Treatment of early and intermediate stages of supradiaphragmatic Hodgkin's disease: The Swedish National Care Programme Experience

PURPOSE: Since 1985 a Swedish National Care Programme has provided tailoredprinciples for the staging, treatment and follow-up of patientswith Hodgkin's disease (HD). This report presents treatmentresults for all patients below 60 years of age who were diagnosedwith early and intermediate stages, between 1985 and 1989. PATIENTS AND METHODS: During that period, 210 patients with supradiaphragmatic HDin clinical (CS) and pathological (PS) stages IA + IIA, PS IB+ IIB, and PS III₁, A were diagnosed in five Health Care Regionsin Sweden. In patients with CS IA, staging laparotomy was notrecommended provided that the radiological assessment of theabdomen was adequate, whereas this procedure was recommendedin stages CS IB, IIA and IIB in order to minimize treatment.In the absence of bulky mediastinal disease, patients with CS+ PS IA and PS IIA were treated with mantle (occasionally mini-mantle)irradiation alone, while patients with bulky disease, as wellas those with stages PS IB + IIB + III₁A, were treated withone cycle of MOPP/ABVD prior to mantle (PS III₁, A sub-totalnodal) irradiation. Full chemotherapy followed by radiotherapy to initial siteswith bulky disease was recommended for patients with CS IIAwho did not undergo laparotomy. RESULTS: After a median follow-up in excess of five years, treatmentresults are ‘favourable’ for all stages, providedthe recommendations were followed. In patients with CS + PSIA treated according to the recommendations, recurrence rateswere 14% (9/65) with all but one patient (64/65, 98%) remainingin continuous first or second remission. These figures wereworse in patients treated inadequately (9/26 [35%] and 22/26[85%], respectively). In PS IIA, adequately-treated patientshad a recurrence rate of 13% (7/52) whereas 5/7 (71%) of thosewith bulky disease who received only mantle irradiation developedrecurrences. Similar patterns also emerged in patients withCS IIA, PS IB + IIB and PS III, A. CONCLUSIONS: The tailored principles, which usually entail less staging and/ortreatment than is generally the case, produced favourable resultswhen applied to an entirely un-selected group of patients withearly and intermediate stages of HD. Hodgkin's disease, combined-modality treatment, radiotherapy     

Octreotide scintigraphy and Chromogranin A do not predict clinical response in patients with octreotide acetate-treated hormone-refractory prostate cancer

In this pilot study, the predictive value of Octreotide scintigraphy (Octreoscan) and/or Chromogranin-A (CgA) was investigated in patients with hormone-refractory prostate cancer treated with Octreotide acetate. In total, 20 patients with progressive disease and bone metastases entered the trial. At baseline Octreoscan, CgA, PSA, alkaline phosphates (ALP) and two self-administered questionnaires (EORTC QLQ C-30 (v3) and brief pain index) were performed and a diary of the pharmaceutical was started. The treatment consisted of Octreotide (Sandostatin LAR) acetate 30 mg intramuscular injection every month. The blood samples and questionnaires were repeated every month until 3 months. Clinical responder was defined as a patient with increased global health score more than 10 units and stable or decreased pain score without an increase in analgesic. In all, 17 patients were treated per protocol, and four were assessed as clinical responders. Six patients developed a reduction in ALP (median -26%, range -5 to -78%). All patients increased in PSA. At baseline, three patients had a negative Octreoscan and the patients with positive lesions, demonstrated uptake of low intensity. At baseline the CgA was elevated above the normal range in 15 of the patients, and during treatment five patients decreased their CgA to the normal range. Neither baseline Octreoscan nor CgA could identify the clinical reponders. A minority of patients improves their health-related quality of life. The decrease and normalization of CgA levels in five patients during therapy indicates therapeutic activity but Octreoscan and CgA could not identify clinical responders.     

Clinical significance of circulating CD44 in non-Hodgkin's lymphoma

Soluble isoforms of various adhesion molecules have recently been observed in the blood circulation, but the physiological effects of such molecules remain unsettled. Our earlier results indicate that soluble CD44 can be detected in sera of healthy individuals and that significantly higher levels of serum CD44 (s-CD44) can be found in lymphoma patients. The serum level of the standard form of CD44 parallels the clinical treatment response in patients with lymphoma. In the present study, we have investigated the clinical significance of s-CD44 in non-Hodgkin's lymphoma measured at the time of the diagnosis. S-CD44 was measured from the sera of 123 patients with non-Hodgkin's lymphoma by dot blotting High levels of s-CD44 were associated with high serum levels of lactate dehydrogenase and thymidine kinase, high histological grade of malignancy and poor overall survival. However, s-CD44 level did not have independent prognostic value in a multivariate analysis. In conclusion, a high s-CD44 level at the time of diagnosis was associated with poor survival and several other adverse prognostic factors. Our previous and present studies taken together suggest that measurement of s-CD44 is a valuable tool to monitor treatment response in lymphoma patients. However, it may not be an improved prognostic marker. Int. J. Cancer (Pred. Oncol.) 79:221–225, 1998.© 1998 Wiley-Liss, Inc.     

Antibodies against double-stranded DNA and development of polymyositis during treatment with interferon

Alpha interferons have become effective palliative treatments for patients with neuroendocrine tumours such as carcinoids and endocrine pancreatic tumours. However, several reports indicate an increased incidence of both autoantibodies and autoimmune diseases in patients treated with interferon-alpha (IFN-alpha). We studied the development of antibodies against double-stranded DNA (dsDNA) and clinical signs of autoimmune disease in 214 patients with malignant carcinoids or endocrine pancreatic tumours consecutively admitted for treatment with IFN-alpha. Seventeen patients (8%) developed antibodies against dsDNA, predominantly females (12 females and 5 males). One patient had clinical and laboratory signs of polymyositis. Among the other 16 patients, three developed hypothyroidism and in six patients the anti- dsDNA autoantibodies normalized despite continuing therapy. Although a significant number of patients developed autoantibodies against dsDNA, overt autoimmune disease related to these antibodies is a rare event and many patients spontaneously normalize these titres despite continuing IFN-alpha treatment.