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Biomedical subjects

Peter Koch

Publications and source records attributed to Peter Koch.

At least 19 recordsLinked to original sources
PubMed2006

Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations.

INTRODUCTION: Evidence to support or refute closed suction drainage (CSD) in primary total hip replacement (THR) is not conclusive. Our anecdotical experience was that persistent ooze from the drainage hole often delayed wound recovery. We hypothesized that, without CSD, wound care would be simplified without short or long term disadvantage. MATERIALS AND METHODS: Hundred patients scheduled for primary THR were randomly assigned for CSD or non-drainage. Drains were withdrawn at day 2. Pain, wound hematoma, number of dressing changes, time of persistent discharge from the operation site (skin incision and drain hole), total blood loss and number of blood transfusions were prospectively recorded. Hip function, presence of heterotopic ossifications (HTO) and complications were recorded at a follow visit 1 year after surgery. RESULTS: Wound sites managed without CSD needed significantly less wound dressings (P < 0.001) and were dry at an earlier time (P < 001). Despite a significant bigger subfascial hematoma in the non-drained group (P < 0.05), in terms of pain, thigh swelling, total blood loss, number of transfusions needed, hip function and HTO no difference was recorded between the groups (P = 0.2-0.82). CONCLUSION: To omit CSD in primary THR results in simplified and more rapid wound management without any disadvantage at short and long term.

Adult↗
PubMed2006

Mortality and life expectancy of professional fire fighters in Hamburg, Germany: a cohort study 1950-2000.

BACKGROUND: The healthy worker effect may hide adverse health effects in hazardous jobs, especially those where physical fitness is required. Fire fighters may serve as a good example because they sometimes are severely exposed to hazardous substances while on the other hand their physical fitness and their strong health surveillance by far exceeds that of comparable persons from the general population. METHODS: To study this effect a historic cohort study was conducted to assess mortality and life expectancy of professional fire fighters of the City of Hamburg, Germany. Fire departments and trade unions questioned the validity of existing studies from outside Germany because of specific differences in the professional career. No mortality study had been conducted so far in Germany and only few in Europe. Information on all active and retired fire fighters was extracted from personnel records. To assure completeness of data the cohort was restricted to all fire fighters being active on January 1, 1950 or later. Follow up of the cohort ended on June 30th 2000. Vital status was assessed by personnel records, pension fund records and the German residence registries. Mortality of fire fighters was compared to mortality of the Hamburg and German male population by means of standardized mortality ratios. Life expectancy was calculated using life table analysis. Multivariate proportional hazard models were used to assess the effect of seniority, time from first employment, and other occupational characteristics on mortality. RESULTS: The cohort consists of 4640 fire fighters accumulating 111,796 person years. Vital status could be determined for 98.2% of the cohort. By the end of follow up 1052 person were deceased. Standardized Mortality Ratio (SMR) for the total cohort was 0.79 (95% CI, 0.74-0.84) compared to Hamburg reference data and 0.78 (95% CI, 0.74-0.83) compared to National German reference data. Conditional life expectancy of a 30 year old fire fighter was 45.3 years as compared to 42.9 year of a German male in normal population. Job tasks, rank status and early retirement negatively influenced mortality. For fire fighters with comparably short duration of employment the mortality advantage diminished with longer time since first employment. SMR of persons who retired early was 1.25 (95% CI, 1.13-1.60) in reference to the general German population and the SMR of 1.71 (1.18-2.50) in the multivariate regression model. CONCLUSION: A strong healthy worker effect was observed for the cohort, which diminished with longer time since first employment for fire fighters with shorter duration of employment, as expected. The negative effects on mortality of job tasks, rank status and in particular early retirement indicate the presence of undetermined and specific risks related to occupational hazards of fire fighters.

Adolescent↗
PubMed2006

Linear optical coherence tomography system with extended measurement range.

Optical coherence tomography (OCT) sensors traditionally use scanning optical delay lines with moving parts and a single detector. OCT systems with a linear detector array (linear OCT or L-OCT) are simple and robust, but a detector with approximately 10,000 pixels is needed for an imaging depth of 2mm, which is necessary for most biomedical applications. We present a new optical setup for L-OCT with an increased measurement range. An additional grating performs a reduction of the spatial frequencies of the fringe pattern on the detector without loss in the signal-to-noise ratio, so the signal can be sampled with a minimal number of pixels. The theory for this approach is addressed and the first measurements are presented.

