Györgyi Vadász

Successful Treatment of B Cell Chronic Lymphocytic Leukemia-Associated Severe Paraneoplastic Pemphigus with Cyclosporin A

Since the first description of paraneoplastic pemphigus, several cases have been described in the literature. However, curative therapy is usually a challenge to the physicians treating this disease. Several publications are available discussing the efficacy of steroids, cyclophosphamide and cyclosporin A. Recently, a report of the successful use of rituximab was also published. However, the use of cyclosporin A is controversial in the case of B cell malignancies, as there are reports showing the cytotoxic effect of this drug on B cells. However, other authors report no effect, or even unwanted effects resulting in B cell proliferation. We report the case of a 50-year-old Caucasian male. He developed a B cell lymphoma consisting of CD5/CD20-double-positive cells, and 2 months later, it was followed by a very severe paraneoplastic pemphigus affecting the mucosa and the skin. The lymphoma was well managed with CHOP and CVP polychemotherapy, followed by oral chlorambucil; however, the bullous eruptions did not disappear. Oral steroids, cyclophosphamide, plasmapheresis and IVIG therapy were only partially successful, so we decided to use oral cyclosporin A. Starting with 7 mg/kg and maintaining a steady plasma level of no less then 110 ng/l, the bullae completely disappeared within 6 weeks, and the patient has been in remission for 17 months now, taking the oral cyclosporin A continuously. The underlying B cell disorder did not relapse during the therapy.

Mediastinal Bulky Tumour in Hodgkin’s Disease and Prognostic Value of Positron Emission Tomography in the Evaluation of Post-Treatment Residual Masses

Among the 193 patients (82 female, 111 male) treated primarily for Hodgkin’s disease at our clinic between 1990 and 2001 and followed up until 2003, 42 (22%) had mediastinal bulky tumours (MBTs) by the Cotswolds criteria. The rate of MBT diagnosis was significantly greater in the early stage of the disease, these patients were younger and – in contrast to the other group – they all received combined therapy. No significant differences were found in the overall and relapse-free survival rate in the two groups, but relapse and death rates were lower in the patients with bulky tumours. Of the total number of patients, 27 underwent a total of 31 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) examinations, mainly for the evaluation of post-treatment residual mass viability. In the 12 positive cases, the majority of patients received further therapy. During the mean follow-up time of 58 months (range 5–98 months) after obtaining negative results, progression of the disease was found in 2 cases 14 and 23 months later, respectively. Based on our results, we conclude that FDG-PET examinations show a good correlation with clinical follow-up results.

Hodgkin's disease in the elderly: a single institution retrospective study of 40 patients aged 65 or over.

Out of 485 patients with Hodgkins disease (HD) treated in our institution between 1970-1998, 40 (8.2%) patients aged 65 or over at the date of the first presentation were examined retrospectively. The localization of the disease was more frequently infradiaphragmatic and rarely mediastinal in the elderly. The time that elapsed from the first clinical sign to the diagnosis of HD was twice as long as that in the young patient population. Since the first treatment was often inadequate and due to severe associated diseases, therapeutic and overall survival results in this patient population were less favourable than in the case of young patients. However, the relapse-free survival rate of the elderly patients treated successfully did not differ from that of the young patient population. Complete healing should be the final aim of treatment in the aged population, while the status of the patient, associated diseases and life expectancy not related with HD should also be taken into consideration. Besides the search for effective and less toxic treatment strategies and supportive therapy, more frequent and overall patient follow-up and care is of great importance.

Relapse of Hodgkin’s Disease after Ten Years

We report four cases of Hodgkins disease (HD) relapsing after complete remission for over a 10-year period after the initial therapy. Three of the patients had mixed-cellularity subtypes as a primary histological diagnosis, and the rebiopsies demonstrated mixed cellularity in all very late relapse cases. Two patients were initially treated with radiotherapy, while in the other two advanced cases polychemotherapy was administered. All patients had advanced disease at the time of the very late relapses, though the relapse was not identifiable in the previously involved regions. By rescue therapy, all patients achieved a second complete remission. However, two patients relapsed again with one of them dying during relapse. The three remaining patients are still in complete remission. Our report demonstrates the necessity of prolonged follow-up of patients with HD.

