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PubMed2000

Treatment of Adult ALL according to protocols of the German Multicenter Study Group for Adult ALL (GMALL).

The German Multicenter Study Group for Adult Acute Lymphoblastic leukemia (GMALL) has conducted 5 consecutive trials with more than 3000 patients since 1981. This article provides an overview on aims, treatment concepts, and results of these studies. It includes brief summaries on the development of prognostic models within the GMALL group and on approaches for prophylaxis of CNS relapse, and it summarizes specific treatment concepts for mature B-lineage acute lymphocytic leukemia.

Adolescent↗

PubMed1997

Pathologic prognostic factors in diffuse aggressive non-Hodgkin's lymphoma.

Recent advances in understanding the immunophenotypic, molecular genetic, and cytogenetic heterogeneity of diffuse large-cell lymphomas (DLCL) have provided new insights into the diversity of these disorders. Clinical prognostic factors are useful for predicting outcome in DLCL, but are surrogates of the underlying biology. The role of pathologic prognostic factors as the biologic correlates of clinical behavior in DLCL should allow the development of new prognostic models that incorporate both clinical and pathological data, and lead to improved outcome for those patients not cured by modern-day treatment regimens.

Apoptosis↗

PubMed1998

Prognostic factors in soft tissue sarcomas: the Aarhus experience.

In the present study, the outcome, patterns of local recurrence and survival, as well as prognostic factors, were evaluated in patients surgically treated for soft tissue sarcomas. Between January 1979 and July 1993, 316 consecutive patients were referred to the Sarcoma Centre in Aarhus with localised malignant soft tissue sarcoma of the extremities or trunk. If possible, the patients were treated with a limb-sparing resection, primarily by use of a wide excision. 50 patients received adjuvant radiotherapy. There were 161 men (51%) and 155 women (49%) median age 56 years (range 1-94 years). 94 patients (30%) had tumours in the trunk, including shoulder and buttock lesions, 163 (52%) in the lower extremity and 59 (19%) in the upper extremity. 52 patients (16%) had grade 1 tumour, 60 (19%) grade 2 and 204 (65%) grades 3A-3B. The 5-year local recurrence rate was 18% and the 5-year survival rate was 75%. Multivariate analysis indicated the following variables as independent unfavourable factors for local recurrence: extracompartmental location, histological high grade, local excision, no adjuvant radiotherapy and intralesional/marginal excision. Independent unfavourable factors for survival were advanced age, extracompartmental location, histological high grade, lower extremity location and large tumour size. If the variable local recurrence was included in the analysis, it was found to have a very strong influence on survival. Based on these variables, a prognostic model was developed.

Adolescent↗

PubMed2003

Liver transplantation for primary biliary cirrhosis.

Liver transplantation is the accepted treatment for patients with end-stage liver disease or intractable symptoms secondary to primary biliary cirrhosis (PBC), and has proven survival benefit. Indications for transplantation are an unacceptable quality of life or anticipated death in less than 1 year. Although there are a number of prognostic models, serum bilirubin provides the simplest guide to transplantation timing. Those grafted for PBC are at greater risk of developing chronic rejection, and are less likely to be successfully weaned from immunosuppression than those grafted for other indications. Following transplantation, antimitochondrial antibodies persist and histological features of recurrent PBC may be seen in the allograft in up to 50% by 10 years; however, at least in the medium-term, this rarely causes clinical problems.

Europe↗

PubMed2006

Screening wish theories: dream psychologies and early cinema.

The analogy between dream and film represents a central thread in the psychoanalytic discussion of cinema. Using examples taken from films created between 1900 and 1906, this paper develops a typology of dream scenes in early film. The basis for the proposed typology is provided by the dream knowledge in circulation toward the end of the nineteenth century. This knowledge was fed by a great variety of sources, some of them in the proximity of scientific research and some of them far from it, including wish-fulfilling prognostic models and those based on the reservoir of memory or on bodily stimuli. By setting cinema in a context of contemporary dream psychologies, it is possible to trace the specific conditions under which the analogy between dream and cinema could become effective.

