CAP Profiles

Bio

Clinical Focus

  • Cancer > Lymphoma
  • Hodgkin's Disease
  • Hodgkin's Disease - Hematology
  • Hodgkin's Disease - Medical Oncology
  • Lymphoma
  • Medical Oncology

Academic Appointments

Professional Education

  • Fellowship:Memorial Sloan-Kettering Cancer Center (1958) NY
  • Residency:Peter Bent Brigham Hospital (1961) MA
  • Residency:Peter Bent Brigham Hospital (1957) MA
  • Board Certification: Medical Oncology, American Board of Internal Medicine (1973)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (1961)
  • Internship:University Hospitals of Cleveland (1954) OH

Contact

    • Tel: (650) 725-6455
  • Lymphoma Clinic 875 Blake Wilbur Dr Clinic C Stanford, CA 94305
    • Tel: (650) 725-6455
    Fax: (650) 725-1420

Research & Scholarship

Current Research and Scholarly Interests

Clinical Investigations of Hodgkin’s Disease: Current trials are defining (1) the utility of an abbreviated chemotherapy and minimal radiotherapy for favorable, clinically-staged patients with the disease; (2) the development of new dose-intensive chemotherapy programs for unfavorable and advanced disease. In collaboration with radiotherapists and Dr. Sandra Horning, careful retrospective and prospective studies of fertility, cardiopulmonary and secondary neoplasms are being done.

Clinico-laboratory Studies in the Non-Hodgkin’s Lymphomas: A major research interest of Dr. Rosenberg is the clinical, pathological and molecular basis of diagnosis, evolution, treatment and understanding of the non-Hodgkin’s lymphomas. This research is performed by a large interdisciplinary group of investigators which Dr. Ronald Levy directs.

Teaching

2018-19 Courses

Publications

All Publications

  • The Paris Conference "La Radiothérapie de la Maladie de Hodgkin": A First Step in the Cure of Hodgkin Disease. International journal of radiation oncology, biology, physics Hoppe, R. T., Rosenberg, S. A. 2015; 92 (1): 3-4

    View details for DOI 10.1016/j.ijrobp.2015.01.027

    View details for PubMedID 25863747

  • Histologic subtypes of breast cancer following radiotherapy for Hodgkin lymphoma. Annals of oncology Horst, K. C., Hancock, S. L., OGNIBENE, G., Chen, C., Advani, R. H., Rosenberg, S. A., Donaldson, S. S., Hoppe, R. T. 2014; 25 (4): 848-851

    Abstract

    The purpose of the study was to determine whether breast cancers (BCs) that develop in women previously irradiated for Hodgkin lymphoma (HL) are biologically similar to sporadic BC.We retrospectively reviewed the charts of patients who developed BC after radiotherapy (RT) for HL. Tumors were classified as ductal carcinoma in situ (DCIS) or invasive carcinoma. Invasive carcinomas were further characterized according to the subtype: hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)-, HR+/HER2+, HR-/HER2+, and HR-/HER2-. BCs after HL were compared with four age-matched sporadic, non-breast cancer (BRCA) I or II mutated BCs.One hundred forty-seven HL patients who were treated with RT between 1966 and 1999 and subsequently developed BCs were identified. Of these, 65 patients with 71 BCs had complete pathologic information. The median age at HL diagnosis was 23 (range, 10-48). The median age at BC diagnosis was 44 (range, 28-66). The median time to developing BC was 20 years. Twenty cancers (28%) were DCIS and 51 (72%) were invasive. Of the 51 invasive cancers, 24 (47%) were HR+/HER2-, 2 (4%) were HR+/HER2+, 5 (10%) were HR-/HER2+, and 20 (39%) were HR-/HER2-. There were no differences in BC histologic subtype according to the age at which patients were exposed to RT, the use of chemotherapy for HL treatment, or the time from RT exposure to the development of BC. In a 4 : 1 age-matched comparison to sporadic BCs, BCs after HL were more likely to be HR-/HER2- (39% versus 14%) and less likely to be HR+/HER2- (47% versus 61%) or HR+/HER2+ (4% versus 14%) (P = 0.0003).BCs arising in previously irradiated breast tissue were more likely to be triple negative compared with age-matched sporadic invasive cancers and less likely to be HR positive. Further studies will be important to determine the molecular pathways of carcinogenesis in breast tissue that is exposed to RT.

    View details for DOI 10.1093/annonc/mdu017

    View details for PubMedID 24608191

  • Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience. Blood Tan, D., Horning, S. J., Hoppe, R. T., Levy, R., Rosenberg, S. A., Sigal, B. M., Warnke, R. A., Natkunam, Y., Han, S. S., Yuen, A., Plevritis, S. K., Advani, R. H. 2013; 122 (6): 981-987

    Abstract

    Recent studies report an improvement in overall survival (OS) of patients with follicular lymphoma (FL). Previously untreated patients with grade 1-2 FL referred from 1960-2003 and treated at Stanford were identified. Four eras were considered: era 1, pre-anthracycline (1960-1975, n=180); era 2, anthracycline (1976-1986, n=426), era 3, aggressive chemotherapy/purine analogs (1987-1996, n=471) and era 4, rituximab (1997-2003, n=257). Clinical characteristics, patterns of care and survival outcomes were assessed. Observed OS was compared with the expected OS calculated from Berkeley Mortality Database life tables derived from population matched by gender and age at time of diagnosis. The median OS was 13.6 years. Age, gender and stage did not differ across the eras. Although primary treatment varied, event free survival after the first treatment did not differ between eras (p=0.17). Median OS improved from approximately 11 years in eras 1 and 2 to 18.4 years in era 3 and has not yet been reached for era 4 (p<0.001) with no suggestion of a plateau in any era. These improvements in OS exceeded improvements in survival in the general population during the same time period. Several factors, including better supportive care and effective therapies for relapsed disease, are likely responsible for this improvement.

    View details for DOI 10.1182/blood-2013-03-491514

    View details for PubMedID 23777769

  • Efficacy of abbreviated Stanford V chemotherapy and involved-field radiotherapy in early-stage Hodgkin lymphoma: mature results of the G4 trial ANNALS OF ONCOLOGY Advani, R. H., Hoppe, R. T., Baer, D., Mason, J., Warnke, R., Allen, J., Daadi, S., Rosenberg, S. A., Horning, S. J. 2013; 24 (4): 1044-1048

    Abstract

    To assess the efficacy of an abbreviated Stanford V regimen in patients with early-stage Hodgkin lymphoma (HL). PATIENTS AND METHODS PATIENTS: with untreated nonbulky stage I-IIA supradiaphragmatic HL were eligible for the G4 study. Stanford V chemotherapy was administered for 8 weeks followed by radiation therapy (RT) 30 Gy to involved fields (IF). Freedom from progression (FFP), disease-specific survival (DSS) and overall survival (OS) were estimated.All 87 enrolled patients completed the abbreviated regimen. At a median follow-up of 10 years, FFP, DSS and OS are 94%, 99% and 94%, respectively. Therapy was well tolerated with no treatment-related deaths.Mature results of the abbreviated Stanford V regimen in nonbulky early-stage HL are excellent and comparable to the results from other contemporary therapies.

    View details for DOI 10.1093/annonc/mds542

    View details for PubMedID 23136225

  • Risk of Therapy-Related Secondary Leukemia in Hodgkin Lymphoma: The Stanford University Experience Over Three Generations of Clinical Trials JOURNAL OF CLINICAL ONCOLOGY Koontz, M. Z., Horning, S. J., Balise, R., Greenberg, P. L., Rosenberg, S. A., Hoppe, R. T., Advani, R. H. 2013; 31 (5): 592-598

    Abstract

    To assess therapy-related acute myeloid leukemia/myelodysplastic syndrome (t-AML/MDS) risk in patients treated for Hodgkin lymphoma (HL) on successive generations of Stanford clinical trials.Patients with HL treated at Stanford with at least 5 years of follow-up after completing therapy were identified from our database. Records were reviewed for outcome and development of t-AML/MDS.Seven hundred fifty-four patients treated from 1974 to 2003 were identified. Therapy varied across studies. Radiotherapy evolved from extended fields (S and C studies) to involved fields (G studies). Primary chemotherapy was mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or procarbazine, mechlorethamine, and vinblastine (PAVe) in S studies; MOPP, PAVe, vinblastine, bleomycin, and methotrexate (VBM), or doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in C studies; and VbM (reduced dose of bleomycin compared with VBM) or mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) in G studies. Cumulative exposure to alkylating agent (AA) was notably lower in the G studies compared with the S and C studies, with a 75% to 83% lower dose of nitrogen mustard in addition to omission of procarbazine and melphalan. Twenty-four (3.2%) of 754 patients developed t-AML/MDS, 15 after primary chemotherapy and nine after salvage chemotherapy for relapsed HL. The incidence of t-AML/MDS was significantly lower in the G studies (0.3%) compared with the S (5.7%) or C (5.2%) studies (P < .001). Additionally, in the G studies, no t-AML/MDS was noted after primary therapy, and the only patient who developed t-AML/MDS did so after second-line therapy.Our data demonstrate the relationship between the cumulative AA dose and t-AML/MDS. Limiting the dose of AA and decreased need for secondary treatments have significantly reduced the incidence of t-AML/MDS, which was extremely rare in the G studies (Stanford V era).

    View details for DOI 10.1200/JCO.2012.44.5791

    View details for PubMedID 23295809

  • STAGE I-IIIA NON-BULKY HODGKIN'S LYMPHOMA. IS FURTHER DISTINCTION BASED ON PROGNOSTIC FACTORS USEFUL? THE STANFORD EXPERIENCE INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Advani, R. H., Hoppe, R. T., Maeda, L. S., Baer, D. M., Mason, J., Rosenberg, S. A., Horning, S. J. 2011; 81 (5): 1374-1379

    Abstract

    In the United States, early-stage Hodgkin's lymphoma (HL) is defined as asymptomatic stage I/II non-bulky disease. European groups stratify patients to more intense treatment by considering additional unfavorable factors, such as age, number of nodal sites, sedimentation rate, extranodal disease, and elements of the international prognostic score for advanced HL. We sought to determine the prognostic significance of these factors in patients with early-stage disease treated at Stanford University Medical Center.This study was a retrospective analysis of 101 patients treated with abbreviated Stanford V chemotherapy (8 weeks) and 30-Gy (n=84 patients) or 20-Gy (n=17 patients) radiotherapy to involved sites. Outcomes were assessed after applying European risk factors.At a median follow-up of 8.5 years, freedom from progression (FFP) and overall survival (OS) rates were 94% and 97%, respectively. From 33% to 60% of our patients were unfavorable per European criteria (i.e., German Hodgkin Study Group [GHSG], n=55%; European Organization for Research and Treatment of Cancer, n=33%; and Groupe d'Etudes des Lymphomes de l'Adulte, n=61%). Differences in FFP rates between favorable and unfavorable patients were significant only for GHSG criteria (p=0.02) with there were no differences in OS rates for any criteria. Five of 6 patients who relapsed were successfully salvaged.The majority of our patients deemed unfavorable had an excellent outcome despite undergoing a significantly abbreviated regimen. Application of factors used by the GHSG defined a less favorable subset for FFP but with no impact on OS. As therapy for early-stage disease moves to further reductions in therapy, these factors take on added importance in the interpretation of current trial results and design of future studies.

    View details for DOI 10.1016/j.ijrobp.2010.07.041

    View details for PubMedID 20934280

  • Rare presentation of classical Hodgkin lymphoma with a clonal T-cell receptor gene rearrangement in the tissue LEUKEMIA & LYMPHOMA Nguyen, T. T., Warnke, R. A., Seo, K., Rosenberg, S. A., Arber, D. A. 2010; 51 (7): 1356-1359

    View details for DOI 10.3109/10428194.2010.486094

    View details for Web of Science ID 000279485700026

    View details for PubMedID 20496992

  • Dynamic CD8 T-Cell Responses to Tumor-Associated Epstein-Barr Virus Antigens in Patients With Epstein-Barr Virus-Negative Hodgkin's Disease ONCOLOGY RESEARCH Kohrt, H., Johannsen, A., Hoppe, R., Horning, S. J., Rosenberg, S. A., Advani, R., Lee, P. P. 2009; 18 (5-6): 287-292

    Abstract

    In almost half of patients diagnosed with Hodgkin's disease (HD), the malignant Reed-Sternberg (RS) cells express Epstein-Barr virus (EBV) antigens. Multiple translational efforts are actively investigating antitumor immune strategies by stimulating cytotoxic T lymphocytes (CTL) against tumor-associated EBV antigens. It has previously been believed that this therapeutic strategy and presence of EBV-specific CTLs are limited to EBV-positive HD. In an effort to explore the EBV-specific immune response, here we characterize EBV-specific CTL responses to lytic and latent EBV antigens in 12 consecutive EBV carriers with EBV-negative HD. Compared to healthy donors, we detected weak, baseline EBV-specific responses to both lytic and latent antigens by IFN-gamma ELISPOT in patients with EBV-negative HD at diagnosis. Chemoradiotherapy was associated temporally with a decrease EBV-specific responses. At final follow-up (24 months), recovery of EBV-specific CTL responses was observed with robustness of lytic-specific response equivalent to healthy controls. We confirm evidence of EBV-specific CTLs in patients with EBV-negative HD and provide the first report of dynamic variance in this population during treatment. Our observation challenges prior belief that patients with HD remain immunodeficient following therapy and argues that the clinical significance of the EBV-specific immune response in EBV-negative HD should be further investigated.

