Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The role of radiation therapy (RT) in Hodgkin lymphoma has changed substantially; it has evolved from a first-line comprehensive single agent into a complementary adjuvant following chemotherapy. Yet, the significant contribution of adding radiotherapy has repeatedly been confirmed by recent information from several prospective randomized trials in early stage patients (CCG, Canada NCIC, and EORTC/GELA H9F). In a recent study that included patients of all stages adding radiotherapy impacted significantly on overall survival. Even in advanced-stage disease, in patients with less than CR, and/or bulky disease or in programs that use short-course chemotherapy (e.g. Stanford V) involved-field radiation therapy (IFRT) remained essential. Randomized studies and most recently the GHSG HD 10 and HD 11 documented excellent results with low-dose IFRT of only 20 Gy in both early stage and in intermediate-stage patients. It is now standard of care to use IFRT rather than the extended radiation fields of the past (mantle, inverted Y, and STLI/TLI). Even smaller volumes than IFRT, such as 'lymph-node fields' are advocated by paediatrics groups and are under consideration for future adults treatment programs. This change in RT concept has been motivated by need to reduce normal tissue exposure in order to markedly lessen the risk of late complications. The small fields of current radiotherapy allow more conformal and innovative approaches that have not been technically feasible in the past. They also mandate better targeting. Both the accuracy and the confirmality of 'min-radiation' are augmented, by using new advances in imaging, treatment planning, and new radiation delivery systems. The PET/CT/Simulator integrated hardware with innovative software allows more accurate PET and CT (or MRI) parallel volume contouring, radiation 'dose painting' (dose tailored to PET residual activity) and field 'sculpting'. Introducing intensity modulated radiotherapy technology (IMRT)--a technology that was originally designed for small tumors treated with very high doses--to the field of lymphoma provides safer and more accurate radiotherapy to selected patients with very bulky residual disease and permits re-irradiation of relapsed disease.
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PMID:Transformation in the use of radiation therapy of Hodgkin lymphoma: new concepts and indications lead to modern field design and are assisted by PET imaging and intensity modulated radiation therapy (IMRT). 1600 75

Many new treatment approaches have given promising results in experimental Hodgkin's lymphoma (HL) models. Early clinical trials evaluating antibody based compounds as immunotoxins (ITs), radioimmunotherapy (RIT), bispecific molecules (BSMs), and recently monoclonal antibodies (MAbs), have demonstrated some clinical efficacy in patients with advanced refractory or relapsed HL. In addition, cellular immunotherapy is evolving. Although it seems unlikely to cure chemotherapy resistant patients with larger tumor masses by either of these approaches alone, the combination with conventional chemotherapy might help to overcome resistance of Hodgkin-/ReedSternberg (H-RS) cells. Another rationale for the development of these immunotherapies is to eliminate residual disease and thereby to prevent relapses from the disease. Currently, several clinical studies are running. A murine MAb (Ki-4) based 131 Iodine conjugate has shown efficacy in refractory HL patients in a phase II study, but less toxic constructs using alternate MAbs or isotopes should be developed. A humanized as well as a fully human anti-CD30 MAb are being tested in clinical phase I/II studies. These MAbs could engage the human immune system against the H-RS cells. In addition, these MAbs could be then combined with conventional chemotherapy in order to improve the treatment of HL.
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PMID:Immunotherapy of Hodgkin's lymphoma. 1600 86

In Hodgkin's lymphoma (HL), PET imaging should be performed in all patients, particularly in stage I or II disease where change in staging will alter management. For aggressive Non-Hodgkin's lymphoma (NHL), PET imaging is valuable to provide a baseline for response evaluation. For indolent NHL, it is concluded that PET imaging is not generally indicated. For HL, a negative FDG-PET scan is highly indicative of long-term, disease-free survival and is particularly useful in the presence of residual CT mass. For aggressive NHL, a positive FDG-PET scan is predictive of disease persistence or recurrence. There is a significant incidence of false-negative FDG-PET scans, which in most cases means minimal residual disease that cannot be detected by the current instrumentation. For both NHL and aggressive HL, early assessment of response appears to be predictive of long-term outcome. Optimal time of FDG-PET scan during therapy needs to be determined. For indolent NHL, the high rate of false-negative FDG-PET scans raises questions to its clinical role in response evaluation. FDG-PET and PET-CT improve primary staging and restaging of lymphomas. Metabolic imaging will be the standard technology for assessment of therapy with documented prognostic value. Imaging during therapy may be valuable to individualize therapeutic protocols and to define chemosensitivity of tumor tissue. Minimal residual disease cannot be detected with current imaging devices.
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PMID:Role of PET in lymphoma. 1608 46

