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In a large, randomized trial, the efficacies of Stanford V and ABVD were comparable when given in combination with appropriate radiotherapy.

Summary The safety and efficacy of rituximab with CODOX‐M/IVAC (cyclophosphamide, doxorubicin, vincristine, methotrexate/ifosfamide, etoposide, high dose cytarabine) was retrospectively analysed in 23 patients with non‐human immunodeficiency virus‐related B‐cell non‐Hodgkin lymphoma with proliferation index >95% [14 with classical Burkitt lymphoma (BL), five with B‐cell lymphoma unclassifiable, with features intermediate between diffuse large B cell lymphoma (DLBCL) and BL, and four with DLBCL]. Six (26%) low‐risk (LR) patients received three cycles of CODOX‐M and 17 (74%) high‐risk (HR) cases were assigned to four cycles of alternating CODOX‐M/IVAC. Rituximab 375 mg/m2 was infused on days 1 and 10 of each cycle. Toxicity was comparable to that reported with CODOX‐M/IVAC, with no treatment‐related death. Two patients developed grade 3 rituximab‐induced delayed neutropenia, with no adverse outcome. After completing treatment, 83% LR patients and 71% HR patients achieved CR by positron emission tomography–computerized tomography (PET–CT). Three (13%) patients received salvage treatment. At a median follow‐up of 34 months (range = 18–75), 19 (83%) patients (100% LR and 74% HR) were alive, including one case undergoing salvage for late relapse. Four HR patients (17%) had died, three from primary progressive disease and one from treatment‐refractory relapse 2 months after achieving CR. These results with R‐CODOX‐M/R‐IVAC compare favourably with existing data using CODOX‐M/IVAC and warrant further prospective studies. The potential pitfalls of PET–CT to assess response are highlighted.

The time between radiation therapy treatments is strongly predictive of survival in patients undergoing sequential chemotherapy and radiation therapy. The use of induction chemotherapy does not negate the need to avoid treatment interruptions during definitive radiation therapy.

SummaryPopulation-level survival in older patients with lymphoma is significantly lower than in younger patients. In this study, data were obtained from cancer registries in England and the United States (US) for patients diagnosed with Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL) and myeloma. Five-year relative survival was calculated using period analysis. Generalised linear models were used to determine excess hazard ratios (EHR) for older compared to younger patients. Five-year relative survival was lower for older patients diagnosed with HL, NHL and myeloma in both countries. The greatest age-related survival inequality was observed for patients with HL: in 2006-10 the EHR comparing patients aged 75 + years with those aged 15-24 years was 14Á02 in the US and 15Á69 in England. For NHL, the EHR was 1Á91 in the US and 3Á81 in England. For myeloma, comparing patients aged 75 + years with those aged 25-44 years, the EHR was 2Á79 in the US and 3Á60 in England. Survival of patients with lymphoma is lower for older patients in both the US and England but the discrepancy is less in the US. Physicians should be encouraged to evaluate patients' frailty and co-morbidities as well as their age when considering treatment options for patients with lymphoma and myeloma.Keywords: non-hodgkin lymphoma, hodgkin lymphoma, multiple myeloma, survival, disparity.Compared with younger patients, older age is a poor prognostic factor in patients with Hodgkin lymphoma (HL) Sj€ oberg et al, 2012), non-Hodgkin lymphoma (NHL) (Storm et al, 2010;Pulte et al, 2013), and myeloma (Brenner et al, 2008a;Renshaw et al, 2010). Possible reasons for this disparity include more aggressive disease, difficulty in treating older patients adequately due to co-morbidities and frailty, under-treatment due to fear of increased risk of complications in older patients, or a combination of these. An indirect method by which possible under-treatment can be investigated is comparison of survival of patients by age in different countries. A significant disparity in survival of older patients in different countries with similar overall life expectancy and level of medical care might suggest under-treatment in the population with lower survival.The United States (US) and England have quite different systems in respect of the delivery of health services. In England, although some individuals and employees have private health insurance, all citizens are covered by the National Health Service, which is free at the point of delivery. In the US there is no universal health coverage, with the exception of citizens and permanent residents aged 65 years and older who are eligible for Medicare, a government-run health insurance system.The aim of the current study was to compare survival by age, in patients with HL, NHL and myeloma in the US and England, as a preliminary investigation of the extent of which health system factors affect survival from haematological malignancies. MethodsCancer registry data were obtained from each country. Eligible patients were those ...

Summary Patients with relapsed or refractory lymphoma can be cured with stem cell transplantation if they are shown to have disease that is responsive to salvage chemotherapy. Patients who fail to respond to first‐line salvage chemotherapy tend to do very poorly. Here we report on 39 such patients who received mini‐BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy as second or subsequent‐line salvage chemotherapy. Fifty‐six percent of these patients had primary refractory disease and a further 28% had responses to first‐line therapy that lasted <12 months. Seventy‐two percent had progressive disease following the salvage chemotherapy administered immediately prior to mini‐BEAM and the remaining 28% had stable disease. Overall there was a 38% response to mini‐BEAM (complete response = 28%, partial response = 10%). Patients with Hodgkin lymphoma (HL) had a higher response rate compared to those with diffuse large B cell lymphoma (DLBCL) (63% vs. 20%). Seventy‐four percent of HL patients were able to proceed to transplantation compared with 30% of patients with DLBCL. Mini‐BEAM is a very effective bridge to transplantation in very poor risk patients with HL who have failed to respond to first‐line salvage chemotherapy. Its efficacy in non‐Hodgkin lymphoma is more modest.

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