    View details for DOI 10.3727/096504009X12596189659169

    View details for PubMedID 20225766

  • Lymphography: A Great Advance, Abandoned JOURNAL OF CLINICAL ONCOLOGY Rosenberg, S. A. 2008; 26 (35): 5662-5663

    View details for DOI 10.1200/JCO.2008.20.6946

    View details for Web of Science ID 000261528200001

    View details for PubMedID 19001339

  • Follicular lymphoma revisited JOURNAL OF CLINICAL ONCOLOGY Rosenberg, S. A. 2008; 26 (4): 515-516

    View details for DOI 10.1200/JCO.2007.13.8131

    View details for Web of Science ID 000254177400001

    View details for PubMedID 18235110

  • Splenic diffuse large B-cell lymphoma in a patient with type 1 Gaucher disease: diagnostic and therapeutic challenges ANNALS OF HEMATOLOGY Brody, J. D., Advani, R., Shin, L. K., Bingham, D. B., Rosenberg, S. A. 2006; 85 (11): 817-820

    View details for DOI 10.1007/s00277-006-0176-3

    View details for Web of Science ID 000240520100011

    View details for PubMedID 16937096

  • Stanford V and radiotherapy for locally extensive and advanced Hodgkin's disease: Mature results of a prospective clinical trial JOURNAL OF CLINICAL ONCOLOGY Horning, S. J., Hoppe, R. T., Breslin, S., Bartlett, N. L., Brown, B. W., Rosenberg, S. A. 2002; 20 (3): 630-637

    Abstract

    To provide more mature data on the efficacy and complications of a brief, dose-intense chemotherapy regimen plus radiation therapy (RT) to bulky disease sites for locally extensive and advanced-stage Hodgkin's disease.One hundred forty-two patients with stage III or IV or locally extensive mediastinal stage I or II Hodgkin's disease received Stanford V chemotherapy for 12 weeks followed by 36-Gy RT to initial sites of bulky (> or =5 cm) or macroscopic splenic disease. Freedom from progression (FFP), overall survival (OS), and freedom from second relapse (FF2R) were determined using life-table estimates. Outcomes were analyzed according to the international prognostic score. Late effects of treatment were recorded in follow-up.With a median follow-up of 5.4 years, the 5-year FFP was 89% and the OS was 96%. No patient progressed during treatment, and there were no treatment-related deaths. FFP was significantly superior among patients with a prognostic score of 0 to 2 compared with those with a score of 3 and higher (94% v 75%, P <.0001). No secondary leukemia was observed. To date, there have been 42 pregnancies after treatment. Among 16 patients who relapsed, the FF2R was 69% at 5 years.These data confirm our preliminary report that Stanford V chemotherapy with RT to bulky disease sites is highly effective in locally extensive and advanced Hodgkin's disease. It is most important to compare this approach with standard doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy in the ongoing intergroup trial (E2496) to determine whether Stanford V with or without RT represents a therapeutic advance.

    View details for Web of Science ID 000173669400007

    View details for PubMedID 11821442

  • High-dose therapy and autologous bone marrow transplantation for follicular lymphoma in first complete or partial remission: results of a phase II clinical trial BLOOD Horning, S. J., Negrin, R. S., Hoppe, R. T., Rosenberg, S. A., Chao, N. J., Long, G. D., Brown, B. W., Blume, K. G. 2001; 97 (2): 404-409

    Abstract

    Advanced stage follicular small cleaved and mixed cell lymphoma is characterized by relapse from remission and survival ranging from 6 to 12 years. Because young patients have the greatest compromise in longevity, the efficacy and toxicity of high-dose radiochemotherapy and bone marrow transplantation after conventional chemotherapy was evaluated in a prospective phase II clinical trial. Thirty-seven patients in a minimal disease state after conventional chemotherapy received fractionated total body irradiation and high-dose etoposide and cyclophosphamide, followed by purged autologous bone marrow. A reference sample of 188 patients of similar age, stage, and histology managed at this institution before 1988 was identified for comparison of patient characteristics and outcomes. Compared with reference patients, transplant recipients had a higher tumor burden at diagnosis. With a median follow-up of 6.5 years, the estimated 10-year survival after transplantation was 86%. There was a single lymphoma death yielding a 10-year disease-specific survival of 97%. There were 2 early transplant-related deaths and 2 late acute leukemia deaths. Ten patients relapsed, one with microscopic disease only. High tumor burden at diagnosis and incomplete response to chemotherapy adversely influenced survival in the reference but not in the transplanted patients. The estimated risk of death of 14% and relapse of 30% at 10 years in our transplanted follicular lymphoma patients, the majority of whom had high tumor burdens, compares favorably with our observations in appropriately matched reference patients.

    View details for Web of Science ID 000166388000011

    View details for PubMedID 11154216

  • Treatment of multicentric Castleman's disease complicated by the development of non-Hodgkin's lymphoma with high-dose chemotherapy and autologous peripheral stem-cell support ANNALS OF ONCOLOGY Advani, R., Warnke, R., Rosenberg, S. 1999; 10 (10): 1207-1209

    Abstract

    Castleman's disease or angiofollicular lymph node hyperplasia is a rare entity with a localized/unicentric or a generalized/multicentric presentation. While surgery is curable for most localized presentations, there is limited information regarding the optimal management of the multicentric type. The latter type is associated with a poor prognoses and can be associated with the development of lymphoma and infections.In this report we describe a case of multicentric Castleman's disease who failed steroids and chemotherapy and developed a follicular mixed lymphoma. He was treated with high-dose chemotherapy with autologous stem-cell support and remains disease at four years of follow-up.A long-term durable remission may be possible with high dose chemotherapy with stem-cell support. This treatment modality should be considered an option in the management of multicentric Castleman's disease.

    View details for PubMedID 10586338

  • Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity JOURNAL OF CLINICAL ONCOLOGY Yang, J. C., Chang, A. E., BAKER, A. R., SINDELAR, W. F., Danforth, D. N., Topalian, S. L., Delaney, T., Glatstein, E., STEINBERG, S. M., MERINO, M. J., Rosenberg, S. A. 1998; 16 (1): 197-203

    Abstract

    This randomized, prospective study assesses the impact of postoperative external-beam radiation therapy on local recurrence (LR), overall survival (OS), and quality of life after limb-sparing resection of extremity sarcomas.Patients with extremity tumors and a limb-sparing surgical option were randomized to receive or not receive postoperative adjuvant external-beam radiotherapy. Patients with high-grade sarcomas received postoperative adjuvant chemotherapy whereas patients with low-grade sarcomas or locally aggressive nonmalignant tumors were randomized after surgery alone.Ninety-one patients with high-grade lesions were randomized; 47 to receive radiotherapy (XRT) and 44 to not receive XRT. With a median follow-up of 9.6 years, a highly significant decrease (P2 = .0028) in the probability of LR was seen with radiation, but no difference in OS was shown. Of 50 patients with low-grade lesions (24 randomized to resection alone and 26 to resection and postoperative XRT), there was also a lower probability of LR (P2 = .016) in patients receiving XRT, again, without a difference in OS. A concurrent quality-of-life study showed that extremity radiotherapy resulted in significantly worse limb strength, edema, and range of motion, but these deficits were often transient and had few measurable effects on activities of daily life or global quality of life.This study indicates that although postoperative external-beam radiotherapy is highly effective in preventing LRs, selected patients with extremity soft tissue sarcoma who have a low risk of LR may not require adjuvant XRT after limb-sparing surgery (LSS).

    View details for Web of Science ID 000071368500030

    View details for PubMedID 9440743

  • Stanford-Kaiser permanente G1 study for clinical stage I to IIA Hodgkin's disease: Subtotal lymphoid irradiation versus vinblastine, methotrexate, and bleomycin chemotherapy and regional irradiation JOURNAL OF CLINICAL ONCOLOGY Horning, S. J., Hoppe, R. T., Mason, J., Brown, B. W., Hancock, S. L., Baer, D., Rosenberg, S. A. 1997; 15 (5): 1736-1744

    Abstract

    We have demonstrated that a relatively mild chemotherapy regimen, vinblastine, methotrexate, and bleomycin (VBM), and involved-field radiotherapy (IFRT) could substitute for extended-field radiotherapy in patients with favorable Hodgkin's disease (HD) who have been laparotomy-staged. The purpose of this study is to determine if VBM and regional radiotherapy can substitute for extended-field radiotherapy in favorable clinical stage (CS) I and II HD.Seventy-eight patients with favorable CS I to II HD were randomly assigned to subtotal lymphoid irradiation (STLI) or VBM chemotherapy and regional radiotherapy. Randomization was stratified on the basis of age, sex, number of Ann Arbor sites, histology, and institution. Patients were evaluated for freedom from progressive HD, survival, and toxicity. Results were compared with the predecessor trial in pathologically staged patients.With a median follow-up period of 4 years, the rate of freedom from progressive HD was 92% (95% confidence interval [CI], 88% to 96%) for patients treated with STLI and 87% (95% CI, 81% to 93%) for patients treated with VBM and regional radiotherapy. Six of seven patients who relapsed are alive and in remission following successful second-line therapy.Given the caveat of a small number of patients, the results of extended-field radiotherapy and VBM and regional radiotherapy are comparable with a median follow-up period of 4 years. VBM serves as a paradigm to reduce late effects in favorable early-stage HD. We do not advocate its routine use in clinical practice, but instead encourage participation in clinical trials with the objective of maintaining efficacy while reducing toxicity in CS I and II HD.

    View details for Web of Science ID A1997WZ56400006

    View details for PubMedID 9164180

  • Comparison between conventional salvage therapy and high-dose therapy with autografting for recurrent or refractory Hodgkin's disease BLOOD Yuen, A. R., Rosenberg, S. A., Hoppe, R. T., HALPERN, J. D., Horning, S. J. 1997; 89 (3): 814-822

    Abstract

    Sixty patients with Hodgkin's disease, refractory to or at first recurrence after chemotherapy, received cytoreductive therapy followed by high-dose etoposide, cyclophosphamide and either total body irradiation or carmustine and autografting (median follow-up, 3.6 years; range, 1.1 to 7.5 years). A matched conventional salvage group of 103 patients was selected from patients treated at Stanford University Medical Center between January 1976 and January 1989 (median follow-up, 10.3 years; range, 3.0 to 15.7 years). Overall survival (OS), event-free survival (EFS), and freedom from progression (FFP) at 4 years follow-up favored patients who received high-dose therapy compared with conventional salvage treatment (OS: 54% v 47%, P = .25; EFS: 53% v 27%, P < .01; FFP: 62% v 32%, P < .01). In Cox regression analysis, response to cytoreductive or salvage therapy and B symptoms at relapse were the most important predictors of OS. The use of high-dose therapy at relapse, a longer duration of remission, and favorable response to cytoreductive or salvage therapy were most predictive of superior FFP and EFS. These data from a single institution comparing conventional and high-dose therapy in matched patients demonstrate an advantage for high-dose therapy and autografting in the sustained control of Hodgkin's disease. As with primary therapy, it is difficult to demonstrate a statistically significant survival advantage, despite an apparently superior cure rate. However, patients failing induction therapy or relapsing within 1 year benefited significantly from high-dose therapy by all outcome measures (OS, EFS, FFP). As the transplant-related mortality rates decline in Hodgkin's disease, it is predicted that cure rates and late effects will become ultimate determinants of the success of high-dose therapy and autografting.

    View details for Web of Science ID A1997WG07300009

    View details for PubMedID 9028312

  • The management of Hodgkin's disease: Half a century of change - The Kaplan Memorial Lecture ANNALS OF ONCOLOGY Rosenberg, S. A. 1996; 7 (6): 555-560

    Abstract

    The results of treating more than 2600 patients with Hodgkin's disease at Stanford over a 35-year period are summarized. It is now a reality that Hodgkin's disease can be cured with initial treatment programs in virtually all patients, except the elderly. Histologic factors, staging methods, and prognostic groups are becoming less and less relevant. The current protocols used at Stanford and elsewhere will be reviewed to emphasize that combined modality is really the key to improving the cure rate and minimizing late complications.

    View details for Web of Science ID A1996VG53400009

    View details for PubMedID 8879367

  • BRIEF CHEMOTHERAPY, STANFORD-V, AND ADJUVANT RADIOTHERAPY FOR BULKY OR ADVANCED-STAGE HODGKINS-DISEASE - A PRELIMINARY-REPORT JOURNAL OF CLINICAL ONCOLOGY Bartlett, N. L., Rosenberg, S. A., Hoppe, R. T., Hancock, S. L., Horning, S. J. 1995; 13 (5): 1080-1088

    Abstract

    Although survival rates have improved for patients with bulky and advanced-stage Hodgkin's disease (HD), current treatments entail substantial acute morbidity and risks for late effects such as infertility, second malignancies, and cardiopulmonary toxicities. A novel, brief chemotherapy regimen (doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone [Stanford V]) was designed to shorten the duration of treatment, significantly reduce cumulative doses of alkylating agents, doxorubicin, and bleomycin, and maintain dose-intensity (DI). This brief chemotherapy was combined with radiation therapy (RT) to bulky disease sites.Since May 1989, 65 previously untreated patients were treated for stage II HD with bulky mediastinal involvement (n = 21) or for stage III or IV HD (n = 44). Patients received weekly chemotherapy for 12 weeks. Consolidative RT was given to the first 25 patients to sites of initial bulky disease or radiographic abnormalities that persisted after chemotherapy; in the remaining 40 patients, RT was limited to bulky disease (adenopathy > or = 5 cm and/or macroscopic splenic nodules defined by computed tomography [CT]).With a median follow-up period of 2 years, actuarial 3-year survival rate is 96% and failure-free survival (FFS) rate is 87%. The 3-year FFS rate is 100% for stage II patients with bulky mediastinal disease and 82% for patients with stage III to IV disease. There were no treatment-related deaths. In a preliminary analysis on a subset of patients, female and male fertility appears to be preserved.These preliminary results indicate that the Stanford V chemotherapy regimen with or without RT is well-tolerated and effective therapy for bulky, limited-stage, and advanced-stage HD. Less cumulative exposure to alkylating agents, doxorubicin, and bleomycin and limited use of radiation is expected to decrease risks for second neoplasms and late cardiopulmonary toxicity. Based on these results, the Stanford V chemotherapy with or without RT regimen deserves further study in the context of a randomized clinical trial.

