levoleucovorin and Hodgkin-Disease

Topics: Adolescent; Adult; Antineoplastic Agents; Cyclophosphamide; Drug Therapy, Combination; Hodgkin Disease; Humans; Leucovorin; Leukemia, Myeloid, Acute; Lymphoma; Methotrexate; Middle Aged; Neoplasm Staging; Nitrogen Mustard Compounds; Prednisone; Procarbazine; Remission, Spontaneous; Vincristine

During the last few years, morphological, immunohistochemical, and genetic findings have placed anaplastic large cell lymphoma (ALCL) as a distinct clinicopathologic entity, and several reports have focused on the existence of different subtypes of the tumor. Particular attention has been paid to the ALCL-Hodgkin's-like (HL) subtype, which seems to be on the border between Hodgkin's disease (HD) and high-grade non-Hodgkin's lymphoma (HG-NHL). From September 1994 to July 1997, during the course of an Italian multicentric trial, 40 ALCL-HLs were randomized to receive as front-line chemotherapy MACOP-B (methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin-a third-generation HG-NHL regimen) or ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine-a scheme specific for HD). All patients with bulky disease in the mediastinum at diagnosis underwent local radiotherapy after the chemotherapeutic program. Complete response (CR) was achieved in 17 of the 19 (90%) patients who were treated with MACOP-B, and in 19 of the 21 (91%) patients who were administered ABVD. The probability of relapse-free survival, projected at 32 months, was 94% for the MACOP-B subset and 91% for the ABVD subset. The majority of patients with mediastinal bulky disease obtained CR (evaluated with 67Ga single photon emission computed tomography [SPECT]) after their radiotherapy. The present study suggests that ALCL-HL, in line with its borderline status, responds in an equivalent way to third-generation chemotherapy for HG-NHL and to conventional HD treatment in terms of both CR and relapse-free survival rates. However, as to the latter, a longer follow-up period may be needed before stating the absolute equivalence of the two regimens used.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Dacarbazine; Disease-Free Survival; Doxorubicin; Female; Follow-Up Studies; Hodgkin Disease; Humans; Leucovorin; Lymphoma, Large-Cell, Anaplastic; Male; Mediastinum; Methotrexate; Middle Aged; Prednisone; Remission Induction; Survival Analysis; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Vinblastine; Vincristine

Treatment of both Hodgkin's disease (HD) and high-grade non-Hodgkin's lymphoma (HG-NHL) with bulky presentation at diagnosis frequently results in residual masses detected radiologically. Conventional diagnostic radiology and computed tomography (CT) are generally unable to detect the differences between tumor tissue and fibrosis. Gallium-67-citrate (67Ga) SPECT and magnetic resonance imaging (MRI) can potentially differentiate residual active tumor tissue and fibrosis. Thirty-three patients with HD or HG-NHL presenting with bulky mediastinal disease were studied with CT, 67Ga SPECT, and MRI (only for 16 patients) at diagnosis, after two-thirds of their chemotherapy, at the end of chemotherapy, and after radiotherapy in order to evaluate the mediastinal region on the basis of persistence of residual masses and activity of pathological tissue. After treatment, all patients with 67Ga-negative (30/33) disease are still in continuous complete response. Among the three 67Ga-positive patients, 2 relapsed within one year and another one is still alive without evidence of disease. Regarding MRI, two patients were found to be positive, one of them concomitant with 67Ga-positivity; both patients survive in complete response. In lymphoma patients with bulky mediastinal presentation, the 67Ga SPECT remains the preferable imaging technique for monitoring and differentiating the eventual active residual tumor. In combination, CT and 67Ga SPECT represent a suitable complete imaging approach to the radiological diagnosis which may be useful in these particular patients. MRI could probably be considered as a second-line method and from our data would be used only in selected cases because of the high cost, accessibility, and lower specificity as opposed to 67Ga SPECT in evaluating potentially active residual disease.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dacarbazine; Disease-Free Survival; Doxorubicin; Female; Fluorouracil; Gallium Radioisotopes; Hodgkin Disease; Humans; Leucovorin; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Male; Mediastinal Neoplasms; Methotrexate; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Prednisone; Radioimmunodetection; Radiotherapy; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome; Vinblastine; Vincristine