Our experiences in treating patients with Hodgkin disease in the last decade

Bevezetes: A Hodgkin-lymphoma diagnosztikajaban, kezeleseben az elmult evtizedben jelentős valtozasok kovetkeztek be. Cel: Ennek tukreben a szerzők celul tűztek ki az 1995–2004 kozott a DEOEC III. sz. Belgyogyaszati Klinikan elsődlegesen kezelt Hodgkin-lymphomas betegek adatainak attekinteset 2006 januarjaban, atlagosan 69 (12–132) honap kovetes utan. Modszerek: a kortortenetek adatait SPSS statisztikai programmal ertekeltek. Eredmenyek: A 163 beteg atlageletkora a diagnoziskor 36 (14–75) ev volt, bimodalis koreloszlassal. A leggyakoribb (48,5%) a kevert sejtes altipus volt. A betegek 41,1%-a volt korai stadiumu, legkedvezőtlenebb prognozissal 15,7%-uk birt, bulky tumort 28,2%-ban eszleltek. 7 betegnel radioterapiat, 63-nal kemoterapiat es 92-nel tervezett kombinalt kezelest alkalmaztak. A sugarkezelesek 61,6%-a erintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyeb kemoterapiat kapott. Az elsődleges kezelesre 146 komplett, 10 parcialis remisszio jott letre, 6 beteg nem reagalt. 10 reszleges remisszioban levő es 5 nem reagalo beteget tovabb kezeltek. 27 komplett remisszioban levő betegnel alakult ki relapszus, kozuluk 15-nel tortent nagy dozisu kezeles autolog periferias haemopoeticus őssejt-transzplantacioval. A kovetesi idő alatt 18 beteg halt meg, 11 a lymphoma progresszioja vagy a kezeles szovődmenye, 6 masodik tumor, 1 egyeb ok miatt. Betegeik 10 eves prognosztizalt teljes tulelese 83% (reszletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az esemenymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konkluzio: Hodgkin-lymphomas betegeik kezelesi eredmenyei javultak, azonban arra is ramutatnak, hogy a korai, kedvező prognozisu betegeknel a kezelesi toxicitas csokkentendő, mig az előrehaladott, rossz prognozisu betegek (az osszes beteg kb. 10%-a) agresszivebb primer kezeleset akar a sulyosabb mellekhatasok, szovődmenyek ismereteben is vallalni kell. Introduction: Recently, in the diagnostics and treatment of Hodgkin’s disease significant developments have occurred. Aim: To sumarize the clinical and histological data of patients with Hodgkin’s disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995–2004. In 2006 January, the mean follow-up was 69 (12–132) months. Methods: Patients data was analyzed by using SPSS statistical software. Results: The mean age of the 163 patients at the diagnosis was 36 years (14–75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin’s disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radioterapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients recieved cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycine, vinblastine, 87 adriamycine, bleomycine, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occured, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continoually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secundary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). Conclusion: The treatment results of our Hodgkin’s disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patiets) agressive primary treatment should be used even with more severe side effects and complications.INTRODUCTION Recently, in the diagnostics and treatment of Hodgkins disease significant developments have occurred. AIM To summarize the clinical and histological data of patients with Hodgkins disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months. METHODS Patients data was analyzed by using SPSS statistical software. RESULTS The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkins disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). CONCLUSION The treatment results of our Hodgkins disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.

Hodgkin-lymphomás betegeink kezelése során szerzett tapasztalatok az utóbbi évtizedben

