Seven-year follow-up for energy/vitality outcomes in early stage Hodgkin's disease patients treated with subtotal lymphoid irradiation versus chemotherapy plus radiation: SWOG S9133 and its QOL companion study, S9208.

PURPOSE: We describe 7 years of follow-up for the energy/vitality outcome in early-stage Hodgkin's disease patients treated on a randomized clinical trial that compared subtotal lymphoid irradiation (STLI) with combined modality treatment (CMT) (SWOG 9133). Survivorship research questions involved the extent to which symptoms/side effects endured over a follow-up period of 7 years for this early-stage patient group. METHODS: Two hundred thirty-nine patients participated in the quality of life (QOL) companion study (SWOG 9208) and completed the SF-36 vitality scale, SF-36 health perception item, Cancer Rehabilitation Evaluation System-Short Form (CARES-SF), and symptom distress scale. This paper reports vitality outcome results obtained from randomization, 6 months, and annually for 7 years. To assess changes in vitality over time, we used linear mixed models with patient as a random effect. RESULTS: Patients receiving CMT had lower observed vitality at 6 months than did the STLI patients (p < .0001). However, beginning at year 1, vitality results did not differ significantly by treatment over the 5-year (p = .13) and 7-year (p = .16) follow-up periods. Vitality only slightly improved over baseline in either group after treatment. The results were similar after accounting for patterns of recurrence and missing data. CONCLUSIONS: This study demonstrated that patients with early-stage Hodgkin's disease experience a short-term (at 6 months) decrease in vitality with treatment, which is more severe with CMT, but that after the first year, vitality scores were similar between the two treatment groups. Enduring fatigue results for patients receiving these therapies were not observed. Implications for cancer survivors These data provide comprehensive 7-year follow-up vitality information, an important symptom for early-stage lymphoma survivors.

Recent progress in the treatment of myelodysplastic syndrome in adult patients.

Peripheral blood cytopenias and dysplastic hematopoietic progenitors characterize the myelodysplastic syndrome. Patients suffer from the consequences of chronic cytopenias or progression to acute myelogenous leukemia. Although allogeneic hematopoietic stem cell transplantation is a potentially curative option, the standard of care for most patients with myelodysplastic syndrome continues to be supportive care, with blood product transfusion and antibiotics for infectious complications. Many patients with myelodysplastic syndrome are not candidates for allogeneic hematopoietic stem cell transplantation because of advanced age, comorbid illnesses, and lack of a histocompatible donor. Increased rates of apoptosis in hematopoietic progenitors, altered production of inflammatory cytokines, neoangiogenesis, and autoreactive T lymphocytes have all been shown to contribute to the phenotype of myelodysplastic syndrome. These recent insights into the pathophysiology of myelodysplastic syndrome have been translated into therapeutic trials of noncytotoxic agents for this disorder. Although clinical responses have been seen with these novel agents, the critical biologic targets have not yet been clearly defined.