Patients with Hodgkin's disease (HD) who fail to enter a complete remission after an initial course of combination chemotherapy are usually considered to have an induction failure (IF); this subset of patients has an extremely poor outcome with further conventional therapy. Since 1985, we have entered 30 IF patients into protocols using conditioning with high-dose cyclophosphamide, carmustine (BCNU), and etoposide (VP16-213) with or without cisplatin (CBV +/- P) followed by autologous stem cell transplantation (ASCT) with bone marrow (19 patients), peripheral blood stem cells (PBSCs; 8 patients), or both (3 patients). All except 2 patients had previously received chemotherapy regimens for HD that contained at least 7 drugs, and 9 had received prior radiotherapy (RT). After documentation of IF, the majority of patients received some cytoreductive therapy as specified by protocol (local RT in 9, two cycles of conventional chemotherapy in 2, both modalities in 2, or high-dose cyclophosphamide to enhance PBSC collection in 11) before CBV +/- P. Five treatment-related deaths occurred, all before day 150 posttransplant. Eleven patients have had progressive HD at a median of 6 months (range, 0.1 to 45 months) after ASCT. The actuarial progression-free survival (PFS) at a median follow-up of 3.6 years (range, 0.2 to 8.2 years) is 42% (95% confidence intervals, 21% to 61%). The statistical analysis identified only prior clinical bleomycin lung toxicity as an adverse risk factor for PFS, mainly because of the increased nonrelapse mortality seen in these patients. CBV +/- P and ASCT can produce durable remission in a substantial proportion of IF HD patients who otherwise have a poor survival, and we believed ASCT approaches represent the best therapy currently available for these patients. Additional measures are needed to reduce the primary problem of disease progression despite high-dose chemotherapy and stem cell transplantation.

Topics: Actuarial Analysis; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Marrow Diseases; Bone Marrow Transplantation; Carmustine; Cisplatin; Cyclophosphamide; Dacarbazine; Disease-Free Survival; Doxorubicin; Etoposide; Female; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Leucovorin; Male; Mechlorethamine; Methotrexate; Prednisolone; Prednisone; Procarbazine; Remission Induction; Salvage Therapy; Survival Analysis; Treatment Outcome; Vinblastine; Vincristine

In a pilot study, Cancer and Leukemia Group B (CALGB) incorporated etoposide into primary combination therapy for advanced Hodgkin disease.. Thirty-six evaluable patients were treated with two or three courses of methotrexate, vincristine, prednisone, leucovorin, etoposide, and cyclophosphamide (MOPLEC), and then treated with five to seven additional courses of a known "curative" regimen: nitrogen mustard, vinblastine, prednisone, and procarbazine (MVPP).. After treatment with MOPLEC, there were 16 complete responders (44%) and 18 partial responders (50%). One patient had progressive disease and one patient was taken off study after an anaphylactic reaction to etoposide. After completing the entire protocol, 32 patients achieved complete remission (CR) (89%) and 3 achieved partial remission (PR) (8%). Five CR patients have relapsed and three additional patients have died in CR without recurrence. At 36 months, the estimated failure-free survival is 61% and overall survival is 72%.. This combination, which includes etoposide, is active for the primary treatment of advanced Hodgkin disease.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Etoposide; Female; Hodgkin Disease; Humans; Leucovorin; Male; Mechlorethamine; Methotrexate; Middle Aged; Prednisolone; Prednisone; Procarbazine; Vinblastine; Vincristine