Bevezetes: A Hodgkin-lymphoma diagnosztikajaban, kezeleseben az elmult evtizedben jelentős valtozasok kovetkeztek be. Cel: Ennek tukreben a szerzők celul tűztek ki az 1995–2004 kozott a DEOEC III. sz. Belgyogyaszati Klinikan elsődlegesen kezelt Hodgkin-lymphomas betegek adatainak attekinteset 2006 januarjaban, atlagosan 69 (12–132) honap kovetes utan. Modszerek: a kortortenetek adatait SPSS statisztikai programmal ertekeltek. Eredmenyek: A 163 beteg atlageletkora a diagnoziskor 36 (14–75) ev volt, bimodalis koreloszlassal. A leggyakoribb (48,5%) a kevert sejtes altipus volt. A betegek 41,1%-a volt korai stadiumu, legkedvezőtlenebb prognozissal 15,7%-uk birt, bulky tumort 28,2%-ban eszleltek. 7 betegnel radioterapiat, 63-nal kemoterapiat es 92-nel tervezett kombinalt kezelest alkalmaztak. A sugarkezelesek 61,6%-a erintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyeb kemoterapiat kapott. Az elsődleges kezelesre 146 komplett, 10 parcialis remisszio jott letre, 6 beteg nem reagalt. 10 reszleges remisszioban levő es 5 nem reagalo beteget tovabb kezeltek. 27 komplett remisszioban levő betegnel alakult ki relapszus, kozuluk 15-nel tortent nagy dozisu kezeles autolog periferias haemopoeticus őssejt-transzplantacioval. A kovetesi idő alatt 18 beteg halt meg, 11 a lymphoma progresszioja vagy a kezeles szovődmenye, 6 masodik tumor, 1 egyeb ok miatt. Betegeik 10 eves prognosztizalt teljes tulelese 83% (reszletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az esemenymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konkluzio: Hodgkin-lymphomas betegeik kezelesi eredmenyei javultak, azonban arra is ramutatnak, hogy a korai, kedvező prognozisu betegeknel a kezelesi toxicitas csokkentendő, mig az előrehaladott, rossz prognozisu betegek (az osszes beteg kb. 10%-a) agresszivebb primer kezeleset akar a sulyosabb mellekhatasok, szovődmenyek ismereteben is vallalni kell. Introduction: Recently, in the diagnostics and treatment of Hodgkin’s disease significant developments have occurred. Aim: To sumarize the clinical and histological data of patients with Hodgkin’s disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995–2004. In 2006 January, the mean follow-up was 69 (12–132) months. Methods: Patients data was analyzed by using SPSS statistical software. Results: The mean age of the 163 patients at the diagnosis was 36 years (14–75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin’s disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radioterapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients recieved cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycine, vinblastine, 87 adriamycine, bleomycine, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occured, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continoually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secundary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). Conclusion: The treatment results of our Hodgkin’s disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patiets) agressive primary treatment should be used even with more severe side effects and complications.INTRODUCTION Recently, in the diagnostics and treatment of Hodgkins disease significant developments have occurred. AIM To summarize the clinical and histological data of patients with Hodgkins disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months. METHODS Patients data was analyzed by using SPSS statistical software. RESULTS The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkins disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). CONCLUSION The treatment results of our Hodgkins disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.

Searching for antigen epitope specificities in the monoclonal IgG molecules of patients with multiple myeloma. The description of a monoclonal antibody with a dynein-specific antigen epitope character

