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The effectiveness of chemotherapy or chemoradiotherapy for diffuse astrocytoma (DA) has been largely unknown until recently. However, a randomized controlled study (RTOG 9802) showed that adding of procarbazine, CCNU, and vincristine (PCV) chemotherapy to fractionated radiotherapy (FRT) in patients with "high-risk" WHO grade II gliomas, including DA, has significant positive impact on both progression-free survival and overall survival. Effectiveness of temozolomide (TMZ) in cases of low-grade gliomas was also reported, and a randomized phase III trial comparing FRT alone or in combination with TMZ in cases of unresectable DA (JCOG 1303) is currently ongoing., (© 2018 S. Karger AG, Basel.)

The escalated BEACOPP (escBEACOPP) regimen improves the outcome of patients with advanced-stage Hodgkin lymphoma (HL) but is associated with cumbersome toxicity. We analyzed the survival outcome of high-risk, advanced-stage HL patients treated with response-adapted therapy. escBEACOPP was administered for 2 cycles, and after complete remission (CR) or partial remission (PR) was observed on FDG-PET/CT, treatment was de-escalated to 4 cycles of ABVD. Sixty-nine patients were evaluated, of them 45 participated in the multicenter, phase II prospective study between 2001 and 2007. Sixty patients had an international prognostic score ≥3. At a median follow-up of 5.6 years, 4 patients had died, 2 of them due to advanced HL. After the initial 2 cycles of escBEACOPP, 52 (75%) patients were in CR and 17 (25%) had a PR. Progression-free survival and overall survival (OS) were 79 and 93%, respectively. OS was predicted from the results of early-interim FDG-PET/CT: 98% of the patients in CR and 79% of those with a PR (p = 0.015). Hematological toxicity was more frequent during the first 2 cycles of escBEACOPP than in the ABVD phase. In conclusion, this retrospective analysis indicates that combined escBEACOPP-ABVD therapy is well tolerated and efficacious in HL patients who achieve negative early-interim PET results, while a positive PET result partially identified those with a worse prognosis., (© 2015 S. Karger AG, Basel.)

The authors report the case of a 67-year-old-man who presented with stage IIIAa Hodgkin's disease (HD) almost 17 years after developing CD30+ type A lymphomatoid papulosis (LP). Combination chemotherapy resulted in a complete remission of the HD for 2 years, although the LP continued relentlessly as before. A possible link between HD and LP is discussed in the light of similar cases reported in the literature.

We present the cytopathologic features of lymphomatoid granulomatosis in a case affecting the subcutaneous tissue. Atypical lymphocytes mixed with histiocytes and well-formed granulomas were the main findings. Fine needle aspiration biopsy can be a useful method of diagnosing subcutaneous relapses in lymphomatoid granulomatosis. To our knowledge, this is the first case report of these characteristics.

A 61-year-old man developed steroid-resistant nephrotic syndrome in which renal biopsy showed membranous nephropathy. Six months after the initial presentation, nodular sclerosing Hodgkin's disease was diagnosed. Cyclophosphamide, vincristine, prednisolone and procariazine chemotherapy was administered, after which proteinuria gradually decreased resulting in complete remission in the course of 7 months. A second renal biopsy, which was undertaken 4 months after complete remission, revealed significant histological improvement with disappearance of immune deposit.

The aim of this study was to determine the effect of immunophenotype on the clinical characteristics and prognosis of 144 adult Chinese patients with non-Hodgkin's lymphomas. Those entities with well-recognised immunophenotype and clinical characteristics were excluded. Significantly more patients with T-cell lymphomas had B symptoms (52 vs. 30%, p = 0.05) and fewer had bulky disease (7 vs. 25%, p = 0.04). Extranodal involvements of liver, spleen, marrow, nasal region and skin were significantly more common in T-cell lymphomas. On the other hand, gastro-intestinal involvement was more commonly seen in B-cell tumours. Induction chemotherapy of comparable intensity was used in treating these patients. The immunophenotype did not appear to affect significantly their prognosis.