Computer Simulation↗
PubMed2006

Femoral stress fracture after computer navigated total knee arthroplasty.

Computer navigation for total knee arthroplasty is increasingly used because it improves the accuracy of femoral and tibial components implantation. However, every new technique is associated with its own complications. Here, we report on a patient who developed a distal femoral stress fracture after two attempts at fixing the navigation tracker.

Aged↗
PubMed2006

Cartilaginous defects of the femorotibial joint: accuracy of coronal short inversion time inversion-recovery MR sequence.

PURPOSE: To retrospectively assess the diagnostic performance of the short inversion time inversion-recovery (STIR) magnetic resonance (MR) sequence for depiction and classification of articular cartilaginous lesions in femorotibial joint, with arthroscopy as reference standard. MATERIALS AND METHODS: Institutional review board did not require approval and informed consent for review of patients' records or images. All patients (and parents of underage patients) agreed to use of their data. Two musculoskeletal radiologists independently analyzed femorotibial cartilage on coronal STIR images from 84 knee MR examinations in 83 patients (48 male patients [49 knees], 35 female patients; mean age, 39.5 years). Slightly modified Outerbridge classification was used: grade 0, normal cartilage; grade 1, softening or swelling; grade 2, partial-thickness defect; grade 3, fissuring to the level of the subchondral bone; and grade 4, exposed subchondral bone. Arthroscopy performed within 15 weeks was the standard of reference. Classification for arthroscopy differed only in definition of grade 1 (softening or swelling of cartilage). Sensitivity, specificity, accuracy, positive and negative predictive values, and weighted kappa values were calculated to assess interobserver reliability. RESULTS: At arthroscopy, 212 (63%) of 336 surfaces were classified as grade 0 (normal); 37 (11%), as grade 1 abnormalities; 30 (9%), as grade 2 lesions; 25 (7%), as grade 3 lesions; and 32 (10%), as grade 4 lesions. Grades 0 and 1 were considered normal; grades 2-4, as abnormal. For detection of contour defects of the cartilaginous surface, coronal STIR MR imaging had sensitivity values of 77% and 76%, specificity values of 96% and 89%, accuracy values of 91% and 85%, positive predictive values of 86% and 70%, and negative predictive values of 92% and 91% for readers 1 and 2, respectively. Weighted kappa value was 0.63. CONCLUSION: Contour defects of femorotibial cartilage can be detected with reasonable accuracy with routine STIR sequence.

Adolescent↗
PubMed2006

MRI of meniscal lesions: soft-copy (PACS) and hard-copy evaluation versus reviewer experience.

OBJECTIVE: The purpose of our study was to compare diagnostic performance, reviewer confidence, and time requirements in the MRI diagnosis of meniscal tears for three types of reviewers and two types of image documentations (PACS vs hard copies). MATERIALS AND METHODS: An experienced musculoskeletal radiologist (reviewer 1), a fellow in musculoskeletal radiology (reviewer 2), and a junior staff member in orthopedic surgery (reviewer 3) evaluated MR images displayed on PACS monitors and hard copies independently and in a blinded fashion with regard to the presence or absence of meniscal tears. Seventy-one patients (mean age, 45.4 years; range, 16-80 years) were consecutively included if they had undergone both MRI of the knee and arthroscopy within 4 months. Arthroscopy was the standard of reference. Evaluation time and the reviewer's confidence in his or her diagnosis (Visual Analogue Scale, possible values of 0-100) were determined. RESULTS: Accuracies, sensitivities, and specificities in diagnosing meniscal tears were 80-87%, 63-85%, and 87-93% for soft copies and 82-85%, 64-76%, and 87-94.0%, respectively, for hard copies. Intrareviewer differences between PACS and hard copies were not significant for any of the three reviewers (McNemar tests). Reviewer 3 was less sensitive but more specific in the diagnosis of meniscal tears than reviewers 1 and 2. This difference was significant for both the PACS and hard copies. The reviewers' confidence in their diagnoses and evaluation times were not significantly different for PACS and hard copies (analysis of variance with Bonferroni post hoc analysis). CONCLUSION: Differences in the diagnostic performance of suspected meniscal tears depend on reviewer experience rather than on the type of documentation.

Adolescent↗
PubMed2005

Treatment results in localized primary gastric lymphoma: data of patients registered within the German multicenter study (GIT NHL 02/96).