Dreams↗

PubMed2005

Predictors of death within six months in patients with advanced AIDS.

OBJECTIVES: This study sought to identify potential predictive variables of death within 6 months in patients with advanced AIDS. METHODS: Investigators enrolled a consecutive series of patients with advanced AIDS admitted to a skilled nursing facility in New York City over a 1-year period. Demographic, clinical, laboratory, and outcome data were abstracted from medical records using a standardized data collection instrument. RESULTS: Of the 152 patients enrolled during the study period, 61 patients (40%) died within 6 months from date of admission. Serum albumin, percent deviation from ideal body weight, and number of comorbidities at the time of admission proved to be the best combination of predictors of death within 6 months. SIGNIFICANCE OF RESULTS: The decrease in AIDS mortality over the past decade, along with an increase in prevalence due to longer survival, has been attributed primarily to the successful use of highly active antiretroviral therapy (HAART). HAART regimens, however, can also produce both short-term adverse effects and long-term complications. The prognostic model developed by this study may be useful in guiding treatment decisions in patients with advanced AIDS for whom a more palliative care plan may be sought.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Prognostic significance of Ki-67 and topoisomerase IIalpha expression in infiltrating ductal carcinoma of the breast. A multivariate analysis of 863 cases.

To evaluate the prognostic relevance of Ki-67 and topoisomerase IIalpha expression in relation to tumor stage, grade, and hormone receptor content, 942 ductal infiltrating carcinomas of the breast were examined by means of the monoclonal antibodies Ki-S11 (Ki-67) and Ki-S4 (topoisomerase IIalpha). pS2, c-erbB2, and p53 were additionally considered as prognostic variables. The median follow-up time was 149 months. Eight-hundred-and-sixty-three tumors reacted with Ki-S11 and Ki-S4; the labeling indices of the two antigens were closely associated (r = 0.93). Both correlated positively with the tumor size, c-erbB2, and p53 expression, and negatively with patient age, hormone receptor content, and pS2 immunostaining. In the univariate analysis, Ki-S11 and Ki-S4 scores, nodal status, tumor size, tumor grade, and progesterone receptor content strongly predicted both overall and metastasis-free survival (p < 0.00001). Estrogen receptor status, p53, and c-erbB2 were of minor significance. Concerning overall survival, multivariate Cox regression analysis selected a Ki-S4 score >25% (p < 0.00001) next to the nodal status, and before tumor size, progesterone receptor content, and patient age. Independent predictors of the occurrence of distant metastases were nodal status, Ki-S4, tumor size, grade 1, and progesterone receptor negativity, in that order. The Ki-S11 score was of independent prognostic significance only if examined as a continuous variable. We conclude that topoisomerase IIalpha expression as assessed by monoclonal antibody Ki-S4 may add valuable information to current prognostic models for breast cancer. Its predictive value appears to be essentially related to the proliferative activity of tumor cells.

Adult↗

PubMed1999

A multi-center prospective phase II study of high-dose chemotherapy in germ-cell cancer patients relapsing from complete remission.