An analysis of the therapy details of 99 patients receiving primary MOPP chemotherapy for Hodgkin's disease revealed that treatment modification was a frequent occurrence. The mean cumulative dose calculated as a percentage of the projected ideal dose was 76%. Dose modifications of individual components of the MOPP combination were, however, variable and in part reflected disease-related factors, e.g. patients with stage 4 disease received significantly less vincristine than those with less advanced disease. An initial univariate analysis of factors influencing remission showed that the remission rate was significantly lower among those patients who had (a) liver involvement and (b) drug doses less than 75% of the ideal cumulative dose. Among the individual drug dosages, modification of the vincristine dose appeared to be the most significant treatment-related factor associated with lower remission rates. In a multivariate analysis where both disease-related and treatment-related factors were taken into account drug dosage remained a significant prognostic factor. The most important factors adversely affecting initial remission were the presence of liver involvement and reduction of the drug intensity index (cumulative dose divided by cumulative time). Disease-free survival was adversely influenced mainly by the presence of B symptoms and to a lesser degree, but still significantly, by a lower cumulative vincristine dose. Total survival was, however, influenced adversely only by the presence of B symptoms. The quality of MOPP therapy appears to play a significant role in determining the outcome of Hodgkin's disease.

By evaluating the results obtained in 50 patients the authors stated that VM-26 given in combination with Natulan and Prednisolone is a drug of value in the therapy of generalized Hodgkin's disease. It cause milder side effects than drugs previously used in combination therapy. Complete or partial remissions were obtained in 84% of patients treated. 75% of the therapy-resistant cases proved to be Hodgkin's sarcoma by the postmortem examination. Remission lasted longer in stage III than in stage IV and the previously untreated patients responded better than the treated one. Definite correlation could not be revealed between histologic type and duration of remission.

In 6 cases with poor prognosis who had undergone perforating keratoplasty, the local steroid therapy was combined, for an average duration of 15 months, with a systemic treatment of cyclophosphamide and procarbazine. During a postoperative following up duration between 19 and 32 months five grafts remained clear, however, in 1 case this therapy could not stop an allograft reaction.

Some clinical trials have indicated that combination therapy with intensive radiation therapy followed by chemotherapy significantly prolongs the disease-free interval of patients with Hodgkin's disease confined to lymph nodes. The present report updates the results of a small previously published study of combined-modality treatment of stages I and II Hodgkin's disease. Although patients tested with radiation therapy followed by chemotherapy have the longest median complete remission duration, patients treated with radiation alone have a superior survival rate. Follow-up in this study ranges from 34 to 93 months after the completion of all therapy.

A remarkable augmentation of Hb F and a reduction of Hb A2 were observed in a Sicilian woman during and after a course of treatment for Hodgkin's disease. An inverse correlation between the proportion of Hb F and Hb A2 was found over an 8-year period, as well as in populations of red blood cells fractionated by density gradient. She exhibited two genetic defects, the Swiss type of heterocellular hereditary persistence of fetal hemoglobin and a beta-thalassemia trait, which were confirmed by the study of the hemoglobin synthesis and by a family study. The lasting reactivation of Hb F synthesis is attributable to the interaction of several acquired and inherited factors.

Development of Nil disease and focal segmental glomerulosclerosis (FGS) in sequential renal biopsies is reported in a patient with Hodgkin's lymphoma. Although steroid resistance was demonstrated, a complete and sustained clinical remission of the renal lesion followed anti-Hodgkin's chemotherapy. These findings support the hypothesis that Nil disease and FGS are manifestations of the same clinical entity.

The results obtained by chemo+radiotherapy in 100 patients with Hodgkin's disease at stage I or II as defined by clinical and radiological staging are analysed. All patients were treated by chemotherapy followed by radiotherapy; 74 received a complement chemotherapy after the radiotherapy. Statistical analysis emphasizes the usefulness of associating two cycles of chemotherapy with the classical radiotherapy. With this treatment which gives a constant remission rate of about 90% a long-term chemotherapy is no longer necessary and the interest of exploratory laparotomy becomes negligible.

