Fixed versus response-adapted MOPP/ABVD chemotherapy in Hodgkin's disease

Björkholm, Magnus; Axdorph, Ulla; Grimfors, Gunnar; Merk, K.; Johansson, B.; Landgren, Ola; Svedmyr, Erik; Mellstedt, Håkan; Holm, G.

doi:10.1093/oxfordjournals.annonc.a059356

Cited by 33 publications

(22 citation statements)

References 24 publications

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“…[24][25][26] In 1975, the successful use of the combination ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) was reported, 27 and since the early 1980s, a variety of chemotherapy combinations other than conventional MOPP, including ABVD, MOPP/ABVD, MOPP/ABV (for younger patients), and ChLVPP (chlorambucil, vinblastine, procarbazine, prednisolone), LVPP/OEPA (chlorambucil, vinblastine, procarbazine, vincristine, etoposide, prednisone, doxorubicin), and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone; mostly elderly patients) were used in previously untreated patients with stage IIB-IV disease. [28][29][30][31][32] Since the 1980s patients with advanced disease reaching a complete remission after 2 cycles traditionally received a total of 6 cycles of chemotherapy. 29,33 Very few HL patients with advanced disease and high-risk features received BEACOPP chemotherapy (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) during the study period.…”

Section: Treatment Principles Of Hl During the Study Periodmentioning

confidence: 99%

“…[28][29][30][31][32] Since the 1980s patients with advanced disease reaching a complete remission after 2 cycles traditionally received a total of 6 cycles of chemotherapy. 29,33 Very few HL patients with advanced disease and high-risk features received BEACOPP chemotherapy (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) during the study period. 2,34 Combined modality treatment for patients with limited-stage disease became increasingly common during the 1980s.…”

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confidence: 99%

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Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Sjøberg

Halthur

Kristinsson

et al. 2012

Blood

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In recent decades, attention has focused on reducing long-term, treatment-related morbidity and mortality in Hodgkin lymphoma (HL). In the present study, we looked for trends in relative survival for all patients diagnosed with HL in Sweden from 1973-2009 (N ‫؍‬ 6949; 3985 men and 2964 women; median age, 45 years) and followed up for death until the end of 2010. Patients were categorized into 6 age groups and 5 calendar periods (1973-1979, 1980-1986, 1987-1994, 1994-2000, and 2001-2009 IntroductionOver the past 40 years, major advances have been made in the management of patients with Hodgkin lymphoma (HL). These include the introduction of more accurate radiotherapy, effective multiagent chemotherapy, immunotherapy, improved staging procedures, and important developments in supportive measures for myelosuppression and infectious and other complications. 1 Therefore, HL has gone from being an invariably fatal disorder to one of the few malignancies that are now highly curable. This is particularly true for patients with early-stage disease, but today disease control rates also exceed 70% in patients presenting with high-risk features. 2 This therapeutic success has unfortunately been darkened by elevated risks of secondary primary cancers, cardiovascular disease (CVD), cerebrovascular disease, and infections in longterm HL survivors. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] CVD has been reported to be the most important cause of excess mortality after HL and second malignancies. [10][11][13][14] During the last 2-3 decades, treatment strategies have been and are being adapted based on increased knowledge of treatment-related morbidity and mortality. Awaiting novel and less toxic targeted therapies of HL, the largest potential for improving survival and healthrelated quality of life in long-term survivors 17 is by reducing the excess morbidity and mortality from causes other than HL. To evaluate progress in long-term outcome, we studied patient survival among all 6949 HL patients diagnosed in Sweden between 1973 and 2009 and followed up for death to the end of 2010. Our aim was to assess trends in patient survival and long-term excess mortality in the entire population during this 37-year period starting when curative treatment principles were well-established. Methods Central registers and patientsInformation regarding patients diagnosed with a malignant disorder in Sweden is reported to a population-based nationwide Swedish Cancer Register that was established in 1958. The register contains information on diagnosis, sex, date of birth, date of diagnosis, and the hospital where the diagnosis was made, 18-19 but does not contain detailed clinical information such as symptoms, routine laboratory tests, treatment, or comorbidities.In Sweden, every physician and pathologist/cytologist is obliged by law to report each occurrence of cancer to the registry. All deaths are recorded in the nationwide causes of death register. Each person in Sweden is given a unique national registration number used to index a...

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Section: Treatment Principles Of Hl During the Study Periodmentioning

confidence: 99%

mentioning

confidence: 99%

Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Sjøberg

Halthur

Kristinsson

et al. 2012

Blood

View full text Add to dashboard Cite

show abstract

“…Patients with limited disease were treated with radiotherapy, and patients in advanced stages were given chemotherapy, mainly 6-8 courses of MOPP (mechlurethamine, vincerstine sulphate, procarbazine hydrochloride and premissive) or MOPP/ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), for details see Björkholm et al (1977Björkholm et al ( , 1995. All clinical and immunological studies were approved by the Ethics Committee at Karolinska Institute Institutet and all patients gave informed consent.…”