To further evaluate possible non-cross-resistant regimens in Hodgkin's disease, a phase II trial utilizing antimetabolites and etoposide was initiated by the Cancer and Leukemia Group B (CALGB). Etoposide was included because of its known efficacy in relapsed Hodgkin's disease and to evaluate for synergy with an alkylating agent and vincristine. Cytosine arabinoside and methotrexate were included to evaluate their effectiveness in rapidly growing resistant disease. Forty-two patients with previously treated Hodgkin's disease were entered, of which 37 are evaluable for response and toxicity. All patients had at least 2 prior regimens of chemotherapy and 59% had additional radiation therapy. Complete and partial response was observed in 61%; there were 32% complete responders. Duration of complete response was a median of 8 months (range 2-28+ months). Duration of partial response was 7 months (range 1-17 months). Three patients remain in complete remission at 19, 19, and 28 months. Major toxicity was hematologic with severe or life-threatening toxicity in 54%. There was one patient with a fatal infection. Non-hematologic toxicity, save for nausea and vomiting, was mild and uncommon. There were two fatal and one severe pulmonary toxicities reported in patients who had previous exposure to bleomycin and mediastinal radiation. Three had interstitial pneumonitis and one pulmonary emboli. The interstitial pneumonitis was thought to be drug related. Survival of the entire group is estimated at 61% at 12 months. We conclude that MOPLACE is an effective regimen with an appreciable complete response rate in this heavily pretreated group of patients. Hematologic and pulmonary toxicities are severe and may necessitate dose modifications. The use of etoposide containing combinations requires further study as primary therapy in untreated patients.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Cytarabine; Drug Administration Schedule; Drug Evaluation; Drug Tolerance; Etoposide; Female; Hodgkin Disease; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Prednisone; Remission Induction; Survival Rate; Vincristine

Bilateral acute angle-closure is a rare occurrence. When the central anterior chambers are shallow, it is often associated with systemic disease. We present 2 patients with atypical bilateral acute angle-closure as the presentation of systemic lymphoma. In these patients, angle closure may be caused by a uveal effusion or swelling of the ciliary body. If an atypical bilateral acute angle-closure attack cannot be attributed to a drug reaction or a bilateral iatrogenic cause, the patient should be evaluated for an associated systemic disease. In some patients, the acute angle-closure cannot be fully resolved until the underlying disease is treated. This report discusses the spectrum of presentations and the various diseases that have been associated with bilateral acute angle-closure.

Topics: Acute Disease; Aged; Antihypertensive Agents; Antineoplastic Combined Chemotherapy Protocols; Biopsy, Needle; Bleomycin; Cyclophosphamide; Doxorubicin; Functional Laterality; Glaucoma, Angle-Closure; Glucocorticoids; Hodgkin Disease; Humans; Intraocular Pressure; Leucovorin; Lymphoma, Large-Cell, Immunoblastic; Male; Methotrexate; Middle Aged; Prednisone; Tomography, X-Ray Computed; Vincristine; Visual Acuity

Patients treated for Hodgkin's disease and non-Hodgkin lymphomas were followed for 5 years after start of therapy. The patients received combinations of anticancer drugs for curative intent for 6 months (Hodgkin's disease) or 7 months (non-Hodgkin lymphomas).. Cumulated data of 22 surviving patients (mean age, 49 years) were compared with that of 17 patients (mean age, 52 years) who had died or were terminally ill at the 5-year examination. Saliva samples were taken at baseline, and 4, 6, 12, and 60 months after start of chemotherapy. Salivary flow rate and a variety of biochemical constituents were analyzed.. The results showed no long-term effect of anticancer treatment on salivary flow rates. Neither was there any difference between the surviving or deceased patients' baseline values (1.5 +/- 0.7 mL/minute versus 1.5 +/- 0.8 mL/minute) and after chemotherapy. Lysozyme, IgA, IgG, and IgM concentrations decreased after chemotherapy. Significantly lower values were observed at the 5-year examination than at baseline. This was particularly evident in IgA, which is the major immunoglobulin in saliva; mean IgA was 70.5 +/- 52.8 mg/mL at baseline, 35.8 +/- 15.0 mg/mL 5 years later (p < 0.001). Salivary total protein and amylase concentrations were significantly decreased (p < 0.001 and p < 0.05, respectively), whereas albumin concentration was significantly increased at the 5-year examination (p < 0.05). When the salivary biochemical results were compared between the surviving and deceased patients, no statistically significant differences were observed. At baseline, however, the mean immunoglobulin values were lower in patients who later died, in comparison with those who survived.. These results showed that modern anticancer therapy need not cause severe side effects on salivary flow rates and composition. In addition, apart from the long-term immunosuppression, no significant decreases were expressed in salivary defensive factors.

