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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 use of combined modality therapy (irradiation and combinations of drugs) in the treatment of Hodgkin's disease has produced a significant improvement in survival, during which most patients lead an active and productive life. The estimated 1% incidence of leukemia in treated Hodgkin's disease patients, however, is greater than would be expected in the general population. There is a vast amount of literature which indicates that alkylating agents, procarbazine and irradiation are leukemogenic and immunosuppressive in animals and man. It is than conceivable that the current intensive treatment programs which use these agents are promoting the development of acute non-lymphocytic leukemia (ANLL). This leukemia has occurred most often in patients whose Hodgkin's disease is poorly controlled and who have received more aggressive therapy. The latent period from the diagnosis of Hodgkin's disease to the diagnosis of leukemia is significantly shorter (p less than .0005) in those patients who have received intensive and near maximal radiotherapy (total nodal irradiation), combination chemotherapy (MOPP or equivalent) or a sequential combination of the two modalities than similar patients who were treated with less than total nodal irradiation and or single agent chemotherapy. The following characteristic features have occurred with sufficient frequency to suggest that the subsequent leukemia is a distinct clinicopathological entity: pancytopenia, megaloblastoid marrow, nucleated red blood cells in the peripheral blood, random chromosomal aberrations of the bone marrow in most patients (94%), and refractoriness to antileukemia therapy (response rate 6.5%) with a very short survival (median one month).
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PMID:Acute nonlymphocytic leukemia: a delayed complication of Hodgkin's disease therapy: analysis of 109 cases. 40 79

This paper presents a technique for total nodal irradiation used at Memorial Hospital for the treatment of Stage IIIA and previously untreated Stage IIIB Hodgkin's disease. This method of treating large fields for this type of lymphoma overcomes problems of dosimetry and treatment tolerance. There are two courses of treatment used in which all lymph node bearing areas from the tips of the mastoids to the femoral triangles are irradiated. A comparison will be made between this technique and the conventional treatment fields for Hodgkin's disease.
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PMID:The 3 and 2 technique for Hodgkin's disease at Memorial Hospital. 41 24

A retrospective analysis is presented of 38 cases of malignant lymphomas of the stomach, 20 of the reticulum cell type, 6 lymphoblastic, 6 lymphocytic and 4 mixed forms. Two patients had a primary Hodgkin's malignant lymphogranuloma. A follow-up was obtained for 35 patients. There proved to be no significant difference between the symptomatology of carcinoma and lymphoma of the stomach. In patients with lymphomas only signs of stenosis were missing, although the majority of the tumors were located in the antrum. As a consequence of the extreme tendency of the lymphomas to exulcerate (89%), the mean duration of symptoms of 21/2 months (patient's delay) is shorter than that for carcinomas. Malignant lymphomas of the stomach are very difficult to identify as such by radiology and endoscopy, because of their uncharacteristic macroscopic appearance. The best diagnostic method has proved to be endoscopic wire-loop biopsy, which serves to obtain adequate material for histology. An unexpected finding was that at the time of operation half of the patients had clinical stage I E. This indicates that lymphomas remain limited to the stomach longer than carcinomas do. The prognosis depends on both histological type and clinical stage. It is somewhat better than that of nodal malignant lymphomas. The 5-year survival rate of all cases with malignant lymphoma of the stomach is 31%.
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PMID:[Primary malignant lymphoma of the stomach. Analysis of 38 cases]. 43 96

The Cancer and Acute Leukemia Group B studied the effect of combination chemotherapy-radiotherapy on Stage III Hodgkin's disease. Chemotherapy consisting of 4 weekly doses of vinblastine and one dose of mechlorethamine hydrochloride was followed by no therapy (CT), radiation to involved fields (CTIF) or total nodal radiation (CTTN). Two other treatment arms included total nodal radiation alone (TN) or total nodal radiation followed by chemotherapy (TNCT). Maximum follow-up is ten years. Complete remission percentages were 36 (8/22) for CT, 71 (17/24) for CTIF, 100 (21/21) for CTTN, 86 (19/22) for TNCT and 89 (16/18) for TN. Disease-free survival in patients receiving radiation +/- chemotherapy is 23% (19/73) at 5 years, but even after 9 years relapses were observed in two patients. Forty-one percent of all patients are alive and 32% have survived for five years. Ability to administer adequate therapy was the main determined for response duration and survival. Factors influencing the outcome of the disease include histology, age, splenectomy, initial white blood cell count and performance status, whereas symptomatology, initial absolute lymphocyte count and sex played no role on survival.
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PMID:Long term follow-up of combination chemotherapy-radiotherapy of stage III Hodgkin's disease: a Cancer and Acute Leukemia Group B study. 44 26