    View details for Web of Science ID A1995QV95100006

    View details for PubMedID 7537796

  • A CLINICAL AND EPIDEMIOLOGIC-STUDY OF HUMAN-LEUKOCYTE ANTIGEN-DPB ALLELES IN HODGKINS-DISEASE CANCER RESEARCH Oza, A. M., Tonks, S., Lim, J., FLEETWOOD, M. A., Lister, T. A., Bodmer, J. G., Howell, W. M., Devereux, S., Taylor, G. M., GOKALE, D., Loeliger, C., Kuehnl, P., Pellegris, G., Takacs, K., Petranyi, G., Gazit, E., Klein, T., Dutoit, E., Martell, R., Hammond, M. G., VANTONDER, S. V., Liang, R., Wong, T., Chan, V., Klitz, W., Begovich, A., Woodfield, G., Roberts, M., Bignon, J. D., Mikata, A., Takenouchi, T., Cunningham, D., Robinson, E., Haim, N., Chen, P. M., Ferreira, E., Whitehouse, J. M., Sweetenham, J., Mead, G. M., Crowther, D., Woll, P., ZELLER, W., Hossfeld, D. K., KUSE, W., Bonadonna, G., Molnar, Z., ECKHARDT, S., BENBASSAT, I., Jacobs, P., Johnson, C., KENOYER, D. J., Todd, D., Chan, T. K., Horning, S., Rosenberg, S., Harvey, V., Thompson, P., Browett, P., Harousseau, J. L. 1994; 54 (19): 5101-5105

    View details for Web of Science ID A1994PH77400016

  • CLASSIFICATION OF LYMPHOID NEOPLASMS BLOOD Rosenberg, S. A. 1994; 84 (5): 1359-1360

    View details for Web of Science ID A1994PE38700001

    View details for PubMedID 8068935

  • Modern combined modality management of Hodgkin's disease. Current opinion in oncology Rosenberg, S. A. 1994; 6 (5): 470-472

    Abstract

    The combination of chemotherapy and irradiation in the management of patients with Hodgkin's disease is being reported with increased frequency. In some situations, higher cure rates have been achieved with combined modality. In other situations, a reduction or modification of one or both modalities has reduced the acute toxicity (and later morbidity) of successful therapy.

    View details for PubMedID 7827149

  • The treatment of Hodgkin's disease. Annals of oncology Rosenberg, S. A. 1994; 5: 17-21

    View details for PubMedID 8204516

  • THE TREATMENT OF HODGKINS-DISEASE ANNALS OF ONCOLOGY Rosenberg, S. A. 1994; 5: S17-S21

    View details for Web of Science ID A1994MZ48600003

  • THE STANFORD EXPERIENCE WITH COMBINED PROCARBAZINE, ALKERAN AND VINBLASTINE (PAVE) AND RADIOTHERAPY FOR LOCALLY EXTENSIVE AND ADVANCED STAGE HODGKINS-DISEASE ANNALS OF ONCOLOGY Horning, S. J., Ang, P. T., Hoppe, R. T., Rosenberg, S. A. 1992; 3 (9): 747-754

    Abstract

    This report describes the efficacy and toxicity of PAVe (procarbazine, Alkeran, vinblastine) and irradiation (RT) in the management of 159 patients with locally extensive or advanced stage Hodgkin's disease (HD) at Stanford University. Patients received six courses of chemotherapy alternating with RT. The extent of RT and the schedule of treatment varied according to the stage of disease. About 2/3 of patients received PAVe/RT in the setting of prospective, randomized clinical trials. The rate of complete response was 93%. With a median follow-up of seven years (range 2-17), the 15 year actuarial freedom from progression (FFP) is 78% and overall survival is 75%. Ten-year FFP by stage is: 80% for locally extensive stage II, 90% for stage IIIA and 70% for stage IIIB. Excellent and equal results were attained with PAVe/RT vs. MOP(P) (mustard, Oncovin, procarbazine with or without prednisone)/RT in the randomized combined modality studies. Progression or recurrence was documented in 30 patients and was more common in irradiated sites. PAVe was well tolerated acutely. There were no treatment related fatalities. Twenty-three (14%) patients were admitted to the hospital for neutropenic fever. Five second malignancies have occurred after PAVe/RT only: one myelodysplastic syndrome, one acute myelogenous leukemia, one non-Hodgkin's lymphoma and two solid tumors including a case of non-small cell lung cancer and an in situ carcinoma of the cervix. Three patients died from myocardial infarction several years after the completion of treatment. These mature data show that PAVe/RT is effective and well-tolerated therapy for locally extensive stage II and IIIA/B HD.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1992JW88200021

    View details for PubMedID 1450064

  • REDUCING THE TOXICITY OF THE COMBINED MODALITY THERAPY OF FAVORABLE STAGE HODGKINS-DISEASE EUROPEAN JOURNAL OF CANCER Rosenberg, S. A. 1992; 28A (8-9): 1379-1380

    View details for Web of Science ID A1992JC98100023

    View details for PubMedID 1515253

  • DEATHS AFTER TREATMENT OF HODGKIN DISEASE - CORRECTION ANNALS OF INTERNAL MEDICINE Hancock, S. L., Cox, R. S., Rosenberg, S. A. 1991; 114 (9): 810-810

    View details for Web of Science ID A1991FJ11700023

  • CEPP(B) - AN EFFECTIVE AND WELL-TOLERATED REGIMEN IN POOR-RISK, AGGRESSIVE NON-HODGKINS-LYMPHOMA BLOOD Chao, N. J., Rosenberg, S. A., Horning, S. J. 1990; 76 (7): 1293-1298

    Abstract

    Eighty-three patients with intermediate- or high-grade non-Hodgkin's lymphoma were treated with CEPP(B) (cyclophosphamide, etoposide [VP-16], procarbazine, and prednisone with or without bleomycin) chemotherapy at Stanford University Medical Center (Stanford, CA) from January 1982 through June 1989. Sixty-nine received CEPP(B) as second-line or subsequent therapy after relapse from previous combination chemotherapy, and 14 patients received CEPP(B) as first-line therapy. Of 75 patients evaluable for response, 30 patients (40%) achieved a complete response (CR) and 24 patients (32%) achieved a partial response (PR), providing an overall response rate of 72%. Complete responses were recorded on 21 of 61 (34%) patients with recurrent disease and 9 of the 14 patients who received CEPP(B) as first line therapy (64%). Myelosuppression was the major side effect of treatment, resulting in eight neutropenic-febrile episodes from a total of 253 courses. A single fatal toxic event occurred on a patient who developed adult respiratory distress syndrome. Overall, CEPP(B) was well-tolerated and proved to be effective palliative therapy for patients with non-Hodgkin's lymphoma after relapse. As such, CEPP(B) may be considered for cytoreduction before ablative therapy and bone marrow transplantation. CEPP(B) may also be considered for initial therapy in selected patients who cannot tolerate doxorubicin-containing regimens.

    View details for Web of Science ID A1990EB07800005

    View details for PubMedID 2207307

  • REPORT OF A COMMITTEE CONVENED TO DISCUSS THE EVALUATION AND STAGING OF PATIENTS WITH HODGKINS-DISEASE - COTSWOLDS MEETING JOURNAL OF CLINICAL ONCOLOGY Lister, T. A., Crowther, D., Sutcliffe, S. B., Glatstein, E., Canellos, G. P., Young, R. C., Rosenberg, S. A., Coltman, C. A., Tubiana, M. 1989; 7 (11): 1630-1636

    Abstract

    The Ann Arbor classification for describing the stage of Hodgkin's disease at initial presentation has formed the basis upon which treatment is selected and has allowed comparison of results achieved by different investigators for almost two decades. A meeting was convened to review the classification and modify it in the light of experience gained in its use and new techniques for evaluating disease. It was concluded that the structure of the classification be maintained. It was particularly recommended: (1) that computed tomography (CT) be included as a technique for evaluating intrathoracic and infradiaphragmatic lymph nodes; (2) that the criteria for clinical involvement of the spleen and liver be modified to include evidence of focal defects with two imaging techniques and that abnormalities of liver function be ignored; (3) that the suffix 'X' to designate bulky disease (greater than 10 cm maximum dimension) be introduced; and (4) that a new category of response to therapy, unconfirmed/uncertain complete remission (CR[u]), be introduced to accommodate the difficulty of persistent radiological abnormalities of uncertain significance.

    View details for Web of Science ID A1989AX30100007

    View details for PubMedID 2809679

  • HODGKINS-DISEASE - CHALLENGES FOR THE FUTURE CANCER RESEARCH Rosenberg, S. A. 1989; 49 (4): 767-769

    Abstract

    Clinical investigators of Hodgkin's disease of the recent past have reason to be proud. Tens of thousands of individuals, many of them young, fertile, and productive, have been cured of their life-threatening disease. There are few better examples of the success and rewards of clinical oncology than in the control of Hodgkin's disease by improved diagnostic methods and the appropriate use of radiation and chemotherapy. Yet the clinical investigator of today cannot be satisfied with these successes. The treatment required for high cure rates remains empirical, difficult, and costly. The goal must be to prevent or reverse this fascinating disease, utilizing specific therapy designed from a knowledge of the cause and pathogenesis of the disease. There are sufficient biological clues and methodologies to predict that this will be possible, and in the decade of the 1990s!

    View details for Web of Science ID A1989T082400001

    View details for PubMedID 2643461

  • Current Stanford clinical trials for Hodgkin's disease. Recent results in cancer research. Fortschritte der Krebsforschung. Progrès dans les recherches sur le cancer Hoppe, R. T., Horning, S. J., Hancock, S. L., Rosenberg, S. A. 1989; 117: 182-190

    View details for PubMedID 2690227

  • PROGNOSTIC INDICATORS OF LAPAROTOMY FINDINGS IN CLINICAL STAGE-I-II SUPRADIAPHRAGMATIC HODGKINS-DISEASE JOURNAL OF CLINICAL ONCOLOGY LEIBENHAUT, M. H., Hoppe, R. T., Efron, B., Halpern, J., Nelsen, T., Rosenberg, S. A. 1989; 7 (1): 81-91

    Abstract

    Between July 1968 and July 1986, 915 patients with clinical stage (CS) I and II Hodgkin's disease limited to sites above the diaphragm underwent laparotomy and splenectomy at Stanford University. Fifteen percent were CS I, of whom 76% had cervical/supraclavicular disease, 13% axillary disease, and 9% mediastinal presentations. CS I patients were more likely to be male, were significantly older, and were significantly less likely to have nodular sclerosis (NS) histology than CS II patients. Twenty percent of CS I patients and 30% of CS II patients were pathologically upstaged. No CS I patients were upstaged to pathological stage (PS) IV. Univariate and multivariate analyses of presenting clinical characteristics were performed to predict staging laparotomy findings. CS I women, CS I patients with mediastinal-only disease, and CS I men with either lymphocyte predominance or interfollicular histologies were at low risk for having disease below the diaphragm (5%) or requiring chemotherapy (0%). CS II women who were less than 27 years old and had only two or three sites of disease were also at low risk for upstaging (9%) or requiring chemotherapy (2%). Mixed cellularity histology and male gender were associated with increased risk for subdiaphragmatic disease and require laparotomy; the presence of systemic symptoms was not correlated with laparotomy findings. These results confirm the importance of performing staging laparotomy for the majority of patients who present with supradiaphragmatic Hodgkin's disease if treatment programs are based on the presence and extent of subdiaphragmatic disease. Selected subgroups are at low risk for subdiaphragmatic disease and might be spared laparotomy if they are treated with mantle, paraaortic, and splenic irradiation.

    View details for Web of Science ID A1989R711000012

    View details for PubMedID 2909669

  • VINBLASTINE, BLEOMYCIN, AND METHOTREXATE - AN EFFECTIVE ADJUVANT IN FAVORABLE HODGKINS-DISEASE JOURNAL OF CLINICAL ONCOLOGY Horning, S. J., Hoppe, R. T., Hancock, S. L., Rosenberg, S. A. 1988; 6 (12): 1822-1831

    Abstract

    Sixty-seven patients with favorable pathologic stage (PS) I and IIA or B or IIIA Hodgkin's disease were randomized to receive subtotal or total lymphoid irradiation (STLI/TLI) alone or involved field irradiation (IF) plus six cycles of a novel adjuvant chemotherapy containing vinblastine, bleomycin, and methotrexate (VBM). With a follow-up from 6 to 72 months (median, 37 months), the actuarial freedom-from-progressive disease (FFP) at 5 years is 70% after STLI/TLI and 95% after IF plus VBM. One death has occurred in the irradiation-only treatment group. The data for IF plus VBM are significantly superior to previous actuarial results at 5 years using IF alone (FFP = 35%, P less than .00001) and compare favorably with prior results with IF plus nitrogen mustard, vincristine, procarbazine, +/- prednisone (MOP[P]) chemotherapy (FFP = 80% at 5 years, P = .10). VBM is well tolerated with greater than 90% of calculated doses delivered. As anticipated, VBM has had relatively little adverse effect on male or female fertility. Selected pulmonary functions are reduced early after IF plus VBM to a greater degree than with irradiation of the mediastinum alone, but the differences are modest. Based upon our current numbers and follow-up, we can be 90% confident that VBM as an adjuvant to irradiation in favorable Hodgkin's disease is as effective, or even superior, to MOP(P) chemotherapy. Because of its lesser toxicity, adjuvant VBM may have a broader role in the management of Hodgkin's disease.

