Effectiveness of Repeat Glycerol Rhizotomy in Treating Recurrent Trigeminal Neuralgia

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1125-1134 ◽  
Author(s):  
Matthew Bender ◽  
Gustavo Pradilla ◽  
Sachin Batra ◽  
Alfred See ◽  
Neal Bhutiani ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Median Time ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Time To Treatment ◽  
Cox Regression Analysis ◽  
Sensory Change ◽  
Time To Treatment Failure

Abstract BACKGROUND: Percutaneous glycerol rhizotomy (GR) is used to treat trigeminal neuralgia (TN), with satisfactory pain relief lasting 2 to 3 years in most patients after the first intervention. The efficacy of subsequent GRs, however, has not been studied. OBJECTIVE: To compare the pain relief and durability achieved by the first GR with those obtained after subsequent GRs in a retrospective cohort of TN patients. METHODS: Between 1998 and 2010, 548 patients with TN underwent 708 GRs. After exclusions, 430 initial GRs (GR1) and 114 subsequent GRs (GR2+) were compared in terms of initial pain relief, durability, sensory change, and complications. Durability was assessed by determining median time to treatment failure for all GRs achieving complete pain relief without medications (n = 375: 264 failures, 111 censored). Predictors of initial pain relief were assessed by logistic regression, and predictors of failure were assessed by Cox regression analysis. RESULTS: After GR1, pain relief results were as follows: 285 patients (66%) were pain free without medications, 26 (6%) were pain free with medications, 66 (15%) improved, and 53 (12%) were unchanged. After GR2+, results were as follows: 90 patients (79%) were pain free without medications, 6 (5%) were pain free with medications, 7 (6%) improved, and 11 (10%) were unchanged (P = .03). Median time to treatment failure was 26 months after GR1 and 25 months after GR2+ (P = .34). On multivariate analysis, prior GR was a positive predictor of initial pain relief (odds ratio, 2.067; 95% confidence interval, 1.243-3.437; P = .005) and had no effect on durability. CONCLUSION: TN patients experienced greater pain relief and equivalent durability after GR2+ beyond the initial treatment.

scholarly journals DOP81 Time to loss of efficacy among patients in remission following induction treatment with tofacitinib 10 mg BID who reduced tofacitinib dose or discontinued tofacitinib in OCTAVE sustain

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S120-S121
Author(s):  
M C Dubinsky ◽  
J W Chou ◽  
C Su ◽  
W Wang ◽  
I Modesto ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Clinical Response ◽  
Median Time ◽  
Induction Treatment ◽  
Phase 3 ◽  
Time To Treatment ◽  
Mayo Score ◽  
Kaplan Meier ◽  
Point Increase ◽  
Time To Treatment Failure

Abstract Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Safety and efficacy of tofacitinib were evaluated in two Phase 3 induction studies (OCTAVE Induction 1 and 2; NCT01465763, NCT01458951), a 52-week, Phase 3 maintenance study (OCTAVE Sustain, NCT01458574) and an ongoing, open-label, long-term extension study (NCT01470612).1,2 Here, we assess time to treatment failure among patients in remission at the end of OCTAVE Induction 1 and 2 who enrolled in OCTAVE Sustain. Methods In OCTAVE Induction 1 and 2, patients received placebo or tofacitinib 10 mg twice daily (BID) for 8 weeks; clinical responders were re-randomised to placebo, tofacitinib 5 or 10 mg BID in OCTAVE Sustain for 52 weeks. Kaplan–Meier method was used to estimate median time to treatment failure (withdrawal due to insufficient clinical response) in patients who received 10 mg BID in induction studies and entered OCTAVE Sustain in remission (total Mayo score ≤2 with no subscore >1, and rectal bleeding subscore [RB] 0). Treatment failure: ≥3-point increase from baseline total Mayo score, plus ≥1-point increase in RB and endoscopic subscore (ES; centrally read) and absolute ES ≥2 after ≥8 weeks of maintenance therapy. Results Following induction, 156 patients in remission entered OCTAVE Sustain and received tofacitinib 5 mg BID (N = 57) or 10 mg BID (N = 50), or placebo (N = 49). Estimated treatment failure rates are reported in the table. At Week 52, Kaplan–Meier rates of treatment failure were higher in patients who switched to placebo (81.8% [95% confidence interval 67.0, 90.4]) vs. those who continued to receive tofacitinib 10 mg BID (25.6% [14.2, 38.6]) or reduced their dose to 5 mg BID (34.4% [21.8, 47.3]). Median time to treatment failure was 169 days for placebo and >52 weeks for tofacitinib 5 and 10 mg BID (due to the low number of treatment failure events, exact median time to treatment failure was not available for tofacitinib 5 or 10 mg BID). Conclusion For patients in remission following 8 weeks of induction treatment with tofacitinib 10 mg BID, median time to treatment failure for those who continued tofacitinib treatment (5 or 10 mg BID) was >52 weeks. After treatment interruption (remission patients who were re-randomised to placebo), median time to treatment failure was 169 days; this was similar to previously published time-to-treatment-failure data for patients with clinical response (including remission) following 8 weeks of induction treatment with tofacitinib who were re-randomised to placebo.3. References