Topics: Adult; Aged; Aged, 80 and over; Albumins; Amylases; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dacarbazine; Dexamethasone; Doxorubicin; Epirubicin; Female; Follow-Up Studies; Hodgkin Disease; Humans; Immunoglobulin A, Secretory; Leucovorin; Lymphoma; Lymphoma, Non-Hodgkin; Male; Mechlorethamine; Methotrexate; Middle Aged; Muramidase; Prednisone; Procarbazine; Saliva; Salivary Proteins and Peptides; Secretory Rate; Statistics, Nonparametric; Vinblastine; Vincristine

Thromboembolic complications and decrease in protein C and S have been observed in patients while receiving combination chemotherapy for breast cancer. We investigated whether initial cytotoxic treatment of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) is also associated with changes in these anticoagulant parameters. For this purpose 25 patients with intermediate to high grade NHL and seven with HD, undergoing primary treatment with cytotoxic drugs were evaluated at three time-points: pre-therapy, mid-therapy and post-therapy. In contrast to the breast cancer patients, no significant changes in protein C, protein S and antithrombin III levels were observed in the NHL patients during the various stages of therapy. However in HD patients, the mean protein C values had a tendency to be higher at mid-therapy compared to pre-therapy and protein S levels had a tendency to be higher at mid-therapy compared to post-therapy. In lymphoma patients receiving primary cytotoxic treatment we did not find changes in anticoagulant parameters that can explain a chemotherapy-induced hypercoagulable state, as has been reported in breast cancer patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; alpha-2-Antiplasmin; Antineoplastic Combined Chemotherapy Protocols; Antithrombin III; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Etoposide; Female; Fibrin Fibrinogen Degradation Products; Hodgkin Disease; Humans; Leucovorin; Lymphoma; Lymphoma, Non-Hodgkin; Male; Mechlorethamine; Methotrexate; Middle Aged; Mitoxantrone; Partial Thromboplastin Time; Plasminogen; Prednisone; Procarbazine; Protein C; Protein S; Thrombophilia; Time Factors; Vinblastine; Vincristine

The occurrence of HIV associated non-Hodgkin's lymphoma (NHL) is a well recognized event. HIV associated Hodgkin's disease (HD) has also been observed. A unique patient with both entities is described. The patient was a 29 year old homosexual male who developed clinical IIA nodular sclerosis HD in 1985. He was HIV + with CD4/CD8 = 0.2 and his sister had HD 20 years earlier. He received MOPP and had a complete response. In October 1988 he developed weight loss with an abdominal mass and biopsy revealed diffuse small non-cleaved NHL, with bone marrow involvement. This was his first AIDS associated illness. Probes identified clonally rearranged DNA fragments in the J region of IgH chains and clonal rearrangements in the c-myc gene were also observed but EBV sequences could not be demonstrated. He was treated with m-BACOD but died in March 1989. His course was not complicated by opportunistic infection. Possible etiologies for the HD include his HIV status or shared sibling environment. The development of the NHL may have resulted from HIV infection and/or secondary to his treatment for HD. The relationship between the two lymphomas is uncertain and factors other than HIV exposure and its immune dysfunction may have been causal.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Child; Cyclophosphamide; Dexamethasone; DNA, Neoplasm; Doxorubicin; Environmental Exposure; Female; Gene Rearrangement, B-Lymphocyte, Heavy Chain; Herpesvirus 4, Human; HIV Infections; Hodgkin Disease; Humans; Incidence; Leucovorin; Lymphoma, AIDS-Related; Lymphoma, Non-Hodgkin; Male; Mechlorethamine; Methotrexate; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Prednisone; Procarbazine; Remission Induction; Vincristine

