Treatment of Progressive Hodgkin’s Disease With Intensive Chemoradiotherapy and Autologous Bone Marrow Transplantation
Twenty-six patients with progressive Hodgkin's disease after conventional chemotherapy received intensive che-moradiotherapy and autologous bone marrow transplantation (ABMT); 19 also received additional involved-field radiotherapy. Twenty-one patients [81%, 95% confidence intervals (Cl) 61% to...
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Veröffentlicht in: | Blood 1989-06, Vol.73 (8), p.2086-2092 |
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creator | Phillips, G.L. Wolff, S.N. Herzig, R.H. Lazarus, H.M. Fay, J.W. Lin, H.-S. Shina, D.C. Glasgow, G.P. Griffith, R.C. Lamb, C.W. Herzig, G.P. |
description | Twenty-six patients with progressive Hodgkin's disease after conventional chemotherapy received intensive che-moradiotherapy and autologous bone marrow transplantation (ABMT); 19 also received additional involved-field radiotherapy. Twenty-one patients [81%, 95% confidence intervals (Cl) 61% to 94%] attained complete (n = 18) or partial responses. Ten patients (38%, 95% Cl 20% to 59%) are disease-free a median of 4.5 years later (range 3.5 to 7.0 years), including seven patients with continuous complete responses. The likelihood of overall response was not significantly influenced by any clinical or treatment variable examined. However, there was a trend favoring patients with higher Karnofsky scores, and higher scores were associated with attainment of complete responses (P - .06 and P - .02, respectively, Mann-Whitney U test). Both higher Karnofsky scores and shorter durations of disease before transplantation were associated with improved survival in a stepwise Cox multivariate analysis. The chief cause of failure was progression at sites previ- ously involved with Hodgkin's disease. No patient relapsed in the marrow, and two of three patients with a history of marrow involvement with Hodgkin's disease achieved durable complete responses after transplantation. These data suggest that inadequate pretransplant conditioning, and not the reinoculation of occult tumor cells in the autologous marrow, caused most relapses. Fatal treat-ment-related toxicity occurred in six patients. Three patients died of idiopathic interstitial pneumonitis; each had previously received local mediastinal irradiation before intensive chemoradiotherapy. Intensive chemoradiother-apy and ABMT produces durable responses in some patients with Hodgkin's disease incurable with conventional therapy. Use of such therapies at the first sign of failure with conventional chemotherapy and development of more effective conditioning regimens should further improve results.© 1989 by Grune & Stratton, Inc. 0006-4971/89/7308-0018$3.00/0 |
doi_str_mv | 10.1182/blood.V73.8.2086.2086 |
format | Article |
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Twenty-one patients [81%, 95% confidence intervals (Cl) 61% to 94%] attained complete (n = 18) or partial responses. Ten patients (38%, 95% Cl 20% to 59%) are disease-free a median of 4.5 years later (range 3.5 to 7.0 years), including seven patients with continuous complete responses. The likelihood of overall response was not significantly influenced by any clinical or treatment variable examined. However, there was a trend favoring patients with higher Karnofsky scores, and higher scores were associated with attainment of complete responses (P - .06 and P - .02, respectively, Mann-Whitney U test). Both higher Karnofsky scores and shorter durations of disease before transplantation were associated with improved survival in a stepwise Cox multivariate analysis. The chief cause of failure was progression at sites previ- ously involved with Hodgkin's disease. No patient relapsed in the marrow, and two of three patients with a history of marrow involvement with Hodgkin's disease achieved durable complete responses after transplantation. These data suggest that inadequate pretransplant conditioning, and not the reinoculation of occult tumor cells in the autologous marrow, caused most relapses. Fatal treat-ment-related toxicity occurred in six patients. Three patients died of idiopathic interstitial pneumonitis; each had previously received local mediastinal irradiation before intensive chemoradiotherapy. Intensive chemoradiother-apy and ABMT produces durable responses in some patients with Hodgkin's disease incurable with conventional therapy. Use of such therapies at the first sign of failure with conventional chemotherapy and development of more effective conditioning regimens should further improve results.