Between April 1969 and December 1974, 37 patients with surgically staged III A Hodgkin's disease were treated with total nodal irradiation (TNI). Their probability of relapse-free survival at 7 years is 51% and overall survival 82% with the majority of patients remaining disease free after retreatment with MOPP (10 of 16). In contrast, 21 stage III B patients treated with TNI and MOPP chemotherapy over the same time period have a relapse-free survival of 74% and overall survival of 91%. Because of superior results in treating stage III B patients with combined modality treatment, we fell that a relapse-free survival of 51% may not justify continuation of TNI as the only modality of treatment for patients with stage III A disease, and we have initiated a trial of combined radiation therapy and MOPP chemotherapy in these patients. The most effective treatment of stage III A Hodgkin's disease, however, remains uncertain and depends both on the ultimate risk of combined modality treatment and the success of retreatment following relapse after radiation.
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PMID:An evaluation of total nodal irradiation as treatment for stage III A Hodgkin's disease. 44 28

90 patients suffering from Hodgkin's disease, 32 in stages I and II, 42 in stage III and 16 in stage IV have been studied retrospectively. The first were treated with supra and subdiaphragmatic extensive radiotherapy, the second with total nodal or polychemotherapy (MOPP), the third with polychemotherapy. Results were highly satisfactory in stages I and II with a complete remission rate of 100% (duration: 4/100 months) and with survival of 91.8% at 7 years. At the 3rd stage, total nodal therapy led to complete remission in 73.3% of patients (9--46 months) with 5-year survival of 76.1%; at this stage, polychemotherapy induced complete remission in 65.2% of cases (6--34 months) with 4-year survival of 64%. Much worse were the results of polychemotherapy in the IVth stage. The same series has been reconsidered with allowance for explorative laparotomy by splenectomy carried out in 15 patients in I-II stage and treated with extensive radiotherapy, in 7 IIIrd stage patients subjected to total nodal therapy and in 10 in IIIrd stage treated with MOPP. In IIIrd stage splenectomized patients, the incidence of recurrences is lower than in the controls and independent of treatment. The lower incidence of recurrences also observed in I-II stage cannot be evaluated for the moment.
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PMID:[Treatment of Hodgkin's disease: review of 90 cases]. 51 82

From 1968 to 1976 in the Radiological Clinic of the Karl-Marx-University of Leipzig 199 patients with Hodgkin's disease were irradiated, 24 patients totally nodal. As this form of treatment has been used in our institution only since 1976, on account of the small time interval not the survival rate, but only the quota of recidivation could be used for the judgment of the effectiveness of the total nodal irradiation. Compared with the local irradiation the result was a decrease of the distribution recidivations from 82.3% to 20.8%. Also in comparison to the systemic X-ray treatment above or below the diaphragm (= 34% of recidivations) a clear progress was shown.
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PMID:[Value of total nodal radiotherapy in the treatment of lymphogranulomatosis]. 53 96

