Long-term results of conventional-dose salvage chemotherapy in patients with refractory and relapsed Hodgkin's disease (Croatian experience).

BACKGROUND: The aim of this study was to analyze outcome of patients with Hodgkin's disease (HD) in whom first-line chemotherapy with mustine/vincristine/procarbazine/prednisone (MOPP) had failed. PATIENTS AND METHODS: From January 1982 to December 1989 among 210 patients treated with MOPP and radiotherapy to initial bulky sites, 65 patients were primary refractory to or relapsed after initial treatment. RESULTS: Twenty-nine of 65 patients (44%) were primary refractory to initial chemotherapy, 20 relapsed within 12 months after complete remission (CR) and 16 relapsed after CR that lasted more than 12 months. Patients with primary refractory HD and early relapse (<12 months after CR) were treated with doxorubicin/bleomycin/vinblastine/darcarbazine. In patients with late relapse (>12 months after CR) MOPP was repeated. The median follow-up for all patients was 115 months. The overall response rate was 63%. Thirty-three patients (51%) achieved a second CR and eight patients (12%) partial response. Remission rate was greatest in patients with late relapse (CR >12 months) (75 versus 55% for early relapse versus 35% for primary refractory HD) (P <0.01). At 10 years, overall and failure-free survival rates were 21 and 16%, respectively. Patients who were in first remission longer than 12 months had a superior overall survival (37 versus 18% for early relapse) and failure-free survival (24 versus 10% for early relapse). No patient with primary refractory HD was alive beyond 52 months after initial treatment failure (P <0.01). Main prognostic factors were duration of the first remission and tumor bulk at relapse. CONCLUSIONS: Our results confirm previous observations that a significant proportion of patients with HD who experience induction treatment failure cannot be cured with conventional treatment and probably need more aggressive therapy.

Total body irradiation with or without lung shielding for allogeneic bone marrow transplantation.

From June 1986 to June 1990, 64 patients with leukaemia (25 acute myelogenous leukaemia, 21 acute lymphoblastic leukaemia and 18 chronic myeloid leukaemia) undergoing marrow transplantation were randomized to receive cyclophosphamide (CY) and fractionated total body irradiation (TBI) without lung shielding (n = 33) or CY and fractionated TBI with lung shielding (n = 31, control group) as conditioning. Patients conditioned with TBI without lung shielding received a significantly higher total lung dose compared with the control group (p less than 0.0001). The 3-year leukaemia-free survival for patients receiving TBI without lung shielding is 54 +/- 18% versus 51 +/- 18% for patients receiving TBI with lung shielding (p = ns). There was no significant difference in the probability of leukaemia relapse (22 +/- 18% for TBI without lung shielding versus 24 +/- 18% for control group; p = ns). The probability of interstitial pneumonitis is 15 +/- 14% for TBI without lung shielding and 5 +/- 5% for TBI with lung shielding (p = ns). A higher incidence of lung fungal infection (15 versus 3%) and interstitial pneumonitis (12 versus 3%) has been documented in patients receiving TBI without lung shielding compared with the control group. The results indicate that higher radiation dose to the lung did not increase antileukaemic efficacy of TBI but seemed to be associated with the increased pulmonary toxicity.

[Radiotherapy in carcinoma of the epipharynx]. / Radioterapija karcinoma epifarinksa.

In five year period (1977-1982) 38 patients were treated for the epipharyngeal cancer in Department for oncology and radiotherapy and Department of otolaryngology of Medical Faculty in Zagreb. Most of the patients were male (76%), between 40 and 70 years of age. In 23 (60%) the cancer was poorly differentiated, in 15 (40%) well differentiated. Most of the patients were in advanced stage (III and IV - 37 patients, only one in I stage). All patients were primary treated by radiotherapy (telecobalt). The applied dose was 60 Gy in 50% of the patients. The other received lower doses (ten of them less than 55 Gy), only one received 70 Gy by classic fractions. Surgery was performed for residual neck nodes (radical neck dissection). Adjuvant chemotherapy was administrated as a rule in cases of poorly differentiated squamous carcinoma, as well as in all cases with local recurrence and/or distant metastases. Two years survival was 45%, three years 42% and five years 21%. The other radiotherapy techniques are discussed concerning the treatment improvement and diminishment of irradiation sequalae.

Experience with bone marrow transplantation for severe aplastic anemia and leukemia. Two years experience with 31 patients in Zagreb (Yugoslavia).

Since 1983, twelve patients with severe aplastic anemia and nineteen patients with leukemia were treated with bone marrow transplantation. Six patients with severe aplastic anemia are still alive at 300 to 1,210 days after transplantation, and twelve patients with leukemia are alive at 199 to 671 days. The incidence of GvHD was relatively high (60%). Bacterial infections were the main causes of death.

Cyclosporin neurotoxicity in patients treated with allogeneic bone marrow transplantation.

Toxicity to the central nervous system was observed in 3 out of 15 patients receiving cyclosporin prophylaxis for graft-versus-host-disease after allogeneic bone marrow transplantation. Neurological clinical features included grand mal seizures, dysarthria and vestibular and cochlear toxicity. In all three patients, cyclosporin plasma levels were increased at the time of overt clinical neurological signs. The symptoms resolved quickly with the reduction of the cyclosporin dose.