Long-term survival of patients treated for Hodgkin's disease in 1971-1996 depending on the clinical stage of the disease, patient's fertility after therapy and cause of death analysis.

The long-term survival in a group of 370 patients treated for Hodgkin's disease in the years 1971-1996 was retrospectively analyzed. Up to now 191 patients live. 179 patients have died. Since the year 1978 the uniform diagnostic and therapy protocol has been used. The therapy consisted in the combination of a radiation therapy (usual dose 40 Gy) with the COPP chemotherapy (6 cycles). Since the year 1988 the alternation of the ABVD and COPP chemotherapy has been used. According to the stage of the Hodgkin's disease and the patient's age the modification of the therapy was introduced. One chemotherapy cycle was removed for each 10 years above the 50 year age of the patient. The radiation therapy was not applied to the areas of the reproductive organs in young patients to preserve their fertility. The percentage of surviving patients for thirty years was 58.8% for Stage I and IIA,B and for Stage IIIA was 60.72%. In the group of surviving patients, we have registered 11 fathers and 34 females with up to 3 children. All together 75 children without health problems are monitored.

[Results of the monitoring the group of patients treated for the Hodgkin disease in the period of 1971 to 1996. Part 1: long-time survival in dependence of the clinical stage of the disease]. / Výsledky sledování souboru pacientu lécených pro Hodgkinovu nemoc v létech 1971 az 1996. I. cást: Dlouhodobé prezití pacientu v záivislosti na klinickém stádiu onemocnení.

BACKGROUND: This authors team has been dealing with the Hodgkin disease problems since 1971. The MORHO study started at eight working places in 1978 according to unified diagnostic and medical protocol. PATIENTS AND METHODS: 370 patients were treated. The treatment consisted in the combination of radiation and chemotherapy COPP and since 1988 in alternance of COPP and ABVD. Therapy was modificated with accordance to clinical stages and patient's histological type and age. Treatment of the patients over 50 was reduced in decades of one chemotherapy cycle less. RESULTS: Results from the clinical study are--patients with the stage IIA, IIB and IIIA survive 30 years in 59.29%, 57.86% and 60.72%. Patients diagnosed as stage IIIB survive after 30 years 36.78%, while patients in stages IVA and IVB survived 10 years 24.51% and 23.32% and 20 years 8.61% in stage IVB. Women survived longer than men. Histological types had no influence to the lenght of survival. The total number of relapses in the group was 55. There were 39 men and 16 women from that. 64% was in stage III and IV and in 73% mediastinal nodules were affected. 42% of relapses was till 1 year after the treatment. After the treatment 75 children were born to the patients from the group. 60 children from that were born to the women under treatment. CONCLUSION: The success of therapy of Hodgkin's disease according to protocol created by expert group of study MORHO is comparable with results of similar studies in the world. The most important contribution of this study was unification of treatment protocol in Czechoslovakia. This study changed the formerly paliative therapy to real curative treatment.

[Results of the monitoring the group of patients treated for the Hodgkin disease in the period of 1971 to 1996. Part 2: fertility after therapy]. / Výsledky sledování souboru pacientu lécených pro hodgkinovu nemoc v letech 1971-1996. II: fertilita po terapii.

BACKGROUND: This authors team has been dealing with the Hodgkin disease problems since 1971. The MORHO study started at eight working places in 1978 according to unified diagnostic and medical protocol. The aim of this study is evaluation of influence of Hodgkin disease therapy on the fertility in young patients. PATIENTS AND METHODS: Group of patients treated for Hodgkin disease in years 1971-1996 at workplaces using the same treatment protocol has been analyzed and the results have been compared with results of other medical centers in the world. Some of the young patients in fertile age became parents after the treatment. RESULTS: Information of number of pregnancies and of children born, long term surveillance and complications of treatment has been collected and discussed. Many patients stayed fertile also after therapy of numerous relapses. There was 75 children born to 34 women and 11 men previously treated for Hodgkin disease. CONCLUSION: The results of our study are comparable with results of statistial evaluation of similar studies in the world cancer research centers.

[Clinical study of Hodgkin's disease after 25 years]. / Klinická studie MORbus HOdgkin po 25 letech.

BACKGROUND: On the 25th anniversary of the unified protocol of 1978, the authors report the results of the first clinical study in the Czech Republic performed in patients with Hodgkin's lymphoma. 290 patients were treated with both chemotherapy (Cyklophosphamide, Natulan, Prednison, Vinblastin) and radiotherapy according to this widely used protocol. The dosage of cytotoxic therapy was reduced based on age, in patients over 50 years of age. METHODS AND RESULTS: In the year 2003, the survival rate was 77.3% (194/290 patients) and of these, 85% (165/194 patients) have lived more than 10 years with complete remission. Of the 194 surviving patients, 24 were successfully treated for relapses. Of the 66 (22.8%) patients that died, the cause of death in 33 patients was Hodgkin's lymphoma. 33 women of the studied group gave birth to 43 children. In one case, phocomelia was diagnosed post-partum. In this instance, no causal relationship to the cytotoxic treatment (which had been given three years before the birth) could be established. The second child of the same mother was born healthy. In one case, a possible genetic relationship was noted--both the father and the daughter suffered from Hodgkin lymphoma and the granddaughter from non-Hodgkin lymphoma. CONCLUSIONS: The success of this treatment depends on complex diagnostic procedures, and on an experienced team of physicians.