint. Actuarial FF2F for all patients was 38% after a median follow-up of 75 months for patients who were alive. Risk factor analysis was performed on the 71 patients who had been treated with curative intent. The presence or absence of any one of three risk factors had a strong negative impact on outcome: stage IV disease at primary diagnosis, B symptoms at relapse, or a time from primary treatment to relapse of less than 1 year. Actuarial FF2F at 5 years was 17% in the group of patients with one or more of these three factors present (n = 49). If none of these factors was present, FF2F was 82% (n = 22) (P less than .001). Even high-dose chemotherapy and autologous bone marrow transplantation were not able to overcome the negative impact of one or more risk factors (FF2F = 19%, n = 12). The outcome of salvage treatments depends most on the presence or absence of these three risk factors and less on the type of salvage treatment. Patients with none of these risk factors present have an excellent outcome if they are treated with non-cross-resistant chemotherapy, or radiotherapy, or both. Novel approaches are needed for patients with one or more of these factors present. Reports on salvage treatments for Hodgkin's disease in first relapse after primary chemotherapy should include data on the proportion of patients having stage IV disease at diagnosis, B symptoms at relapse, and a time from primary treatment to relapse of less than 1 year.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Marrow Transplantation; British Columbia; Dose-Response Relationship, Drug; Doxorubicin; Female; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Prednisone; Procarbazine; Risk Factors; Time Factors; Vinblastine; Vincristine
PubMed: 1709382
DOI: No ID Found -
Blood Aug 1994Second primary cancers are a serious late occurrence for patients surviving Hodgkin's disease (HD). In addition to previously described risk factors such as age, gender,... (Comparative Study)
Comparative Study
Second primary cancers are a serious late occurrence for patients surviving Hodgkin's disease (HD). In addition to previously described risk factors such as age, gender, clinical stage, and treatment modalities, splenectomy was found to correlate with an increase in risk for secondary acute leukemia. We assumed that splenic irradiation inducing functional hyposplenia and splenectomy could have similar consequences on second cancer risk. We studied a series of 892 continuously disease-free HD adult patients treated at a single institution between 1960 and 1984. The risk of second cancer was analyzed (1) relative to the general population and (2) between risk subgroups using the Cox proportional hazards model. Fifty-six patients developed a second cancer (8 acute leukemias, 3 myelodysplastic syndromes, 8 non-Hodgkin's lymphomas, and 37 solid tumors; basal cell and in situ cervix carcinomas were excluded). The 15-year cumulative incidence rate (with 95% confidence limits) was 13.2% (9.3% to 17.2%). Relative to the general population incidence data, the risk of second cancer was multiplied by 4.68 (3.51 to 6.12; P < .001); it was multiplied by 2.80 (1.63 to 4.48; P < .001) in patients whose spleen was not treated and multiplied by 6.87 (4.81 to 9.51; P < .001) in splenectomized patients or patients whose spleen was irradiated. Multivariate regression analysis that controlled for confounding variables (age, gender, clinical stage, extent of radiation therapy, and chemotherapy regimen) showed that, in addition to age above 40 years (relative risk [RR] = 3.72; P < .001), combination of MOPP chemotherapy and regional irradiation (RR = 4.99; P = .015) and combination of MOPP chemotherapy and extended irradiation (RR = 10.86; P < .001), splenic irradiation (RR = 3.67; P = .003), and splenectomy (RR = 2.54; P = .018) also significantly correlated with an increased risk. The results of this hospital-based registry study strongly suggest that splenic irradiation and splenectomy might increase the risk for treatment-related second cancer. These findings, if confirmed, have to be considered in future HD treatment policies.
Topics: Adolescent; Adult; Age Factors; Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Female; Follow-Up Studies; Hodgkin Disease; Humans; Incidence; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Neoplasms, Second Primary; Prednisone; Procarbazine; Risk Factors; Sex Factors; Spleen; Splenectomy; Vincristine
PubMed: 8049435
DOI: No ID Found -
Journal of Cancer Research and... 2010Non Hodgkin's Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite...