PURPOSE: To prospectively determine the efficacy of repeated high-dose alkylating chemotherapy to salvage patients with germ-cell tumors who relapsed after adequate first-line chemotherapy. PATIENTS AND METHODS: Patients with germ-cell cancers relapsing from a first, second or third complete remission induced by chemotherapy were offered to participate in a Dutch national prospective trial with broad entry criteria. The salvage treatment began with a conventional dose of ifosfamide (4 g/m2 on day 1) and etoposide (100 mg/m2 on days 1, 2 and 3) followed by daily s.c. administration of G-CSF (10 micrograms/kg) until peripheral blood progenitor cells had been harvested. Immediately after bone marrow recovery, an intermediate dose chemotherapy course of carboplatin (target AUC: 10 mg.ml-1 min on day 1) and etoposide (500 mg/m2 on days 1, 3 and 5) was given with G-CSF daily s.c. After bone marrow recovery, two subsequent courses of high-dose 'CTC' chemotherapy were given, each containing cyclophosphamide (6 g/m2), thiotepa (480 mg/m2) and carboplatin (target AUC: 20 mg.ml-1 min). The high-dose chemotherapy was administered as 30-60-minute infusions, divided over 4 days and the stem-cell transplants were given 48-72 hours after the last chemotherapy infusion. Whenever possible, residual masses were resected at the end of treatment. RESULTS: Thirty-five patients were treated between January 1994 and October 1997. The toxicity of the treatment was manageable. Second CTC courses were administered in 25 patients and were associated with hemorrhagic cystitis and veno-occlusive disease in 3 and 4 patients, respectively. One patient who had recently undergone a partial hepatectomy, died of veno-occlusive disease. At the time of analysis, the median follow-up of the surviving patients was 37 months (range 12-56 months). The median progression-free survival for all patients was 44 months, and the median overall survival has not been reached. According to the internationally accepted criteria for predicting the outcome of salvage chemotherapy in germ-cell cancer (Beyer et al. J Clin Oncol 1996; 14: 2638-45), 30 patients had 'good risk' criteria. Of these, 29 received high-dose chemotherapy. Of this group, the salvage rate at two years was 65% (95% confidence interval: 49.5%-85.1%). CONCLUSIONS: Over half of the germ-cell cancer patients relapsing from a chemotherapy-induced complete remission can be salvaged by a treatment strategy that incorporates high-dose chemotherapy, even when treatment is given in a multi-center setting. These data confirm the international prognostic model proposed by Beyer et al. in a prospectively studied, independent patient group and provide further evidence that high-dose therapy has a role in the salvage setting of patients with germ-cell cancer.

Adult↗

PubMed2000

Multivariable analysis of prognostic factors for toxicity and survival for patients enrolled in phase I clinical trials.

BACKGROUND: Patients with advanced solid tumors may be included in phase I clinical trials. In such studies, the benefit expected is generally lower than the likelihood of toxicity and may even be non-existent if the patient's life expectancy is too short. This study was performed to identify prognostic variables for toxicity and survival in patients who participate in phase I clinical trials. PATIENTS AND METHODS: One hundred fifty-four patients treated on a phase I clinical trial in our institute were evaluated retrospectively. Univariable and multivariable analyses of patients' characteristics were undertaken to determine their effects on the probability of grade 3 and 4 toxicity and on survival. RESULTS: Grade 3 or 4 toxicity was experienced by 56 patients (36%): dosage level at entry (P < 0.001) and age over 65 years (P = 0.03) were independently associated with the risk of toxicity. Median overall survival was 5 months. The multivariable analysis identified performance status 2 or 3 (P < 0.001) and lactate dehydrogenase levels greater than 600 UI (P < 0.001) as independent adverse prognostic variables for overall survival. Using these two parameters, we determined a prognostic index which allowed us to discriminate three risk groups of patients with an observed median survival of 8.5, 4.5 and 1.5 months, respectively. CONCLUSIONS: Subgroups with different survival expectancy can be identified among patients who are eligible for phase I clinical trials. If confirmed, the proposed prognostic model may be useful for therapeutic decision making in palliative oncology.

Adult↗

PubMed2006

[Risk-classification in liver cirrhosis].