    View details for Web of Science ID A1988R308000006

    View details for PubMedID 2462025

  • INTERCURRENT DEATH AFTER HODGKIN DISEASE THERAPY IN RADIOTHERAPY AND ADJUVANT MOPP TRIALS ANNALS OF INTERNAL MEDICINE Hancock, S. L., Hoppe, R. T., Horning, S. J., Rosenberg, S. A. 1988; 109 (3): 183-189

    Abstract

    To assess long-term differences in mortality associated with initial Hodgkin disease therapy.Retrospective review of patients treated in prospectively randomized clinical trials.Three hundred twenty-six patients with pathologic stage I, II, or III, A or B Hodgkin disease treated between 1967 and 1980 with median follow-up exceeding 14 years.Patients at the same stage of disease were randomized to receive radiation alone (167 patients) or radiation followed by 6 cycles of mechlorethamine hydrochloride, vincristine, procarbazine, and prednisone (MOPP) chemotherapy (159 patients) with additional therapy for progression or recurrence.No significant differences between treatment regimens for actuarial survival, intercurrent disease, or Hodgkin disease mortality were seen. Thirty-three patients who received radiation alone and 30 patients who received adjuvant chemotherapy died without evident Hodgkin disease. Death was caused by second neoplasms in 28 patients (relative risk, 2.35; 95% CI, 1.46 to 3.24). Six patients developed acute myelogenous leukemia or a myeloproliferative disorder after treatment including MOPP. Chemotherapy exposure varied among the 8 patients with lung cancers, 6 with gastrointestinal and 3 with other adenocarcinomas, 3 with sarcomas, 1 with diffuse large cell lymphoma, and 1 with melanoma. Acute myocardial infarction caused 9 of 17 cardiovascular disease deaths with 5 occurring in patients between the ages of 33 and 43. Nonetheless, the risk for acute myocardial infarction was not clearly increased (relative risk, 0.86; 95% CI, 0.42 to 1.57). Fifteen patients died from infection: 5, opportunistic; 5, asplenic sepsis; and 5, other pneumonias. Two patients died in accidents, and 1 died from radiation pneumonitis.Adjuvant MOPP chemotherapy improved freedom from relapse without significant survival benefit or impairment. Leukemogenesis was the only lethal complication associated with MOPP. Survivors of Hodgkin disease had an increased risk for death from a second neoplasm, but no apparent increased risk for death from acute myocardial infarction.

    View details for Web of Science ID A1988P606500005

    View details for PubMedID 3291657

  • 2ND CANCERS AFTER RADIOTHERAPY FOR HODGKINS-DISEASE - REPLY NEW ENGLAND JOURNAL OF MEDICINE TUCKER, M. A., Coleman, C. N., Rosenberg, S. A. 1988; 319 (4): 245-246

    View details for Web of Science ID A1988P410500018

  • EXPLORATORY LAPAROTOMY AND SPLENECTOMY FOR HODGKINS-DISEASE - A COMMENTARY JOURNAL OF CLINICAL ONCOLOGY Rosenberg, S. A. 1988; 6 (4): 574-575

    View details for Web of Science ID A1988N007300002

    View details for PubMedID 3357003

  • RISK OF 2ND CANCERS AFTER TREATMENT FOR HODGKINS-DISEASE NEW ENGLAND JOURNAL OF MEDICINE TUCKER, M. A., Coleman, C. N., Cox, R. S., Varghese, A., Rosenberg, S. A. 1988; 318 (2): 76-81

    Abstract

    We estimated the risk of second cancers among 1507 patients with Hodgkin's disease treated at Stanford University Medical Center since 1968. Eight-three second cancers occurred more than one year after diagnosis, as compared with 15.9 expected on the basis of rates in the general population (relative risk, 5.2; 95 percent confidence interval, 4.2 to 6.5). The mean (+/- SE) 15-year actuarial risk of all second cancers was 17.6 +/- 3.1 percent, of which 13.2 +/- 3.1 percent was due to solid tumors. The risk of leukemia appeared to reach a plateau level of 3.3 +/- 0.6 percent at 10 years, whereas non-Hodgkin's lymphoma continued to increase, to 1.6 +/- 0.7 percent by the end of the follow-up period. The risk of solid tumors did not vary significantly according to treatment category, with the array of neoplasms resembling that previously observed in populations exposed to radiation and in immunosuppressed groups. The risk of leukemia, although elevated after radiation therapy alone (relative risk, 11; 95 percent confidence interval, 1.2 to 38), was much higher after either adjuvant chemotherapy (relative risk, 117; 95 percent confidence interval, 69 to 185) or chemotherapy alone (relative risk, 130; 95 percent confidence interval, 26 to 380). These data suggest that the risk of solid tumors after therapy for Hodgkin's disease continues to increase with time.

    View details for Web of Science ID A1988L600100003

    View details for PubMedID 3336397

  • SUBDIAPHRAGMATIC HODGKINS-DISEASE - LAPAROTOMY AND TREATMENT RESULTS IN 49 PATIENTS JOURNAL OF CLINICAL ONCOLOGY LEIBENHAUT, M. H., Hoppe, R. T., Varghese, A., Rosenberg, S. A. 1987; 5 (7): 1050-1055

    Abstract

    The clinical records of 1,616 patients with previously untreated Hodgkin's disease were reviewed. Forty-nine of these patients (3%) presented with disease limited to sites below the diaphragm and underwent laparotomy as part of their staging evaluation. The clinical and histological characteristics of this group of patients with subdiaphragmatic Hodgkin's disease are compared with those who presented with supradiaphragmatic disease. Splenectomy in 47 patients revealed splenic involvement in 16 (39%), and bulky splenic involvement (more than five gross nodules) in ten (24%). The final pathological stage (PS) distribution was PS I = 8, PS II = 37, PS IV = 4. No clinical stage (CS) IA patients and only two of 20 patients with negative paraaortic nodes on lymphogram had splenic involvement in contrast to eight of nine CS IIB patients. Freedom from relapse and survival were similar to patients with equivalent stage supradiaphragmatic disease. Splenic involvement and bulky splenic involvement were associated with a significantly decreased survival. Twelve out of 44 PS IA to IIB patients relapsed. In eight of these 12 patients, relapse was limited to sites above the diaphragm and another two patients relapsed both above and below the diaphragm. Patients who received total lymphoid irradiation were less likely to relapse above the diaphragm than patients who received no supradiaphragmatic irradiation. We recommend that CS IA and IIA patients with subdiaphragmatic disease undergo staging laparotomy and receive supradiaphragmatic irradiation as part of their treatment. Laparotomy may not be necessary for CS IIB patients who are at high risk for splenic disease if chemotherapy is planned as part of their treatment program.

    View details for Web of Science ID A1987J134800011

    View details for PubMedID 3598609

  • TREATMENT OF REFRACTORY NON-HODGKINS-LYMPHOMAS OF UNFAVORABLE HISTOLOGY WITH TENIPOSIDE, CYTARABINE, AND CISPLATIN CANCER TREATMENT REPORTS Tseng, A., Jacobs, C., Coleman, C. N., Horning, S. J., Lewis, B. J., Rosenberg, S. A. 1987; 71 (6): 659-660

    View details for Web of Science ID A1987H910800023

    View details for PubMedID 3581106

  • 3RD-LINE CHEMOTHERAPY FOR RESISTANT HODGKINS-DISEASE WITH LOMUSTINE, ETOPOSIDE, AND METHOTREXATE CANCER TREATMENT REPORTS Tseng, A., Jacobs, C., Coleman, C. N., Horning, S. J., Lewis, B. J., Rosenberg, S. A. 1987; 71 (5): 475-478

    Abstract

    Thirty-two patients with recurrent Hodgkin's disease have been treated with an oral regimen employing lomustine (CCNU, 100 mg/m2 orally on Day 1); etoposide (VP-16, 100 mg/m2 orally on Days 1-3 and 21-23); and methotrexate (30 mg/m2 orally on Days 1, 8, 21, and 28). The regimen was repeated every 6 weeks. Most patients had been treated with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine); 20 had had prior irradiation. Lymph node was the predominant site of disease and the majority of patients had B symptoms. Four patients achieved complete response (13%), with a median duration of 33+ months, and 11 achieved partial response (34%), with a median duration of 5 months, for an overall response rate of 47%. The major toxic effect was severe myelosuppression, which occurred in six patients; there were no treatment-related deaths. This oral regimen was easy to administer in heavily pretreated patients with poor venous access and had minimal toxicity.

    View details for Web of Science ID A1987H634200008

    View details for PubMedID 3567972

  • RADIOTHERAPY WITH CURATIVE INTENT - AN OPTION IN SELECTED PATIENTS RELAPSING AFTER CHEMOTHERAPY FOR ADVANCED HODGKINS-DISEASE JOURNAL OF CLINICAL ONCOLOGY Roach, M., Kapp, D. S., Rosenberg, S. A., Hoppe, R. T. 1987; 5 (4): 550-555

    Abstract

    Thirteen patients who had relapsed or failed to obtain a complete remission after combination chemotherapy for the treatment of advanced Hodgkin's disease were treated with subtotal or total lymphoid irradiation with curative intent. Twelve of the 13 patients achieved a complete response (CR). Five of the 12 CRs subsequently relapsed at 3, 9, 9, 12, and 19 months. One patient died of leukemia 11 months following radiotherapy. The actuarial relapse-free survival at 1 year was 60%, and six patients (50%) remain disease-free with a median follow-up of 34 months (range, 10 to 115 months) following the completion of radiotherapy. Patients who failed to obtain a CR to their initial chemotherapy, whose chemotherapy CR was of short duration, or who relapsed initially in extranodal sites, tended to have a worse outcome with radiotherapy. Patients who had long disease-free intervals after initial chemotherapy or relapsed only in nodal sites tended to do relatively well. Radiation therapy was well tolerated with no major toxicity. Potentially curative radiation therapy should be considered an option in the management of selected patients who relapse following combination chemotherapy for advanced Hodgkin's disease.

    View details for Web of Science ID A1987G740800007

    View details for PubMedID 3559648

  • TREATMENT OF LYMPHOBLASTIC LYMPHOMA IN ADULTS JOURNAL OF CLINICAL ONCOLOGY Coleman, C. N., Picozzi, V. J., Cox, R. S., MCWHIRTER, K., Weiss, L. M., Cohen, J. R., Yu, K. P., Rosenberg, S. A. 1986; 4 (11): 1628-1637

    Abstract

    Forty-four adult patients with lymphoblastic lymphoma (LBL) were treated according to one of two protocols. Both included (1) induction with cyclophosphamide, doxorubicin, vincristine, prednisone, and L-asparaginase; (2) CNS prophylaxis; and (3) maintenance therapy with methotrexate (MTX) and 6-mercaptopurine. In the second protocol, CNS prophylaxis began earlier than in the first protocol and included cranial irradiation and intrathecal (IT) MTX rather than simultaneous high-dose systemic and IT MTX. The overall response rate was 100% (95% complete). With a 26-month median follow-up, the 1-and 3-year actuarial freedom from relapse (FFR) for the composite patient group was 70% and 56%, respectively. The incidence of CNS relapse was reduced from 31% in the first protocol to 3% in the second protocol (P = .04, Gehan). Patients can be assigned retrospectively to low (n = 19) and high (n = 25) risk prognostic groups, as indicated by a multivariate analysis of pretreatment prognostic factors. High-risk is defined by Ann Arbor stage IV disease with bone marrow or CNS involvement or initial serum lactate dehydrogenase (LDH) concentration of greater than 300 IU/L (normal, less than 200). FFR of low- and high-risk groups at 5 years are 94% and 19%, respectively (P = .0006). Low-risk patients are highly curable using this approach to adult LBL. More intensive treatment for high-risk patients is warranted.

    View details for Web of Science ID A1986E677300010

    View details for PubMedID 3772416

  • HODGKINS-DISEASE - NO STAGE BEYOND CURE HOSPITAL PRACTICE Rosenberg, S. A. 1986; 21 (8): 91-?

