Source:http://linkedlifedata.com/resource/pubmed/id/10534059
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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
5
|
| pubmed:dateCreated |
1999-11-24
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| pubmed:abstractText |
Complete remission rates of 70-90% can be achieved following combination chemotherapy for patients with advanced-stage Hodgkin's disease (HD). Patients who present with unfavorable poor prognostic factors, however, have a 5-year disease-free survival of only 40-50%. In an attempt to improve the prognosis of 20 patients with poor-risk advanced-stage HD, we evaluated the role of early high-dose therapy (HDT) and autologous bone marrow/stem cell transplantation (ASCT) during the first complete or partial remission (CR/PR). Patients were eligible for ASCT if they either achieved a PR (defined as > 50% regression) (six patients), or achieved a CR (14 patients) but had presented with three or more of the following unfavorable features: stage IV disease with bone marrow involvement or > or = 2 extranodal sites of involvement; bulky mass > 10 cm or bulky mediastinal mass > 1/3 of mediastina/thoracic ratio; B symptoms; and elevated serum lactate dehydrogenase (LDH) level. The study included 11 men (55%) and 9 women (45%). The median age was 37 years (range 20-57). Seventeen patients (85%) had stage IV disease; 14 (70%) had B symptoms; 13 (65%) had bulky mass > 10 cm; 14 (70%) had > or = 2 extra nodal sites involvement; and eight patients (40%) had elevated LDH levels. All patients were treated with standard four or 7-8 drug combination chemotherapy regimens until they achieved maximal response prior to ASCT with a median of six cycles (range 4-11). Six patients also received involved field radiotherapy to residual bulky mass > 5 cm or bony lesions before ASCT. The median time from diagnosis to ASCT was 8.6 months (range 5.5-18.9). Preparative regimens consisted of fractionated total body irradiation (FTBI) 1200 cGy in combination with etoposide 60 mg/kg and cyclophosphamide 100 mg/kg in all patients except one who had borderline pulmonary function and received lomustine 15 mg/kg instead of FTBI. All patients engrafted and there was no transplant-related mortality. One patient developed congestive cardiomyopathy at 4 years post-ASCT. All patients remain alive and in remission at a median follow-up of 42.8 months (range, 13.2-149.2). These preliminary results suggest that HDT and ASCT can be performed safely during first CR/PR in selected patients with advanced-stage HD who have an unfavorable prognosis. Further randomized studies comparing HDT and ASCT during first CR with conventional chemotherapy and ASCT at relapse in poor-risk advanced-stage HD should be conducted. The prognostic factors and risk groups described recently by an international prognostic study can be used to identify high-risk patients who may be candidates for more intensive therapy.
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| pubmed:grant | |
| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
IM
|
| pubmed:status |
MEDLINE
|
| pubmed:issn |
1083-8791
|
| pubmed:author |
pubmed-author:BhatiaRR,
pubmed-author:DagisAA,
pubmed-author:FormanS JSJ,
pubmed-author:FungHH,
pubmed-author:KashyapAA,
pubmed-author:KrishnanAA,
pubmed-author:MolinaAA,
pubmed-author:NademaneeAA,
pubmed-author:NilandJ CJC,
pubmed-author:O'DonnellM RMR,
pubmed-author:ParkerPP,
pubmed-author:PlanasII,
pubmed-author:SlovakMM,
pubmed-author:SniecinskiII,
pubmed-author:SnyderD SDS,
pubmed-author:SpielbergerRR,
pubmed-author:SteinAA,
pubmed-author:VoraNN
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| pubmed:issnType |
Print
|
| pubmed:volume |
5
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
292-8
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| pubmed:dateRevised |
2007-11-14
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| pubmed:meshHeading |
pubmed-meshheading:10534059-Adult,
pubmed-meshheading:10534059-Bone Marrow Transplantation,
pubmed-meshheading:10534059-Combined Modality Therapy,
pubmed-meshheading:10534059-Disease-Free Survival,
pubmed-meshheading:10534059-Drug Therapy, Combination,
pubmed-meshheading:10534059-Female,
pubmed-meshheading:10534059-Follow-Up Studies,
pubmed-meshheading:10534059-Hematopoietic Stem Cell Transplantation,
pubmed-meshheading:10534059-Hodgkin Disease,
pubmed-meshheading:10534059-Humans,
pubmed-meshheading:10534059-Male,
pubmed-meshheading:10534059-Middle Aged,
pubmed-meshheading:10534059-Remission Induction,
pubmed-meshheading:10534059-Risk Factors,
pubmed-meshheading:10534059-Survival Rate,
pubmed-meshheading:10534059-Transplantation, Autologous,
pubmed-meshheading:10534059-Whole-Body Irradiation
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| pubmed:year |
1999
|
| pubmed:articleTitle |
High-dose chemo/radiotherapy and autologous bone marrow or stem cell transplantation for poor-risk advanced-stage Hodgkin's disease during first partial or complete remission.
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| pubmed:affiliation |
Department of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, California 91010, USA.
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| pubmed:publicationType |
Journal Article,
Clinical Trial,
Research Support, U.S. Gov't, P.H.S.
|