scholarly journals Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes

2019 ◽  
Vol 130 (6) ◽  
pp. 1877-1888
Author(s):  
Mark G. Bigder ◽  
Sandeep Krishnan ◽  
E. Francis Cook ◽  
Anthony M. Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Rank Test ◽  
Control Group ◽  
Chi Square ◽  
Time To Treatment ◽  
Pain Scores ◽  
Kaplan Meier ◽  
Time To Treatment Failure ◽  
Chi Square Test

OBJECTIVEPatients with multiple sclerosis (MS)–associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.METHODSTime to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test.RESULTSTTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR.CONCLUSIONSTTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.

A multicenter phase II study of pemetrexed and cisplatin in patients with advanced gastric cancer (AGC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14008-14008
Author(s):  
Y. Bang ◽  
Y. Kim ◽  
H. C. Chung ◽  
W. Kang ◽  
S. Park ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Failure ◽  
Median Time ◽  
Progressive Disease ◽  
Treatment Schedule ◽  
Curative Surgery ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Common Grade ◽  
Grade 3

14008 Background: Pemetrexed is a novel folate antimetabolite, and it inhibits a number of folate-dependent enzymes. This agent has demonstrated activity in a variety of tumor types including AGC. This study was performed to evaluate the combination of pemetrexed and cisplatin in the treatment of AGC. The primary endpoint was response rate, and secondary endpoints were duration of response, time to progressive disease, time to treatment failure, overall survival, and toxicity. Methods: Patients with stage IV AGC not to be amendable to curative surgery and measurable disease were eligible. Pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 were given on day 1, every 21 days. Treatment was supplemented with folic acid, vitamin B12, and dexamethasone. Response was assessed by RECIST, and toxicity was assessed by NCI-CTC v 2.0. Results: From October 2003 to September 2004, 51 patients were enrolled, but 1 did not meet the eligibility criteria. There were 37 men and 13 women with a median age of 56 years (range, 24–69) and an ECOG PS 0/1 for 14/36 patients; all had metastatic disease. Of 50 evaluable patients, there were no complete responses, and 13 had confirmed partial responses (26%; 95% CI, 14.6%-40.3%). Fifteen patients (30%) had stable disease, and 21 (42%) progressed, and 1 (2%) was unknown. Among 13 responders, the median durarion of response was 3.60 months (95% CI, 2.80–9.40). Median time to progressive disease was 2.8 months (95% CI, 2.20–4.40), and median overall survival was 6.6 months (95% CI, 4.80–10.40). The median time to treatment failure was 2.10 months (95% CI, 1.00–2.80). Survival estimates were 32.0% at 3 months and 7.0% at 6 months. A total of 212 cycles were administered to 51 patients (median 4 [range, 1–13]). Based on 51 patients, most common grade 3/4 hematologic toxicities were neutropenia (49.0%), leukopenia (19.7%), and anemia (13.7%); the most common grade 3/4 nonhematologic toxicities were hyponatremia (15.7%), anorexia (9.8%), nausea (7.8%), and vomiting (7.8%). Conclusions: : The combination of pemetrexed and cisplatin in the current dose and schedule has a modest activity and a mild toxicity profile in patients with AGC. Further study is warranted using a different dose and treatment schedule. [Table: see text]

Dose Reduction of Thalidomide in Multiple Myeloma: A Feasible Option without Reducing of Efficacy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5129-5129
Author(s):  
Peter Haas ◽  
Ulrich Denz ◽  
Gabriele Ihorst ◽  
Monika Engelhardt
Keyword(s):  
Multiple Myeloma ◽  
Side Effects ◽  
Treatment Failure ◽  
Dose Reduction ◽  
Median Time ◽  
Maintenance Treatment ◽  
High Dose ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Feasible Option