PURPOSE: In the prospective study 02/96 on primary GI lymphoma, we have collected data on histology, clinical features, and treatment results. In particular, in stages I and II localized primary gastric lymphoma (PGL), our objectives were to reduce treatment intensity and to confirm our hypothesis from study 01/92, which maintained that an organ-preserving approach is not inferior to primary surgery. PATIENTS AND METHODS: Patients receiving radiotherapy and/or chemotherapy were stratified for histologic grade, stage, and whether surgery had been carried out or not (as decided by each participating center). Patients with aggressive PGL received six cycles of CHOP-14 (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by involved-field radiotherapy (40 Gy). Patients with indolent PGL (including patients experiencing treatment failure with antibiotic therapy for Helicobacter pylori) were treated with extended-field radiotherapy. The volume depended on stage. The irradiation dose was 30 Gy, followed by a boost of 10 Gy (the latter omitted after complete resection) to the tumor region. RESULTS: Seven hundred forty-seven patients were accrued. Of these patients, 393 with localized PGL were treated with radiotherapy and/or chemotherapy only or additional surgery between December 1996 and December 2003. The survival rate at 42 months for patients treated with surgery was 86% compared with 91.0% for patients without surgery. CONCLUSION: In this nonrandomized study (02/96), we reproduced the previous results of study 01/92 showing no disadvantage for an organ-preserving treatment. Therefore, primary stomach resection should be questioned.

Adult↗
PubMed2005

Suppression of kindled seizures by paracrine adenosine release from stem cell-derived brain implants.

PURPOSE: Stem cells and their derivatives have emerged as a promising tool for cell-based drug delivery because of (a) their unique ability to differentiate into various somatic cell types, (b) the virtually unlimited donor source for transplantation, and (c) the advantage of being amenable to a wide spectrum of genetic manipulations. Previously, adenosine-releasing embryonic stem (ES) cells have been generated by disruption of both alleles of adenosine kinase (Adk-/-). Lack of ADK did not compromise the cells' differentiation potential into embryoid bodies or glial precursor cells. The aim of the present study was to investigate the potential of differentiated Adk-/- ES cell progeny for seizure suppression by paracrine adenosine release. METHODS: To isolate paracrine effects of stem cell-derived implants from effects caused by network integration, ES cell-derived embryoid bodies and glial precursor cells were encapsulated into semipermeable polymer membranes and grafted into the lateral brain ventricles of kindled rats. RESULTS: While seizure activity in kindled rats with wild-type Adk+/+ implants remained unaltered, rats with adenosine-releasing Adk-/- ES cell-derived implants displayed transient protection from convulsive seizures and a profound reduction of afterdischarge activity in EEG recordings. Long-term seizure suppression was precluded by limited viability of the encapsulated cells. CONCLUSIONS: We thereby provide a proof-of-principle that Adk-/- ES cell-derived brain implants can suppress seizure activity by a paracrine mode of action. Adk-deficient stem cells therefore represent a potential tool for the treatment of epileptic disorders.

Adenosine↗
PubMed2005

Imaging of patellar cartilage with a 2D multiple-echo data image combination sequence.

OBJECTIVE: We sought to evaluate the diagnostic value of a 2D multiple-echo data image combination (MEDIC) MRI sequence in the detection of patellar cartilage defects. MATERIALS AND METHODS: Our study included 52 consecutive patients who had knee surgery within 4 months of undergoing an MRI examination including an axial 2D MEDIC (TR/TE, 884/26; flip angle, 30 degrees ) sequence. Cartilage was surgically graded on a 5-point scale: 0, normal; 1, softening or swelling; 2, partial thickness defect; 3, fissuring to the level of the subchondral bone; or 4, exposed subchondral bone. Cartilage was graded on MRI according to a scale that was almost identical to the surgical scale except that grade 1 lesions were defined as signal alteration or swelling of cartilage. Two blinded reviewers independently analyzed patellar cartilage. Sensitivity, specificity, accuracy, and weighted kappa values for interobserver variability were calculated. RESULTS: Low-grade cartilage lesions predominated in our study group. When grade 2 or higher was considered the threshold for relevance, the sensitivity, specificity, and accuracy for the MEDIC sequence was as high as 79%, 82%, and 81%, respectively. Increasing the threshold of relevance to grade 3 increased the sensitivity, specificity, and accuracy to as high as 83%, 91%, and 90%, respectively. Interobserver agreement for the MEDIC sequence was good (weighted kappa = 0.68). CONCLUSION: The 2D MEDIC sequence performs comparably to previously described sequences optimized for cartilage imaging such as the 3D double-echo steady-state or 3D spoiled gradient-recalled sequences with good interobserver agreement, high sensitivity, and excellent specificity for revealing low- to intermediate-degree cartilage defects.