© 1989 by Grune & Stratton, Inc. 0006-4971/89/7308-0018$3.00/0</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood.V73.8.2086.2086</identifier><identifier>PMID: 2659100</identifier><language>eng</language><publisher>Washington, DC: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Bone Marrow Transplantation ; Female ; Follow-Up Studies ; Hematologic and hematopoietic diseases ; Hodgkin Disease - drug therapy ; Hodgkin Disease - mortality ; Hodgkin Disease - radiotherapy ; Hodgkin Disease - surgery ; Humans ; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis ; Lymphatic Irradiation ; Male ; Medical sciences ; Middle Aged ; Recurrence ; Transplantation, Autologous - adverse effects</subject><ispartof>Blood, 1989-06, Vol.73 (8), p.2086-2092</ispartof><rights>1989 American Society of Hematology</rights><rights>1989 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-4206cd579344837a31d4515bcf0d8f9470d0241ed9ef6c0ce88acb73771df4b23</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7223577$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2659100$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phillips, G.L.</creatorcontrib><creatorcontrib>Wolff, S.N.</creatorcontrib><creatorcontrib>Herzig, R.H.</creatorcontrib><creatorcontrib>Lazarus, H.M.</creatorcontrib><creatorcontrib>Fay, J.W.</creatorcontrib><creatorcontrib>Lin, H.-S.</creatorcontrib><creatorcontrib>Shina, D.C.</creatorcontrib><creatorcontrib>Glasgow, G.P.</creatorcontrib><creatorcontrib>Griffith, R.C.</creatorcontrib><creatorcontrib>Lamb, C.W.</creatorcontrib><creatorcontrib>Herzig, G.P.</creatorcontrib><title>Treatment of Progressive Hodgkin’s Disease With Intensive Chemoradiotherapy and Autologous Bone Marrow Transplantation</title><title>Blood</title><addtitle>Blood</addtitle><description>Twenty-six patients with progressive Hodgkin's disease after conventional chemotherapy received intensive che-moradiotherapy and autologous bone marrow transplantation (ABMT); 19 also received additional involved-field radiotherapy. Twenty-one patients [81%, 95% confidence intervals (Cl) 61% to 94%] attained complete (n = 18) or partial responses. Ten patients (38%, 95% Cl 20% to 59%) are disease-free a median of 4.5 years later (range 3.5 to 7.0 years), including seven patients with continuous complete responses. The likelihood of overall response was not significantly influenced by any clinical or treatment variable examined. However, there was a trend favoring patients with higher Karnofsky scores, and higher scores were associated with attainment of complete responses (P - .06 and P - .02, respectively, Mann-Whitney U test). Both higher Karnofsky scores and shorter durations of disease before transplantation were associated with improved survival in a stepwise Cox multivariate analysis. The chief cause of failure was progression at sites previ- ously involved with Hodgkin's disease. No patient relapsed in the marrow, and two of three patients with a history of marrow involvement with Hodgkin's disease achieved durable complete responses after transplantation. These data suggest that inadequate pretransplant conditioning, and not the reinoculation of occult tumor cells in the autologous marrow, caused most relapses. Fatal treat-ment-related toxicity occurred in six patients. Three patients died of idiopathic interstitial pneumonitis; each had previously received local mediastinal irradiation before intensive chemoradiotherapy. Intensive chemoradiother-apy and ABMT produces durable responses in some patients with Hodgkin's disease incurable with conventional therapy. Use of such therapies at the first sign of failure with conventional chemotherapy and development of more effective conditioning regimens should further improve results.© 1989 by Grune & Stratton, Inc. 0006-4971/89/7308-0018$3.00/0</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Bone Marrow Transplantation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hodgkin Disease - drug therapy</subject><subject>Hodgkin Disease - mortality</subject><subject>Hodgkin Disease - radiotherapy</subject><subject>Hodgkin Disease - surgery</subject><subject>Humans</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Lymphatic Irradiation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Recurrence</subject><subject>Transplantation, Autologous - adverse effects</subject><issn>0006-4971</issn><issn>1528-0020</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1989</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkM9uEzEQhy1EVULhESr5gLht6n-79p5QCYVWKoJDgKPltWcTw64dbKelN16D1-uTdJtEvXKZOcw3Mz99CJ1SMqdUsbNuiNHNv0s-V3NGVLMrz9CM1kxVhDDyHM0IIU0lWklfoJc5_ySECs7qY3TMmrqlhMzQn2UCU0YIBccef01xlSBnfwP4MrrVLx_u__7L-IPPYDLgH76s8VUoEHbIYg1jTMb5WNaQzOYOm-Dw-bbEIa7iNuP3MQD-bFKKt3iZTMibwYRiio_hFTrqzZDh9aGfoG8fL5aLy-r6y6erxfl1ZXmjSiUYaayrZcuFUFwaTp2oad3ZnjjVt0ISR5ig4FroG0ssKGVsJ7mU1PWiY_wEvd3f3aT4ewu56NFnC8MUBKaIWrZEUE7rCaz3oE0x5wS93iQ_mnSnKdGPxvXOuJ6Ma6UfZe_KtHd6eLDtRnBPWwfF0_zNYW6yNUM_abA-P2GSMV5LOWHv9hhMMm48JJ2th2DB-QS2aBf9f4I8AA4Lo0I</recordid><startdate>19890601</startdate><enddate>19890601</enddate><creator>Phillips, G.L.</creator><creator>Wolff, S.N.</creator><creator>Herzig, R.H.</creator><creator>Lazarus, H.M.</creator><creator>Fay, J.W.</creator><creator>Lin, H.-S.</creator><creator>Shina, D.C.</creator><creator>Glasgow, G.P.</creator><creator>Griffith, R.C.</creator><creator>Lamb, C.W.</creator><creator>Herzig, G.P.