    View details for Web of Science ID A1986E107000015

    View details for PubMedID 3090078

  • COMBINED MODALITY THERAPY FOR ADULTS WITH SMALL NONCLEAVED CELL LYMPHOMA (BURKITTS AND NON-BURKITTS TYPES) JOURNAL OF CLINICAL ONCOLOGY Bernstein, J. I., Coleman, C. N., Strickler, J. G., Dorfman, R. F., Rosenberg, S. A. 1986; 4 (6): 847-858

    Abstract

    Between June 1979 and June 1984 18 adult patients with small noncleaved cell lymphoma (SNCL) (diffuse undifferentiated lymphoma, Burkitt's and non-Burkitt's types of the Rappaport classification) were treated with high-dose cyclophosphamide, doxorubicin, vincristine, prednisone, midcycle high-dose methotrexate, and intrathecal methotrexate. Early in the course of treatment, hyperfractionated radiotherapy (125 cGy, every two days, for 1,500 to 2,250 centigray [cGy]) was administered to unresected masses greater than 10 cm in their greatest dimension. Chemotherapy was administered every 21 days for six to ten cycles. Treatment was generally well tolerated; however, one patient died of probable tumor lysis syndrome. With a median follow-up of 1.2 years, actuarial survival was 66.8% and relapse-free survival (RFS) was 71.3% for the entire group. All treatment failures and deaths occurred in patients with stage D disease. RFS projected at 2 years was 100% for stages A and AR and 60.6% for stage B, C, and D (P = .13 Gehan). Two-year RFS for patients with stage A, AR, B, or C disease was 100 v 41% for those with stage D disease. Patients with adverse prognostic features (n = 7)--unresected bulk measuring greater than 10 cm, pretreatment serum lactate dehydrogenase (LDH) 500 IU/L (normal, 200) or involvement of CNS or bone marrow--had a projected RFS of 28.6% compared with 100% for those patients without these features (P = .002 Gehan). Too few patients received induction radiotherapy to assert its role in therapy. By using aggressive multiagent therapy, cure can be expected in a high percentage of adults with SNCL. In the subset with adverse prognostic features, more effective therapy is necessary.

    View details for Web of Science ID A1986C594800006

    View details for PubMedID 3711961

  • FACTORS PREDICTING SURVIVAL IN ADULTS WITH STAGE I AND II LARGE-CELL LYMPHOMA TREATED WITH PRIMARY RADIATION-THERAPY ANNALS OF INTERNAL MEDICINE Kaminski, M. S., Coleman, C. N., Colby, T. V., Cox, R. S., Rosenberg, S. A. 1986; 104 (6): 747-756

    Abstract

    The records of 148 consecutive patients with Ann Arbor stage I and II large-cell lymphoma treated with primary radiation therapy with or without adjuvant chemotherapy were analyzed retrospectively for pretreatment prognostic variables and results of treatment. For patients treated with radiation to fields on one side of the diaphragm, the 5 year freedom-from-relapse rate was 25% and the survival rate was 35%, but for those given additional transdiaphragmatic radiation or for those given radiation plus adjuvant chemotherapy, the rates were both approximately 67%. In a multivariate analysis, the only significant pretreatment prognostic variables were the number of sites of involvement and bulk of disease, with relapse as the endpoint. For patients treated with radiation to both sides of the diaphragm or with radiation plus adjuvant chemotherapy, the 5-year freedom-from-relapse rate was 82% for the group with a favorable prognosis (with less than three sites of involvement and a mass size of less than 10 cm) and 55% for those with an unfavorable prognosis.

    View details for Web of Science ID A1986C631300002

    View details for PubMedID 3518561

  • STAGE-IIB HODGKINS-DISEASE - THE STANFORD EXPERIENCE JOURNAL OF CLINICAL ONCOLOGY CRNKOVICH, M. J., Hoppe, R. T., Rosenberg, S. A. 1986; 4 (4): 472-479

    Abstract

    Between 1968 and 1982, 126 patients with pathologic stage (PS) IIB Hodgkin's disease were treated at Stanford University with either irradiation alone or irradiation combined with chemotherapy. Actuarial survival and freedom from relapse rates at 10 years for the overall group were 81% and 74% respectively, with no statistically significant difference between the treatment approaches. The impact of the severity and number of constitutional (B) symptoms, as defined by the Ann Arbor Conference, was analyzed. Patients who presented with all three B symptoms had significantly poorer survival and freedom from relapse compared with those patients with only one or two B symptoms (for survival differences, P = .005 and .007; for freedom from relapse differences, P = .002 and .04). Male sex was the only other prognostic factor that correlated with a poor outcome. At 10 years, the survival rate was 66% for males v 84% for females (P = .01), and the freedom from relapse rate was 75% for males v 89% for females (P = .02). The presence of extralymphatic sites of involvement, age greater than 40, or involvement of greater than three lymphoid sites had no significant adverse effect on either freedom from relapse or survival. Patients with large mediastinal masses treated with irradiation alone had a 10-year freedom from relapse rate of 54% v 81% for those treated with combined-modality therapy (P = .15), but there was no significant difference in survival rates (85% for irradiation alone v 71% for combined modality therapy). Treatment recommendations for stage IIB Hodgkin's disease are discussed.

    View details for Web of Science ID A1986A743500005

    View details for PubMedID 3958761

  • SELECTION OF PATIENTS WITH HODGKINS-DISEASE AND NON-HODGKINS-LYMPHOMA FOR BONE-MARROW TRANSPLANTATION INTERNATIONAL JOURNAL OF CELL CLONING Sullivan, K. M., Appelbaum, F. R., Horning, S. J., Rosenberg, S. A., Thomas, E. D. 1986; 4: 94-106

    Abstract

    Despite substantial progress in curative therapy of malignant lymphomas, some patients fail current treatment and die of refractory disease. Although Although high-dose chemotherapy and supralethal total body irradiation followed by bone marrow transplantation may salvage and cure a proportion of these refractory patients, treatment of such end-stage patients with marrow grafting often fails because of resistant disease or transplant-related complications. Using the analogy of transplantation in the early phases of acute and chronic leukemias, results of marrow transplant in Hodgkin's disease and non-Hodgkin's lymphoma might be improved if performed earlier in the course of the malignancy. The following collaborative report by the Seattle and Stanford groups examines current results of conventional lymphoma therapy to define subgroups of patients with "high-risk" lymphoma for whom early marrow transplant might be offered to control otherwise incurable disease.

    View details for Web of Science ID A1986D800800008

    View details for PubMedID 3528333

  • HUMAN INTERFERON ALPHA IN MALIGNANT-LYMPHOMA AND HODGKINS-DISEASE - RESULTS OF THE AMERICAN CANCER SOCIETY TRIAL CANCER Horning, S. J., Merigan, T. C., Krown, S. E., GUTTERMAN, J. U., Louie, A., Gallagher, J., MCCRAVEY, J., Abramson, J., Cabanillas, F., Oettgen, H., Rosenberg, S. A. 1985; 56 (6): 1305-1310

    Abstract

    Forty-nine patients with non-Hodgkin's lymphoma or Hodgkin's disease were entered into a multi-institutional phase II trial to evaluate the antitumor activity of human interferon alpha, prepared from buffy coats. Interferon alpha was administered intramuscularly in doses of 1 X 10(6) u, 3 X 10(6) u or 9 X 10(6) u daily for 30 days. Objective partial responses were seen in 3 of 18 patients with nodular lymphoma, all at the 9 X 10(6) u dose. Interferon alpha was not observed to be of therapeutic benefit in the other subtypes of non-Hodgkin's lymphoma or Hodgkin's disease. The major toxicities consisted of fatigue, fever, myalgias and weight loss. Serum interferon levels obtained 3 to 4 hours after injection varied widely, even among patients treated at the same dose level. Despite the relatively low doses of interferon used and the brief period of administration, this study extends the earlier observations of the antitumor effect of interferon in nodular lymphoma. These results are discussed in relation to the cumulative experience in human lymphoma using alpha interferons induced in human leukocytes and those produced in bacteria by recombinant DNA techniques.

    View details for Web of Science ID A1985APT3300013

    View details for PubMedID 4027869

  • CUTANEOUS MALIGNANT-MELANOMA AFTER HODGKINS-DISEASE ANNALS OF INTERNAL MEDICINE TUCKER, M. A., MISFELDT, D., Coleman, C. N., Clark, W. H., Rosenberg, S. A. 1985; 102 (1): 37-41

    Abstract

    Eight cutaneous malignant melanomas occurred in 6 of 1405 patients with Hodgkin's disease, although the expected incidence rate was 0.77 (relative risk, 8; 95% confidence interval, 3 to 17). One melanoma was a thin, level II lesion less than 0.76 mm thick; the rest were mostly bulky, deeply invasive lesions despite close clinical surveillance. The melanomas spread aggressively; 3 of 6 patients died within 1 to 3 years. Two of the six patients developed a second primary malignant melanoma 1 year after the first. Two of six patients had biopsy-proven dysplastic nevus syndrome, a known precursor to cutaneous malignant melanoma, and an additional 3 patients had clinical evidence of dysplastic nevus syndrome. Histologically, the malignant melanomas showed a sparse inflammatory infiltrate, an abnormal host response seen previously in cutaneous melanomas developing in immunosuppressed patients. Dysplastic nevi may identify patients at highest risk who require modified medical management.

    View details for Web of Science ID A1985TZ58500006

    View details for PubMedID 3966743

  • LATE RELAPSE AMONG PATIENTS TREATED FOR HODGKINS-DISEASE ANNALS OF INTERNAL MEDICINE Herman, T. S., Hoppe, R. T., Donaldson, S. S., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. 1985; 102 (3): 292-297

    Abstract

    Of 1360 consecutive patients with Hodgkin's disease treated at Stanford University, 1312 patients (96%) had complete remission, but 424 patients had a relapse. Fifty-five patients had relapses 36 months or more after completion of therapy. The actuarial risk of relapse in patients disease-free 3 years after therapy was 12.9%. The occurrence of late relapse was significantly related to stage I disease and nodular sclerosis histologic subtype. Late relapse was detected in 88% of patients by history, physical findings, or chest radiographs. Most patients with stage III and IV disease had late relapses in previously irradiated nodes or extranodally, but patients with stage I and II disease had late relapses primarily in unirradiated nodes. Disease-free survival after salvage therapy for late relapse was similar to that seen after treatment of earlier relapse. Prolonged surveillance of patients for late relapse is necessary after treatment of patients with Hodgkin's disease.

    View details for Web of Science ID A1985ACZ2400002

    View details for PubMedID 3970468

  • THE EVOLUTION AND SUMMARY RESULTS OF THE STANFORD RANDOMIZED CLINICAL-TRIALS OF THE MANAGEMENT OF HODGKINS-DISEASE - 1962-1984 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Rosenberg, S. A., KAPLAN, H. S. 1985; 11 (1): 5-22

    Abstract

    This is a summary report of the Stanford randomized clinical trials of the management of Hodgkin's disease, initiated in 1962. There have been four major changes in the treatment protocols during this 22 year period. Between 1962-67, 132 patients with CS I, II and III disease were enrolled on various radiation trials. Between 1968-74, 367 patients were enrolled on studies primarily evaluating the role of adjuvant MOPP chemotherapy. Between 1974-80, variations in the chemotherapy regimen and the sequences of the combined modality programs were studied. The current studies, initiated in 1980, have enrolled 102 patients, and test a new mild adjuvant chemotherapy, VBM, (vinblastine, bleomycin and methotrexate) and utilizes ABVD in combined modality and alternating regimens. During the two decades of these studies, involving more than 800 patients, the initial remission rate and duration and the survival of all patients treated have progressively improved.

    View details for Web of Science ID A1985ABW5500002

    View details for PubMedID 3881376

  • THE POTENTIAL BENEFITS OF THERAPEUTIC SPLENECTOMY FOR PATIENTS WITH HODGKINS-DISEASE AND NON-HODGKINS LYMPHOMAS INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Schreiber, D. P., Jacobs, C., Rosenberg, S. A., Cox, R. S., Hoppe, R. T. 1985; 11 (1): 31-36

    Abstract

    Thirty-four patients with Hodgkin's disease and non-Hodgkin's lymphoma underwent therapeutic splenectomies to improve hematologic tolerance for chemotherapy. The mean age was 40 years; there were 16 males and 18 females. Fourteen had Hodgkin's disease, 19 had non-Hodgkin's lymphoma, and 1 had malignant histiocytosis. Nineteen had palpable splenomegaly, 19 had marrow involvement and 20 had splenic involvement by lymphoma. The following data were analyzed before and after splenectomy: mean white blood cell count (WBC) and platelet count on planned first day of cycle, delay ratio of chemotherapy delivery and percent maximal dose rate. Thirteen patients had non-Hodgkin's lymphoma, splenomegaly and positive bone marrow and showed significant benefit in all of the aforementioned parameters. Of the patients with prior irradiation, only those who completed their radiation greater than six months prior to splenectomy showed benefit. Ten patients had Hodgkin's disease, negative bone marrow and no splenomegaly. This group showed significant improvement in mean platelet count but more limited benefit in delay ratio and percent maximal dose rate. Thus, selected patients with lymphoma who are experiencing delays in chemotherapy because of poor count tolerance may benefit from splenectomy.

