Correspondence
Chemotherapy plus Involved-Field Radiation in Early-Stage Hodgkin's Disease
N Engl J Med 2008; 358:742-743February 14, 2008DOI: 10.1056/NEJMc073375
- Article
To the Editor:
Fermé et al. (Nov. 8 issue)1 and Diehl in the accompanying editorial2 question the possibility that chemotherapy alone is curative in early-stage Hodgkin's disease. We wish to draw attention to the reported experience with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy in childhood Hodgkin's disease in Uganda.3,4 Lacking resources for radiotherapy, we treated 48 children with six cycles of MOPP, the standard of care in the 1970s. Of these 48 children, 42 had complete responses, and the overall survival rate at 10 years was 67%. All 18 patients with stages I to IIIA disease had complete responses; two were lost to follow-up at 2 and 6 months. The actuarial survival rate for the remaining 16 was 75%.
Bearing in mind that the disease in these patients was probably understaged, our cure rate of 75% for early-stage Hodgkin's disease with chemotherapy alone may be an underestimate.
4 ReferencesCharles L.M. Olweny, M.B., Ch.B., M.D.
Uganda Martyrs University, Kampala, UgandaJohn L. Ziegler, M.D., M.Sc.
University of California at San Francisco, San Francisco, CA 94143
john.ziegler@ucsf. edu 1
Ferme C ,Eghbali H ,Meerwaldt JH , et al. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med 2007;357:1916-1927
Free Full Text | Web of Science | Medline2
Diehl V . Hodgkin's disease -- from pathology specimen to cure. N Engl J Med 2007;357:1968-1971
Full Text | Web of Science | Medline3
Ziegler JL ,Fass L ,Bluming AZ ,Magrath IT ,Templeton AC . Chemotherapy of childhood Hodgkin's disease in Uganda. Lancet 1972;2:679-682
CrossRef | Web of Science | Medline4
Olweny CLM ,Katongole-Mbidde E ,Kiire C ,Lwanga SK ,Magrath I ,Ziegler JL . Childhood Hodgkin's disease in Uganda: a ten year experience. Cancer 1978;42:787-792
CrossRef | Web of Science | Medline
To the Editor:
Diehl states that chemotherapy for Hodgkin's disease began in 1943 and had its origin in an explosion in the harbor of Bari, Italy. The explosion at Bari occurred in 1943, a year after the initial clinical trial with a nitrogen mustard at Yale University.1,2 Goodman and Gilman, who were in the section of Chemical Warfare during World War II, conducted experiments on the mustard compounds in the Department of Pharmacology at Yale University, which led to the initial clinical trial in 1942, antedating the Bari incident. The interest in the mustard compounds followed observations made during World War I, when exposure to mustard gas was found to induce marrow hypoplasia and involution of lymphoid tissue.3 Research on the biologic effects of these agents was published during the 1920s and 1930s.4,5
5 ReferencesRose J. Papac, M.D.
Yale University School of Medicine, New Haven, CT 065201
Infield GB. Disaster at Bari. New York: Macmillan, 1971.
2
Gilman A . The initial clinical trial of nitrogen mustard. Am J Surg 1963;105:574-578
CrossRef | Web of Science | Medline3
Krumbhaar EB . Role of the blood and the bone marrow in certain forms of gas poisoning. I. Peripheral blood changes and their significance. JAMA 1919;72:39-41
CrossRef4
The pathology of mustard poisoning. In: Winternitz MC. Collected studies on the pathology of war gas poisoning from the Department of Pathology and Bacteriology, medical science section, chemical warfare. New Haven, CT: Yale University Press, 1920:101-16.
5
Berenblum I . The anti-carcinogenic action of dichlorodiethylsulphide (mustard gas). J Pathol Bacteriol 1931;34:731-746
CrossRef | Web of Science
To the Editor:
The editorial by Diehl discusses the use of positron-emission tomography with 18F-fluorodeoxyglucose (FDG-PET) in the follow-up of patients with Hodgkin's disease, but false positive results occur.1 Sarcoidlike reactions can occur after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy, and FDG-PET imaging may not be capable of distinguishing between Hodgkin's lymphoma and sarcoidosis.
1 ReferenceVivek Subbiah, M.D.
Case Western Reserve University, Cleveland, OH 44109
vivek.subbiah@case. edu 1
Schaefer NG ,Taverna C ,Strobel K ,Wastl C ,Kurrer M ,Hany TF . Hodgkin disease: diagnostic value of FDG PET/CT after first-line therapy -- is biopsy of FDG-avid lesions still needed? Radiology 2007;244:257-262
CrossRef | Web of Science | Medline
Author/Editor Response
Olweny and Ziegler were among the first to report on the efficacy of chemotherapy alone in childhood Hodgkin's disease. In our report on the H8 trial results, our intent was not to give arguments for or against chemotherapy alone in adults; this unanswered question is raised in our conclusion, but we do not cite all previous studies on the subject, particularly those relating to children. Since the H8 trial was designed, treatment strategies for early stages have evolved. Until now, the possibility of curing Hodgkin's lymphoma with chemotherapy alone has not been demonstrated in randomized trials.
Christophe Fermé, M.D.
Institut de Cancérologie Gustave-Roussy, F-94805 Villejuif, France
christophe.ferme@igr. fr Houchingue Eghbali, M.D.
Institut Bergonié, 33076 Bordeaux, FranceMichel Henry-Amar, M.D., Ph.D.
Centre François-Baclesse, 14033 Caen, France- Citing Articles (2)
Citing Articles
1
Victoria Walusansa, Fred Okuku, Jackson Orem. (2012) Burkitt lymphoma in UGANDA, the legacy of Denis Burkitt and an update on the disease status. British Journal of Haematology 156:6, 757-760
2
Francesca Olcese, Marino Clavio, Edoardo Rossi, Mauro Spriano, Filippo Ballerini, Letizia Canepa, Ivana Pierri, Sara Aquino, Riccardo Varaldo, Annunziata Manna, Vincenzo Secondo, Omar Racchi, Enrico Balleari, Giulio Fraternali Orcioni, Angelo Michele Carella, Riccardo Ghio, Marco Gobbi. (2009) The addition of radiotherapy to chemotherapy does not improve outcome of early stage Hodgkin’s lymphoma patients: a retrospective long-term follow-up analysis of a regional Italian experience. Annals of Hematology 88:9, 855-861
