Evolving Approaches to Primary Treatment of Hodgkin Lymphoma

Abstract

> 10 cm) at diagnosis may require adjuvant irradiation at the conclusion of chemotherapy, but its utility has not been unequivocally established and radiation should be avoided in those who achieve a complete remission, where it is known to be ineffective.With careful selection of treatment program most patients found to have Hodgkin lymphoma today can be offered a high probability of cure and a low likelihood of major late toxicity. However, without detailed attention to the extent of lymphoma and other prognostic factors, there is as much danger of over-treatment as undertreatment. Only by thoughtfully adjusting the treatment program to the extent of disease and response to treatment can the clinician determine the optimal approach, maximizing likelihood of cure and minimizing late toxicity.

Hodgkin lymphoma: answers take time!

“…5 One possibility is that PHD activity is maintained by an alternative cellular reducing agent that can substitute for vitamin C. Reduced glutathione (L-␥-glutamyl-L-cysteinylglycine; GSH) acts as the major cellular antioxidant defense protecting against damage from free radicals and reactive oxygen species. GSH was tested in vitro, and consistent with previously reported findings 6 it was found to stimulate hydroxylation in reactions involving…”

“…These efforts include minimizing radiation fields and dose with involved node (rather than involved field) radiation, 5 using a responseadapted approach incorporating fluorodeoxyglucose position emission tomography (FDG-PET) imaging to eliminate radiation therapy in patients obtaining an early, complete response to chemotherapy, 6 and minimizing exposure to chemotherapy drugs. 7 In the current study by CALGB, 99 evaluable patients were treated with a novel chemotherapy combination (AVG: doxorubicin, vinblastine, gemcitabine) for 6 cycles with no radiation therapy.…”

Expression of the human germinal center–associated lymphoma (HGAL) protein identifies a subset of classic Hodgkin lymphoma of germinal center derivation and improved survival

“…7 At least 80% of patients with cHL are cured with currently available therapies. 8 However, biologic markers capable of accurately separating risk groups to better predict treatment failure and to reduce unnecessary treatment have not been identified. The International Prognostic Score (IPS) incorporates 7 clinical and laboratory parameters and is currently considered the gold standard for stratifying patients with advanced-stage cHL.…”

Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated M.D. Anderson Cancer Center experience

“…However, the prognosis for many patients with relapsed and refractory disease remains poor. [1][2][3][4] Many of them can be successfully salvaged with high-dose chemotherapy and autologous stem cell transplantation (SCT). However, patients who relapse after autologous SCT have a particularly poor prognosis, especially those who are chemorefractory.…”