One hundred autotransplants for relapsed or refractory Hodgkin's disease and lymphoma: value of pretransplant disease status for predicting outcome.

PURPOSE One hundred autotransplants for Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) were examined prospectively to identify variables with prognostic significance. PATIENTS AND METHODS Ninety-six patients with relapsed or refractory HD or NHL underwent 100 autotransplants. Patients received high-dose carmustine (BCNU), etoposide, cytarabine, and cyclophosphamide (BEAC) followed by unpurged autologous stem-cell rescue. RESULTS The 3-year actuarial event-free survival (EFS) rate for the 47 HD patients is 49%, with a median followup duration of 2 years. For the 53 NHL patients, the 3-year actuarial EFS rate is 40%, with a median follow-up duration of 19 months. By multivariate analysis, minimal disease on admission (all areas < or = 2 cm) is associated with improved EFS (HD, P = .003, NHL, P = .03). The projected EFS rate for HD patients entering with minimal disease is 70% versus 15% for patients with bulky disease (P = .0001). The projected EFS rate for NHL patients with minimal disease is 48% versus 25% for patients with bulky disease (P = .04). Posttransplant involved-field radiotherapy, administered to 26 of the last 61 patients, was associated with an improved EFS rate for NHL patients (P = .015). The BEAC regimen was well tolerated by patients who entered the study with minimal disease (mortality rate, < 5%), but caused significant toxicity in patients with bulky disease (mortality rate, 25%). CONCLUSION Disease burden before autotransplantation is an important predictor of regimen-related toxicity and EFS. Posttransplant involved-field radiotherapy may improve outcomes in select patients with NHL. The BEAC regimen is safe and effective, particularly for patients with minimal disease.

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Treatment of 49 Unrandomized Patients with Advanced Hodgkin's Disease

Tumori Journal ◽

10.1177/030089168306900515 ◽

1983 ◽

Vol 69 (5) ◽

pp. 463-467

Author(s):

Teodoro Chisesi ◽

Orlando Ricciardi ◽

Sandra Dal Fior ◽

Francesco Cappellari ◽

Franco Pozza ◽

...

Keyword(s):

Hodgkin's Disease ◽

Adjuvant Radiotherapy ◽

Hodgkin’S Disease ◽

Treatment Modalities ◽

Significant Difference ◽

Involved Field ◽

Involved Field Radiotherapy ◽

Abvd Chemotherapy ◽

Advanced Hodgkin’S Disease

Forty-nine patients with previously untreated advanced Hodgkin's disease were treated in our Institution between 1973 and 1981. Treatment modalities of these patients were reviewed, and they were divided into 3 groups according to the treatment employed: 13 patients received MOPP only, 22 patients received MOPP plus involved field radiotherapy, and 14 received alternating MOPP/ABVD chemotherapy. The response rates for the 3 groups were respectively 38.5%, 63.6% and 78.6%. A longer follow-up is needed to assess a significant difference in survival curves. The advantages of adjuvant radiotherapy and alternating non-cross-resistant drugs in advanced Hodgkin's disease are discussed.

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Assessment of the Stanford V Regimen and Consolidative Radiotherapy for Bulky and Advanced Hodgkin’s Disease: Eastern Cooperative Oncology Group Pilot Study E1492

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.5.972 ◽

2000 ◽

Vol 18 (5) ◽

pp. 972-972 ◽

Cited By ~ 89

Author(s):

Sandra J. Horning ◽

Jovanne Williams ◽

Nancy L. Bartlett ◽

John M. Bennett ◽

Richard T. Hoppe ◽

...

Keyword(s):

Hodgkin's Disease ◽

Chemotherapy Regimen ◽

Hodgkin’S Disease ◽

Eastern Cooperative Oncology Group ◽

Institutional Setting ◽

High Dose ◽

Oncology Group ◽

Bulky Disease ◽

Consolidative Radiotherapy ◽

Advanced Hodgkin’S Disease

PURPOSE: This study was performed, in a multi-institutional setting, to evaluate the efficacy and feasibility of the Stanford V chemotherapy regimen plus radiotherapy to bulky Hodgkin’s disease sites. PATIENTS AND METHODS: A two-stage design was implemented in a phase II study involving 47 patients with bulky mediastinal stage I/II or stage III/IV Hodgkin’s disease. Twelve weeks of the Stanford V chemotherapy regimen were given with consolidative radiotherapy (36 Gy) to lymph nodes ≥ 5 cm and/or macroscopic splenic disease. Treatment was administered in one of five institutions participating in the Eastern Cooperative Oncology Group. RESULTS: With a median follow-up of 4.8 years, 45 patients are alive and 40 have been continuously disease-free. The estimated freedom from progression was 87% at 2 years and 85% at 5 years. Overall survival was 96% at 2 and 5 years. There was one death from Hodgkin’s disease and one death from an M5 acute leukemia. Six of seven relapsed patients received high-dose therapy and autologous stem-cell transplantation. The freedom from second progression for the seven relapsed patients was estimated at 98% at 3 years. CONCLUSION: Stanford V chemotherapy and consolidative radiotherapy to bulky disease is effective in bulky and advanced Hodgkin’s disease in a multi-institutional setting. On this basis, an Intergroup study comparing doxorubicin, bleomycin, vinblastine, and dacarbazine with the Stanford V regimen has been initiated.