In patients with Hodgkin's lymphoma (HL) at the end of first line therapy an accurate imaging technique with high prognostic value is needed to assess response to treatment and predict those patients who will suffer disease relapse. This technique and its results permit the quick initiation of a second line therapy in patients suffering from a progressive disease or those unresponsive to treatment avoid over-treatment of patients in complete remission or those having a non-active residual disease. We included a (18)FDG-positron emission tomography (PET) scan to the diagnostic set-up to investigate 28 patients following the end of their treatment. Fifteen patients out of the 28 (54%) had positive CT scans while 13 (46%) had negative ones. Eleven patients out of the 15 CT positive (73%) had negative PET scans and no relapse. The remaining four patients (27%) had positive PET scans with only one relapse (25%). With respect to the 13 patients who had negative CT scans, 9 patients (69%) had negative PET scans and no relapse. The remaining 4 patients (31%) had positive PET scans with 3 relapse cases (75%). In our final assessment after a median follow-up period of 45 months, starting from PET execution to the last follow-up, overall sensitivity of the CT and the PET were 25 and 100% respectively, specificity 42 and 83% respectively, positive predictive value (PPV) 7 and 50% respectively, negative predictive value (NPV) 77 and 100% respectively, and accuracy 39 and 86% respectively. In our experience, FDG-PET performed in patients after induction therapy appears to offer important additional information: FDG-PET results are predictors of prognosis giving 100% DFS in PET negative patients and 54% DSF in PET positive patients.
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PMID:18FDG-positron emission tomography in post treatment evaluation of residual mass in Hodgkin's lymphoma: long-term results. 1621 Dec 87

Although advanced Hodgkin lymphoma is highly curable, balancing the high cure rate with long-term toxicity is challenging. ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, dacarbazine) is the standard chemotherapy regimen, producing a high cure rate with acceptable toxicity. Stanford V and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) are new regimens with encouraging results and are undergoing randomized clinical trials. The International Prognostic Score provides a clinical tool that may help identify patients with high-risk disease who may require a more aggressive regimen. Consolidative radiation's role in managing advanced Hodgkin lymphoma is still controversial, but it is most accepted for bulky or residual disease or after brief chemotherapy. The development and integration of newer imaging tools, such as fluorodeoxyglucose-positron emission tomography imaging, may allow a more precise evaluation of disease and help define which patients might benefit from consolidative treatment.
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PMID:Management of advanced stage Hodgkin lymphoma. 1650 71

Despite the increasing number of publications concerning 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for post-treatment evaluation of lymphoma and the increasing availability of this novel diagnostic modality, its exact role in response assessment after therapy is still unknown. The aim of this study was to systematically review the literature regarding the diagnostic performance of dedicated FDG-PET in evaluation of first-line therapy of Hodgkin's disease and (aggressive) non-Hodgkin's lymphoma, and to calculate summary estimates of its sensitivity and specificity. The databases of PubMed and Embase were searched for relevant studies up to January 2004. Two reviewers independently assessed the methodological quality of each study. As a valid reference test, histology or follow-up of at least 12 months were accepted. A meta-analysis of the reported sensitivity and specificity of each study was performed. Fifteen studies, involving 705 patients, met the inclusion criteria. The studies had several design deficiencies. The majority of studies did not describe whether the reference test was interpreted without knowledge of the FDG-PET findings. In all studies, there was a description of the spectrum of patients included, i.e. all patients for post-treatment evaluation or only patients with substantial residual masses post-treatment. Pooled sensitivity and specificity for detection of residual disease in Hodgkin's lymphoma were 84% (95% CI 71-9192%) and 90% (95% CI 84-9394%), respectively. For non-Hodgkin's lymphoma, pooled sensitivity and specificity were 72% (95% CI 61-82%), and 100% (95% CI 97-100%), respectively. FDG-PET showed reasonable sensitivity and high specificity for evaluation of first-line therapy in Hodgkin's and in non-Hodgkin's lymphoma. Standardization of procedures is required before implementation in clinical practice.
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PMID:18F-fluoro-deoxyglucose positron emission tomography for post-treatment evaluation of malignant lymphoma: a systematic review. 1658 17

The aim of this retrospective study was to compare the value of FDG-PET with conventional imaging in patients with residual disease or suspected relapse in Hodgkin's lymphoma (HL). We reviewed the records of all patients with HL who were referred for FDG-PET at our PET centre between April 2002 and August 2004. Thirty-four FDG-PET scans performed on 26 patients were included in the study. Referrals were based on either the presence of a residual mass on computed tomography (CT) (n = 13) or suspicion of relapse (n = 21). We found one false negative and one false positive FDG-PET scan. The high positive predictive value of FDG-PET in the residual group and the high negative predictive value in the relapse group strongly indicate that FDG-PET has an important role to play in the management of HL.
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PMID:FDG-PET in the detection of residual disease and relapse in patients with Hodgkin's lymphoma. Experience from a Swedish centre. 1693 18

