[Brentuximab vedotin treatment in patients with relapsed or refractory Hodgkin lymphoma. A Hungarian retrospective study]. / Relabáló/refrakter Hodgkin-lymphoma brentuximab vedotin kezelése. Hazai tapasztalatok.

INTRODUCTION: The treatment of relapsed or refractory Hodgkin lymphoma is still a major therapeutic challenge. The use of brentuximab vedotin, an anti-CD30 antibody-drug conjugate, represents a promising approach for these patients, however clinical outcomes have not yet been evaluated in Hungary. AIM: Our aim was to assess the efficacy, safety and outcome of brentuximab vedotin treatment in Hungarian Hodgkin lymphoma patients. METHOD: In this retrospective case note review we enrolled patients at 6 clinical sites countrywide who were diagnosed with Hodgkin lymphoma and received brentuximab vedotin between 1 January 2013 and 31 December 2016. RESULTS: A total of 86 patients were treated with brentuximab vedotin during the examined period. Before therapy initiation 66% of our patients had advanced-stage disease. Overall response rate to brentuximab vedotin, administered before autologous hematopoietic stem cell transplantation (n = 54) was 66.6%, complete remission rate was 42.6%. Thirty patients received brentuximab vedotin after AHSCT, 46.67% responded to treatment, 30% achieved complete remission. Thirty-six patients received the drug as a single-agent therapy, 50 patients were given brentuximab vedotin in combination, 39 of them with bendamustin. Toxicity was observed only in 13.95% of our patients, most common symptom was skin rash. Based on our analysis the estimated 5-year overall survival rate was 78.7%, the estimated progression free survival rate was 23.59 months (95% CI: 19.50-27.68). CONCLUSION: Brentuximab vedotin carries a substantial improvement in the treatment of relapsed or refractory Hodgkin lymphoma. Our results underline prior observations published in the literature. The use of brentuximab vedotin in combination can be beneficial, however further investigation is needed on the subject. Orv Hetil. 2017; 158(41): 1630-1634.

[Is ceCT necessary beyond FDG-PET/CT for primary staging in Hodgkin lymphoma?]. / Szükséges-e Hodgkin-limfóma primer stádium-megállapításához FDG-PET/CT mellett iv. ka. CT elvégzése is?

INTRODUCTION: Several study supported that 18F-Fluoro-deoxy-glucose (FDG) positron emission tomography/computer tomography with low dose CT (standard PET/CT) is more accurate than contrast-enhanced CT (ceCT) in the primary staging of Hodgkin disease. AIM: The authors compared the accuracy of these examinations with this indication in their practice, and analysed the added value of ceCT which was performed as a supplement to standard PET/CT. METHOD: Twenty-eight patients were categorized based on ceCT, single standard PET/CT and standard PET/CT with ceCT. RESULTS: Twenty-four patients were in the same disease-stage based on all methods. Disease was upstaged by standard PET/CT compared to ceCT in 4 patients. There was no change in stage when comparing standard PET/CT and standard PET/CT with ceCT. CONCLUSIONS: Standard PET/CT is more accurate than ceCT in the primary staging of Hodgkin disease. The authors established that it is not reasonable to supplement standard PET/CT with ceCT in this indication.

[Prognostic value of FDG-PET in Hodgkin lymphoma for posttreatment evaluation. Long-term follow-up results]. / Az FDG-PET prognosztikai értéke Hodgkin-lymphomás betegek követésében - hosszú távú eredményeink.

UNLABELLED: In the past few decades Hodgkin lymphoma (HL) has become a highly curable malignant disease, as a result of using modern polychemotherapy and irradiation. Differentiation of active tumor from fibrosis or necrosis within residual radiographic masses represents a problem of interpretation. AIMS: The aim of this retrospective study is to assess the value of FDG-PET for prediction of remission or relapse in HL. PATIENTS AND METHODS: Data of 128 patients, who had residual masses on CT after completion of their planned treatment, have been analyzed. FDG-PET was performed between January 1995 and February 2005. RESULTS: The median duration of the follow-up from PET was 75.5 months (range: 20-180 months). 89 (70%) patients had negative and 39 (30%) patients had positive FDG-PET results. The numbers of true-positive, true-negative, false-positive and false-negative subjects were 29, 83, 10 and 6, respectively. Sensitivity of post-treatment FDG-PET was 83%, specificity 93%, positive predictive value 74%, negative predictive value 93%, and accuracy 88%. The difference between the event free survival of PET positive and negative cases is highly significant (p = 0.0000), according to the Mantel-Cox test. CONCLUSION: Our results, in accordance with literature, clearly indicate that patients with negative FDG-PET results are unlikely to progress or relapse during a long follow-up. However, false positive uptake is a problem. We have investigated the effect of age, histological subtype, clinical stage and the type of treatment on the accuracy, but on the basis of these facts we could not find any significant difference. However, the date of the investigation influenced the results: before 2000 the number of false results was significantly higher than after that time, which shows the importance of investigators' experience.

Determination of long-lived Nb isotopes in nuclear power plant wastes.

(94)Nb and (93m)Nb are long-lived radionuclides, produced by thermal and fast neutrons from (93)Nb that is a major component of the Zr alloys used in nuclear reactors. A radiochemical method for the determination of these nuclides has been developed. The separation is based on the insolubility of Nb oxides and the retention of the fluoric complexes on anion exchange resin. The Nb sources are detected by gamma- and X-ray spectrometries. Activity concentrations determined in radioactive waste samples of a nuclear power plant are presented.