    View details for Web of Science ID A1985ABW5500004

    View details for PubMedID 3838166

  • THE CONCEPT, EVOLUTION AND PRELIMINARY-RESULTS OF THE CURRENT STANFORD CLINICAL-TRIALS FOR HODGKINS-DISEASE CANCER SURVEYS Hoppe, R. T., Horning, S. J., Rosenberg, S. A. 1985; 4 (2): 459-475

    View details for Web of Science ID A1985AXK0700010

    View details for PubMedID 3916086

  • KARNOFSKY MEMORIAL LECTURE - THE LOW-GRADE NON-HODGKINS LYMPHOMAS - CHALLENGES AND OPPORTUNITIES JOURNAL OF CLINICAL ONCOLOGY Rosenberg, S. A. 1985; 3 (3): 298-310

    View details for Web of Science ID A1985ADF2000003

  • THE TREATMENT OF MALIGNANT HISTIOCYTOSIS BLOOD Tseng, A., Coleman, C. N., Cox, R. S., Colby, T. V., Turner, R. R., Horning, S. J., Rosenberg, S. A. 1984; 64 (1): 48-53

    Abstract

    Twenty-four consecutive cases of malignant histiocytosis (MH) treated at Stanford Medical Center between 1973 and 1983 have been reviewed. Most patients presented with systemic symptoms (91%) and advanced disease (stage IV, 80%). Multiple organ involvement was common. In six cases, pathologic tissue was further characterized by frozen section immune histochemistry, using a panel of monoclonal antibodies known to react with monocytes and macrophages, as well as a variety of hematopoietic cells. One case expressed a mature monocyte/macrophage phenotype; three cases were considered null cell or primitive lesions; and two cases were identified as probable T cell lymphomas. Seven patients underwent splenectomy. Two patients died prior to any treatment. Twenty-two patients were treated with CHOP (cyclophosphamide, Adriamycin, vincristine, prednisone) +/- bleomycin (B), +/- midcycle high-dose methotrexate (HD-MTX) with leucovorin rescue. Seven patients received prophylactic intrathecal MTX. Of 22 evaluable patients, there was a 68% complete response rate (CR), a 23% partial response rate (PR), and a 9% no response rate (NR). Median duration of CR was 30+ months; median duration of PR was 2.4 months. Median survival for patients attaining a CR has not been reached v 3 months for the PR and NR groups. For all 24 patients, median survival was 2 years, with a 5-year actuarial survival of 40%. Multivariate analysis revealed that a platelet count less than 150,000 (P Cox = .005) and the dose of drug delivered (P Cox = .057) were the most important prognostic factors. Prophylactic intrathecal MTX therapy and splenectomy did not influence survival. Although MH is an aggressive disease with a poor prognosis, it is potentially curable. Systematic and aggressive treatment should further improve the outcome.

    View details for Web of Science ID A1984SY61300006

    View details for PubMedID 6610448

  • HODGKINS-DISEASE IN PATIENTS OVER 60 YEARS OLD ANNALS OF INTERNAL MEDICINE AUSTINSEYMOUR, M. M., Hoppe, R. T., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. 1984; 100 (1): 13-18

    Abstract

    Fifty-two patients 60 to 75 years of age were treated for Hodgkin's disease at Stanford University between 1968 and 1980. Adequate staging was defined as including a lymphogram and staging laparotomy for stage I to III and a positive bone marrow or liver biopsy or other evidence of diffuse involvement of extralymphatic tissues for stage IV. Adequate treatment was defined as subtotal lymphoid irradiation for pathologic stages I to IIA; total lymphoid irradiation for stages IIB to IIIA; and chemotherapy with or without irradiation for stages IIIB to IV. Twenty-four patients (46%) had advanced disease (IIIB to IV). Those patients who received appropriate treatment had a median survival of only 39 months. Of the 28 patients with limited disease (I to IIIA), 15 had laparotomy and adequate treatment. Thirteen did not have a laparotomy and 7 were treated with involved-field irradiation. The 5-year survival rate in the laparotomy-staged and adequately treated group was 86%, but in the clinically staged group, only 35% (p = 0.006).

    View details for Web of Science ID A1984RY26100003

    View details for PubMedID 6691638

  • COMPUTED-TOMOGRAPHY, LYMPHOGRAPHY, AND STAGING LAPAROTOMY - CORRELATIONS IN INITIAL STAGING OF HODGKIN DISEASE AMERICAN JOURNAL OF ROENTGENOLOGY Castellino, R. A., Hoppe, R. T., Blank, N., Young, S. W., Neumann, C., Rosenberg, S. A., KAPLAN, H. S. 1984; 143 (1): 37-41

    Abstract

    One hundred twenty-one patients with newly diagnosed, previously untreated Hodgkin disease underwent abdominal and pelvic computed tomographic (CT) scanning and bipedal lymphography. These studies were followed by staging laparotomy, which included biopsy of the liver, retroperitoneal and mesenteric lymph nodes, and splenectomy. Correlation of the results of the imaging studies with the histopathologic diagnoses revealed a small--but significant--increased accuracy of lymphography compared with CT in assessing the retroperitoneal lymph nodes. The theoretical advantages of CT scanning in detecting lymphomatous deposits in lymph nodes about the celiac axis and the mesentery, or in the liver and spleen, were not confirmed. In part this was due to the relative incidence and the small size of individual lesions at these sites in patients with Hodgkin disease at the time of initial diagnosis and staging.

    View details for Web of Science ID A1984SW34800010

    View details for PubMedID 6610327

  • COMBINATION CHEMOTHERAPY FOR ADVANCED HODGKINS-DISEASE AFTER FAILURE OF MOPP - ABVD AND B-CAVE ANNALS OF INTERNAL MEDICINE Harker, W. G., KUSHLAN, P., Rosenberg, S. A. 1984; 101 (4): 440-446

    Abstract

    Between 1973 and 1982, 110 patients with advanced Hodgkin's disease who had had disease progression while receiving MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) chemotherapy or a relapse after a MOPP-induced complete remission were treated with either ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) (58 patients) or B-CAVe (bleomycin, lomustine, doxorubicin, and vinblastine) (52 patients) chemotherapy in concurrent nonrandomized trials. Responses were seen in 39 of 55 (71%) evaluable ABVD-treated patients--21 (38%) complete and 18 partial responses--and in 34 of 48 (71%) evaluable B-CAVe-treated patients--21 (44%) complete and 13 partial responses. The median duration of the ABVD-induced complete remissions is greater than 25 months compared with 24.3 months for B-CAVe-induced remissions. The 5-year actuarial freedom from progression is 8.5% for evaluable ABVD-treated patients and 25% for B-CAVe-treated patients (p = 0.10). Toxicity in the two treatment groups was similar, with only significant thrombocytopenia (platelet count, less than 50 000/mm3) being more common with B-CAVe. Although most patients with Hodgkin's disease refractory to MOPP treatment will respond to either ABVD or B-CAVe chemotherapy, subsequent long-term disease-free survival is unusual. The need for improved treatment programs for this patient group is evident.

    View details for Web of Science ID A1984TM39400004

    View details for PubMedID 6206757

  • THE NATURAL-HISTORY OF INITIALLY UNTREATED LOW-GRADE NON-HODGKINS LYMPHOMAS NEW ENGLAND JOURNAL OF MEDICINE Horning, S. J., Rosenberg, S. A. 1984; 311 (23): 1471-1475

    Abstract

    To learn more about the natural history of low-grade non-Hodgkin's lymphoma, we have studied 83 patients in whom the advanced disease was initially managed without therapy. Actuarial survival was 82 per cent at 5 years and 73 per cent at 10 years. The median time until therapy was required was three years. Spontaneous regressions occurred in 19 untreated patients (23 per cent), including 30 per cent of patients with nodular, poorly differentiated lymphocytic lymphoma. Histologic transformation to an intermediate-grade or high-grade lymphoma occurred both before and after primary therapy. The actuarial risk of transformation among the initially untreated patients was similar to that in a group of patients treated at this institution immediately after diagnosis. Neither the time to histologic transformation nor the incidence of transformation was influenced by when therapy was started.

    View details for Web of Science ID A1984TU61400003

    View details for PubMedID 6548796

  • PHASE-I STUDY OF HUMAN-LEUKOCYTE INTERFERON IN PATIENTS WITH ADVANCED CANCER JOURNAL OF BIOLOGICAL RESPONSE MODIFIERS Horning, S. J., Levine, J. F., Meyer, M., Merigan, T. C., Rosenberg, S. A. 1983; 2 (1): 47-56

    Abstract

    Seventeen patients with disseminated cancer were treated with a human leukocyte interferon preparation in doses ranging from 3 X 10(6) to 50 X 10(6) IU daily for 30 days. Doses above 18 X 10(6) IU were considered intolerable in this schedule of administration due to severe fatigue and weight loss. Serum concentrations of interferon were lower than those achieved with either partially pure native or recombinant leukocyte interferon. Three of 17 patients in this study showed minimal evidence of tumor regression. Two patients treated at doses of 18 X 10(6), 36 X 10(6), and 50 X 10(6) IU also received a 5 X 10(6)-IU dose of a second human leukocyte interferon preparation. The latter resulted in less toxicity but similar serum levels. These results suggest that human leukocyte interferons prepared in the same manner may differ significantly in their in vivo biologic properties.

    View details for Web of Science ID A1983RF47400003

    View details for PubMedID 6196450

  • ANALYSIS OF NON-HODGKINS LYMPHOMAS WITH NODULAR AND FAVORABLE HISTOLOGIES, STAGE-I AND STAGE-II CANCER PARYANI, S. B., Hoppe, R. T., Cox, R. S., Colby, T. V., Rosenberg, S. A., KAPLAN, H. S. 1983; 52 (12): 2300-2307

    Abstract

    Between 1961 and 1980, 124 patients with Stages I and II nodular lymphocytic poorly differentiated (NLPD), nodular mixed histiocytic-lymphocytic (NM), nodular histiocytic (NH), or diffuse well-differentiated lymphocytic (DLWD) lymphoma according to the Rappaport classification were treated at Stanford University. Initial staging studies included lymphangiography in 91%, bone marrow biopsy in 93%, and diagnostic or staging laparotomy in 41% of patients. All patients were treated with megavoltage irradiation to either involved field (IF), extended field (EF), or total lymphoid fields (TLI) to a total dose of 3500-5000 rad. Median follow-up was 5.5 years. Kaplan-Meier actuarial survival at 5, 10, and 15 years was 84%, 68%, and 42%, respectively. Freedom from relapse at 5 and 10 years was 62% and 54%, respectively. In addition, there was a flattening of the relapse curve suggesting cure of approximately 50% of patients. Patients with NH had a significantly poorer survival (P = 0.03) while there were no differences among the other histologic groups. Freedom from relapse was higher in patients treated with TLI compared with those treated with IF or EF. However, a prospective study of 20 patients who all underwent staging laparotomy and were randomized to treatment with either IF or TLI revealed no significant difference in either survival or freedom from relapse. Utilizing multivariate analysis for the entire group, important prognostic factors included age, stage, histologic subtype, and treatment field.

    View details for Web of Science ID A1983RT51300023

    View details for PubMedID 6416664

  • HODGKINS-DISEASE LIMITED TO INTRATHORACIC SITES CANCER Johnson, D. W., Hoppe, R. T., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. 1983; 52 (1): 8-13

    Abstract

    The records of 1470 patients treated for Hodgkin's disease between 1960 and 1980 were reviewed, and sites of initial involvement were scored. Forty-four patients had disease limited to the chest after clinical and/or pathologic staging. Eighteen asymptomatic patients underwent a staging laparotomy and no occult subdiaphragmatic disease was identified. All 44 patients were treated with irradiation (XRT) to involved (IF), mantle (M), subtotal lymphoid (STLI), or total lymphoid (TLI) fields. Eighteen patients were also treated with chemotherapy, consisting of nitrogen mustard, vincristine, and procarbazine, with or without prednisone (MOP(P)), or procarbazine, melphalan, and vinblastine (PAVe). With a median follow-up of 7.5 years the survival at five and ten years was 93% and 89%, respectively, and the freedom from relapse (FFR) at five and ten years was 81% and 78%, respectively. Ten patients relapsed, all in supradiaphragmatic sites (including six relapses within lung parenchyma). Eight had initially received XRT alone, and two had received combined modality treatment. The risk of relapse in the 26 patients treated with XRT alone varied inversely with the volume irradiated: IF, 100% (3/3); M, 45% (3/7); STLI, 17% (2/12); TLI, 0% (0/4) relapsed. Seven of the eight relapsing patients treated with XRT alone were salvaged with subsequent XRT and/or chemotherapy whereas both of the combined modality patients who relapsed, died with progressive disease despite all salvage therapy.

    View details for Web of Science ID A1983QV52700002

    View details for PubMedID 6850546

  • HISTOLOGIC CONVERSION IN THE NON-HODGKINS LYMPHOMAS JOURNAL OF CLINICAL ONCOLOGY Acker, B., Hoppe, R. T., Colby, T. V., Cox, R. S., KAPLAN, H. S., Rosenberg, S. A. 1983; 1 (1): 11-16

    Abstract

    Between July 1, 1971 and December 31, 1978, 150 patients with favorable subtypes of non-Hodgkin's lymphoma [nodular poorly differentiated lymphocytic (NLPD), nodular mixed, or diffuse well differentiated lymphocytic] were entered into prospective randomized clinical trials at Stanford University. Treatments included involved field, total lymphoid, or whole body irradiation, single alkylating agent chemotherapy, combination chemotherapy with cyclophosphamide, vincristine and prednisone (CVP) or with cyclophosphamide, vincristine, procarbazine, and prednisone (C-MOPP), or various combinations of chemotherapy and irradiation. The initial complete response rate (CR) was 79%. Among patients who achieved a CR, 31% later relapsed. There were 78 patients who either failed to achieve a CR or achieved a CR and later relapsed. Histologic conversion (change from initially favorable to an unfavorable subtype of non-Hodgkin's lymphoma) was documented in 22/78 patients (28%). However, the actuarial risk for conversion was actually much greater (60% at 8 yr). The median time to documentation of conversion was 51 mo. The most common type of histologic conversion was from NLPD to diffuse histiocytic lymphoma. Documented histologic conversion was often associated with a more aggressive clinical behavior of the lymphoma, and the median survival after conversion was less than 1 yr. However, those patients who achieved a CR after conversion had a more favorable outcome (actuarial survival 75% at 5 yr). No specific risk factors predictive of histologic conversion could be identified.