Abstract The central goal in improving multiple myeloma (MM) treatment is the achievement of higher complete remission (CR) rates and prolonged progression free (PFS) and overall survival (OS). Maintenance treatment after high-dose regimens has been one approach to attain this goal. As one of these maintenance agents Thalidomide (Thal) is used, since it leads to the inhibition of fibroblast growth factor (bFGF) and monocyte-derived TNF-alpha, reduced vascularisation, immune response upregulation and others. Response rates with single Thal are 30% and can be increased up to 60–70% with combined Dexamethasone (Dex) use. Maintenance treatment has shown an improved 3-year PFS rate of 15% after tandem autologous stem cell transplantation (auto-SCT). Although Thal is well tolerated compared to regular cytotoxic drugs, side effects occur in about one third of patients (pts), most disturbing being fatigue, polyneuropathy and deep venous thrombosis. As these are dose dependent, a dose-reduction has evolved from 800mg to 200mg/day (d). In this study, we analyzed, whether the Thal dose of 100mg/d is feasible and effective: 38 consecutive MM pts received Thal at our center between 5/01 and 6/05. The time to treatment failure was calculated from treatment start to death, relapse or therapy modification due to side effects. The median age of all pts was 62.4 years; 27 were male and 11 female. All pts had stage II and III MM according the DurieIgG was the most frequent MM subtype in 23 pts. Twelve showed deletion 13q14. The median time from initial diagnosis to Thal therapy was 3.9 years (range; 0–18.7). Pts had received a median of 2 treatment lines (range 0–3), three pts had received Thal as first-line treatment. Twenty-six pts (68.4%) underwent SCT prior to Thal treatment (23 pts single auto-SCT, 1 pt tandem auto SCT, 1 pt sequential auto- and allo-SCT and 1 pt with 2 allo-SCT). The median Thal dose was 125mg/d (range 50–800mg/d), 22 pts received more than 200mg/d and 16 pts less. The median Thal duration was 7 months (range; 0.3–37.8). Nineteen pts received Thal as a single-agent, 16 pts in combination with Dex or melphalan (Alexanian). Remission before Thal was PD in 21 pts, SD in 9 pts, MR in 1 pt, PR in 4 pts and CR in 3 pts. Causes for treatment failure were side effects in 10 pts, relapse in 18 pts and death in 1 pt. The median time to treatment failure (TTF) was 7.6 months. Subgroup analyses showed an advantage for pts without deletion 13q14 (8.2 vs. 2.8 months; p=0.054) and for the combination therapy with Thal/Dex or Thal/Alexanian (8.7 vs. 4.5 months; p=0.0554). Other parameters tested in univariate analysis (age, stage, remission status, prior Tx) showed no difference in TTF. Of note was that different dose-levels (&lt;200 vs. ≥200mg/d) revealed no difference in TTF (7.5 vs. 8.2 months; p=0.087). We conclude that a Thal dose of 100/d is efficient, which can be increased with combined Dex or other effective anti-MM usage. This is of importance since side-effects show a dose-relation and often lead to treatment discontinuation. The strategy to lower the Thal dose with persistence of high efficacy rates is a promising approach to optimize MM-treatment and make it a feasible option for more pts.

scholarly journals Trigeminal Neuralgia: Outcomes after Gamma Knife Radiosurgery

2009 ◽  
Vol 36 (1) ◽  
pp. 78-82 ◽  
Author(s):  
Henri Knafo ◽  
Brendan Kenny ◽  
David Mathieu
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Cox Regression ◽  
Statistical Significance ◽  
Gamma Knife Radiosurgery ◽  
Cox Regression Analysis

Background:Trigeminal neuralgia (TN) often remains difficult to treat despite multiple available medications, and can severely impact on the quality of life of affected patients. Gamma knife radiosurgery has recently emerged as a minimally-invasive alternative to surgery for patients suffering from drug-resistant TN. The goal of this study was to report the short-term efficacy of gamma knife radiosurgery for TN and assess its impact on the quality of life of patients treated in the first 18 months of our experience.Methods:Patients with medically-refractory TN or with unacceptable drug side effects were considered for radiosurgery. A maximum dose of 80 Gy was administered to the affected nerve using a single 4-mm isocenter. Follow-up assessments were made at 2, 4 and 6 months, with evaluation of pain relief, drug reduction and quality of life. Factors impacting treatment response were assessed using Cox regression analysis.Results:A total of 67 patients were treated. Significant pain relief was seen in 77.6% of patients, including 32.6% who became pain-free. Patients were able to discontinue all medications in 34.3% or reduce drug intake by more than 50% in an additional 28.4% of cases. No variable was found to predict pain relief although older age (>66 years) approached statistical significance. Sensory side effects were seen in 14.9% of patients. Quality of life improved in the majority of patients after radiosurgery.Conclusions:Gamma knife radiosurgery is a safe and effective management alternative for trigeminal neuralgia, providing good or excellent pain relief and improvement in quality of life in the majority of patients with few side effects.

