Search PubMed⌕ Search

Biomedical subjects

V T DeVita

Publications and source records attributed to V T DeVita.

At least 19 recordsLinked to original sources
PubMed1999

Hodgkin's disease and transplantation: a room with a (nontransplanter's) view.

Hodgkin's disease is a malignancy curable by combination chemotherapy in newly diagnosed patients. Management of refractory disease or relapse has been unsatisfactory with salvage chemotherapy alone, although some patients with long initial remission can be cured with this approach. Because correlations between dose intensity and response to treatment in animal models and in clinical studies have been positive, high-dose chemotherapy (HDT) with bone marrow (BM) or peripheral blood stem-cell (PBSC) transplantation support has been used in an attempt to improve disease-free and overall survival in patients with refractory disease or relapse. Controversy exists over who and when to transplant. Results are difficult to interpret because of the heterogeneous nature of the patients under study and short follow-up times. In general, patient disease-free and overall survival appear to be improved with HDT and PBSC support when compared with historical controls. Allografting has also been tried in Hodgkin's disease as well, but is not recommended due to high associated mortality. Improvements in supportive care for transplantation in general, and antiviral and graft-versus-host disease prophylaxis in particular, have decreased early mortality associated with allografting in other malignancies, but not yet in Hodgkin's disease. The fact that allografted patients who survive the initial transplant procedure have an impressively lower relapse rate makes Hodgkin's disease patients potential candidates for future studies of allografting under more modern circumstances. Some suggestions are made about the introduction of new approaches to treatment.

Antineoplastic Agents↗
PubMed1999

The lymphomas.

The history of therapeutic advances in the lymphomas is reviewed. The initial studies that led to the cure of Hodgkin's disease and diffuse large B-cell lymphomas set a paradigm of cancer treatment broadly applicable to a number of malignancies. In recent times our knowledge of the biology of the Immune system has clarified the origin of subsets of lymphomas and provided specific targets of future therapeutic approaches.

Drug Therapy↗
PubMed1997

Late sequelae of treatment of Hodgkin's disease.

Twenty-three years after it was observed that successful treatment of Hodgkin's disease was associated with risk of a second malignancy related to treatment, the literature is maturing. Early reports of leukemia risk rising and falling between 5 and 10 years after treatment continue to be supported. The real problem is the steady emergence of solid tumors in radiation treatment fields, particularly breast cancer and in females treated between the ages of 10 and 25. Several reports this year again emphasize this point. One avenue to pursue to avoid this complication is to use combination chemotherapy alone, especially in young women. The other relates to one observation made this year that low doses of radiation may not be as carcinogenic as full doses. These data suggest that chemotherapy and low-dose radiotherapy in early stage Hodgkin's disease need our attention in rigorously designed clinical trials.

Antineoplastic Agents↗
PubMed1997

Alternating MOPP and ABVD chemotherapy plus mantle-field radiation therapy in patients with massive mediastinal Hodgkin's disease.

PURPOSE: To evaluate the efficacy and toxicity of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy plus mantle-field radiation therapy in the treatment of patients with massive mediastinal Hodgkin's disease of any stage. PATIENTS AND METHODS: Eighty patients presented with Hodgkin's disease and a mediastinal mass greater than one third the greatest chest diameter on chest radiograph. Patients were staged and treated with MOPP alternated with ABVD chemotherapy for a total of six cycles. Patients then received 10 Gy mantle-field radiation therapy delivered to the original extent of disease followed by 25 to 35 Gy to the residual abnormalities. RESULTS: The complete response (CR) rate was 89%. With a median follow-up duration of 10 years, disease-free survival of the complete responders is 78% at 15 years and overall survival is 75% at 15 years. For patients with stage I or II disease, disease-free survival was 76% at 15 years and overall survival was 79%; for those with stage III or IV disease, disease-free survival was 82% at 15 years and overall survival was 64%. Age, stage, sex, B symptoms, number of extranodal sites, lactate dehydrogenase (LDH) levels, erythrocyte sedimentation rate, and platelet count did not influence treatment outcome. Treatment-related pneumonitis was noted in 16% of patients (fatal in one), mainly in those older than age 35 years who received total doses of radiation therapy greater than 42 Gy. Fertility is more often preserved with MOPP/ABVD therapy than with MOPP chemotherapy and there appears to be less pulmonary and cardiac disease than with ABVD chemotherapy. Two patients have developed second solid tumors within radiation ports and one relapsed patient developed acute leukemia after MOPP salvage therapy. CONCLUSION: MOPP/ABVD followed by mantle-field radiation therapy is an effective treatment for all stages of Hodgkin's disease that present with a large mediastinal mass. Our data suggest that the large mediastinal mass is a more dominant determinant of prognosis than Ann Arbor stage or other clinical prognostic factors.