To investigate the effect of modern, intensive chemotherapy on salivary flow rate and composition, 79 patients suffering from Hodgkin's disease or non-Hodgkin lymphoma were studied before, during and after administration of cytostatic drugs. 49 patients (mean age 49.9 years, 30 men, 19 women) completed the 1-year study. All patients who received radiotherapy or medication other than cytostatics were excluded. The results showed no marked differences in stimulated salivary flow rates, buffering capacities and amylase and total protein concentrations between the beginning and the end of the 12 month trial. However, significant increases in albumin secretion into saliva and salivary lysozyme concentrations were observed. Total salivary IgG, IgA and IgM concentrations decreased significantly during the cancer therapy but values returned to the baseline levels after termination of treatment. Despite the well-known cytolytic effect of anticancer drugs, chemotherapy need not therefore be permanently detrimental to saliva.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dacarbazine; Dexamethasone; Doxorubicin; Female; Hodgkin Disease; Humans; Immunoglobulin A, Secretory; Immunoglobulin G; Immunoglobulin M; Leucovorin; Longitudinal Studies; Lymphoma, Non-Hodgkin; Male; Mechlorethamine; Methotrexate; Middle Aged; Prednisone; Procarbazine; Saliva; Salivary Proteins and Peptides; Salivation; Secretory Rate; Sex Factors; Vinblastine; Vincristine

Treatment of elderly patients with hematological malignancies is difficult and a matter of controversy. Low responsiveness to therapy and high risk of mortality have been reported. The risk of chemotherapeutic death increases after age 60, and an age-adjusted chemotherapy schedule is needed. In stage III and IV Hodgkin's disease, for example, an age-adjusted COPP regimen may be adopted. Many non-Hodgkin lymphomas (NHL) of elderly patients have a slow course. However, for intermediate to high grade aggressive NHL, dose-reduced CHOP regimen, or non- or low-dose methotrexate-containing programs like BECALM, CNOP, and low dose-ACOP-B are acceptable. MACOP-B regimen with G-CSF may be used for patients under age 65. For the treatment of elderly patients with AML, it is reported that a reduced-dose DAT regimen is better than the standard dose for inducing CR in patients older than 60. In elderly AML patients over 60, the dose-adjustment reported by Mori, or low-dose cytarabine with G-CSF, is recommended. Information about elderly patients with acute lymphoblastic leukemia is scarce. Aggressive treatments like L-17 M regimen are not tolerable by elderly patients, and a combination chemotherapy consisting of vincristine and prednisolone is recommended.

Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Drug Administration Schedule; Etoposide; Hodgkin Disease; Humans; Leucovorin; Leukemia, Myeloid, Acute; Lymphoma, Non-Hodgkin; Methotrexate; Mitoxantrone; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Prednisone; Vincristine

Between 1981 and 1986, 126 patients with diffuse large cell lymphoma were treated with MACOP-B (methotrexate/doxorubicin/cyclophosphamide/vincristine/prednisone/bleomy cin). All had advanced-stage lymphoma (Ann Arbor stage III or IV or stage I or II if the tumor mass was greater than 10 cm or B symptoms were present). The complete response (CR) rate was 84% and the toxic death rate was 6%. Actuarial overall survival at 3 years was 67% and at 8 years 62%; the failure-free survival at 8 years was 52%. The follow-up for MACOP-B is 39 to 106 months (median 76) for living patients. A multivariate prognostic factor analysis for this group of patients identified age greater than 60 years. B symptoms, more than one extranodal site of disease, and more than three nodal sites of disease as the four significant prognostic variables. From June 1986, 108 patients were enrolled on a modification of MACOP-B called VACOP-B (etoposide/doxorubicin/cyclophosphamide/vincristine/prednisone/bleomycin ). Their CR rate was 81%, and the toxic death rate was lower, at 3%. The 60% overall survival at 3 years is not statistically significantly different from that of MACOP-B. The incidence of moderate or severe mucositis and Cushingoid changes was much lower with VACOP-B. The MOPP/ABV (mechlorethamine/vincristine/procarbazine/prednisone- doxorubicin/bleomycin/vinblastine) hybrid chemotherapy regimen for advanced-stage Hodgkin's disease was standard therapy from April 1981 to June 1988 for untreated patients aged 16 to 65. Advanced stage was defined as stages IIB, IIIB, III2A, IVA, IVB, or stages IIA or IIIA with greater than four splenic nodules or a mediastinal mass greater than one third of the transthoracic diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Actuarial Analysis; Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Doxorubicin; Drug Evaluation; Etoposide; Female; Hodgkin Disease; Humans; Leucovorin; Lymphoma, Large B-Cell, Diffuse; Male; Mechlorethamine; Methotrexate; Middle Aged; Mouth Mucosa; Prednisone; Procarbazine; Prognosis; Remission Induction; Stomatitis; Survival Rate; Vinblastine; Vincristine

