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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hodgkin's disease is one of the commoner malignancies presenting in adolescence and young adulthood and is curable in the majority of cases. A number of therapeutic regimens have been used successfully, often at the expense of the development of side-effects in later life, including second malignancies, infertility and cardiac disease. We discuss the challenge faced by paediatric oncologists today in finding the balance between maximising cure and minimising the late effects.
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PMID:Treatment of paediatric Hodgkin's disease. a balance of risks. 1187 38

Prepubertal boys treated for cancer may exhibit impaired fertility in later life. A number of chemotherapeutic agents have been identified as being gonadotoxic, and certain treatment regimens, such as that used for Hodgkin's disease, are particularly associated with subsequent infertility. Radiotherapy may also cause gonadal damage, most notably following direct testicular irradiation or total body irradiation. Because of the varied nature of the cytotoxic insult, it can be difficult to predict the likelihood of infertility in later life. Currently it is not possible to detect gonadal damage early due to the lack of a sensitive marker of gonadal function in the prepubertal age group. Semen cryopreservation is currently the only method of preserving fertility in patients receiving gonadotoxic therapy. This is only applicable to postpubertal patients and can be problematic in the adolescent age group. At present there is no provision for the prepubertal boy, although there are a number of experimental methods currently being investigated. By harvesting testicular tissue prior to gonadotoxic therapy, restoration of fertility could be achieved following treatment, either by germ cell transplantation or by in vitro maturation of the germ cells harvested. Alternatively, rendering the testes quiescent during cytotoxic treatment may protect the germ cells from subsequent damage. In addition to the many scientific and technical issues to be overcome prior to clinical application of these techniques, a number of ethical and legal issues must also be addressed to ensure a safe and realistic prospect for future fertility in these patients.
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PMID:Male fertility following childhood cancer: current concepts and future therapies. 1469 83

More than 80% of those diagnosed with Hodgkins disease (HD) will survive long-term. For the past decade, a modified hybrid consisting of cyclophosphamide (2.4-3.6g/m(2)), vincristine, procarbazine, and prednisone (COPP) together with adriamycin, bleomycin, and vinblastine (ABV) has been used to treat patients with HD. Little data exists on how this modified hybrid impacts male fertility. Eleven male patients treated with COPP-ABV hybrid were studied. Nine out of 11 subjects were categorized as infertile by semen analysis; 7 of 9 were azoospermic. There was no association between fertility status and prepubertal status at diagnosis or gonadotropin status. Despite lower doses of cyclophosphamide, treatment with the current COPP/ABV hybrid leads to infertility in the majority of young men. It is likely that procarbazine, an effective yet potent gonadotoxic agent, is responsible for this outcome.
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PMID:Fertility in males treated for Hodgkins disease with COPP/ABV hybrid. 1539 Feb 72

With the development of an integrated treatment approach, the cure rate and survival of patients with Hodgkin Lymphoma (HL) is now high. Treatment tailored to stage, using chemotherapy, with or without involved field radiotherapy is the standard of care. Paediatric oncologists have been developing treatment regimens to maximise cure rate whilst trying to minimise the associated late side-effects, and cure rates in children are now often greater than 90%. It has been suggested that the outcome of adolescents with HL does not match that of younger children, but published data focusing on this group of patients is scarce. Future treatment strategies may direct the treatment of adolescents with HL away from the current "adult" regimens, and closer to that currently received by children, but prospective randomised trials are required. Rationalisation of both chemotherapy and radiotherapy administered to children and adolescents aims to minimise the risk of significant long-term side effects without sacrificing high cure rates. Infertility, secondary malignancies, cardiac and respiratory morbidity are all significant risks of current combined modality treatment that need to be discussed when obtaining informed consent and may influence the choice of treatment offered or accepted. Monitoring late effects of treatment (both physical and psychological) is especially important in this group of young patients.
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PMID:Hodgkin Lymphoma in adolescents. 1595 Nov 18