[A new neonatal primitive reflex: "elbowing." First experiences obtained on 543 Hungarian human newborns and infants]. / Egy új újszülöttkori primitív reflex: könyöklés. Elso tapasztalatok 543 magyar újszülöttön és csecsemon.

Between March 2007 and March 2008, authors studied the characteristics of a newly described neonatal primitive reflex, named "elbowing", on 481 mature, mostly healthy human newborns, and 62 premature ones. 1329 examinations were done at birth and later on at different ages, during the first 6 months. The reflex proved to be positive to around 70-80% on the first days of life, and with decreasing prevalence, remained positive to around 25-30% between 4-6 months. There were no significant differences between mature and premature newborns. Further studies are needed especially on pediatric patients with different neonatal pathology, and following newborns with unusual screening (early negative and/or late positive) results is essential.

Brain aluminum, magnesium and phosphorus contents of control and Alzheimer-diseased patients.

A study was undertaken to determine Al, Mg and P concentrations in 5 different brain regions of 3 control and 3 Alzheimer-diseased patients. One of the aims of this work was to evaluate the performance of applied analytical techniques. The digested samples were analyzed by inductively coupled plasma atomic emission spectrometry for Al, Mg and P. The dried samples were measured by instrumental neutron activation analysis for Al and Mg. The determination of human brain Al levels is complicated by the interfering reaction of P. We have previously worked out an analytical method which can eliminate this interference. The accuracy of the measured data was investigated by the analysis of biological standard reference materials. Our second goal was to study the possible elemental concentration changes in Alzheimer-diseased patients. Significantly higher Al and lower Mg and P values were found in some AD brain regions compared to the controls.

[Primary treatment of early stage Hodgkin's disease]. / Korai stádiumú Hodgkin-kór elsodleges kezelése.

Until the beginning of the 1990s, early stage Hodgkin's disease had been treated by (involved field) radiotherapy in most cases. Since the mid-1990s, by revealing a range of prognostic factors and late complications of radiotherapy, the treatment protocol has been modified. The use of combined modality therapy (programmed combined use of chemo- and radiotherapy) has gained ground. At present, in early stage Hodgkin's disease, 2-6 cycles ABVD followed by decreased dose involved field irradiation is considered to be the standard treatment. The number of chemotherapy cycles depends on the prognostic factors and reaction time. In cases of early stage nodular lymphocyte predominance with good prognosis, only involved field irradiation therapy is used.

[Primary treatment of advanced Hodgkin's disease]. / Az elorehaladott Hodgkin-kór elsodleges kezelése.

Primary treatment of advanced Hodgkin's disease. Hodgkin's disease is one of the few malignant diseases that can be cured even in an advanced stage in the majority of cases. By employing a polychemotherapy containing anthracyclines, a long remission and recovery can be achieved in 60-70% of the patients. At present the standard treatment is ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) scheme for the following reasons: besides good treatment results early side effects are more favourable; sterility and secondary acute leukemia present themselves less often than by employing regimens containing alkylating agents. Unfortunately, some of the patients do not react properly to the treatment and about one third of the patients who are in remission following primary treatment will relapse at a later stage. The main goal is now to further improve treatment (recovery) results without an increase, or even a decrease of early or late side effects. Awareness of prognostic factors should lead to the employment of a less intensive but not toxic therapy in patients with good prognosis to prevent overtreatment, while in cases with bad prognosis a more effective regimen is needed (even for the price of expected complications). The latest meta-analysis on the subject has shown that--similarly to sequential high dose therapy--the addition of radiotherapy to an effective chemotherapy does not seem to prolong the survival of patients. Despite the excellent therapeutic results achieved by the many new "intensive" chemotherapies, there is unfortunately no optimal therapy or protocol available today. The multicentre analysis to confirm these results and to compare them with standard scheme is still under way. It is to be hoped that risk adapted management for advanced stage Hodgkin's disease will also be available soon.

Comparison of the International Harmonization Project, London and Gallamini criteria in the interpretation of 18F-FDG PET/CT examinations after first-line treatment in Hodgkin's lymphoma.

OBJECTIVE: Fluorine 18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) has been reported to have a wide-ranging positive predictive value (PPV) in the literary data on Hodgkin's lymphoma after first-line therapy. This study was carried out to compare the usefulness of the International Harmonization Project, London and Gallamini criteria in the interpretation of F-FDG PET/CT examinations for this indication. METHODS: Data from 66 patients with a median follow-up care of 54 months were evaluated. The initial stage had been I-II in the case of 45 patients and III-IV in the case of 21 patients. RESULTS: The analysis based on the International Harmonization Project criteria resulted in a negative predictive value (NPV) of 98.0% and a PPV of 62.5%. Using mediastinal blood pool and liver activity as the thresholds for the London criteria, the NPV and PPV were 98.0 and 62.5% and 98.1 and 71.4%, respectively. Considering only those lesions with F-FDG uptake that was markedly higher than liver uptake as positive, the NPV and PPV were 94.7 and 88.9%, respectively. The analysis based on the Gallamini criteria resulted in an NPV of 96.2% and a PPV of 69.2%. CONCLUSION: Using the London criteria with liver activity as the threshold seems to be a good approach for the interpretation of post-treatment F-FDG PET/CT studies because of its high accuracy and simplicity.