In a 54-year-old male patient suffering from Hodgkin's disease, lymphomatoid papulosis occurred. Complete clearing of the skin lesions was observed immediately after intravenously administered acyclovir. The patient had numerous relapses of his skin eruption with complete responses after each course of intravenously applied acyclovir. This striking therapeutic effect parallels reports of regression of mycosis fungoides and chronic generalized lymphadenopathy after acyclovir application. The mode of action of acyclovir in these disorders is not known. They all are characterized by involvement of the T cell system, and in all these diseases, a virus etiology has been proved or is suggested. Thus, a specific effect of acyclovir on T lymphocytes or selectively on helper T cells is discussed. Alternatively, the virustatic effect of acyclovir could be responsible for the therapeutic success.

The results of modern radiotherapy for Hodgkin's disease are correlated to the stage of the disease. Five-year disease-free survival for pathologically staged patients can be estimated as follows: PS I & II A...90%, PS III A & IIIsA...60%, PS I & II B ...75%, PS III B & IIIsB ...40%. Combination chemotherapy of the MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) type can be successfully employed for patients who develop recurrent disease after total lymphoid irradiation. There have been several randomized clinical trials attempting to improve the curative potential of radiotherapy by combining modern chemotherapy with the irradiation as an adjuvant. The tolerance of patients to total lymphoid irradiation and chemotherapy will be presented. The Stanford trial, initiated 5 years ago (1968), has demonstrated prolonged disease free survival when both forms of treatment are used initially in certain stages of the disease. However, actual survival has not yet improved, probably because the chemotherapy is successful in inducing durable remissions for patients who recur after irradiation.

2 fatal cases of graft-versus-host disease (GvHD) occurred following blood product transfusions given to patients receiving standard chemotherapy for Hodgkin's disease. GvHD was established by HLA typing, clinical course, and compatible skin biopsy. 23 cases of GvHD following transfusion of blood products from normal donors are also reviewed. It should be suspected when fever or rash appear 1-2 weeks after transfusion of unirradiated blood products into a compromised host or when pancytopenia following chemotherapy is prolonged or unexpectedly severe. Prevention of GvHD by irradiation of granulocytes, platelets and packed red blood cells given to immunosuppressed patients is recommended to prevent this often fatal disease.

15 patients with malignant lymphomas (stage III B or IV) who had become resistant to previous combination chemotherapy were treated with DTIC. The drug was administered intravenously as a single agent in doses of 300 mg/m2 on 5 consecutive days, once a month. The results demonstrate good responses in Hodgkin's disease, while in non-Hodgkin's lymphomas only incomplete and short remissions or failures were recorded. The only untoward side effects were nausea, vomiting and pain in the vein during the injection.

Progress in the chemotherapy of Hodgkin's disease and experimental therapeutic, pharmacologic, and clinical studies of the antitumor antibiotic, adriamycin, are presented in this abstract. In patients with disseminated Hodgkin's disease, the combination chemotherapy program (MOPP) produces a significant increase in the complete remission rate. This has been increased to 90% by the addition of low dose bleomycin to the MOPP program. The continuation of MOPP treatment beyond 6 months and to a total of 24 months provides improved results in patients in remission as measured either from time of onset of complete remission or from end of treatment. Finally, the pattern of relapse in patients with Hodgkin's disease provides a rationale basis for the selective use of radiotherapy in patients in complete remission. Adriamycin has a broad spectrum of antitumor activity in man. Its mechanism of action involves intercalation with DNA and inhibition of DNA function. The selective effect against tumors is not understood but may relate to membrane transport. Adriamycin is a highly important new antitumor agent for the treatment, not only of hematologic malignancies, but for a variety of solid tumors as well.