Hodgkin's Lymphoma (HL) has developed to one of the best curable human cancers and overall about 80% of patients experience long-term disease free survival. Therefore, current treatment strategies aim at further improving treatment outcome, thereby trying to by minimize therapy-induced complications, such as infertility, cardiopulmonary toxicity, and secondary malignancies. Ongoing trials investigate a reduction of chemotherapy in terms of dose or cycles given, and the application of lower radiation doses and smaller radiation fields. For patients with a specific high-risk profile, new approaches with more intense drug combinations are currently being investigated. Moreover, the advent of effective salvage high-dose therapy for relapsed disease and a better understanding of prognostic factors have further improved the management of HL. Here, we summarize current strategies of the German Hodgkin Study Group (GHSG) in diagnostics and treatment of primary and relapsed HL, together with recent approaches for specific subgroups of HL patients.
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PMID:Current treatment strategies of the German Hodgkin Study Group (GHSG). 1600 81

Presently Hodgkin's lymphoma can be cured in at least 80% of patients. The major challenge to the clinician in 2005 is how to cure the disease while inducing the least irreversible toxicity. This review focuses on clinical trials and institutional experiences to identify the best choice of treatment, individualized to the stage of the lymphoma permitting minimization of late toxicity such as infertility, premature menopause, cardiac disease, and most importantly, risk of second neoplasms. More than 90% of patients with limited Hodgkin's lymphoma can be cured with either short-course chemotherapy alone or even briefer chemotherapy followed by involved-field radiation. Accumulating evidence suggests that chemotherapy alone is suitable for the large majority of patients with limited disease. For the 80% of patients with advanced disease but without a large number of adverse prognostic factors, standard multi-agent chemotherapy with the well-established ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) provides the best balance of effectiveness and minimization of toxicity. More intensified regimens currently under investigation are appropriate for the 20% with numerous adverse prognostic factors. In 2005 it is insufficient to focus solely on cure of Hodgkin's lymphoma. The treatment program must maximize chance of cure and minimize late toxicity. Fortunately, brief chemotherapy alone or with radiation for patients with limited disease and standard ABVD chemotherapy for patients with advanced disease offer the appropriate balance of these two requirements. Patients with advanced disease plus multiple indicators of a poor prognosis and patients with disease that persists despite optimized primary treatment require specially intensified treatment.
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PMID:State-of-the-art therapeutics: Hodgkin's lymphoma. 1615 26

Two challenges confront the clinician treating Hodgkin lymphoma today: achieving a high level of effectiveness while minimizing toxicity. At least 80% of patients can be cured with currently available chemotherapy regimens, augmented in selected patients with the addition of involved field radiation or intensified chemotherapy assisted by granulocyte growth factors or stem cell transplantation. Major late toxicity including infertility, premature menopause, cardiovascular disease and second neoplasms can be avoided in most patients if the treatment program is chosen carefully. The extent of disease (stage) and, for advanced stage lymphoma, the presence of well-characterized prognostic factors can be established with readily available clinical, laboratory and imaging techniques. Results from carefully designed and analyzed clinical trials have identified optimal treatment approaches for patients with limited and advanced stage disease. Those with limited stage Hodgkin lymphoma should be treated with brief chemotherapy, only augmented with involved field irradiation if an early complete remission is not achieved. Most patients with advanced stage lymphoma can be cured with an extended course of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine). The small minority under the age of 60 years with an International Prognostic Factors Project score of 5 or greater should be considered for intensified chemotherapy. Patients known to have bulky tumor(s) (> 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 under-treatment. 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.
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PMID:Evolving approaches to primary treatment of Hodgkin lymphoma. 1630 87

