Our experiences with treating patients of Hodgkin’s disease in the last decade

2007 ◽  
Vol 148 (15) ◽  
pp. 675-682 ◽  
Author(s):  
Zsófia Simon ◽  
Katalin Keresztes ◽  
Zsófia Miltényi ◽  
Zsuzsanna Ress ◽  
László Váróczy ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease

Bevezetés: A Hodgkin-lymphoma diagnosztikájában, kezelésében az elmúlt évtizedben jelentős változások következtek be. Cél: Ennek tükrében a szerzők célul tűzték ki az 1995–2004 között a DEOEC III. sz. Belgyógyászati Klinikán elsődlegesen kezelt Hodgkin-lymphomás betegek adatainak áttekintését 2006 januárjában, átlagosan 69 (12–132) hónap követés után. Módszerek: a kórtörténetek adatait SPSS statisztikai programmal értékelték. Eredmények: A 163 beteg átlagéletkora a diagnóziskor 36 (14–75) év volt, bimodális koreloszlással. A leggyakoribb (48,5%) a kevert sejtes altípus volt. A betegek 41,1%-a volt korai stádiumú, legkedvezőtlenebb prognózissal 15,7%-uk bírt, bulky tumort 28,2%-ban észleltek. 7 betegnél radioterápiát, 63-nál kemoterápiát és 92-nél tervezett kombinált kezelést alkalmaztak. A sugárkezelések 61,6%-a érintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyéb kemoterápiát kapott. Az elsődleges kezelésre 146 komplett, 10 parciális remisszió jött létre, 6 beteg nem reagált. 10 részleges remisszióban lévő és 5 nem reagáló beteget tovább kezeltek. 27 komplett remisszióban lévő betegnél alakult ki relapszus, közülük 15-nél történt nagy dózisú kezelés autológ perifériás haemopoeticus őssejt-transzplantációval. A követési idő alatt 18 beteg halt meg, 11 a lymphoma progressziója vagy a kezelés szövődménye, 6 második tumor, 1 egyéb ok miatt. Betegeik 10 éves prognosztizált teljes túlélése 83% (részletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az eseménymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konklúzió: Hodgkin-lymphomás betegeik kezelési eredményei javultak, azonban arra is rámutatnak, hogy a korai, kedvező prognózisú betegeknél a kezelési toxicitás csökkentendő, míg az előrehaladott, rossz prognózisú betegek (az összes beteg kb. 10%-a) agresszívebb primer kezelését akár a súlyosabb mellékhatások, szövődmények ismeretében is vállalni kell.

Fertility in male patients with Hodgkin's disease after therapy –results from the German Hodgkin Lymphoma Study Group (GHSG)

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 6547-6547
Author(s):  
M. Sieniawski ◽  
A. Josting ◽  
K. Breuer ◽  
T. Sven ◽  
V. Diehl ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Study Group ◽  
Male Patients ◽  
Lymphoma Study Group

Assessment of Tumor Size Reduction Improves Outcome Prediction of Positron Emission Tomography/Computed Tomography After Chemotherapy in Advanced-Stage Hodgkin Lymphoma

2014 ◽  
Vol 32 (17) ◽  
pp. 1776-1781 ◽  
Author(s):  
Carsten Kobe ◽  
Georg Kuhnert ◽  
Deniz Kahraman ◽  
Heinz Haverkamp ◽  
Hans-Theodor Eich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Outcome Prediction ◽  
Hodgkin’S Disease ◽  
Emission Tomography ◽  
Advanced Stage ◽  
Positron Emission ◽  
Risk Of Progression

Purpose Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT). Patients and Methods The analysis set consisted of 739 patients with residues ≥ 2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression. Results In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P = .022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P = .9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%). Conclusion Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.

Magnetic resonance imaging in the initial staging of Hodgkin's disease and non-Hodgkin lymphoma

1991 ◽  
Vol 12 (2) ◽  
pp. 81-90 ◽  
Author(s):  
John D. Tesoro-Tess ◽  
Luca Balzarini ◽  
Errico Ceglia ◽  
Raffaele Petrillo ◽  
Armando Santoro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Resonance Imaging ◽  
Non Hodgkin Lymphoma ◽  
Initial Staging

HIV-Infection, Hodgkin Lymphoma, and Pregnancy: A Case Report and Recommendations On Treatment.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4638-4638
Author(s):  
Rebecca A Israel ◽  
Russell K. Dorer ◽  
David M. Aboulafia
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Clin Oncol ◽  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Medical Attention ◽  
American Society ◽  
Hiv Negative ◽  
Hiv Aids

