Conventional-dose salvage combination chemotherapy in patients relapsing with Hodgkin's disease after combination chemotherapy: the low probability for cure.

Longo, Dan L.; Duffey, Patricia L.; Young, Robert C.; Hubbard, Susan M.; Ihde, Daniel C.; Glatstein, Eli; Phares, J C; Jaffe, Elaine S.; Urba, Walter J.; DeVita, Vincent T.

doi:10.1200/jco.1992.10.2.210

Cited by 340 publications

(160 citation statements)

References 19 publications

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“…Recurrence reduces long-term disease-free survival with standard dose chemotherapy to below 20% [60] and [61]. Exception exists in two subgroups.…”

Section: Relapsementioning

confidence: 99%

“…Firstly those who recur exclusively in the originally involved but unirradiated lymph nodes without B symptoms or extranodal disease [62] and [63] and here wide-field irradiation with or without additional chemotherapy may cure approximately 50% of patients [63] and [64]. Secondly when this occurs more than 1 year after remission and in the absence of constitutional symptoms repeating the same regimen or using potentially non-cross-resistant chemotherapy with or without irradiation eradicates disease in approximately 35% of the relapsed patients [60], [65] and [66].…”

Section: Relapsementioning

confidence: 99%

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Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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“…Recurrence reduces long-term disease-free survival with standard dose chemotherapy to below 20% [60] and [61]. Exception exists in two subgroups.…”

Section: Relapsementioning

confidence: 99%

Section: Relapsementioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…Failure-free survival (FFS) was measured from the start of treatment to one of the following events: disease progression during treatment, incomplete remission at the end of treatment, recurrence, or death due to the disease. 11 A partial remission (PR) and a null response (NR) were considered to be events, because they often hide a resistant or refractory tumor component 12 and actually share most of the therapeutic requirements 13 for early recurrences, which currently are considered unquestionable events for statistical purposes. Curves were calculated according to the Kaplan-Meier method, 14 and deaths due to causes other than HL were not censored.…”

Section: Statisticsmentioning

confidence: 99%

Vinblastine, bleomycin, and methotrexate chemotherapy plus irradiation for patients with early‐stage, favorable Hodgkin lymphoma

Gobbi

Broglia

Merli

et al. 2003

Cancer

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BACKGROUNDThe acknowledged effectiveness of vinblastine, bleomycin, and methotrexate (VBM) chemotherapy in patients with early‐stage Hodgkin lymphoma has been associated with conflicting toxicity reports.METHODSOne hundred forty‐three patients were evaluated clinically and had favorable Stage IA or IIA Hodgkin lymphoma. Ninety‐three patients were treated with the standard VBM schedule combined with extended‐field radiotherapy (EF‐RT), leaving the choice of the therapeutic sequence free. Fifty subsequent patients were treated with a slightly modified VBM schedule (VbMp) combined with RT limited to involved fields (IF‐RT) and delivered only after the end of chemotherapy. In the VbMp schedule, intervals between cycles were 21 days instead of 28 days, bleomycin doses were reduced, small doses of prednisone were given orally, and the interval before RT was prolonged.RESULTSClinical response was complete in 96% of patients who were treated with VBM plus EF‐RT and in 94% of patients who were treated with VbMp plus IF‐RT. Recurrence rates were nearly identical (12% and 11%, respectively) over necessarily different follow‐up (91 months and 33 months, respectively). Hematologic toxicity was tolerable in both trials, and pulmonary side effects were moderate in the first trial and negligible in the second. On the whole, treatment was tolerated better when RT followed chemotherapy.CONCLUSIONSThe VBM regimen was confirmed to be effective in patients with early‐stage Hodgkin lymphoma. Administration of all cycles before RT improved tolerance; pulmonary toxicity probably is mitigated further by reduced bleomycin doses, mild prednisone therapy, and a more prolonged resting interval before RT. A slightly higher recurrence rate was expectable in the VBM plus IF‐RT trial despite the actual intensification of vinblastine and methotrexate. Cancer 2003. © 2003 American Cancer Society.

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“…As From the observation that patients with relapsed disease when treated with conventional chemotherapy have a progression-free survival (PFS) of around 30% and a median survival of 12 months, it has become accepted that fit patients with HD who have a first remission of < 12 months' duration, those who fail to achieve a complete remission (CR) with satisfactory induction therapy including an anthracycline, or those patients who are in second or subsequent relapse, or high-risk patients in first relapse, should be treated in this way Longo et al, 1992 . The trial demonstrates the difficulty in recruiting to a trial in which one of the treatment modalities, although unproven, is seen to be the best chance of long-term survival.…”

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confidence: 99%

High-dose chemotherapy and autologous bone marrow transplant in relapsed Hodgkin's disease - a pragmatic prognostic index

O’Brien¹,

Milan²,

Cunningham³

et al. 1996

Br J Cancer

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Summary High-dose chemotherapy with autologous bone marrow transplantation is used in the treatment of relapsed or high-risk Hodgkin's disease. As From the observation that patients with relapsed disease when treated with conventional chemotherapy have a progression-free survival (PFS) of around 30% and a median survival of 12 months, it has become accepted that fit patients with HD who have a first remission of < 12 months' duration, those who fail to achieve a complete remission (CR) with satisfactory induction therapy including an anthracycline, or those patients who are in second or subsequent relapse, or high-risk patients in first relapse, should be treated in this way Longo et al., 1992 . The trial demonstrates the difficulty in recruiting to a trial in which one of the treatment modalities, although unproven, is seen to be the best chance of long-term survival. A few years into this randomised study, patients were refusing to be randomised and requested high-dose treatment.We report our experience at a single centre treating relapsed or non-responding HD, the most common category of patients seen being the sensitive relapses with a varying number in each other subgroup. With long follow-up we report both long-and short-term toxicity, response rates and prognostic factors to help predict which patients will have a long PFS Patients and methods

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Conventional-dose salvage combination chemotherapy in patients relapsing with Hodgkin's disease after combination chemotherapy: the low probability for cure.

Abstract: These data with conventional-dose salvage therapy provide results for comparison with novel salvage approaches including myeloablative therapy with autologous marrow or peripheral-blood stem-cell support.

Cited by 340 publications

References 19 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Vinblastine, bleomycin, and methotrexate chemotherapy plus irradiation for patients with early‐stage, favorable Hodgkin lymphoma

High-dose chemotherapy and autologous bone marrow transplant in relapsed Hodgkin's disease - a pragmatic prognostic index

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