Adult↗
PubMed2004

Engineering embryonic stem cell derived glia for adenosine delivery.

Based on the anticonvulsant and neuroprotective properties of adenosine, and based on the long-term survival potential of stem cell derived brain implants, adenosine releasing stem cells may constitute a novel tool for the treatment of epilepsy. Pluripotency and unlimited self-renewal make embryonic stem (ES) cells a particularly versatile donor source for cell transplantation. With the aim to test the feasibility of a stem cell-based delivery system for adenosine, both alleles of adenosine kinase (ADK), the major adenosine-metabolizing enzyme, were disrupted by homologous recombination in ES cells. Adk-/- ES cells were subjected to a glial differentiation protocol and, as a result, gave rise to proliferating glial precursors, which could be further differentiated into mature astrocytes and oligodendrocytes. Thus, a lack of ADK does not compromise the glial differentiation potential of ES cells. The Adk-/- ES cells yielded glial populations with an adenosine release of up to 40.1 +/- 6.0 ng per 10(5) cells per hour, an amount considered to be sufficient for seizure suppression. Our findings indicate that Adk-/- ES cells constitute a potential source for therapeutic adenosine releasing grafts.

Adenosine↗
PubMed2004

Linear optical coherence tomography system with a downconverted fringe pattern.

Linear optical coherence tomography (LOCT) systems are a simple and robust alternative to time-domain optical coherence tomography systems, but a detector with approximately 10(4) pixels is needed for an imaging depth of 2 mm. We present a new system for LOCT with a special mask attached to the image sensor. The mask essentially performs a downconversion of the spatial frequencies by multiplication with a second spatial frequency. This reduces the fringe frequency of the optical coherence tomography signal so that the signal can be sampled with fewer pixels.

Equipment Design↗
PubMed2003

Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin's lymphoma: results of the HD8 trial of the German Hodgkin's Lymphoma Study Group.

PURPOSE: To investigate whether radiotherapy can be reduced without loss of efficacy from extended field (EF) to involved field (IF) after four cycles of chemotherapy. PATIENTS AND METHODS: Between 1993 and 1998, patients with newly diagnosed early-stage unfavorable HD were enrolled onto this multicenter study. Patients were randomly assigned to receive cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) + doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for two cycles followed by radiotherapy of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). RESULTS: Of 1,204 patients randomly assigned to treatment, 1,064 patients were informative and eligible for the arm comparison (532 patients in arm A; 532 patients in arm B). The median observation time was 54 months. Five years after random assignment, the overall survival (OSran) for all eligible patients was 91% and freedom from treatment failure (FFTFran) was 83%. Survival rates at 5 years after start of radiotherapy revealed no differences for arms A and B, respectively, in terms of FFTF (85.8% and 84.2%) and OS at 5 years (90.8% and 92.4%). There also were no differences between arms A and B, respectively, in terms of complete remission (98.5% and 97.2%), progressive disease (0.8% and 1.9%), relapse (6.4% and 7.7%), death (8.1% and 6.4%), and secondary neoplasia (4.5% and 2.8%). In contrast, acute side effects including leukopenia, thrombocytopenia, nausea, gastrointestinal toxicity, and pharyngeal toxicity were more frequent in the EF arm. CONCLUSION: Radiotherapy volume size reduction from EF to IF after COPP + ABVD chemotherapy for two cycles produces similar results and less toxicity in patients with early-stage unfavorable HD.

Adolescent↗
PubMed2003

[Value of endosonography in diagnostic staging of primary gastric lymphoma (MALT type)].