During a preliminary clinical experience (1973-1977) we experimented three different sequences in associating 6 MOPP cycles (CT) with radiotherapy (RT) for the treatment of stage II and III Hodgkin's disease. A total of 55 consecutive previously untreated patients can be estimated to contribute in defining feasibility, immediate results and toxicity of the combined treatment. In this group of patients RT preceded CT in 20 cases (RT-6 MOPP), the opposite sequence (6 MOPP-RT) was preferred in 16 cases, whilst a split-course CT fitting in the RT (3 MOPP-RT-3 MOPP) was employed in 19 cases. Except for the sequence used with respect to irradiation, the CT was carried out in all the cases according to the classical scheme proposed by De Vita et al. (11). RT was effected with 60Co-teletherapy and a wide field or segmental sequential fields, having variable extension depending on the stage ("extended nodal irradiation" for stage II and III cases with lymph node involvement not below L3; "total nodal irradiation" for the remaining cases in stage III). The programmed doses were 45.0 Gy to the involved areas and 40.0 Gy to the clinically uninvolved regions for the RT-6 MOPP and 6 MOPP-RT groups. Doses of 35.0/30.0 Gy were planned for the 3 MOPP-RT-3 MOPP group. The three different groups are not homogeneous with regard to certain important clinical and pathological characteristics; in fact, a higher quota of stage III patients, with systemic symptoms and spleen positivity is present in the 6 MOPP-RT and 3 MOPP-RT-3 MOPP groups. The combined treatment has achieved a complete clinical remission in 18/20 patients in the RT-6 MOPP group (90.0%), in 12/16 patients of the 6 MOPP-RT group (75.0%), and in 17/19 cases in the 3 MOPP-RT-3 MOPP "sandwich" combination (89.5%). The average overall duration of the treatment was 48 weeks for the sandwich combination, 50 weeks for the RT-6 MOPP group, and 56 weeks for the 6 MOPP-RT association. As regards the sandwich combination, both CT and RT took a reasonable length of time to complete. On the contrary, both the medical treatment and irradiation required an excessively long time and were not well tolerated when preceded by either RT or CT in full doses. In particular, myelosuppression was less acute and prolonged in the 3 MOPP-RT-3 MOPP group, whereas the actual doses of CT and RT were higher than those which can be reached with respect to other groups. Three preliminary cycles of CT considerably reduce the target volumes and complications arising from RT. The first CT time gave an objective response greater than 50% in 9/9 cases of the 3 MOPP-RT-3-MOPP group with mediastinal involvement. In this group, rather considerable pulmonary complications were observed in 3/9 patients (33.3%) with respect to the 40% found for the 6 MOPP-RT group (2/5 cases) and the 67.7% for the RT-6 MOPP group (6/9 cases).
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PMID:Feasibility of different combinations of chemotherapy (6 MOPP) plus radiotherapy in Hodgkin's disease. 54 16

The immunoblastosarcoma (IB) was preceeded by another pathological state in almost one third of patients. The clinical picture was often very typical, with large inflammatory node involvement. In one third of cases, the initial site of the tumor was not nodal, but in Waldeyer's ring or a non-lymphoid organ. Analysis of topographic extension indicates a weak propensity to dissemination. The tissues which are the more frequent site of secondary invasion were the lung parenchyma and the subcutaneous tissue. The course was rapid, almost always fatal. Only a combination of radiotherapy and chemotherapy would seem capable of eradicating the tumour. On the basis of all these characteristics, the IB has a special place alongside other non-Hodgkin lymphomas and they may be individualised histologically. These cases are in general in agreement with the little data published in the literature.
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PMID:[Immunoblastic lymphosarcomas. Clinicopathological aspects and course. Retrospective analysis of a series of 50 patients (author's transl)]. 58 Apr 53

Of 47 children with an initial diagnosis of lymphosarcoma, reticulosarcoma or Non-Hodgkin's lymphoma (NHL), 13 had to be excluded at the histologic reevaluation: in 10 an undifferentiated sarcoma, in 2 Hodgkin lymphoma was found; in one patient no definite classification of the tumor was possible. Of the remaining 34 patients there were 26 boys and 8 girls. One patient had a nodular, 33 a diffuse NHL. Of the latter 16 had a Burkitt-type (LB-), 3 a lymphoblastic, convoluted (LC-), 8 a lymphoblastic, "other" (LO-) and 6 a histiocytoid (H-) NHL. Primary localization: abdomen: 13/34; "peripheral" lymph nodes: 9/34; mediastinum: 5/34; nasopharynx: 4/34; subcutis: 2/34; skeleton: 1/34. Twelve of 17 NHL with primary localization in the abdomen or nasopharynx were LB-NHL, 8/14 NHL with primary localization in "peripheral" nodes or mediastinum were LC- or LO-NHL. Only 2/17 NHL with abdominal or nasopharyngeal primary, but 9/14 NHL with "peripheral" nodal or mediastinal primary developed leukemic extension and/or CNS involvement. 6 of 34 patients are living without evidence of disease for 1 1/2+ to 13+ years; 5/34 died but lived for 85, 57, 37, 22 and 22 months; 9/34 lived 6--12 months; 14/34 died within less than 6 months. Patients with abdominal primary either died within 5 months or survived (for 165+, 63+ and 25+ months). Aggressive local therapy (surgery and radiotherapy with approximately 4000 R) may be adequate for strictly localized (stage I) disease, particularly if the primary localization is abdominal. In all other diffuse NHL of childhood an early, aggressive chemotherapy, later combined with radiotherapy to bulk disease and prophylactic CNS-treatment is essential for inducing long-term remissions and, possibly, cures. For prognosis the primary localization appeared to be more important than histology and stage. The most decisive factor, however, is therapy.
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PMID:Malignant non-Hodgkin's lymphoma (NHL) in childhood. Retrospective analysis of 34 cases. 61 79


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