In a random HIV-seropositive population, malignant lymphomas were diagnosed in 31 patients, of whom 24 (77%) had non-Hodgkin lymphoma (NHL) and 7 (23%) Hodgkin lymphoma (HL). The prevalence of NHL among AIDS patients was 8% (23/279 cases), with a prevalence of 17% among autopsied patients (16/96 cases). No patient with HL had AIDS at the time of diagnosis. In 7 of 23 AIDS patients with NHL (30%) the diagnosis was made only post mortem; among these were all 5 patients with primary CNS NHL. Median survival from the time of diagnosis was 1 month for patients with NHL and 3 months for those with HL. In individual patients, survival for several years may be possible with chemotherapy. Certain patients with NHL appear to benefit from intensive chemotherapy with a combination of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOPB protocol). Appropriate, therapeutic strategies taking into account the patients' individual conditions, including the overall prognosis, urgently requires development. Metastatic CNS involvement, which was the primary cause of death in 5 of 11 patients with NHL (45%) receiving chemotherapy, represents a serious limitation to successful treatment.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Central Nervous System Neoplasms; Cyclophosphamide; Doxorubicin; Female; HIV Seropositivity; Hodgkin Disease; Humans; Leucovorin; Lymphoma; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Prednisone; Prognosis; Vincristine

Eleven patients with non-Hodgkin's lymphoma and three patients with Hodgkin's disease were observed among 876 anti-HIV-positive subjects attending the AIDS clinic at the University Hospital, Zurich, Switzerland. Compared to the general population this represents a 50-fold (95% confidence limits: 25-90) increased risk of non-Hodgkin's lymphoma and an 11.4-fold (2.3-33) increased risk for Hodgkin's disease in anti-HIV-positive men. High malignancy, advanced stage of disease at the time of diagnosis, and extranodal localization are characteristic of non-Hodgkin's lymphoma in AIDS patients, which carries a poor prognosis. However, remissions and prolonged disease-free survival are possible in individual cases. Only one opportunistic infection was observed during 92 months of treatment and observation using a mild chemotherapeutic regimen (m-BACOD). Less myelosuppressive chemotherapeutic schedules appear to be more beneficial than aggressive regimens in anti-HIV-positive patients due to the lower incidence of opportunistic infections.

Topics: Acquired Immunodeficiency Syndrome; Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dexamethasone; Doxorubicin; Hodgkin Disease; Humans; Leucovorin; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Opportunistic Infections; Prognosis; Risk Factors; Vincristine

Eleven patients with Hodgkin's disease refractory to chemotherapy were treated with six cycles of intermediate-dose methotrexate with calcium leucovorin rescue, followed by cyclophosphamide, doxorubicin, vincristine, and prednisone (MTX-CHOP). Three other patients were treated with a similar program of treatment minus doxorubicin (MTX-COP). The overall response rate was 57%, with four (29%) patients achieving a complete response and four patients achieving a partial response. None of the three patients treated with MTX-COP had a complete remission (CR); thus the complete remission rate with MTX-CHOP was somewhat higher (36%). Only one of the CR's is in continuous complete remission and free of disease at 99+ months. One patient died of overwhelming sepsis and pancytopenia during treatment. Hematologic toxicity in the other patients was acceptable. The overall median survival was 18 months. The search for an effective treatment program for this group of patients remains a major challenge.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Doxorubicin; Drug Administration Schedule; Drug Evaluation; Female; Hodgkin Disease; Humans; Leucovorin; Male; Methotrexate; Prednisone; Vincristine