BACKGROUND AND AIMS: The incidence of gastric MALT (mucosa-associated lymphoid tissue) lymphomas has significantly increased during the past few years. Especially when MALT lymphomas are treated conventionally, e.g., with eradication or chemotherapy, an exact classification of the lymphoma is required. The goal of this study was to compare the accuracy of endoscopic ultrasound (EUS) with other imaging techniques used in the staging of MALT lymphomas. PATIENTS AND METHODS: In the setting of a prospective trial with a conservative therapeutic approach (Münster Study for GIT-NHL), altogether 44 patients diagnosed with a low-grade or high-grade malignant non-Hodgkin's lymphoma (NHL) were included in the study and classified according to their relative tumor stage using special diagnostic measures, which comprised gastroscopy (esophagogastroduodenoscopy), abdominal ultrasound, computed tomography (CT), and EUS. RESULTS: In 42 out of 44 patients, EUS identified the lymphoma (in two cases, final diagnosis was possible only by histologic analysis). Concerning the identification of a thickening of the stomach wall or a fusion of the layers of the stomach wall, EUS had a significantly superior score over conventional ultrasound or CT, respectively (p < 0.001). In the detection of pathologic lymph nodes, EUS was again significantly superior to ultrasound imaging. CT, however, had a statistically similar detection rate (p > 0.05). In four cases, EUS underrated a less advanced tumor stage with tumor manifestations outside the stomach (IVE). In one case, pathologic lymph nodes could be detected only with thoracic CT. In 70% of the cases, EUS imaging resulted in higher-grade tumor ranking. In 57% of cases, EUS was the only imaging technique to achieve a classification of the tumor stage at all. CONCLUSION: In the diagnosis of gastric NHLs, EUS imaging is superior to conventional imaging techniques (ultrasound and CT). Therefore, the use of endoscopic ultrasound for staging can be regarded as a prerequisite for the exact tumor stage classification required in more recent conventional therapeutic approaches.

Adult↗
PubMed2003

Regulation of macrophage migration inhibitory factor expression by glucocorticoids in vivo.

Glucocorticoid hormones are important anti-inflammatory agents because of their anti-inflammatory and proapoptotic action within the immune system. Their clinical usefulness remains limited however by side effects that result in part from their growth inhibitory action on sensitive target tissues. The protein mediator, macrophage migration inhibitory factor (MIF), is an important regulator of the host immune response and exhibits both glucocorticoid-antagonistic and growth-regulatory properties. MIF has been shown to contribute significantly to the development of immunopathology in several models of inflammatory disease. Although there is emerging evidence for a functional interaction between MIF and glucocorticoids in vitro, little is known about their reciprocal influence in vivo. We investigated the expression of MIF in rat tissues after ablation of the hypothalamic-pituitary-adrenal axis and after high-dose glucocorticoid administration. MIF expression is constitutive and independent of the influence of adrenal hormones. Hypophysectomy and the attendent loss of pituitary hormones, by contrast, decreased MIF protein content in the adrenal gland. Administration of dexamethasone was found to increase MIF protein expression in those organs that are considered to be sensitive to the growth inhibitory effects of glucocorticoids (immune and endocrine tissues, skin, and muscle). This increase was most likely because of a posttranscriptional regulatory effect because tissue MIF mRNA levels were not influenced by dexamethasone treatment. Finally, MIF immunoneutralization enhanced lymphocyte egress from blood during stress-induced lymphocyte redistribution, consistent with a functional interaction between MIF and glucocorticoids on immune cell trafficking in vivo. These findings suggest a role for MIF in both the homeostatic and physiological action of glucocorticoids in vivo.

Adrenal Glands↗
PubMed2003

The impact of reducing dose frequency on health outcomes.

BACKGROUND: Dosing schedules may be one important factor determining whether patients take their prescribed medication. Schedules may influence whether a patient stays on the prescribed therapy and, if so, the degree to which the regimen is followed. Both factors are important determinants of health outcomes and health care costs. OBJECTIVE: The goal of this study was to investigate the impact of reducing dose frequency on health outcomes and health care costs. METHODS: Articles from peer-reviewed journals were identified from the medical literature databases MEDLINE, International Pharmaceutical Abstracts, and HealthSTAR for the years 1985 through 2002. The search included all references that reported on the impact of a change of dose frequency on chronic disease. Search terms used were combinations of dose frequency, dose schedule, and dosing and efficacy, safety, clinical effectiveness, preferences, adherence, compliance, persistence, health-related quality of life, patient satisfaction, resource use, and costs. RESULTS: Reducing the number of daily doses through extended-release formulations or newer drugs has frequently been shown to provide the patient with better symptom control in a number of disease states. Overall improvements were seen in adherence, patient quality of life, patient satisfaction, and costs. However, results of some studies indicate that not all patients, medications, or diseases may be candidates for reduced dosing due to the potential effects on symptom control, incidence of adverse events, and overcompensation for missed doses. CONCLUSION: Where feasible, reducing dose frequency may offer benefits for the patient in terms of health outcomes and for the health care budget holder in terms of costs.