</creator><general>Elsevier Inc</general><general>The Americain Society of Hematology</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19890601</creationdate><title>Treatment of Progressive Hodgkin’s Disease With Intensive Chemoradiotherapy and Autologous Bone Marrow Transplantation</title><author>Phillips, G.L. ; Wolff, S.N. ; Herzig, R.H. ; Lazarus, H.M. ; Fay, J.W. ; Lin, H.-S. ; Shina, D.C. ; Glasgow, G.P. ; Griffith, R.C. ; Lamb, C.W. ; Herzig, G.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-4206cd579344837a31d4515bcf0d8f9470d0241ed9ef6c0ce88acb73771df4b23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1989</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Bone Marrow Transplantation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hodgkin Disease - drug therapy</topic><topic>Hodgkin Disease - mortality</topic><topic>Hodgkin Disease - radiotherapy</topic><topic>Hodgkin Disease - surgery</topic><topic>Humans</topic><topic>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</topic><topic>Lymphatic Irradiation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Recurrence</topic><topic>Transplantation, Autologous - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phillips, G.L.</creatorcontrib><creatorcontrib>Wolff, S.N.</creatorcontrib><creatorcontrib>Herzig, R.H.</creatorcontrib><creatorcontrib>Lazarus, H.M.</creatorcontrib><creatorcontrib>Fay, J.W.</creatorcontrib><creatorcontrib>Lin, H.-S.</creatorcontrib><creatorcontrib>Shina, D.C.</creatorcontrib><creatorcontrib>Glasgow, G.P.</creatorcontrib><creatorcontrib>Griffith, R.C.</creatorcontrib><creatorcontrib>Lamb, C.W.</creatorcontrib><creatorcontrib>Herzig, G.P.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Blood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phillips, G.L.</au><au>Wolff, S.N.</au><au>Herzig, R.H.</au><au>Lazarus, H.M.</au><au>Fay, J.W.</au><au>Lin, H.-S.</au><au>Shina, D.C.</au><au>Glasgow, G.P.</au><au>Griffith, R.C.</au><au>Lamb, C.W.</au><au>Herzig, G.P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of Progressive Hodgkin’s Disease With Intensive Chemoradiotherapy and Autologous Bone Marrow Transplantation</atitle><jtitle>Blood</jtitle><addtitle>Blood</addtitle><date>1989-06-01</date><risdate>1989</risdate><volume>73</volume><issue>8</issue><spage>2086</spage><epage>2092</epage><pages>2086-2092</pages><issn>0006-4971</issn><eissn>1528-0020</eissn><abstract>Twenty-six patients with progressive Hodgkin's disease after conventional chemotherapy received intensive che-moradiotherapy and autologous bone marrow transplantation (ABMT); 19 also received additional involved-field radiotherapy. Twenty-one patients [81%, 95% confidence intervals (Cl) 61% to 94%] attained complete (n = 18) or partial responses. Ten patients (38%, 95% Cl 20% to 59%) are disease-free a median of 4.5 years later (range 3.5 to 7.0 years), including seven patients with continuous complete responses. The likelihood of overall response was not significantly influenced by any clinical or treatment variable examined. However, there was a trend favoring patients with higher Karnofsky scores, and higher scores were associated with attainment of complete responses (P - .06 and P - .02, respectively, Mann-Whitney U test). Both higher Karnofsky scores and shorter durations of disease before transplantation were associated with improved survival in a stepwise Cox multivariate analysis. The chief cause of failure was progression at sites previ- ously involved with Hodgkin's disease. No patient relapsed in the marrow, and two of three patients with a history of marrow involvement with Hodgkin's disease achieved durable complete responses after transplantation. These data suggest that inadequate pretransplant conditioning, and not the reinoculation of occult tumor cells in the autologous marrow, caused most relapses. Fatal treat-ment-related toxicity occurred in six patients. Three patients died of idiopathic interstitial pneumonitis; each had previously received local mediastinal irradiation before intensive chemoradiotherapy. Intensive chemoradiother-apy and ABMT produces durable responses in some patients with Hodgkin's disease incurable with conventional therapy. Use of such therapies at the first sign of failure with conventional chemotherapy and development of more effective conditioning regimens should further improve results.© 1989 by Grune & Stratton, Inc. 0006-4971/89/7308-0018$3.00/0</abstract><cop>Washington, DC</cop><pub>Elsevier Inc</pub><pmid>2659100</pmid><doi>10.1182/blood.V73.8.2086.2086</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Biological and medical sciences Bone Marrow Transplantation Female Follow-Up Studies Hematologic and hematopoietic diseases Hodgkin Disease - drug therapy Hodgkin Disease - mortality Hodgkin Disease - radiotherapy Hodgkin Disease - surgery Humans Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Lymphatic Irradiation Male Medical sciences Middle Aged Recurrence Transplantation, Autologous - adverse effects |
title | Treatment of Progressive Hodgkin’s Disease With Intensive Chemoradiotherapy and Autologous Bone Marrow Transplantation |
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