Prognostic models are useful in estimating disease severity and survivial and are used to make decisions regarding specific medical interventions. These models are developed using analytical methods that involve determining the effects of variables of interest (eg, laboratory values) on specific outcomes such as death. There are two models that are used commonly in the care of patients witch chronic liver disease: the Child-Pugh score and the recently described Model for End-Stage Liver Disease (MELD). MELD score is a prospectively developed and validated chronic liver disease severity scoring system that uses a patient's laboratory values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival. The score was proposed as a the most promising alternative to Child-Pugh score. Weather Child-Pugh score should definitely be abandoned for MELD score remains uncertain. The aims of this paper are to summarize and to compare the characteristics, applications and limitations of Child-Pugh and MELD scores.

Bilirubin↗

PubMed2003

Predictive factors for early mortality following liver transplantation.

AIMS: To retrospectively review our liver transplant performance to identify factors that influenced early outcomes and to prospectively test their validity in predicting outcomes. METHODS: Clinical records from 190 patients with liver transplants (LT; n = 200) performed between 1991 and 1997 were reviewed and the data evaluated by univariate and multivariate analyses regarding clinical outcome. The prognostic model thus obtained was prospectively evaluated in 55 patients undergoing transplant between 1999 and 2000. RESULTS: Main indication for transplant was post-necrotic cirrhosis (61%), mostly HCV(+). The majority of patients were Child-Pugh C status (46%). Post-operative mortality at 3 months was 15.3%. Risk factors predicting death were: Child-Pugh C status (OR 1.3), pre-LT renal insufficiency (OR 5.8), malnutrition (OR 2.9) and technically complex surgery requiring cross-clamping with or without bypass (OR 4.9). None of the donor factors was significant. Prospectively applied to predict outcome in the 55 patients, the model had a sensitivity of 80% and a specificity of 88.8% with a higher-than-anticipated accuracy with a positive predictive value of 61.5% and a negative predictive value of 95.3%. CONCLUSIONS: Pre-LT renal insufficiency is the most significant risk factor for early mortality and suggests that LT should be performed before evidence of irreversible renal insufficiency becomes manifest.

Adult↗

PubMed2003

Clinical outcomes for permanent incisor luxations in a pediatric population. I. Intrusions.

A longitudinal outcome study was undertaken to identify variables that significantly influenced tooth survival as well as pulpal and periodontal outcomes for intruded permanent maxillary incisors of children and adolescents. All cases were treated between June 1988 and June 1998 in a teaching hospital clinic. Clinical and radiographic data were collected for 26 patients (19 males, 7 females) that represented 31 permanent maxillary incisors. Mean age at the time of injury was 9.3 years (range = 5.5-17.8 years). Mean time elapsed to follow up was 1380 days (range = 65-3394 days). Survival analysis was used to identify variables significantly related to the survival and pulp necrosis (PN) for these incisors. Proportional hazards regression yielded significant prognostic models for tooth survival and the diagnosis of PN (P < 0.05). Incisors intruded > 6 mm had significantly decreased survival compared with incisors intruded < 3 mm (5-year survival, 0.45 and 1.0, respectively, (P < 0.05)). Complex crown fractures were significantly related to the development of PN (P < 0.05). Logistic regression analysis showed that treatment method and severity of intrusion were related to the presence of replacement root resorption (P < 0.05). This study represents the largest sample of intruded permanent incisors examined in an outcome study of children and adolescents exclusively.

Adolescent↗

PubMed1998

Risk and outcome in metastatic malignant melanoma patients receiving DTIC, cisplatin, BCNU and tamoxifen followed by immunotherapy with interleukin 2 and interferon alpha2a.