    View details for Web of Science ID A1983QW72900003

    View details for PubMedID 6366124

  • EXTRALYMPHATIC INVOLVEMENT IN DIFFUSE NON-HODGKINS LYMPHOMA JOURNAL OF CLINICAL ONCOLOGY Paryani, S., Hoppe, R. T., Burke, J. S., Sneed, P., Dawley, D., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. 1983; 1 (11): 682-688

    Abstract

    Between 1961 and 1982, 543 patients with diffuse histiocytic, mixed, or undifferentiated lymphoma were treated at Stanford University, Stanford, Calif. Of this group, 281 (52%) had extralymphatic lesions and the 111 patients with stage IE and IIE disease were subjected to analysis. Most patients (94) had diffuse histiocytic lymphoma. Lymphangiography was performed in 77%, bone marrow biopsy in 91%, and diagnostic or staging laparotomy in 52% of the patients. All but five patients were treated with megavoltage irradiation and 35 patients received combination chemotherapy. Median follow-up was 4.0 years. Kaplan-Meier actuarial survival at five and 10 years was 46% and 36%, respectively. Freedom from relapse (FFR) at five years was 49% with no relapses beyond that point. The most common extralymphatic sites were the gastrointestinal tract, the head and neck region, and the lung. Prognosis could not be correlated with the specific sites of involvement. Patients with bulky disease (greater than 10 cm) or more than three sites of involvement had a significantly lower survival and FFR. There was no significant difference in outcome for patients treated with irradiation or combined modality therapy. Most patients (62%) relapsed in distant extralymphatic sites.

    View details for Web of Science ID A1983RQ63300003

    View details for PubMedID 6422003

  • LATE RELAPSE FROM COMPLETE REMISSION IN NODULAR AND DIFFUSE HISTIOCYTIC LYMPHOMA CANCER Mead, G. M., MacKintosh, F. R., Burke, J. S., Rosenberg, S. A. 1983; 52 (8): 1356-1359

    Abstract

    Twelve patients with unfavorable prognosis lymphomas (diffuse histiocytic lymphoma, 11; nodular histiocytic lymphoma, 1) treated predominantly with radiation therapy, are described in whom relapse of disease occurred late (greater than 2.5 years, 2.8-26 years; median, 6.25 years) after achieving a complete remission. Although relapse probably represented regrowth of clinically quiescent tumor, it is also possible that these were second malignancies, perhaps occurring in a predisposed host. Continued long-term analysis of clinical trials is important to document this uncommon occurrence.

    View details for Web of Science ID A1983RL58500002

    View details for PubMedID 6616403

  • CLINICAL ASPECTS OF NON-HODGKINS LYMPHOMAS PRESENTING WITH DISCORDANT HISTOLOGIC SUBTYPES CANCER Mead, G. M., KUSHLAN, P., ONEIL, M., Burke, J. S., Rosenberg, S. A. 1983; 52 (8): 1496-1501

    Abstract

    From July 1971 to December 1980, 323 cases of non-Hodgkin's lymphoma were randomized into prospective clinical trials at Stanford University Medical Center. Analysis of these cases revealed 30 patients (9.3% of the total) with disease of different histologic subtypes at separate anatomic sites (discordant lymphomas). On further analysis, 16 of these patients (4.8% of the total) were found to have disease of different histological and prognostic types. Recommendation is made that initial therapy be directed at the poor-prognosis component of these tumors. Relapses of both favorable prognostic types and unfavorable histologic types were seen, and further biopsy at the time of relapse is recommended in these cases.

    View details for Web of Science ID A1983RL58500026

    View details for PubMedID 6352001

  • PREDICTIVE VALUE OF LYMPHOGRAPHY FOR SITES OF SUBDIAPHRAGMATIC DISEASE ENCOUNTERED AT STAGING LAPAROTOMY IN NEWLY DIAGNOSED HODGKINS-DISEASE AND NON-HODGKINS LYMPHOMA JOURNAL OF CLINICAL ONCOLOGY Castellino, R. A., Dunnick, N. R., Goffinet, D. R., ROSENBERG, S. R., KAPLAN, H. S. 1983; 1 (9): 532-536

    View details for Web of Science ID A1983RK55800003

    View details for PubMedID 6668514

  • A DOSE AND TIME RESPONSE ANALYSIS OF THE TREATMENT OF HODGKINS-DISEASE WITH MOPP CHEMOTHERAPY JOURNAL OF CLINICAL ONCOLOGY Carde, P., MacKintosh, F. R., Rosenberg, S. A. 1983; 1 (2): 146-153

    Abstract

    A dose-response analysis of the results of MOPP chemotherapy in 132 patients with Hodgkin's disease was carried out. Complex statistical methods were utilized including 40 different dose-time variables and multivariate logistic analyses of 21 clinical variables, both simply and in stepwise regression. These covariates were not independent, and in stepwise regression analysis only B-symptoms and the mean three-cycle rate of drug delivery significantly influenced complete remission attainment. Two parameters, bone marrow involvement (negative) and lung involvement (positive), significantly influenced the duration of complete remission. Survival was influenced adversely by pleural involvement (effusion), advanced age, and B-symptoms. Analyses indicate that the dose of all three drugs (mustard, vincristine, and procarbazine), and the rate of drug delivery during the first three cycles are important in achieving maximal complete response rates, especially for patients with B-symptoms.

    View details for Web of Science ID A1983QW73100011

    View details for PubMedID 6689425

  • LYMPHOMAS INVOLVING THE GASTROINTESTINAL-TRACT GASTROENTEROLOGY Gray, G. M., Rosenberg, S. A., Cooper, A. D., Gregory, P. B., Stein, D. T., HERZENBERG, H. 1982; 82 (1): 143-152

    View details for Web of Science ID A1982MW05000026

    View details for PubMedID 7053326

  • HODGKINS-DISEASE AND THE PREGNANT PATIENT - RESPONSE ANNALS OF INTERNAL MEDICINE Jacobs, C., Donaldson, S. S., Rosenberg, S. A., KAPLAN, H. S. 1982; 96 (5): 682-682

    View details for Web of Science ID A1982NP94900040

  • CENTRAL NERVOUS-SYSTEM INVOLVEMENT IN NON-HODGKINS LYMPHOMA - AN ANALYSIS OF 105 CASES CANCER MacKintosh, F. R., Colby, T. V., PODOLSKY, W. J., Burke, J. S., Hoppe, R. T., Rosenfelt, F. P., Rosenberg, S. A., KAPLAN, H. S. 1982; 49 (3): 586-595

    Abstract

    Records of 105 patients with central nervous system (CNS) lymphoma were analyzed in order to better define the incidence, setting, and management of CNS lymphoma and the role for CNS prophylaxis. Survival was best for patient under 30 years of age treated with whole-brain irradiation and intrathecal (IT) chemotherapy whose CNS involvement was an isolated event (median survival time, 1.8 years). Survival was worst for patients over 30 years of age whose CNS invasion occurred at a time of progressive systemic lymphoma (median time ten weeks if treated with whole-brain irradiation with or without IT chemotherapy). The risk of CNS invasion was greatest for those with lymphoblastic lymphoma. Among patients with Stage IIE, III, or IV histiocytic lymphoma, the risk of CNS involvement was greatest for those with progressive or relapsing disease or involvement of the testes, peripheral blood, or epidural space of the spinal cord.

    View details for Web of Science ID A1982MY94600029

    View details for PubMedID 7059915

  • PREGNANCY AND HODGKINS-DISEASE ANNALS OF INTERNAL MEDICINE Jacobs, C., Donaldson, S. S., Rosenberg, S. A., KAPLAN, H. S. 1982; 96 (4): 532-532

    View details for Web of Science ID A1982NJ93900044

  • PROGNOSTIC FACTORS IN PATHOLOGIC STAGE-III HODGKINS-DISEASE CANCER TREATMENT REPORTS Hoppe, R. T., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. 1982; 66 (4): 743-749

    View details for Web of Science ID A1982NQ55100017

    View details for PubMedID 7074644

  • NATIONAL-CANCER-INSTITUTE SPONSORED STUDY OF CLASSIFICATIONS OF NON-HODGKINS LYMPHOMAS - SUMMARY AND DESCRIPTION OF A WORKING FORMULATION FOR CLINICAL USAGE CANCER Rosenberg, S. A. 1982; 49 (10): 2112-2135

    View details for Web of Science ID A1982NN04400023

  • SINGLE AGENT PALLIATIVE CHEMOTHERAPY FOR END-STAGE HODGKINS-DISEASE CANCER Mead, G. M., Harker, W. G., KUSHLAN, P., Rosenberg, S. A. 1982; 50 (5): 829-835

    View details for Web of Science ID A1982PC14300003

    View details for PubMedID 6178495

  • THE MANAGEMENT OF STAGE-I-II HODGKINS-DISEASE WITH IRRADIATION ALONE OR COMBINED MODALITY THERAPY - THE STANFORD EXPERIENCE BLOOD Hoppe, R. T., Coleman, C. N., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. 1982; 59 (3): 455-465

    Abstract

    At Stanford University, between 1968 and 1978, 230 patients with pathologic stage I--II Hodgkin's disease were treated on prospective clinical trials with either irradiation alone or irradiation followed by 6 cycles of adjuvant combination chemotherapy. The actuarial survival at 10 yr was 84% for patients in either treatment group. Freedom from relapse at 10 yr was 77% among patients treated with irradiation alone and 84% after treatment with combined modality therapy [p(Gehan) = 0.09]. Freedom from second relapse at 10 yr was 89% and 94%, respectively [p(Gehan) = 0.56]. Several prognostic factors were evaluated in order to identify patients at high risk for relapse or with poor ultimate survival after initial treatment with irradiation alone. Systemic symptoms, histologic subtype, age, and limited extranodal involvement (E-lesions) did not affect the prognosis of patients and failed to identify patients whose survival could be improved by the routine use of combined modality therapy. Patients with large mediastinal masses (mediastinal mass ratio greater than or equal to 1/3) had a significantly poorer freedom from relapse when treated with irradiation alone than when treated initially with combined modality therapy [45% versus 81% at 10 yr, p(Gehan) = 0.03). The 10-yr survival of these patients, however, was not significantly different (84% versus 74%). The implications of these observations on the management of patient with early stage Hodgkin's disease are discussed.

    View details for Web of Science ID A1982NF36400001

    View details for PubMedID 7059665

  • CLINICAL AND IMMUNOLOGICAL EFFECTS OF RECOMBINANT LEUKOCYTE A INTERFERON IN 8 PATIENTS WITH ADVANCED CANCER JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Horning, S. J., Levine, J. F., MILLER, R. A., Rosenberg, S. A., Merigan, T. C. 1982; 247 (12): 1718-1722

    Abstract

    The clinical and immunologic effects of a biosynthetic human leukocyte interferon, recombinant leukocyte A interferon (IFL-rA), are reported in eight patients with advanced cancer. Single escalating doses from 3 X 10(6) units to 198 X 10(6) units were given by intramuscular injection in a phase I study. Major toxic effects included pyrexia, fatigue, myalgia, and headache. Data on the effects of IFL-rA on lymphocyte subpopulations and peripheral blood mononuclear-cell surface beta 2-microglobulin are presented. Four of eight patients had objective tumor regression, indicating that further investigation of this biologically active material is warranted.

    View details for Web of Science ID A1982NG35000017

    View details for PubMedID 6174742

  • THE RELATIVE CLINICAL-VALUE OF THE VARIOUS CLASSIFICATIONS OF HUMAN NON-HODGKINS LYMPHOMAS UCLA SYMPOSIA ON MOLECULAR AND CELLULAR BIOLOGY Rosenberg, S. A. 1982; 24: 43-50

    View details for Web of Science ID A1982PM05900005

  • MANAGEMENT OF THE PREGNANT PATIENT WITH HODGKINS-DISEASE ANNALS OF INTERNAL MEDICINE Jacobs, C., Donaldson, S. S., Rosenberg, S. A., KAPLAN, H. S. 1981; 95 (6): 669-675

    Abstract

    Fifteen pregnant women with Hodgkin's disease were followed. Five patients had irradiation, 1000 to 3000 rad to the neck, mediastinum, or both, during the second or third trimester with normal outcome of pregnancy. One patient had a spontaneous abortion in the first trimester after radiotherapy of 4400 rad to the breast, an estimated fetal dose of 9 rad. One patient who received chlorambucil throughout pregnancy delivered a normal infant. Six patients had therapeutic abortions; one had early induction of labor. In one patient previously treated for supradiaphragmatic Hodgkin's disease, detection of a supradiaphragmatic relapse was delayed because of pregnancy. We recommend abortion for patients who develop Hodgkin's disease early in pregnancy or who have received chemotherapy or irradiation during the first trimester. During the latter half of pregnancy, asymptomatic disease may be closely followed but early delivery is recommended. Supradiaphragmatic, symptomatic disease can be treated with modified irradiation. For subdiaphragmatic, symptomatic, or extranodal disease, single-agent chemotherapy may be preferable. Treatment requires individualization to insure that the patient will be cured and the fetus protected.

    View details for Web of Science ID A1981MT14300001

    View details for PubMedID 7305142

  • LYMPHOBLASTIC LYMPHOMA IN ADULTS - RESULTS OF A PILOT PROTOCOL BLOOD Coleman, C. N., Cohen, J. R., Burke, J. S., Rosenberg, S. A. 1981; 57 (4): 679-684

    Abstract

    Thirteen adult patients with histologically confirmed lymphoblastic lymphoma were treated with an intensive chemotherapy program consisting of induction with cyclophosphamide, adriamycin, vincristine, and prednisone (modified CHOP); consolidation and central nervous system (CNS) prophylaxis with methotrexate intrathecally and by high-dose intravenous injection, citrovorum factor and L-asparaginase; reinforcement with CHOP; and maintenance with 6-mercaptopurine and methotrexate. Treatment duration was 1 yr. A 14th patient with T-cell acute lymphoblastic leukemia was also treated at presentation by the same regimen. Thirteen patients had at least a mediastinal mass or abnormal cells in the bone marrow; one presented with CNS disease. The median age was 22 yr (range 16--50), and male--female ratio was 2.5:1. All patients had a rapid complete clinical response. Of the 13 patients without initial CNS disease, 4 have relapsed, 3 with primary CNS relapse and 1 with a recurrent abdominal mass. Five patients have died, 2 from drug toxicity, 2 from CNS relapse, and 1 from chronic myelogenous leukemia, which was diagnosed simultaneously with the lymphoblastic lymphoma. The median follow-up is 19 mo, and all patients have completed their planned therapy. At 3 yr, the actuarial survival is 61% and relapse-free survival is 56%.