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cisplatin; Drug Evaluation; Etoposide; Hodgkin Disease; Humans; Leucovorin; Lomustine; Lung Diseases; Lymphoma; Middle Aged

Since 1968 we have treated with antiblastic drugs 164 malignant tumors recurrent or incurable by surgery or radiotherapy in 151 cases. Different therapeutic methods were employed. Today we have the possibility of selecting alternative options with incipient or relatively delimited carcinomas, principally the substitution of radical surgery by initial associated physical and chemical treatment, so that if there is a cure the consequences of radical surgery can be avoided. We emphasize the curve of two primary cancers of the uvula with 300 mg bleomycin exclusively and the results observed in oropharyngeal and laryngeal carcinomas by using three intermittent Schabel cycles and 4,000 rad Telecobalt, avoiding a radical surgery.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dacarbazine; Doxorubicin; Drug Therapy, Combination; Head and Neck Neoplasms; Hodgkin Disease; Humans; Infusions, Intra-Arterial; Leucovorin; Mechlorethamine; Methotrexate; Neoplasm Recurrence, Local; Prednisone; Procarbazine; Prognosis; Vinblastine; Vincristine

The case history of a 24-year-old male with the nodular sclerosing form of Hodgkin's disease (stage IIE) who accidentally received an overdose of vincristine (25 mg, 0.39 mg/kg) is reported. To date, ten patients given a vincristine overdose have been reported. Two of those patients were treated with leucovorin. One patient died after 68 hours. In the second patient, the time to onset and the duration of symptoms were shortened. In an attempt to reduce the duration of toxic effects in our patient, leucovorin was administered 24 hours after the overdose. In agreement with the earlier observation, the time to onset of symptoms was short, but in contrast we did not find a more rapid recovery from the serious side effects. Although the patient might have died without leucovorin administration, we believe its beneficial effect remains to be established.

Topics: Adult; Hodgkin Disease; Humans; Leucovorin; Male; Time Factors; Vincristine

Topics: Adolescent; Adult; Aged; Drug Therapy, Combination; Female; Hodgkin Disease; Humans; Leucovorin; Lymphoma; Male; Methotrexate; Middle Aged

Forty years ago, nitrogen mustard was first used in the treatment of a group of six patients with neoplastic diseases, including lymphosarcoma and Hodgkin's disease at Yale University. Since then different kinds of chemotherapeutic agents have been discovered, which clinical efficacy was reviewed as a single agent and in combination. Especially over the past two decades, the management of malignant lymphoma has improved significantly with combination chemotherapy. Now there are several potentially curative regimens, such as MOPP therapy for Hodgkin's disease, and MOPP (or C-MOPP), CHOP (or HOP), BACOP and COMLA for diffuse histiocytic lymphoma. There are recent trends to include methotrexate in combination and to use two non-cross-resistant regimens alternatively (CVP/ABP, MOPP/ABVD) for improving complete remission rate and remission duration. Treatment for favorable histologies, and clinical features and treatment of adult T-cell leukemia lymphoma were also briefly reviewed.

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Cytarabine; Drug Therapy, Combination; Hodgkin Disease; Humans; Leucovorin; Lymphoma; Mechlorethamine; Methotrexate; Prednisone; Procarbazine; Vincristine

Topics: Antidotes; Female; Hodgkin Disease; Humans; Leucovorin; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Methotrexate; Middle Aged; Neoplasms

Topics: Agranulocytosis; Antineoplastic Agents; Breast Neoplasms; Female; Hemangiosarcoma; Hodgkin Disease; Humans; Kidney Neoplasms; Leucovorin; Leukemia, Lymphoid; Leukemia, Monocytic, Acute; Leukemia, Myeloid, Acute; Lung Neoplasms; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Melanoma; Methotrexate; Osteosarcoma; Pancreatic Neoplasms; Radiography; Rectal Neoplasms; Rhabdomyosarcoma; Testicular Neoplasms; Thrombocytopenia