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

Between January 1991 and December 1993, all newly-diagnosed patients with Hodgkin's disease in the Northern Health Region (population 3.08 million) were entered into a prospective population-based (PACE) study to assess the accuracy of staging at diagnosis, and to evaluate treatment and outcome. On histological review, 202 patients were confirmed to have Hodgkin's disease, an incidence of 2.2 per 100,000 per annum. Radiological review revealed that only 12% of patients were staged to recognized guidelines. In early-stage disease, treatment outcome was comparable to published results in Stage IA disease, but disappointing for Stage IIA. This was partly due to inadequate or inaccurate staging. In-built audit in the process was followed by the introduction and implementation of improved guidelines. Of younger patients (15-55 years) with 'poor-risk disease', 75% of the eligible population were entered into the appropriate randomized controlled trial. This intensive treatment has led to improved survival in this group over that which might be expected on four-drug therapy. The results of the randomized trial are not discussed as it is currently ongoing. This combined research/audit programme has resulted in greater standardization of care across a whole region, and confirms that the PACE (population-adjusted clinical epidemiology) approach facilitates the flow of information from research into practice and vice versa.
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PMID:Hodgkin's disease: a population-adjusted clinical epidemiology study (PACE) of management at presentation. Northern Region Lymphoma Group. 957 95

Reactivation of hepatitis is one of the most serious complications of chemotherapy in lymphoma patients who are carriers of the hepatitis B virus (HBV). Glucocorticoids are linked to increased risk of HBV reactivation. This study seeks to clarify whether removal of glucocorticoids from chemotherapy regimens may decrease the risk of HBV reactivation. Eligible patients were seropositive for hepatitis B surface antigen (HBsAg) and had histologically proven non-Hodgkin's lymphomas for which intensive chemotherapy was indicated. Patients were randomized to receive either ACE (epirubicin, cyclophosphamide, and etoposide) or PACE (prednisolone + ACE). A total of 50 patients were enrolled, 25 each for the ACE and PACE arms. The cumulative incidence of HBV reactivation at 9 months after starting chemotherapy was 38% and 73% for ACE and PACE arm, respectively (P =.03). The degree of clinical hepatitis was significantly more severe in the PACE arm: 11 patients (44%) in the PACE and 3 patients (13%) in the ACE arm had ALT elevation more than 10-fold of normal (P =.025), and 7 patients (28%) in the PACE and 1 patient (4%) in the ACE arm had icteric hepatitis (P =.049). Complete remission of tumors occurred in 11 (46%) patients in the PACE and 8 (35%) patients in the ACE arm (P =.556). The estimated overall survival rate at 46 months was 68% in the PACE arm and 36% in the ACE arm, respectively (P =.18). In conclusion, steroid-free chemotherapy decreases the incidence and severity of HBV reactivation in HBsAg-positive lymphoma patients. However, further research is needed to evaluate whether steroid-free chemotherapy may confer a less satisfactory control of lymphoma.
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PMID:Steroid-free chemotherapy decreases risk of hepatitis B virus (HBV) reactivation in HBV-carriers with lymphoma. 1508 99