BACKGROUND
Non Hodgkin's Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite of this, India is still battling with the prejudices of an economically and educationally impoverished patient base.
METHODS AND RESULTS
We analyzed NHL cases from 2000 to 2006 using data from case sheets. Of 303 cases, only 100 patients had complete workup and received some form of treatment. For 203 patients, reasons for non-compliance were: financial constraint (119), distance from center (38), inability of physician to provide guarantees of cure (13), poor prognosis/fear of recurrence (28)), preferences for alternate medicine (5). Most common investigations that could not be afforded for staging were whole body CT scans and bone marrow aspiration and biopsy. Thirteen patients were in stage III and 53 in Stage IV. The most common regimen was CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). Forty-five patients did not complete six courses of CHOP and 35 patients had significant delay. Reasons for delay were intermittent availability of cash (35), intolerable toxicities (30), absence of supportive care (21), given-up attitudes (17). Eighty-three patients suffered Grade III/IV debilitating toxicities. Overall survival at five years was 50%.
CONCLUSIONS
NHL in India is no different from the developed world. However, there are disparities in survivorship and outcomes, due to un-affordability and attitudes of the patients. Therefore, we suggest the development of Community Health Insurance Schemes (CHIs), with the hospital as the nodal center to address the above mentioned issues.
Topics: Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Developing Countries; Doxorubicin; Epirubicin; Etoposide; Health Knowledge, Attitudes, Practice; Healthcare Disparities; Humans; Ifosfamide; India; Leucovorin; Lymphoma, Non-Hodgkin; Methotrexate; Patient Compliance; Prednisone; Procarbazine; Vincristine
PubMed: 20479545
DOI: 10.4103/0973-1482.63571 -
Annals of Oncology : Official Journal... Jan 1991Two cycles of MOPP (mechlorethamine, vincristine (Oncovin), procarbazine, prednisone) and radiotherapy were used to treat 197 patients with stage III Hodgkin's disease....
Two cycles of MOPP (mechlorethamine, vincristine (Oncovin), procarbazine, prednisone) and radiotherapy were used to treat 197 patients with stage III Hodgkin's disease. Prior to 1980, radiotherapy was delivered to the mantle, abdomen and pelvis; thereafter, pelvic irradiation was deleted for patients with stage III1 disease. Complete remission rates for IIIA and IIIB presentations were 91% and 89%. The 10-year freedom from tumor mortality (FTM) rate for all patients was 81%; for IIIA, it was 87% and for IIIB, it was 72%. Results were not significantly affected by gender, age, pathology, or deletion of pelvic radiotherapy. However, a subgroup of 28 patients with a tumor burden that included pelvic disease who also had B symptoms was identified as having a poor prognosis. Their FTM was 43%, compared with 87% for all other patients combined (P = 0.002). Based on this analysis, we conclude that limited chemotherapy in combination with radiation therapy can yield results similar to programs that use more chemotherapy for all patients with IIIA disease and for most patients with stage IIIB. However, patients with tumor burdens which include pelvic disease and B symptoms require a different approach.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Female; Hodgkin Disease; Humans; Male; Mechlorethamine; Multivariate Analysis; Neoplasm Staging; Prednisone; Procarbazine; Recurrence; Remission Induction; Survival Rate; Vincristine
PubMed: 2009233
DOI: 10.1093/oxfordjournals.annonc.a057819 -