Abstract Abstract 4638 According to the CDC the incidence of HIV-infection in women of child bearing age continues to increase in the era of Highly Active Anti-Retroviral Therapy (HAART). In 1992, women accounted for 14% of all adults and adolescents living with HIV/AIDS, but by the end of 2005 women accounted for 23% of all HIV/AIDS cases [1]. As Hodgkin lymphoma (HL) is the most common non-AIDS defining malignancy, we anticipate that the number of cases of HIV-associated Hodgkin lymphoma (HIV-HL) in pregnant women will increase in the near future. Herein, we describe the case of a pregnant 30-year-old HIV-infected Ethiopian woman with a CD4+ count of 254 cells/μ;L and an HIV viral load of 1200 copies/mL who presented to medical attention with progressive neck adenopathy and fatigue, but no fevers, night sweats, or significant weight loss. An incisional biopsy of a cervical lymph node revealed Reed-Sternberg cells (CD30+, CD15+, CD20-, CD3-) and an absence of sclerosis consistent with Classical Hodgkin Lymphoma, mixed cellularity subtype. A subsequent unilateral posterior iliac crest bone marrow aspirate and biopsy was unremarkable with normal trilineage hematopoiesis. Following a spontaneous miscarriage ten weeks into her pregnancy, a 18F-fluorodeoxy-D-glucose PET and fusion CT scan demonstrated disease above and below the diaphragm, establishing stage IIIA HL. The patient subsequently began HAART consisting of a co-formulation of emtricitabine and tenofovir (Truvada®) and nevirapine, in conjunction with chemotherapy (AVD x 8 cycles). Thirty three months post-completion of chemotherapy, the patient remains disease free without evidence of recurrent HL. Through a literature search, we identified only two additional case reports describing HIV, HL, and pregnancy. One patient received three cycles of chemotherapy, refused further treatment, delivered a HIV-positive girl, and died shortly after from complications of presumed pneumocystis jiroveci pneumonia [2]. The second patient received both active antiretroviral therapy and chemotherapy, delivered a HIV-negative boy, and remained without evidence of HL at nine months follow-up [3]. The paucity of reported cases in the medical literature precludes any evidence based recommendations for the care of pregnant patients with HIV-HL. However, we recommend that medical providers use the same precautions to ensure the safety of both the mother and the child as recommended for pregnant HIV-negative patients with HL. Pregnant patients with HL should not be staged with imaging techniques that require significant radiation exposure including plain radiographs, CT, and PET scans. The extent of substantial mediastinal and pulmonary disease can be safely determined with a postero-anterior radiograph of the chest with proper shielding of the abdomen. Abdominal ultrasounds and magnetic resonance imaging may provide adequate information for the management of disease without placing the fetus at risk [4]. We also suggest controlling the underlying HIV infection when initiating HL treatment as using HAART in parallel with chemotherapy has been correlated with a dramatically improved prognosis for HIV-HL patients [5]. In the hopes of developing more specific management guidelines, we encourage other clinicians to publish their experiences with HIV-HL in pregnant patients.Centers for Disease Control and Prevention. HIV/AIDS Among Youth–United States, 2008. http://www.cdc.gov/hiv/resources/Factsheets/youth.htmOkechukwu CN, Ross J. Hodgkin's Lymphoma in a Pregnant Patient with Acquired Immunodeficiency Syndrome. J Clin Oncol 1998; 10:410-411.Kelpfish A, Schattner A, Shtalrid M,et al. Advanced Hodgkin's Disease in a Pregnant, HIV Seropositive Woman: Favorable Mother and Baby Outcome Following Combined Anticancer and Antiretroviral Therapy. Am J Hematol 2000; 63:57-58.Connors, Joseph. “Challenging Problems: Coicident Pregnancy, HIV infection, and Older Age.” In: Hematology 2008: American Society of Hematology Education Program Book. Gewirtz AM, Muchmore EA, Burns LJ, editors. Washington, D.C.: American Society of Hematology; 2008. p. 334-39.5.Tirelli U, Errante D, Dolcetti R, et al. Hodgkin's Disease and Human Immunodeficiency Virus Infection: Clinicopatholgic and Virologic Features of 114 Patients From the Italian Cooperative Group on AIDS and Tumors. J Clin Oncol 1995; 13:1758-67. Disclosures: No relevant conflicts of interest to declare.

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