Primary gastric lymphomas are the most common extranodal non-Hodgkin's lymphomas and are divided into indolent (low grade) and aggressive (high grade) types. They are mainly the disease of middle age, with a male predominance reported by most of the studies. For several years, surgery played a central role in diagnosis, staging, and treatment of this entity, yet recently there has been a move away from a surgical approach to conservative treatment. To determine the role of surgery as the initial treatment modality, we performed this retrospective single-center research on 245 patients with primary gastric lymphoma who were treated according to our protocol between 1990 and 2003. The patients' characteristics, distribution of histological types, treatment results, and disease-specific survival were followed. According to the histology, 59.2% had diffuse large B-cell lymphoma (DLCL), 26.1% MALT lymphoma, 9.8% mixed lymphoma (indolent and aggressive at the same time), while other types were infrequent. In total, 161 patients (65.7%) were treated with surgical resection as the initial treatment, which was then followed or not by additional therapy (chemotherapy, chemotherapy and radiotherapy, radiotherapy) depending on the histological type of lymphoma and the extent of residual disease after surgery. In 84 patients (34.3%), the treatment approach was conservative. The selection of treatment (chemotherapy, chemotherapy and radiotherapy, radiotherapy or Helicobacter pylori eradication only) was based on the histological type of lymphoma, considering also the patients' physical condition. The disease-specific survival in the group of patients who underwent surgery was statistically significantly better than in patients who were treated conservatively (p=0.049). At 5 years, it was 96.9% for the group treated with surgery and 89.8% in patients treated conservatively. However, the results were biased, as the patients who were treated conservatively were either in a worse performance status or presented with a more extensive disease. Similarly, in the DLCL type the disease-specific survival was better in the surgically treated group (97.2%) than in the conservatively treated patients (89.2%). The difference was barely significant (p=0.046) and again the results have to be considered with caution due to the selection of patients in a worse performance status or with a more extensive disease for conservative treatment. In the MALT lymphoma and mixed lymphoma types, there were no differences in the disease-specific survival between both treatment groups. Regarding the statement that for conservative treatment patients were selected who were unsuitable for the resection on account of concomitant diseases or due to the fact that the process was inoperable, we believe that the conservative approach gives comparable outcomes to the approach including initial surgery. The existing evidence thus no longer justifies surgery as the standard initial treatment and preference should be given to conservative treatment approaches.
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PMID:A single-center study of treatment outcomes and survival in patients with primary gastric lymphomas between 1990 and 2003. 1694 46

Autologous hematopoietic stem cell transplantation (ASCT) has become standard therapy for primary refractory (PR REF) or relapsed (REL) Hodgkin's lymphoma (HL); however, more than half of these patients eventually relapse and die of their disease. We studied long-term outcomes and evaluated factors influencing progression-free survival (PFS) in 141 patients with PR REF or REL HL who underwent ASCT between 1985 and 2003. Median age at ASCT was 30 years (range, 7-60 years); 21 patients had PR REF, and 120 had REL HL. With a median follow-up of 6.3 years (range, 1-20 years), the probability of PFS at 5 and 10 years was 48% (95% confidence interval [CI], 39%-57%) and 45% (95% CI, 36%-54%) and that of overall survival (OS) was 53% (95% CI, 44%-62%) and 47% (95% CI, 37%-57%), respectively. Transplant-related mortality at 100 days was 1.4%. Among 45 5- to 20-year survivors, no late relapses of HL were observed. In multivariate analysis, 3 factors were independently predictive of poor PFS: chemoresistant disease (relative risk [RR], 2.9; 95% CI, 1.7-5.0), B-symptoms at pretransplantation relapse (RR, 2.1; 95% CI, 1.3-3.4), and presence of residual disease at the time of transplantation (RR, 2.3; 95% CI, 1.1-4.8). Patients with 0 or 1 of these 3 adverse factors (low-risk disease) had a 5-year PFS of 67% (95% CI, 55%-79%) compared with 37% (95% CI, 22%-52%) in those with 2 factors (intermediate-risk group) and 9% (95% CI, 0-20%) in those with all 3 factors (high-risk group) (P < .001). The rates of OS at 5 years were 71% (95% CI, 60%-82%), 49% (95% CI, 33%-65%) and 13% (95% CI, 0-27%) in the 3 groups, respectively (P < .001). ASCT is associated with durable PFS in appropriately selected patients with PR REF or REL HL. Using a simple prognostic model, we can identify patients with high-risk disease who have predictably unfavorable outcome after ASCT and require novel therapeutic approaches. A risk-adapted approach should be followed in determining treatment options for patients with PR REF and REL HL.
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PMID:Long-term results of autologous stem cell transplantation for primary refractory or relapsed Hodgkin's lymphoma. 1708 70

Positron emission tomography (PET) using the radiolabelled glucose analog 2-[18F]fluoro-2-deoxy-d-glucose (FDG) is increasingly used for response assessment in patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). These patients often present with a residual mass after therapy, but only a minority will relapse as most of these masses consist of inactive fibrosis. However, some patients have residual disease after first-line treatment and they can benefit from additional or early salvage therapy. Special interest for early, but accurate, assessment of response is growing accordingly. Conventional radiological techniques cannot differentiate between active tumoural tissue and fibrosis in these masses. In contrast, FDG-PET has the ability to differentiate between viable tumour and fibrosis and has been evaluated as an initial staging tool, for response assessment after completion of therapy and as a prognostic marker early during treatment. In this review, we will focus especially on the value of PET for response assessment.
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PMID:PET and PET/CT for response evaluation in lymphoma: current practice and developments. 1732 86


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