Combined chemo-/immunotherapy has shown high objective response rates and a significant though small proportion of long-term complete responders in metastatic malignant melanoma. The purpose of this study was to determine response rates, freedom from treatment failure (FFTF) and overall survival in patients with advanced metastatic malignant melanoma treated with combined chemo-/immunotherapy, and to determine the value of a prognostic model for prediction of treatment outcome, FFTF and survival. Sixty-nine patients with metastatic malignant melanoma received combined chemo-/immunotherapy consisting of up to four cycles of DTIC (220 mg m(-2) i.v. days 1-3), cisplatin (35 mg m(-2) i.v. days 1-3), BCNU (150 mg m(-2) i.v. day 1, cycles 1 and 3 only) and tamoxifen (20 mg orally, daily). Two cycles of chemotherapy were followed by 6 weeks of outpatient immunotherapy with combined interleukin 2 (20 x 10(6) IU m(-2) days 3-5, weeks 1 and 4; 5 x 10(6) IU m(-2) days 1, 3, 5, weeks 2, 3, 5, 6) and interferon-alpha (6 x 10(6) IU m(-2) s.c. day 1, weeks 1 and 4; days 1, 3, 5, weeks 2, 3, 5, 6). All patients were evaluated on an intention-to-treat basis. Of 69 patients entered in the study, seven achieved complete remissions and 20 reached partial remissions with an objective response rate of 39% (95% confidence interval 28-52%). Median survival was 11 months, median FFTF was 5 months. Seven patients achieved ongoing long-term remissions, with maximum survival of 58 + months, and maximum FFTF of 58 + months. By Kaplan-Meier survival analysis and two-proportional Cox regression analysis, pretreatment performance status and serum lactic dehydrogenase were statistically significant and independent predictors of survival; risk groups could be defined as (a) the absence of both or (b) the presence of either one or both of these risk factors. Whereas survival and response were significantly influenced by patient risk, no influence could be demonstrated for FFTF. This combined outpatient chemo-/immunotherapy is feasible and results in objective response rates and survival similar to earlier trials. Pretreatment risk, as defined by serum lactate dehydrogenase (LDH) and performance status, has a significant impact on treatment outcome and patient survival.

Adult↗

PubMed2002

Early prediction of treatment response to high-dose salvage chemotherapy in patients with relapsed germ cell cancer using [(18)F]FDG PET.

To assess the ability of [(18)F]fluorodeoxyglucose positron emission tomography for the early prediction of response in patients with relapsed metastatic germ cell tumours undergoing salvage high-dose chemotherapy. The role of positron emission tomography was compared with established means of tumour response assessment such as CT scans/MRI and serum tumour marker changes. In addition, positron emission tomography was compared with a current prognostic score which differentiates three prognostic groups with failure-free survival rates ranging from 5-50%. [(18)F]fluorodeoxyglucose uptake of metastases from germ cell tumours as well as CT scans and serum tumour marker were acquired after 2-3 cycles of induction chemotherapy but before the start of high-dose chemotherapy and CT scans/serum tumour marker were compared with the baseline examinations in 23 patients with relapsed germ cell tumours. To evaluate the validity of early response prediction by positron emission tomography, radiological monitoring and serum tumour marker decline, histopathologic response after resection of residual masses and/or the clinical course over 6 months after the end of treatment (relapse vs freedom of progression) were used. Overall, 10 patients (43%) achieved a marker-negative partial remission, three (13%) a marker-positive partial remission, five (22%) a disease stabilization and five (22%) progressed during treatment. Nine patients (39%) remained progression-free over 6 months following treatment, whereas 14 (61%) progressed. The outcome of high-dose chemotherapy was correctly predicted by positron emission tomography/CT scan/serum tumour marker in 91/59/48%. Eight patients with a favourably predicted outcome by CT scans plus serum tumour marker but a positive positron emission tomography prior to high-dose chemotherapy, failed treatment. This results in the following sensitivities/specificities for the prediction of failure of high-dose chemotherapy: positron emission tomography 100/78%; radiological monitoring 43/78%; serum tumour marker 15/100%. The positive and negative predictive values of positron emission tomography were 88 and 100%, respectively. As compared with the prognostic score, positron emission tomography was correctly positive in all patients of the three risk groups who failed treatment. In addition, a negative positron emission tomography correctly predicted a favourable outcome in the good and intermediate group. [(18)F]fluorodeoxyglucose positron emission tomography imaging can be used to assess response to chemotherapy in patients with relapsed germ cell tumours early in the course of treatment and may help to identify patients most likely to achieve a favourable response to subsequent high-dose chemotherapy. In patients with response to induction chemotherapy according to CT scans or serum tumour marker evaluation, positron emission tomography seems to add information to detect patients with an overall unfavourable outcome. It may also be a valuable addition to the prognostic model particularly in the good and intermediate group for further selection of patients who will profit from high-dose chemotherapy.