The treatment of Hodgkin's lymphoma has changed significantly over the last decades, rendering this entity one of the most curable human cancers. To date, about 80% of patients achieve long-term disease-free survival. Current strategies in first-line treatment aim at further improving outcome and thereby preventing therapy-induced complications, such as infertility, cardiopulmonary toxicity, and secondary malignancies. Ongoing trials for patients in early stages are investigating lower radiation doses and smaller radiation fields and possible reductions in the doses or number of cycles of chemotherapy given. For patients in advanced stages, new drug combinations with higher dose density and intensity have been developed, and are currently being evaluated in clinical trials. Approaches for relapsed Hodgkin's lymphoma comprise salvage radiotherapy, salvage chemotherapy and high-dose chemotherapy followed by autologous stem cell transplantation. In recent years, the introduction of effective salvage high-dose therapy and a better understanding of prognostic factors have remarkably improved the management of relapsed Hodgkin's lymphoma. For multiple pretreated patients antibody-based agents that showed promising results in experimental models are being investigated in clinical trials. Radioimmunoconjugates and monoclonal antibodies have demonstrated some clinical efficacy. Here, we review new aspects in the treatment of primary and relapsed Hodgkin's lymphoma as well as recent immunotherapeutic approaches.
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PMID:Current treatment and immunotherapy of Hodgkin's lymphoma. 1633 Apr 43

Approximately 15-25% of male infertility cases carry extensive azoospermic factor (AZF) deletions. Moreover, about 80% of Finnish testicular germ cell tumors (TGCT) and about 23-25% of TGCTs from other geographic regions carry short and interstitial AZF deletions. In infertility cases the AZF deficiency occurs in the germ cells of the proband father giving rise to mosaic sperm populations comprising non-deleted and deleted sperms. Fertilization of an oocyte by a Y deleted sperm will give rise to an AZF-deleted and infertile F1 male. In TGCTs the AZF deletions take place in the initial stages of embryogenesis producing individuals that are a mosaic of Y deleted and non-deleted cell lineages. Carcinoma in situ (CIS) is a premalignant lesion that some believe may develop in gonads of male embryos before the ninth week of age due to transformation of a totipotent primordial germ cell. If the transformed cell carries AZF deletions the resultant CIS will also have Y deletions. CIS will differentiate into seminoma or into embryonal carcinoma and non-seminomas in about 1 x 10(-3) of the young adults carrying premalignant CIS outgrowths; if the CIS lesion has AZF deletions the derived forms of testicular cancer will also exhibit these deletions. AZF deletions play no role in the development of testicular cancers. On the other hand, they are a marker of Y chromosome instability and eventually of a more generalized pattern of genome instability associated with the appearance of TGCT. Genetic factors such as malfunction of metabolizing genes, DNA repairing genes, Y-linked or X-linked genes have been considered as possible causes of AZF deletions in testicular cancer. Yet, the exact identification of the genes involved remains elusive. AZF deletions have also been identified in non-Hodgkin lymphomas and in colorectal cancers, two forms of malignancy that have been found to be associated with TGCTs.
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PMID:Y chromosome instability in testicular cancer. 1648 36

As a result of continuous improvement in therapeutic options and their verification by large multicenter trials, Hodgkin's lymphoma (HL) has become one of the best curable cancers in adults. Nowadays, about 80-90% of patients in all stages achieve long-term survival. Nevertheless, these good results are threatened by treatment-associated toxicities such as infertility, cardiopulmonary toxicity and secondary malignancies. It is therefore the aim of future trial generations both to maintain excellent treatment results and to minimize late effects. At early stages, ongoing trials ask how many cycles of ABVD-like chemotherapy are necessary and if radiation doses might be further reduced or even omitted in favorable early-stage disease. In advanced stages, new combinations of chemotherapeutic drugs with higher dose densities are tested with or without the application of consolidating radiotherapy. The treatment of patients with relapsed HL depends on previous therapies with radiotherapy, chemotherapy or high-dose chemotherapy followed by autologous stem cell transplantation. For patients with multiple relapses, experimental treatment strategies include antibody- and small-molecule-based regimens. In this review we present current treatment strategies for patients with a first diagnosis of HL and relapsed HL as well as recent experimental therapeutic approaches.
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PMID:Current strategies and new approaches in the treatment of Hodgkin's lymphoma. 1708 57


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