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Patients with stage III/IV Hodgkin's disease in partial remission after MOPP/ABV chemotherapy have excellent prognosis after additional involved-field radiotherapy: Interim results from the ongoing EORTC-LCG and GPMC phase III trial

Annals of Oncology ◽

10.1093/annonc/8.suppl_1.s111 ◽

1997 ◽

Vol 8 ◽

pp. S111-S114 ◽

Cited By ~ 20

Author(s):

J. Raemaekers ◽

M. Burgers ◽

M. Henry-Amar ◽

A. Pinna ◽

A. Mandard ◽

...

Keyword(s):

Hodgkin's Disease ◽

Partial Remission ◽

Hodgkin’S Disease ◽

Phase Iii ◽

Stage Iii ◽

Phase Iii Trial ◽

Involved Field ◽

Involved Field Radiotherapy

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Efficacy of Abbreviated Stanford V Chemotherapy and Involved Field Radiotherapy in Early Stage Hodgkin's Disease: Mature Results of the G4 Trial.

Blood ◽

10.1182/blood.v114.22.1670.1670 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1670-1670 ◽

Cited By ~ 4

Author(s):

Ranjana H Advani ◽

Richard T Hoppe ◽

David M. Baer ◽

Joseph Mason ◽

Saul A Rosenberg ◽

...

Keyword(s):

Colon Cancer ◽

Hodgkin's Disease ◽

Early Stage ◽

Hodgkin’S Disease ◽

Stage I ◽

Metastatic Colon Cancer ◽

Eortc Criteria ◽

Grade 3 ◽

Involved Field ◽

Involved Field Radiotherapy

Abstract Abstract 1670 Poster Board I-696 The standard management for early stage Hodgkin's disease (HD) is combined modality therapy. In the G4 protocol, patients (pts) with non-bulky, supra-diaphragmatic stage I-IIA disease received 8 weeks of Stanford V chemotherapy + 30 Gy involved field radiotherapy (IFRT). 87 pts were enrolled and treated between 4/1996 and 4/2001. Median age was 30 years (16-59) and stages were IA (n=23), IIA (n=64). Unfavorable risk factors were present in 47 patients (54%) according to German Hodgkin Study Group (GHSG) criteria (> 2 AA sites, ESR > 50 or EN involvement) and 38 (44%) according to EORTC criteria (> 3 AA sites, ESR > 50). Therapy was well tolerated with grade 3-4 non-hematologic toxic events in 7 % of pts. These included constipation (n=3), peripheral neuropathy (n=1), generalized weakness (n=2), chest pain (n=1), mylagias (n=1), abdominal pain (n=1) and an allergic reaction to etoposide (n=1). 42 patients received cytokine support for grade 3-4 neutropenia however only 2 pts developed fever with neutropenia. No cases of clinical bleomycin toxicity or radiation pneumonitis were observed. At a median follow-up of 9 (2-12) years, freedom from progression (FFP) and survival (OS) are 94% and 96% respectively. FFP was 100% for favorable and 89% for unfavorable patients by GHSG criteria (p=0.04) with no differences in OS (96.9% versus 95.7%). All relapses (n=5) occurred in the RT field: limited in 2 patients and combined with distant disease in 3 pts. All relapses were in “unfavorable” risk patients: 5 per GHSG and 4 per EORTC criteria. Secondary therapy included chemotherapy followed by high dose therapy and stem cell support (n=3) and ABVD (n=2). Three pts died, 2 due to disease progression after second-line therapy and one due to metastatic colon cancer. 5 patients developed a second cancer (2 breast, 2 melanomas at unirradiated sites and 1 colon cancer). The cases of breast cancer were considered unrelated to RT as both occurred within 5-years of therapy in women who were > 30 yrs at time of treatment. No secondary AML and no late cardiac or pulmonary toxicities have been observed. In conclusion, for pts with non-bulky stage I/II A HD, abbreviated Stanford V with 8 weeks of chemotherapy and 30 Gy IFRT is a safe and highly effective regimen. It is still too early to assess potential RT-related complications. Our outcomes in “unfavorable” stage I-IIA patients without bulky or symptomatic disease compare favorably with more intensive or prolonged regimens employed by the GHSG and EORTC. Disclosures No relevant conflicts of interest to declare.