scholarly journals Assessment of Antibiotic De-escalation by Spectrum Score in Patients With Nosocomial Pneumonia: A Single-Center, Retrospective Cohort Study

2021 ◽  
Vol 8 (11) ◽  
Author(s):  
Dan Ilges ◽  
David J Ritchie ◽  
Tamara Krekel ◽  
Elizabeth A Neuner ◽  
Nicholas Hampton ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Day Treatment ◽  
Single Center ◽  
Cox Regression Analysis ◽  
Patient Admissions ◽  
The Impact

Abstract Background Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) cause significant mortality. Guidelines recommend empiric broad-spectrum antibiotics followed by de-escalation (DE). This study sought to assess the impact of DE on treatment failure. Methods This single-center retrospective cohort study screened all adult patients with a discharge diagnosis code for pneumonia from 2016 to 2019. Patients were enrolled if they met predefined criteria for HAP/VAP ≥48 hours after admission. Date of pneumonia diagnosis was defined as day 0. Spectrum scores were calculated, and DE was defined as a score reduction on day 3 versus day 1. Patients with DE were compared to patients with no de-escalation (NDE). The primary outcome was composite treatment failure, defined as all-cause mortality or readmission for pneumonia within 30 days of diagnosis. Results Of 11860 admissions screened, 1812 unique patient-admissions were included (1102 HAP, 710 VAP). Fewer patients received DE (876 DE vs 1026 NDE). Groups were well matched at baseline, although more patients receiving DE had respiratory cultures ordered (56.6% vs 50.6%, P = .011). There was no difference in composite treatment failure (35.0% DE vs 33.8% NDE, P = .604). De-escalation was not associated with treatment failure on multivariable Cox regression analysis (hazard ratio, 1.13; 95% confidence interval, 0.96–1.33). Patients receiving DE had fewer antibiotic days (median 9 vs 11, P &lt; .0001), episodes of Clostridioides difficile infection (2.2% vs 3.8%, P = .046), and hospital days (median 20 vs 22 days, P = .006). Conclusions De-escalation and NDE resulted in similar rates of 30-day treatment failure; however, DE was associated with fewer antibiotic days, episodes of C difficile infection, and days of hospitalization.

Hyperbaric Oxygen Therapy for Radionecrosis of the Jaw: A Randomized, Placebo-Controlled, Double-Blind Trial From the ORN96 Study Group

2004 ◽  
Vol 22 (24) ◽  
pp. 4893-4900 ◽  
Author(s):  
Djillali Annane ◽  
Joël Depondt ◽  
Philippe Aubert ◽  
Maryvonne Villart ◽  
Pierre Géhanno ◽  
...  
Keyword(s):  
Pain Relief ◽  
Treatment Failure ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Failure Time ◽  
Hazard Ratio ◽  
Double Blind ◽  
Time To Treatment ◽  
Time To Treatment Failure

Purpose To determine the efficacy and safety of hyperbaric oxygen therapy (HBO) for overt mandibular osteoradionecrosis. Patients and Methods This prospective, multicenter, randomized, double-blind, placebo-controlled trial was conducted at 12 university hospitals. Ambulatory adults with overt osteoradionecrosis of the mandible were assigned to receive 30 HBO exposures preoperatively at 2.4 absolute atmosphere for 90 minutes or a placebo, and 10 additional HBO dives postoperatively or a placebo. The main outcome measure was 1-year recovery rate from osteoradionecrosis. Secondary end points included time to treatment failure, time to pain relief, 1-year mortality rate, and treatment safety. Results At the time of the second interim analysis, based on the triangular test, the study was stopped for potentially worse outcomes in the HBO arm. A total of 68 patients were enrolled and analyzed. At 1 year, six (19%) of 31 patients had recovered in the HBO arm and 12 (32%) of 37 in the placebo arm (relative risk = 0.60; 95% CI, 0.25 to 1.41; P = .23). Time to treatment failure (hazard ratio = 1.33; 95% CI, 0.68 to 2.60; P = .41) and time to pain relief (hazard ratio = 1.00; 95% CI, 0.52 to 1.89; P = .99) were similar between the two treatment arms. Conclusion Patients with overt mandibular osteoradionecrosis did not benefit from hyperbaric oxygenation.