Annals of Oncology : Official Journal... Feb 1991The long-term therapeutic results achieved in a previous randomized study on stage IV Hodgkin's disease confirm the superiority of MOPP monthly alternated with ABVD... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The long-term therapeutic results achieved in a previous randomized study on stage IV Hodgkin's disease confirm the superiority of MOPP monthly alternated with ABVD compared to MOPP alone. To more closely meet the requirements of the Goldie and Coldman hypothesis, we activated a randomized study testing MOPP-ABVD through two different sequences in July 1982. One arm consisted of monthly alternating one cycle of MOPP and one cycle of ABVD; in the other arm, one half cycle of MOPP was alternated with one half cycle of ABVD within a one-month period (hybrid regimen). Each regimen was given to complete remission plus two consolidation cycles (minimum six cycles). After maximal tumor shrinkage, moderate doses of radiotherapy (25-30 Gy) were delivered to the lymphoid region(s) if bulky at the start of chemotherapy. A total of 300 patients with stage IB, IIA bulky, IIB, III (A + B) and IV Hodgkin's disease previously untreated with chemotherapy or failing after extensive irradiation were evaluated. At a median follow-up of five years, alternating and hybrid regimens yielded superimposable treatment outcomes: complete remission 89 versus 88%, freedom from first progression 65 versus 70%; relapse-free survival 72 versus 78%, overall survival 81 versus 80%, respectively. Tumor cell burden expressed as number of involved nodal sites and presence of pulmonary hilus involvement were the prognostic variables able to significantly influence treatment outcome. Conversely, stage, constitutional symptoms, and histology had no impact on the five-year results.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Dacarbazine; Doxorubicin; Drug Administration Schedule; Drug Resistance; Female; Follow-Up Studies; Hodgkin Disease; Humans; Lymphatic Metastasis; Male; Mechlorethamine; Neoplasms, Multiple Primary; Patient Compliance; Prednisone; Procarbazine; Prospective Studies; Radiotherapy Dosage; Recurrence; Remission Induction; Survival Rate; Vinblastine; Vincristine
PubMed: 1710921
DOI: 10.1007/978-1-4899-7305-4_9 -
Blood Sep 1998Autologous stem-cell transplantation has become a widely used therapy in Hodgkin's disease (HD). To appreciate the early and late risks associated with this procedure,...
Autologous stem-cell transplantation has become a widely used therapy in Hodgkin's disease (HD). To appreciate the early and late risks associated with this procedure, its lethal toxicity and effects on the incidence of secondary cancers were studied. Data related to 467 French patients grafted from 1982 to 1995 for primary sensitive disease (PSD, 22%), primary refractory disease (PRD, 18%), first relapse (R1, 45%), or subsequent relapses (R2, 15%) were analyzed. Grafted patients (PSD, PRD, and R1; n = 393) were matched (3 controls for 1 case) on age, gender, clinical stage, B symptoms, and time at risk with 1179 conventionally treated patients issued from international databases. The proportional hazards (Cox) model was used to assess relative risks (RR). Among grafted patients, 8% died of toxicity related to the procedure, and 18 secondary cancers occurred leading to a 5-year cumulative incidence rate of 8.9%. In this series, risk factors for second cancer were age >/=40 years (RR = 3.73, P = .007) and the use of peripheral blood stem cells as source of graft (RR = 3.10, P = .03). Among grafted and matched ungrafted patients, risk factors for the development of secondary cancer were age >/=40 years (RR = 2.90, P < .001), relapse versus no relapse (RR = 5.22, P = .006), PRD versus other patients (RR = 3.86, P = .033), and grafted versus ungrafted patients (RR = 2.04, P = . 024). Solid tumors were more frequent in grafted than in ungrafted patients (RR = 5.19, P = .001) although the incidence of myelodysplasia and acute myeloid leukemia was similar in the two groups. We conclude that high-dose chemotherapy administered as first-line treatment or after relapse is associated with an acceptable toxic death rate. The risk of secondary myelodysplasia or acute myeloid leukemia is not significantly increased after autologous stem-cell transplantation for HD, whereas an increased risk of solid tumors exists. The peripheral blood stem-cell-associated risk of secondary cancer among grafted patients needs further investigations.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Child; Female; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Male; Mechlorethamine; Middle Aged; Neoplasms, Second Primary; Prednisone; Procarbazine; Risk Factors; Transplantation, Homologous; Vincristine
PubMed: 9731050
DOI: No ID Found