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Clinical outcome of pediatric Hodgkin’s disease in upper Egypt

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.9035 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 9035-9035 ◽

Cited By ~ 2

Author(s):

E. N. Ebeid ◽

M. Zaghloul ◽

M. Khairy

Keyword(s):

Bone Marrow ◽

Clinical Outcome ◽

Rural Areas ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Supportive Therapy ◽

High Rate ◽

Secondary Malignancy ◽

Involved Field ◽

Involved Field Radiotherapy

9035 Background: To assess clinical outcome of chemotherapy and involved field radiotherapy in all stages of pediatric Hodgkin’s Disease in rural areas of Egypt treated at Menya oncology centre which is located 300km south the capital. Methods: Between April 2000 and November 2005, 27 previously untreated patients were investigated, treated and analyzed for remission and survival. Results: There were 21 males and 6 girls with a median age of 11 years, 29.6% were less than 10 years, 70.3% had advanced stage disease (IIB-IV), bulky mediastinal mass in 19 cases spleen involvement in 6 cases, bone marrow aspirate was free in all cases, bone marrow biopsy was not done. patients with stage I and IIA received 2 courses of EOPA (etopsid, vincristine, prednisone and doxorubicin), patients with stage IIb and IIIa received 2 courses of EOPA and 2 courses of ECOP (etopsid, cyclophophamide, vincristine and prednisone), while patients with stage IIIb and IV received 2courses of EOPA and 4 courses of ECOP, All patients received involved field radiotherapy according to stage. Complete remission was achieved in 96.2%. Progressive disease in 1 (3.7%) which required change line of therapy. Out of the 27 patients 3 (11.1%) have relapsed (17, 22 and 25 months) post completion of chemotherapy and were treated with another line of chemotherapy. The 2 years DFS was 90.9% with 95% of CI (73%-100%). Treatment was given outpatient, with no supportive therapy or toxic deaths and no secondary malignancy from etopsid Conclusions: This regimen provides high rate of durable remission in rural areas of Egypt with limited resources (drugs availability and supportive measures). No significant financial relationships to disclose.

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Chemotherapy Combined with Involved-Field Radiotherapy for 177 Children with Hodgkin's Disease Treated in 1983–1987

Pediatrics International ◽

10.1111/j.1442-200x.1991.tb02594.x ◽

1991 ◽

Vol 33 (6) ◽

pp. 703-708 ◽

Cited By ~ 5

Author(s):

Walentyna Balwierz ◽

Jerzy Armata ◽

Angelina Moryl-Bujakowska ◽

Teresa Depowska ◽

Anna Najbar ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Involved Field ◽

Involved Field Radiotherapy

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1005 poster Inter-clinician variability in treatment definition for involved-field radiotherapy of advanced Hodgkin's disease; results from the UK Stanford V vs. ABVD clinical trial quality assurance programme

Radiotherapy and Oncology ◽

10.1016/s0167-8140(04)82872-x ◽

2004 ◽

Vol 73 ◽

pp. S423

Keyword(s):

Clinical Trial ◽

Quality Assurance ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Quality Assurance Programme ◽

Trial Quality ◽

The Uk ◽

Involved Field ◽

Involved Field Radiotherapy ◽

Advanced Hodgkin’S Disease

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Secondary acute myelogenous leukemia following safe exposure to etoposide.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1583 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1583-1586 ◽

Cited By ~ 52

Author(s):

K C Stine ◽

R L Saylors ◽

J R Sawyer ◽

D L Becton

Keyword(s):

Acute Myelogenous Leukemia ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Disease Patient ◽

Myelogenous Leukemia ◽

Chromosome 11 ◽

Acute Myelogenous ◽

Involved Field ◽

Involved Field Radiotherapy ◽

French American British

PURPOSE To present two patients as illustrations of the risk of developing secondary acute myelogenous leukemia (sAML) when theoretically safe doses of etoposide (VP-16) are used. PATIENTS AND METHODS Patient no. 1 was a 15-year-old white girl diagnosed with stage IIa Hodgkin's disease. She was treated with a combination of vincristine, doxorubicin, bleomycin, and VP-16 (2 g/m2 total) over 4 months, followed by 25.5 Gy of involved-field radiotherapy. Patient no. 2 was an 11-year-old white boy diagnosed with virus-associated hemophagocytic syndrome (VAHS). He was treated with VP-16 intravenously (IV) and orally (0.3 g and 2.8 g/m2, respectively). RESULTS Patient no. 1 developed AML 16 months from the diagnosis of Hodgkin's disease. Patient no. 2 developed AML 26 months from diagnosis. Both bone marrows were consistent with French-American-British (FAB) M4 disease. Both patients had abnormalities of the long arm of chromosome 11. CONCLUSION The use of low-dose or oral VP-16 can be associated with the development of sAML. Clinicians should be cautious in the use of VP-16 in low-risk diseases.

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