Adult↗

PubMed1997

Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin's disease: analysis of 280 patients from the French registry. Société Française de Greffe de Moëlle.

High-dose therapy with autologous stem cell transplantation (ASCT) has been widely proposed for patients with relapsed Hodgkin's disease (HD). From 1982 to 1993, we selected (from the French registry for bone marrow transplantation) 280 patients, who underwent ASCT for relapsed HD after initial treatment including chemotherapy. Patient characteristics at diagnosis were: sex ratio (M/F): 1.5; median age: 30 years (5-59 years), stage I, II: 43%; III, IV: 57%; 32% had chemotherapy, 68% chemo+ radiotherapy. All patients achieved complete remission after first-line therapy and subsequently relapsed. The median interval between diagnosis and high-dose therapy was 34 months. First relapse occurred in 78% of the patients at a median end-of-treatment to relapse time of 18 months. All patients received salvage chemotherapy before high-dose therapy, and the median time between relapse and high-dose therapy was 5 months. After this regimen, 84% of the patients were considered to have chemosensitive relapse. Conditioning regimens were: BEAM: 60%; CBV/BEAC: 26%. Transplant-related mortality was 6%. With a median follow-up of 3 years after high-dose therapy, overall and progression-free survivals at 4 years were 66 and 60%, respectively. Neither the conditioning regimen nor the stem cell source affected survival. Good prognostic factors for survival were: chemosensitivity of relapse (P < 0.01) and first relapse vs further relapse (P < 0.05). For 214 patients in first relapse, other significant factors for survival were: end-of-treatment to relapse interval < 12 months (P < 0.05) and nodal vs extranodal relapse (P < 0.001). These two prognostic factors were used to validate a prognostic model with three significantly different subgroups: 0 (n = 59), 1 (n = 125), or 2 factors (n = 30) with 4-year survival, respectively, at 93, 59 and 43% (P < 0.001). Salvage therapy can be tailored in patients with relapsing HD: conventional treatment in the good prognosis group (0 factor), high-dose therapy after response to second line regimen (1 factor) and more intensive treatments for the bad prognosis group (2 factors).

Adolescent↗

PubMed1999

Treatment outcome and prognostic factors for relapse after high-dose chemotherapy and peripheral blood stem cell rescue for patients with poor risk high grade non-Hodgkin's lymphoma.

