Similar response rates and superior early progression‐free survival with gemcitabine, dexamethasone, and cisplatin salvage therapy compared with carmustine, etoposide, cytarabine, and melphalan salvage therapy prior to autologous stem cell transplantation for recurrent or refractory Hodgkin lymphoma

Abstract

The role of fine needle aspiration (FNA) as a first‐line diagnostic modality is well‐established for neoplastic and nonneoplastic liver masses in adults. However, cytopathologic analysis of such lesions in children and adolescents has not been well studied. An 18‐year retrospective review of the cytopathology archives at The Johns Hopkins Hospital identified 44 cases of hepatic FNA in children and adolescents (i.e., 21 years and younger). The cytopathologic material was reviewed and correlated with subsequent surgical pathology diagnoses and/or clinical follow‐up. Among the 44 FNAs studied, 40 (90.9%) were deemed diagnostic for evaluation and 4 (9.1%) were nondiagnostic. Twenty four (60%) of the diagnostic FNAs were neoplasms, 10 (25%) were nonneoplastic lesions, and 6 (15%) were “atypical” or “suspicious.” There were 21 (87.5%) malignant and 3 (12.5%) benign tumors. Among the malignant cases, metastases/secondary tumors accounted for 12 (54.5%) followed by hepatocellular carcinoma (HCC)—7 (38.1%). The types of metastatic/secondary neoplasms were Wilms tumor (2), germ cell tumor (2), acute leukemias (2), and miscellaneous others (6). Among the nonneoplastic lesions focal nodular hyperplasia was most common—4 (40%). Among the “atypical” cases, 4 (66.6%) turned out to be benign on follow‐up, 2 were HCC, and 1 was Hodgkin lymphoma. Immunoperoxidase (IPOX) studies were done in 20 (45.5%) cases to confirm the cytopathologic diagnoses. Overall, FNA showed a sensitivity of 95.2% and a specificity of 100% for a malignant diagnosis. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.

Different response to salvage chemotherapy but similar post-transplant outcomes in patients with relapsed and refractory Hodgkin's lymphoma

“…The majority of patients in the study received mini-BEAM 18 or, more recently, GDP based on our institutional data. 35 The role and timing of consolidative radiotherapy peri-ASCT has not been tested in controlled trials. Historically pre-ASCT consolidative radiation has been a source of concern because of potentially high rates of pulmonary toxicity if mediastinal radiation is required.…”

Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma

“…In the majority of previous reports on high-dose chemotherapy, data on CD34 + cell mobilization are lacking and details on PBSC mobilization and collection are reported in a limited number of studies 11,23,[30][31][32] (Table 6). An adequate stem cell collection (>2×10 6 CD34 + cells/kg) was observed in over 80% of patients.…”

“…Very few studies reported data relating to which standard-dose salvage regimen is the best to induce a good clinical response and shrinkage of bulky disease [16][17][18][19][20][21][22][23][24][25] before high-dose therapy. Hence, the identification of new active regimens, combining therapeutic activity and CD34 + stem cell mobilizing potential, is of the utmost importance to increase pre-transplant response rates and, possibly, the final outcome.…”

Human immunodeficiency and Hodgkin lymphoma

“…Thus etoposide with high-dose cytarabine and cisplatinum -ESHAP, ICE, mini-BCNU or etoposide, cytosine arabinoside, and melphalan -BEAM, have been used. Recently gemcitabine-containing regimens have shown high response rates with an acceptable side-effect profile [72] and [73].…”