Long-term survival and competing causes of death in patients with early-stage Hodgkin's disease treated at age 50 or younger.

PURPOSE: To analyze the long-term survival and the pattern and timing of excess mortality in patients with early-stage Hodgkin's disease. PATIENTS AND METHODS: Between 1969 and 1997, 1,080 patients age 50 or younger were treated for clinical stage IA to IIB Hodgkin's disease. Overall survival was determined, and prognostic factors were assessed. Relative risk and absolute excess risk (AR) of mortality were calculated for the entire cohort and by prognostic groups (on the basis of B symptoms, mediastinal status, and number of sites, modified from the European Organization for Research and Treatment of Cancer). RESULTS: The median follow-up was 12 years. The 15- and 20-year Kaplan-Meier survival estimates were 84% and 78%, respectively. Cox proportional hazards models showed that number of involved sites (P =.006), mediastinal status (P =.02), and histology (P =.02) were independent predictors of death from all causes. The AR of mortality in patients with a favorable prognosis increased over time, whereas for those with an unfavorable prognosis, the AR peaked in the first 5 years, predominantly from Hodgkin's disease. The relative risk of mortality from all causes, causes other than Hodgkin's disease, second tumors, and cardiac disease remained significantly elevated more than 20 years after treatment. CONCLUSION: Patients treated for early-stage Hodgkin's disease have a sustained excess mortality risk despite good control of the disease. Treatment reduction efforts in patients with early-stage, favorable-prognosis disease should continue, but for patients with an unfavorable prognosis, modified treatment may not be advisable. The excess mortality noted beyond two decades underscores the importance of long-term follow-up care in patients treated for Hodgkin's disease.

Treatment outcome of mucosa-associated lymphoid tissue/marginal zone non-Hodgkin's lymphoma.

PURPOSE: To evaluate the treatment outcome in patients with mucosa-associated lymphoid tissue (MALT)/marginal zone (MZ) non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: Between 1986 and 2000, 66 patients with clinical stage (CS) I-IV MALT/MZ NHL were treated; these comprise the study population. The progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier technique. Forty-five patients (68%) had CS I-II and 21 (32%) had CS III-IV disease. Twenty-nine of the 45 CS I-II patients received radiation therapy (RT) alone, and 6 patients had surgery and RT. The median RT dose was 3350 cGy. Among the 21 CS III-IV patients, treatment included chemotherapy alone (15), chemotherapy + RT (3), surgery (1), surgery + chemotherapy (1), and RT alone (1). Median follow-up was 48 months. RESULTS: All 35 early-stage and all 4 advanced-stage patients who received RT as part of initial treatment achieved local control. Among the 63 evaluable patients, the 5-year OS and PFS were 90 and 57%, respectively. The 5-year OS was 93% and PFS was 75% among CS I-II patients; the corresponding estimates in CS III-IV patients were 83% and 14%, respectively. CONCLUSION: Modest doses of RT provide excellent local control in patients with MALT/MZ NHL. The poor PFS in advanced-stage patients suggests the need to develop alternative systemic treatment strategies for this disease.