The aim of the study was to determine treatment outcome and identify a particularly high risk group in a consecutive series of 66 patients with poor prognosis high grade lymphoma (NHL) treated with conventional induction chemotherapy followed by high-dose chemotherapy (HDCT) and peripheral blood stem cells (PBSC) rescue. Fifty-one patients with intermediate grade NHL (Kiel) and two or three adverse prognostic features as defined by the age-adjusted International Prognostic Index (IPI) received induction treatment with 7 weeks of doxorubicin, cyclophosphamide, vincristine, bleomycin, etoposide, prednisolone and methotrexate (VAPEC-B) followed by three cycles of ifosfamide/cytarabine. Fifteen patients with high grade Burkitt's and lymphoblastic NHL received 11 weeks of VAPEC-B followed by three cycles of high-dose methotrexate. HDCT for all 66 patients consisted of busulphan/cyclophosphamide followed by autologous PBSC rescue. Thirty-one patients (47%) received HDCT in first complete remission (CR/CRu) and 34 patients (52%) in first partial remission (PR) after conventional chemotherapy. Following HDCT, 42 patients (64%) were in CR/CRu, 19 patients (29%) in PR and one patient had progressive disease. There were four toxic deaths. After a median follow-up period of 27 months (range 7-73) in 46 surviving patients, the actuarial 3-year estimates of overall survival, event-free survival (EFS) and freedom from progression (FFP) were 67%, 65% and 70%, respectively. In univariate analysis, prognostic factors associated with reduced EFS were mediastinal bulk (P = 0.02), > or = 3 extra-nodal sites (P = 0.02), remission status prior to HDCT (P = 0.05), low albumin (P = 0.08) and raised ESR (P = 0.09). No significant difference was observed between patients with intermediate or high grade NHL or between patients with two or three adverse IPI features. Multivariate analysis identified mediastinal bulk (P = 0.01), > or = 3 extra-nodal sites (P = 0.01) and low albumin (P = 0.03) as joint predictors of poor EFS. Remission status prior to HDCT was not found to be significantly associated with reduced EFS, FFP or survival, suggesting early introduction of HDCT may benefit patients with a PR. Based on these three adverse features, three groups (0, 1 or > or = 2 features) could be identified with differing EFS, survival and freedom from progression (FFP) rates at 3 years; 85%, 63% and 20%, respectively for EFS, 84%, 64% and 25% for survival and 85%, 66% and 33%, respectively for FFP. This prognostic model may identify patients with a particularly poor prognosis despite HDCT, who may benefit from other therapeutic approaches.

Adolescent↗

PubMed2006

Risk and prognostic factors for Japanese patients with chronic graft-versus-host disease after bone marrow transplantation.

The incidence and prognostic factors for chronic graft-versus-host disease (cGVHD) were evaluated for 255 Japanese patients who survived more than 100 days after bone marrow transplantation, and of whom 119 (47%) developed cGVHD. Prior acute GVHD (grade 2-4) and use of an unrelated donor were significantly associated with the onset of cGVHD. Presence of cGVHD did not have an impact on mortality (hazard ratio (HR) = 0.89; 95% confidence interval (CI), 0.59-1.3). Three factors at diagnosis were associated with cGVHD-specific survival: presence of infection (HR = 4.1; 95% CI, 1.6-10.3), continuing use of corticosteroids at the onset of cGVHD (HR = 3.9; 95% CI, 1.7-9.1), and a Karnofsky performance score <80 (HR = 4.7; 95% CI, 2.0-11.3). The probability of cGVHD-specific survival at 4 years was 79% (95% CI, 70-86%). The severity and death rate of Japanese patients with cGVHD was lower than those for populations in Western countries, which might be the result of greater genetic homogeneity of Japanese ethnics. Our patients could not be accurately classified when the proposed prognostic models from Western countries were used, thus indicating the need for a different model to identify high-risk patients.

Adolescent↗

PubMed2003

Current trends in large cell lymphoma.

For the last decade, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has been the best available standard of care for aggressive non-Hodgkin's lymphoma (NHL), based on equivalent therapeutic results with other multiagent chemotherapy accompanied by lower costs and lesser toxicity. However, only 40-45% of these patients are cured with CHOP. New treatment strategies have been employed, including the addition of Rituximab to CHOP in elderly patients; dose escalation using granulocyte-colony-stimulating factor; overcoming the multidrug resistance phenotype with infusional chemotherapeutic regimens and use of some newer agents. Furthermore, the International Prognostic Factor index (IPI) has permitted identification of subsets of patients with large variations in prognosis, allowing prognosis specific therapy to be tested. There is now accumulating evidence that the clinical behavior of certain NHL can be profiled by the expression of certain molecular markers, which will undoubtedly play a role in the development of new prognostic models that may refine our ability to identify poor-risk patients. Regardless, there is still significant opportunity for improving survival in large cell lymphomas.

Antineoplastic Combined Chemotherapy Protocols↗