Dose-Response Relationship, Drug↗
PubMed2002

Rapidly alternating COPP/ABV/IMEP is not superior to conventional alternating COPP/ABVD in combination with extended-field radiotherapy in intermediate-stage Hodgkin's lymphoma: final results of the German Hodgkin's Lymphoma Study Group Trial HD5.

PURPOSE: To investigate whether treatment results in intermediate-stage Hodgkin's lymphoma can be improved by rapid application of non-cross-resistant drugs, the 10-drug regimen cyclophosphamide, vincristine, procarbazine, and prednisone (COPP), doxorubicin, bleomycin, and vinblastine (ABV), and ifosfamide, methotrexate, etoposide, and prednisone (IMEP), repeated every 6 weeks, was compared with conventional alternating COPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) administered every 8 weeks. PATIENTS AND METHODS: From January 1988 to January 1993, 996 patients in stage I or II Hodgkin's lymphoma with at least one risk factor (massive mediastinal tumor, massive spleen involvement, extranodal disease, elevated ESR, or more than two lymph node areas involved) and all patients in stage IIIA Hodgkin's lymphoma were randomized to receive two cycles of COPP/ABVD or COPP/ABV/IMEP followed by extended-field radiotherapy. RESULTS: Both regimens produced similar rates for treatment responses (complete remission, 93% v 94%), freedom from treatment failure (80% v 79%), and overall survival (88% for both regimens) at a median follow-up time of 7 years. Most serious toxicities during chemotherapy were similar in both regimens. However, World Health Organization grade 3 and 4 leukocytopenia occurred significantly more frequently in the COPP/ABV/IMEP arm (53% v 44% of patients; P =.010). There were no differences in the number of serious infections and toxic deaths during therapy. The number of second malignancies was also the same in both arms (22 each). CONCLUSION: Alternating COPP/ABVD and rapid alternating COPP/ABV/IMEP in combination with extended-field radiotherapy are equally effective in intermediate-stage Hodgkin's lymphoma and produce excellent long-term treatment results.

Adolescent↗
PubMed2002

New prognostic score based on treatment outcome of patients with relapsed Hodgkin's lymphoma registered in the database of the German Hodgkin's lymphoma study group.

PURPOSE: To evaluate salvage treatment outcome of patients with relapsed Hodgkin's disease (HD) and to distinguish different risk groups using identified prognostic factors. PATIENTS AND METHODS: From 4,754 patients registered in the German Hodgkin's Lymphoma Study Group (GHSG) database between 1988 and 1999, 422 patients with early (n = 170) or late (n = 252) relapsed HD were identified. One hundred seven patients (25%) relapsed after radiotherapy (RT) for early stages, 133 patients (32%) after combined-modality therapy for intermediate stages, and 182 patients (43%) after chemotherapy (CT) and RT to initial bulky disease or residual lymphoma for advanced stages. At relapse, characteristics of these 422 patients (median age, 38 years; range, 17 to 77) were stage III/IV, 45%; B symptoms, 24%; elevated erythrocyte sedimentation rate, 29%; anemia, 13%; and Karnofsky performance score, less than 90 in 13%. At first relapse, salvage treatment was RT in 13%, CT in 54%, and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation (ASCT) in 33%. RESULTS: Median follow-up time after relapse was 45 months. Freedom from second failure (FF2F) and overall survival (OS) were 81% and 89% for relapse after RT, 33% and 46% for early relapse after CT, and 43% and 71% for late relapse after CT, respectively. In multivariate analysis, independent risk factors were time to relapse, clinical stage at relapse, and anemia at relapse. Four subgroups with significantly different FF2F and OS were identified. The prognostic score was predictive for patients who relapsed after RT, CT with conventional CT salvage, and CT with HDCT/ASCT. CONCLUSION: In the GHSG database, time to relapse and clinical stage and anemia at relapse are relevant factors and can be used to form a prognostic score for HD patients at relapse.

Actuarial Analysis↗