scholarly journals P.023 Clinical and patient satisfaction outcomes after partial sensory rhizotomy for refractory trigeminal neuralgia among MS patients

2018 ◽  
Vol 45 (s2) ◽  
pp. S21-S21
Author(s):  
M Bigder ◽  
S Krishnan ◽  
EF Cook ◽  
AM Kaufmann
Keyword(s):  
Patient Satisfaction ◽  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Control Group ◽  
Rank Tests ◽  
Time To Treatment ◽  
Pain Scores ◽  
Kaplan Meier ◽  
Time To Treatment Failure ◽  
N 93

Background: MS related trigeminal neuralgia (MS-TN) is associated with high recurrence and retreatment rates. Optimal treatment and role for partial sensory rhizotomy (PSR) for MS-TN remains to be determined. Methods: We analyzed time to treatment failure (TTF) after PSR (n=14) versus other prior procedures (n=53) among 12 consecutively treated MS-TN patients. Kaplan-Meier curves and Log-Rank tests were utilized to compare BNI pain scores and TTF after PSR vs prior procedures using the same patient cohort as their own control group. Subsequent analysis compared TTF after PSR to other procedures (n=93) among a second cohort of 18 MS-TN patients not undergoing PSR. Results: TTF was significantly longer after PSR compared to prior procedures among the PSR cohort (p<0.0001) with median TTF of 79 vs 10 months respectively. Similarly, there was a longer TTF after PSR compared to prior procedures among the MS-TN cohort with median TTF 79 vs 16 months respectively (p<0.001). PSR resulted in a higher proportion of excellent pain scores when compared to prior procedures in the MS-TN cohort (77% vs 29%, p<0.001). Conclusions: TTF was significantly longer following partial sensory rhizotomy compared to other prior procedures in MS-TN patients. A higher proportion of patients achieved excellent BNI pain scores after PSR.

Results of a salvage treatment program for relapsing lymphoma: MINE consolidated with ESHAP.

1995 ◽  
Vol 13 (7) ◽  
pp. 1734-1741 ◽  
Author(s):  
M A Rodriguez ◽  
F C Cabanillas ◽  
W Velasquez ◽  
F B Hagemeister ◽  
P McLaughlin ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Median Time ◽  
Prospective Trial ◽  
Salvage Treatment ◽  
High Dose ◽  
Low Grade ◽  
Intermediate Grade ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Hodgkin's Lymphomas

PURPOSE We report the results of a prospective trial in which patients with relapsing non-Hodgkin's lymphomas were sequentially treated with two regimens (mesna, ifosfamide, mitoxantrone, and etoposide [MINE], and etoposide, methylprednisolone, cytarabine, and cisplatin [ESHAP]) if they had no history of disease resistance to these drugs. PATIENTS AND METHODS Ninety-two patients received MINE (mesna 4 g/m2, ifosfamide 4 g/m2, mitoxantrone 8 mg/m2, and etoposide 195 mg/m2) for a maximum of six courses followed by ESHAP (etoposide 240 mg/m2, methylprednisone 500 mg/d, high-dose cytarabine 2 g/m2, and cisplatin 100 mg/m2) for three courses to consolidate complete response (CR) or for a maximum of six cycles after a partial response (PR) or no response to MINE. Pretreatment serum levels of lactate dehydrogenase (LDH) and beta 2-microglobulin (beta 2M) were documented in 80 of 92 patients. RESULTS The response rate to MINE-ESHAP was 69% (48% CRs and 21% PRs), with a median survival time of 24 months and median time to treatment failure of 12 months. The median time to treatment failure according to histology was as follows: low-grade histologies, 16 months; low-grade transformed to intermediate-grade, 8 months; and intermediate-grade, 5 months. The most serious complication was myelosuppression, which resulted in two deaths due to neutropenic sepsis. A risk factor model based on beta 2M and LDH levels before salvage treatment showed three categories of risk, with 36-month survival rates as follows: low (beta 2M < 3 mg/dL and LDH normal), 61%; intermediate (beta 2M > or = 3 mg/dL or LDH above normal), 23%; and high (beta 2M > or = 3 mg/dL and LDH above normal), 0%. CONCLUSION MINE-ESHAP is an effective salvage strategy for patients with recurrent lymphoma. Toxicity was acceptable. Factors that determine prognostic categories at relapse merit further study.

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