Adolescent↗
PubMed1996

Oncology.

Explore the source record for details and available documents.

Antineoplastic Agents↗
PubMed1994

Diffuse small noncleaved-cell, non-Burkitt's lymphoma in adults: a high-grade lymphoma responsive to ProMACE-based combination chemotherapy.

PURPOSE: To review the efficacy of cyclophosphamide, doxorubicin, etoposide, methotrexate with leucovorin, and prednisone (ProMACE)-based combination chemotherapy programs in the treatment of patients with diffuse small noncleaved-cell non-Burkitt's lymphoma. PATIENTS AND METHODS: Thirty-three patients with diffuse small noncleaved-cell non-Burkitt's lymphoma were accrued: eight with localized disease were treated with modified ProMACE-mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) plus involved-field radiation therapy, and 25 with advanced-stage disease were treated with ProMACE/MOPP flexitherapy (n = 8), ProMACE-MOPP (n = 9), or ProMACE-cytarabine, bleomycin, vincristine, and methotrexate with leucovorin (CytaBOM) (n = 8). The median follow-up duration is 10 years. RESULTS: All eight patients with localized disease achieved a complete response, none have relapsed, and one died of intercurrent illness. Among patients with advanced-stage disease, five of eight (63%) flexitherapy-treated patients, six of nine (67%) ProMACE-MOPP-treated patients, and eight of eight (100%) ProMACE-CytaBOM-treated patients achieved a complete response. If the two ProMACE-MOPP-based groups are considered together, disease-free and overall survival rates at 15 years are projected at 61% and 35%, respectively. In contrast, only one patient has relapsed from a ProMACE-CytaBOM-induced complete remission, and overall survival of ProMACE-CytaBOM-treated patients (88%) is significantly higher than that for flexitherapy and ProMACE-MOPP (P2 = .04). CONCLUSION: Adult patients with diffuse small non-cleaved-cell non-Burkitt's lymphoma may be effectively treated with regimens that are effective in other aggressive lymphomas (eg, diffuse large-cell lymphoma).

Adult↗
PubMed1994

Lymphomas.

Explore the source record for details and available documents.

Hodgkin Disease↗
PubMed1993

Hodgkin's disease.

Explore the source record for details and available documents.

Drug Administration Schedule↗
PubMed1993

Lymphomas.

Explore the source record for details and available documents.

Child↗
PubMed1992

Conventional-dose salvage combination chemotherapy in patients relapsing with Hodgkin's disease after combination chemotherapy: the low probability for cure.

PURPOSE: The study was undertaken to evaluate clinical prognostic factors, probability of response to therapy, duration of response, and overall survival of patients with Hodgkin's disease relapsing from a chemotherapy-induced complete remission. PATIENTS AND METHODS: Study population comprised 107 patients with Hodgkin's disease treated with combination chemotherapy at the National Cancer Institute who relapsed after achieving a complete remission. RESULTS: Half of the relapses occurred within the first year of achieving complete remission; among patients in remission 5 years or longer, only 4% relapsed. The overall survival of the relapsed patients is projected to be 17% at 20 years, calculated from the date of relapse. Primary treatment regimen, presence of B symptoms, stage, sex, liver involvement, pleural involvement, marrow involvement, and histologic subtype did not affect the survival of relapsed patients. Only age at diagnosis (older or younger than 30 years) and length of initial remission (shorter or longer than 1 year) made a significant impact on survival. Patients whose initial remission was longer than 1 year had significantly higher complete response rates to salvage therapy, significantly more durable second remissions, and significantly longer survival than patients whose initial remission was shorter than 1 year. Survival beyond 11 years from relapse of patients with long initial remissions was 24%; for those with short initial remissions, 11% (P2 = .027). Despite the fact that with salvage therapy, patients with long initial remission had an 85% complete response rate to mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) with a disease-free survival of 45% at 20 years, acute leukemia and other treatment-related complications combined to lower the survival rate of this more favorable subset. CONCLUSIONS: These data with conventional-dose salvage therapy provide results for comparison with novel salvage approaches including myeloablative therapy with autologous marrow or peripheral-blood stem-cell support.

Adolescent↗
PubMed1992

Lymphomas.

Explore the source record for details and available documents.

Hodgkin Disease↗