[Substitution with immunoglobulins in leukemia].
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Biomedical subjects
Publications and source records attributed to W Gassmann.
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Until now, the possibility of radiotherapeutic treatment after a failure of chemotherapy has not been systematically investigated. Eight cases with primary failure of chemotherapy or recurrence after chemotherapy could be evaluated. The patients were submitted to curative irradiation; six of them achieved a total remission, four had recurrences. Thus two patients remain to give an example that radiotherapy can bring about long-term total remissions after primary failure of chemotherapy or recurrence after chemotherapy. When the data were evaluated, the total remission times of the two patients were 12 and 18 months, respectively. The toxicity of radiotherapy was justifiable. It was increased especially in regions that had already been irradiated or if a ABVD therapy was applied a short time before or after the radiotherapy. There are only few communications in literature about the success of a radiotherapy after failure of chemotherapy. Most of the patients mentioned had "remissions" (total/partial remissions?). In most of the cases, there are no indications about the further development. On the whole, the data show that there may be some special indications for radiotherapy in case of a failure of chemotherapy.
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The results obtained in the treatment of Hodgkin's disease, stages I and II, are discussed comparing survival data of the literature after various radiotherapy programs and after combined modality using additional chemotherapy. In stage IA 90 to 97% and in stage IIA 75 to 80% of patients are not prone to relapse after extended-field irradiation. In stage IIB 0 to 80% long-lasting remissions are reported after radiotherapy. Additional chemotherapy improved relapse-free survival, but not overall survival in stages I and II. Subgroups are discussed which bear a high risk of relapsing disease (big mediastinal masses, E-lesions of the lungs, histological findings with lymphocyte depletion).
22 Patients were treated with ABVD, 19 (18 stage IV B 1 stage III B) could be evaluated. No patient with impaired but 7 of 13 patients with intact bone-marrow function achieved a complete remission. A complete remission was also achieved by all 4 patients with a treatment- and disease-free interval but only by 3 of 15 without a free interval. Pretreatment, histology, duration of disease, and age showed no clear prognostic significance with respect to induction of remission. Toxicity was severe especially in patients over 50 years of age. 2 patients discontinued therapy because of gastro-intestinal toxicity. 2 of 8 died of treatment-related causes (1 leukemia, 1 sudden cardiac death). In 3 patients with high-dose mediastinal irradiation a pneumonitis secondary to bleomycin contributed significantly to death. Our results suggest that ABVD is an effective salvage-regimen for some subgroups of MOPP-failures.