Section: Therapymentioning

confidence: 99%

Epstein–Barr virus expression in Hodgkin’s disease in relation to patient characteristics, serum factors and blood lymphocyte function

et al. 1999

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Summary Epstein-Barr virus (EBV) expression was investigated by immunohistochemistry (latent membrane protein 1 ) and in situ hybridization (EBV encoded RNA [EBER]) in biopsies from 95 patients with untreated Hodgkin's disease (HD). Tumour EBV status was related to EBV antibody titres, spontaneous and concanavallin A induced blood lymphocyte DNA synthesis, serum levels of soluble (s) CD4, sCD8, sCD25, sCD30, sCD54, β2-microglobulin, thymidine-kinase, routine chemistry, patient characteristics, complete remission and survival. The median follow-up time was 145 months (range 60-257). Tumour EBV-positive (n = 30; 33%) and negative (n = 62; 67%) patients did not differ with regard to sex, age, stage, presence of bulky disease or B-symptoms, remission rate or survival. The proportion of EBV+ cases was significantly higher among patients with mixed cellularity histopathology (58%) as compared to the nodular sclerosis subtype (18%; P < 0.001). The total white blood cell (WBC) counts were significantly lower in EBV+ patients (P < 0.01), who also had significantly higher levels of sCD54 (P < 0.02) and a tendency towards lower levels of sCD30 (P = 0.056). Patients in the tumour EBV+ group had significantly higher IgG antibody titres to restricted early antigen (EA-R) (P < 0.02). Hence, clinical features and outcome were not related to tumour EBV status. However, HD patients with EBV+ tumours had elevated sCD54 levels, higher antibody titres to EA-R and decreased total WBC counts. A potential causal relationship between EBV tumour status and these findings needs to be further explored.

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“…days Ϫ6 and Ϫ5). 10 Three patients with MM also received melphalan (140 mg/m 2 i.v. day Ϫ5), 11 and two patients with AML received it in combination with cytarabine (1 g/m 2 twice a day i.v.…”

Section: Patientsmentioning

confidence: 99%

Arterial blood oxygenation, maximum exercise capacity and oxygen transport in patients before and after autologous peripheral blood progenitor cell transplantation

Gruber

Brundin

Björkholm

1999

Bone Marrow Transplant

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Summary:Several studies have reported a reduced pulmonary diffusion capacity for carbon monoxide after total body irradiation (TBI) and/or high-dose chemotherapy (HDCT) and autologous peripheral blood progenitor transplantation (APBPC). The present study describes the oxygenation of arterial plasma (paO 2 ), the maximum exercise capacity (Wmax) and maximum oxygen transport (VO 2 max) before and after such treatment. Pulmonary gas exchange and paO 2 were measured in 15 patients at maximum dynamic bicycle exercise, performed before and at 8 ؎ 0.9 (s.e.m.) months after TBI/HDCT (n = 12) and HDCT (n = 3) followed by APBPC. Wmax was 169 ؎ 14 and 157 ؎ 15 watts (P Ͼ 0.05) before and after therapy, respectively. VO 2 max, 1.8 ؎ 0.1 l/min before treatment, fell to 1.6 ؎ 0.1 l/min (P Ͻ 0.05) after therapy. The maximum exercise paO 2 was 13.2 ؎ 0.4 kPa before and 13.6 ؎ 0.4 kPa (P Ͼ 0.05) after the treatment period. The findings indicate no significant reduction of Wmax or pulmonary diffusion capacity for O 2 after TBI/HDCT and APBPC while VO 2 max fell modestly by approximately 11%. The study was restricted to patients who remained in remission. Keywords: arterial plasma pO 2 ; hematological malignancies; hematopoietic stem cell transplantation; maximum oxygen uptake; pulmonary diffusion capacity Since the introduction of allogeneic bone marrow transplantation (BMT) for the treatment of hematological and other disorders, pulmonary toxicity has been of particular concern and has significantly contributed to both morbidity and mortality (10-40% of toxicity-related deaths). 1 Major factors, thought to be associated with pulmonary toxicity/dysfunction and delayed/incomplete recovery of pulmonary function tests in the allogeneic BMT setting are total body irradiation (TBI), acute and chronic graft-versushost disease and post-transplant pulmonary infection. 2,3 The rapidly increasing number of patients undergoing high-dose treatment with autologous stem cell transplan- tation may present an increasing medical problem with regard to cardiopulmonary sequelae. Procedure-related morbidity and mortality for patients with hematological and solid tumors have been substantially reduced by new developments in stem cell processing, eg autologous peripheral blood progenitor transplantation (APBPC) and improved supportive care. Nevertheless, cardiopulmonary complications have remained a major threat. 4 With the introduction of non-TBI containing high-dose therapies and the omission or dose-reduction of BCNU, acute and long-term lung toxicity seem to have decreased. 5-7 However, published studies reveal considerable variations concerning patient populations, types of high-dose treatment and stem cell sources, post-transplantation treatments, and methods used for the evaluation of cardiopulmonary function. Several earlier studies have indicated that chemotherapy and TBI prior to bone marrow transplantation may lead to pulmonary dysfunction, including a reduced diffusion capacity for carbon monoxide (CO) within the first months after the the...

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Fixed versus response-adapted MOPP/ABVD chemotherapy in Hodgkin's disease

Cited by 33 publications

References 24 publications

Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Progress in Hodgkin lymphoma: a population-based study on patients diagnosed in Sweden from 1973-2009

Epstein–Barr virus expression in Hodgkin’s disease in relation to patient characteristics, serum factors and blood lymphocyte function

Arterial blood oxygenation, maximum exercise capacity and oxygen transport in patients before and after autologous peripheral blood progenitor cell transplantation

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