Dear Editor, Myeloma proteins arise from the proliferation of an abnormal plasma cell clone generating a homogenous population of monoclonal immunoglobulins. These immunoglobulins belong to well-defined classes/subclasses. Usually, they have normal molecular structures. They are biochemically and physicochemically normal immunoglobulins synthesized in an excess amount compared to the physiologic state [1]. Monoclonal antibodies are functional antibodies for selected antigens. One of the best methods for the investigation of antigen specificity is the phage display technology [2]. Therefore, in the current work, we carried out a comparative study on the purified monoclonal antibodies of IgG type from ten patients with multiple myeloma.We used ammonium sulfate precipitation combined with DE-52 (Whatman, England) gel chromatography for the purification of myeloma IgG-s [3, 4]. The filamentous phage library, displaying nine amino acid cyclic random peptide sequences fused to the N-terminal part of the M13 major coat protein VIII, was constructed previously. The affinity selection of phages with purified human monoclonal antibodies was performed using the biopanning technique [5, 6]. Results are summarized in Table 1. We found that using this phage system for three out of the ten monoclonal IgG molecules, definitive antigen epitope structure could be assigned, but no mimotopic antigens could be isolated for the remaining seven monoclonal IgG-s. Possibly, in another phage system, other epitope specificities could have been found. Ro/SSA and Rh erythrocyte antigen specificities have already been described as antigen epitopes of monoclonal immunoglobulins [7, 8]. Among the newly identified mimotopic specificities, we have found dynein, an important molecule of the cell division as antigenic epitope of one of the antibodies tested [9]. Dynein is a motor protein in cells and converts chemical energy into mechanical energy during transportation of cellular elements along cytoskeletal microtubules. Inhibition of dynein by intracellular delivery of anti-dynein antibody may decrease transporting function of dynein [10]. Furthermore, it was plausible to test the IgG with the Ro/ SSA specificity whether it could react in an ELISA kit similarly to anti-Ro/SSA antibodies derived from patients with Sjogren’s syndrome. We found that the monoclonal antibody was not able to bind to the Ro/SSA antigen of the ELISA kit, suggesting two possibilities: (1) the peptide fragment of Ro/SSA antigen used for the phage assay was not able to represent all the crucial epitopes needed for the reactions both with the myeloma IgG and pathogenic anti-Ro/ SSA antibodies; (2) the Ro/SSA epitope-binding character of the monoclonal IgG and the pathologic anti-Ro/SSA antibody were not identical. It is important to mention that the patients with Ro/SSA-specific monoclonal IgG did not show any sign S. Sipka (*) : I. Csípő :G. Vadász :M. Zeher Third Department of Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, H4032, Nagyerdei krt. 98, Hungary e-mail: sipka@iiibel.dote.hu

Our experiences with treating patients of Hodgkin’s disease in the last decade

Bevezetes: A Hodgkin-lymphoma diagnosztikajaban, kezeleseben az elmult evtizedben jelentős valtozasok kovetkeztek be. Cel: Ennek tukreben a szerzők celul tűztek ki az 1995–2004 kozott a DEOEC III. sz. Belgyogyaszati Klinikan elsődlegesen kezelt Hodgkin-lymphomas betegek adatainak attekinteset 2006 januarjaban, atlagosan 69 (12–132) honap kovetes utan. Modszerek: a kortortenetek adatait SPSS statisztikai programmal ertekeltek. Eredmenyek: A 163 beteg atlageletkora a diagnoziskor 36 (14–75) ev volt, bimodalis koreloszlassal. A leggyakoribb (48,5%) a kevert sejtes altipus volt. A betegek 41,1%-a volt korai stadiumu, legkedvezőtlenebb prognozissal 15,7%-uk birt, bulky tumort 28,2%-ban eszleltek. 7 betegnel radioterapiat, 63-nal kemoterapiat es 92-nel tervezett kombinalt kezelest alkalmaztak. A sugarkezelesek 61,6%-a erintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyeb kemoterapiat kapott. Az elsődleges kezelesre 146 komplett, 10 parcialis remisszio jott letre, 6 beteg nem reagalt. 10 reszleges remisszioban levő es 5 nem reagalo beteget tovabb kezeltek. 27 komplett remisszioban levő betegnel alakult ki relapszus, kozuluk 15-nel tortent nagy dozisu kezeles autolog periferias haemopoeticus őssejt-transzplantacioval. A kovetesi idő alatt 18 beteg halt meg, 11 a lymphoma progresszioja vagy a kezeles szovődmenye, 6 masodik tumor, 1 egyeb ok miatt. Betegeik 10 eves prognosztizalt teljes tulelese 83% (reszletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az esemenymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konkluzio: Hodgkin-lymphomas betegeik kezelesi eredmenyei javultak, azonban arra is ramutatnak, hogy a korai, kedvező prognozisu betegeknel a kezelesi toxicitas csokkentendő, mig az előrehaladott, rossz prognozisu betegek (az osszes beteg kb. 10%-a) agresszivebb primer kezeleset akar a sulyosabb mellekhatasok, szovődmenyek ismereteben is vallalni kell. Introduction: Recently, in the diagnostics and treatment of Hodgkin’s disease significant developments have occurred. Aim: To sumarize the clinical and histological data of patients with Hodgkin’s disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995–2004. In 2006 January, the mean follow-up was 69 (12–132) months. Methods: Patients data was analyzed by using SPSS statistical software. Results: The mean age of the 163 patients at the diagnosis was 36 years (14–75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin’s disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radioterapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients recieved cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycine, vinblastine, 87 adriamycine, bleomycine, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occured, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continoually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secundary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). Conclusion: The treatment results of our Hodgkin’s disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patiets) agressive primary treatment should be used even with more severe side effects and complications.INTRODUCTION Recently, in the diagnostics and treatment of Hodgkins disease significant developments have occurred. AIM To summarize the clinical and histological data of patients with Hodgkins disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months. METHODS Patients data was analyzed by using SPSS statistical software. RESULTS The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkins disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). CONCLUSION The treatment results of our Hodgkins disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.

Hodgkin-lymphomás betegeink kezelése során szerzett tapasztalatok az utóbbi évtizedben@@@Our experiences with treating patients of Hodgkin’s disease in the last decade

Bevezetes: A Hodgkin-lymphoma diagnosztikajaban, kezeleseben az elmult evtizedben jelentős valtozasok kovetkeztek be. Cel: Ennek tukreben a szerzők celul tűztek ki az 1995–2004 kozott a DEOEC III. sz. Belgyogyaszati Klinikan elsődlegesen kezelt Hodgkin-lymphomas betegek adatainak attekinteset 2006 januarjaban, atlagosan 69 (12–132) honap kovetes utan. Modszerek: a kortortenetek adatait SPSS statisztikai programmal ertekeltek. Eredmenyek: A 163 beteg atlageletkora a diagnoziskor 36 (14–75) ev volt, bimodalis koreloszlassal. A leggyakoribb (48,5%) a kevert sejtes altipus volt. A betegek 41,1%-a volt korai stadiumu, legkedvezőtlenebb prognozissal 15,7%-uk birt, bulky tumort 28,2%-ban eszleltek. 7 betegnel radioterapiat, 63-nal kemoterapiat es 92-nel tervezett kombinalt kezelest alkalmaztak. A sugarkezelesek 61,6%-a erintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyeb kemoterapiat kapott. Az elsődleges kezelesre 146 komplett, 10 parcialis remisszio jott letre, 6 beteg nem reagalt. 10 reszleges remisszioban levő es 5 nem reagalo beteget tovabb kezeltek. 27 komplett remisszioban levő betegnel alakult ki relapszus, kozuluk 15-nel tortent nagy dozisu kezeles autolog periferias haemopoeticus őssejt-transzplantacioval. A kovetesi idő alatt 18 beteg halt meg, 11 a lymphoma progresszioja vagy a kezeles szovődmenye, 6 masodik tumor, 1 egyeb ok miatt. Betegeik 10 eves prognosztizalt teljes tulelese 83% (reszletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az esemenymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konkluzio: Hodgkin-lymphomas betegeik kezelesi eredmenyei javultak, azonban arra is ramutatnak, hogy a korai, kedvező prognozisu betegeknel a kezelesi toxicitas csokkentendő, mig az előrehaladott, rossz prognozisu betegek (az osszes beteg kb. 10%-a) agresszivebb primer kezeleset akar a sulyosabb mellekhatasok, szovődmenyek ismereteben is vallalni kell. Introduction: Recently, in the diagnostics and treatment of Hodgkin’s disease significant developments have occurred. Aim: To sumarize the clinical and histological data of patients with Hodgkin’s disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995–2004. In 2006 January, the mean follow-up was 69 (12–132) months. Methods: Patients data was analyzed by using SPSS statistical software. Results: The mean age of the 163 patients at the diagnosis was 36 years (14–75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin’s disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radioterapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients recieved cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycine, vinblastine, 87 adriamycine, bleomycine, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occured, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continoually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secundary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). Conclusion: The treatment results of our Hodgkin’s disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patiets) agressive primary treatment should be used even with more severe side effects and complications.INTRODUCTION Recently, in the diagnostics and treatment of Hodgkins disease significant developments have occurred. AIM To summarize the clinical and histological data of patients with Hodgkins disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months. METHODS Patients data was analyzed by using SPSS statistical software. RESULTS The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkins disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). CONCLUSION The treatment results of our Hodgkins disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.