    View details for Web of Science ID A1981LK24900009

    View details for PubMedID 6970598

  • FEMALE REPRODUCTIVE POTENTIAL AFTER TREATMENT FOR HODGKINS-DISEASE NEW ENGLAND JOURNAL OF MEDICINE Horning, S. J., Hoppe, R. T., KAPLAN, H. S., Rosenberg, S. A. 1981; 304 (23): 1377-1382

    Abstract

    The probability of maintaining ovarian function, becoming pregnant, and delivering a normal child is important to young women anticipating successful therapy for Hodgkin's disease. In this study, reproductive function was retrospectively examined in 103 women 40 years old or younger who had undergone treatment for Hodgkin's disease with total-lymphoid irradiation (TLI) alone, combination chemotherapy, or combined TLI and chemotherapy. Infertility was directly related to gonadal exposure to therapy and to age at treatment. Twenty women became pregnant after receiving total-nodal irradiation or combination chemotherapy or both. No fetal wastage occurred, and no birth defects were seen in the 24 infants born to these women. Even after intensive treatment programs, women successfully treated for Hodgkin's disease have become pregnant and delivered phenotypically normal children.

    View details for Web of Science ID A1981LR62000001

    View details for PubMedID 7231460

  • EXTRA-LYMPHATIC HODGKINS-DISEASE - PROGNOSIS AND RESPONSE TO THERAPY AMERICAN JOURNAL OF MEDICINE Torti, F. M., Portlock, C. S., Rosenberg, S. A., KAPLAN, H. S. 1981; 70 (3): 487-492

    Abstract

    Three hundred eighteen patients with pathologic stage IA and IB, IIA and IIB, and IIIA Hodgkin's disease who entered into Stanford University Medical Center randomized trials comparing radiation therapy alone to radiation therapy plus six cycles of adjuvant chemotherapy were evaluated. Of these, 54 patients had extralymphatic (E) lesions. There were five relapses among these patients (9 percent), not different from the 37 relapses among the remaining 264 patients (14 percent) with Hodgkin's disease confined to the lymphatic system. Actuarial survival and freedom from relapse were not significantly different for patients with or without extralymphatic disease. The survival of patients with extralymphatic disease was similar whether they received radiation therapy alone or radiation therapy plus chemotherapy.

    View details for Web of Science ID A1981LG10200004

    View details for PubMedID 7011010

  • THE TREATMENT OF ADVANCED STAGE FAVORABLE HISTOLOGY NON-HODGKINS LYMPHOMA - A PRELIMINARY-REPORT OF A RANDOMIZED TRIAL COMPARING SINGLE AGENT CHEMOTHERAPY, COMBINATION CHEMOTHERAPY, AND WHOLE-BODY IRRADIATION BLOOD Hoppe, R. T., KUSHLAN, P., KAPLAN, H. S., Rosenberg, S. A., Brown, B. W. 1981; 58 (3): 592-598

    Abstract

    Between 1975 and 1978, 51 patients with favorable histology non-Hodgkin's lymphomas, pathologic stage III-IV, were treated prospectively on a randomized treatment protocol. Treatment options were single alkylating agent chemotherapy, combination chemotherapy with cyclophosphamide, vincristine, and prednisone (CVP), or fractionated whole body irradiation followed by low dose involved field irradiation. The median follow-up interval in this group of patients is not 41 mo. Actuarial survival is excellent, 84% at 4 yr for the entire group, with similar survival observed for each of the three treatment options. Initial complete remission rates (64%, 88%, and 71%) were not significantly different in the three treatment arms. Frequent relapse after initial remission induction was noted, however, with a freedom from relapse at 4 yr of only 25%. The toxicities of the three therapies were acceptable. Acute complications of therapy were most numerous in the group of patients treated with CVP; however, long-term hematologic depression was most commonly observed in patients treated with whole body irradiation. In general, hematologic complications were more frequent among patients who had marrow involvement and intact spleens at the time of initial therapy. The relationship of this study to other clinical trials in the management of patients with advanced stage favorable histology lymphomas and its implications for future clinical trials are discussed.

    View details for Web of Science ID A1981MF74600026

    View details for PubMedID 7259838

  • HODGKINS-DISEASE - CURRENT STATUS AND FUTURE CHALLENGES SEMINARS IN ONCOLOGY Rosenberg, S. A. 1980; 7 (2): 212-214

    View details for Web of Science ID A1980JY20800013

    View details for PubMedID 6934622

  • DIFFUSE HISTIOCYTIC LYMPHOMA PRESENTING WITH GASTROINTESTINAL-TRACT LESIONS - THE STANFORD EXPERIENCE CANCER Rosenfelt, F., Rosenberg, S. A. 1980; 45 (8): 2188-2193

    Abstract

    The medical records of all patients with diffuse histiocytic lymphoma (DHL) presenting for treatment at the Stanford University Medical Center between 1970-1978 were reviewed. From this group of 284 patients, 48 were identified with gastrointestinal tract lesions at initial evaluation. Abdominal pain was the most common presenting symptom. Anorexia, weight loss, malaise, and weakness were also common complaints. Twenty percent of these patients noted abdominal masses and 15% experienced gastrointestinal bleeding. Gastric involvement was found in 56% of patients, small intestine in 25%, large intestine in 10%, and pancreas 8%. Following treatment, 83% of Stage IE patients, 43% of Stage IIE patients, and 27% of patients with Stage III and IV DHL achieved durable complete remissions. Considering all stages, a 54% complete remission rate was observed. Of the 26 patients achieving a complete remission, seven have relapsed and the remaining continue free of disease from 6+ to 82+ months. The median survival for patients obtaining a CR was greater than 36 months. Gastrointestinal bleeding or perforation probably as a consequence of therapy was noted 25% of patients. The implications of these findings for improved therapeutic programs and investigations are discussed.

    View details for Web of Science ID A1980JP30800029

    View details for PubMedID 6989486

  • PROGNOSTIC FACTORS IN PATHOLOGICAL STAGE-IIIA HODGKINS-DISEASE CANCER Hoppe, R. T., Rosenberg, S. A., KAPLAN, H. S., Cox, R. S. 1980; 46 (5): 1240-1246

    Abstract

    From July 1968 through December 1977, 171 previously untreated patients with pathological stage IIIA Hodgkin's disease were evaluated at Stanford University Medical Center. All patients underwent lymphography, staging laparotomy and splenectomy; 86 patients were treated with total lymphoid irradiation (mantle followed by inverted-Y) to 4400 rad. These patients received prophylactic irradiation to the preauricular region (3600 rad/4-5 wk.) if the high cervical lymph nodes were positive; the lung (1500 rad/4-5 wk.) if the ipsilateral pulmonary hilum was positive; and the liver (2200 rad/5-6 wk.) if the spleen was positive. Eighty-five patients were treated with total lymphoid irradiation followed by adjuvant chemotherapy-either nitrogen mustard, vincristine and procarbazine (MOP) or procarbazine, L-phenylalanine mustard, and vinblastine (PAVe). Five-year survival rates were not significantly different in the two groups (86% vs. 89%, P = .4); however, the five-year freedom from relapse rate was significantly better in the combined modality group (66% vs. 86%, P = .0026). Because of the success of MOP in the treatment of patients who had relapses after treatment with irradiation alone, the five-year freedom from second relapse rates in the two groups were not significantly different (85% vs. 88%, P = .8). Analysis of a large number of possible prognostic factors failed to identify any subgroup of patients whose survival was significantly improved by the use of adjuvant chemotherapy, including patients with "anatomic substage III2" (P = .52), clinical stage III (P = .26), unfavorable histology (P = .78), age greater than 39 yr. (P = .44), males (P = .55), and S- (P = .92). The most important factors indicating a benefit from adjuvant chemotherapy on survival were greater than or equal to 5 sites of involvement, including those above and below the diaphragm (P = .15) and extensive splenic involvement (more than four nodules detected in the splenectomy specimen) (P = .15). Possible explanations for these observations, which differ from those of series reported at other institutions, are discussed.

    View details for Web of Science ID A1980KF23500025

    View details for PubMedID 7214305

  • ALTERNATING CHEMOTHERAPY AND IRRADIATION IN THE TREATMENT OF ADVANCED HODGKINS-DISEASE CANCER Hoppe, R. T., Portlock, C. S., Glatstein, E., Rosenberg, S. A., KAPLAN, H. S. 1979; 43 (2): 472-481

    View details for Web of Science ID A1979GK93700010

    View details for PubMedID 369676

  • NO INITIAL THERAPY FOR STAGE-III AND STAGE-IV NON-HODGKIN LYMPHOMAS OF FAVORABLE HISTOLOGIC TYPES ANNALS OF INTERNAL MEDICINE Portlock, C. S., Rosenberg, S. A. 1979; 90 (1): 10-13

    Abstract

    The question of whether initial treatment is necessary in relatively asymptomatic patients with stage III and IV non-Hodgkin's lymphomas of favorable histologic types was studied by retrospective analysis. Two groups of patients were studied: [1] 44 nonprotocol patients, followed since 1963, in whom initial treatment was withheld until required to evaluate the pace of disease and the necessity of treatment; and [2] 112 previously untreated patients who have participated in prospectively randomized clinical trials since 1971. For all 44 "deferred" patients, the median time before requiring treatment was 31 months, and there have been 19 patients who have not yet required therapy for periods of 3 to 104 months. The median actuarial survival for all 44 patients was 121 months. At 4 years, the actuarial survival of the 44 patients with deferred treatment is 77.3%, compared with 83.2% for the 112 protocol patients (P = 0.60). Careful observation without initiation of therapy is an appropriate option in the management of patients with relatively asymptomatic advanced non-Hodgkin's lymphomas of favorable histologic types.

    View details for Web of Science ID A1979GD91400003

    View details for PubMedID 369420

  • VALUE OF SEQUENTIAL BONE-MARROW BIOPSY AND LAPAROTOMY AND SPLENECTOMY IN A SERIES OF 200 CONSECUTIVE UNTREATED PATIENTS WITH NON-HODGKINS LYMPHOMA EUROPEAN JOURNAL OF CANCER RIBASMUNDO, M., Rosenberg, S. A. 1979; 15 (7): 941-952

    View details for Web of Science ID A1979HA83100002

    View details for PubMedID 488154

  • NON-HODGKINS LYMPHOMA - SELECTION OF TREATMENT ON THE BASIS OF HISTOLOGIC TYPE NEW ENGLAND JOURNAL OF MEDICINE Rosenberg, S. A. 1979; 301 (17): 924-928

    View details for Web of Science ID A1979HQ98800006

  • PRELIMINARY-OBSERVATIONS ON EFFECT OF HUMAN LEUKOCYTE INTERFERON IN NON-HODGKINS LYMPHOMA NEW ENGLAND JOURNAL OF MEDICINE Merigan, T. C., Sikora, K., BREEDEN, J. H., Levy, R., Rosenberg, S. A. 1978; 299 (26): 1449-1453

    View details for Web of Science ID A1978GC17400008

    View details for PubMedID 362211

  • IMPACT OF SALVAGE TREATMENT ON INITIAL RELAPSES IN PATIENTS WITH HODGKIN DISEASE, STAGES I-III BLOOD Portlock, C. S., Rosenberg, S. A., Glatstein, E., KAPLAN, H. S. 1978; 51 (5): 825-833

    View details for Web of Science ID A1978EZ04900006

    View details for PubMedID 638248

  • OVERVIEW OF NON-HODGKINS LYMPHOMAS CANCER TREATMENT REPORTS DeVita, V. T., Levy, Frei, E., Royston, I., Seligmann, M., Sullivan, P., Bloomfield, C. D., Muggia, F. M., Klein, J., RICK, W., Glatstein, E., Grossman, L., Gibbs, F., Rosenberg, S. A. 1977; 61 (6): 1219-1221

    View details for Web of Science ID A1977DX62400034

  • VALIDITY OF ANN-ARBOR STAGING CLASSIFICATION FOR NON-HODGKINS LYMPHOMAS CANCER TREATMENT REPORTS Rosenberg, S. A. 1977; 61 (6): 1023-1027

    Abstract

    The Ann Arbor staging classification has proved to be valuable for Hodgkin's disease. When proposed in 1971 it was thought that it could also be applied to the non-Hodgkin's lymphomas. The diversity of the non-Hodgkin's groups, the continued evolution of histopathologic classifications, and the great frequency of advanced disease in the lymphocytic subgroups make the Ann Arbor classification of only limited value for the non-Hodgkin's lymphomas.

    View details for Web of Science ID A1977DX62400012

    View details for PubMedID 902260

  • INITIAL RELAPSE IN PREVIOUSLY TREATED HODGKINS-DISEASE .2. RETROGRADE TRANS-DIAPHRAGMATIC EXTENSION INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Weller, S. A., Glatstein, E., Castellino, R. A., KAPLAN, H. S., Rosenberg, S. A. 1977; 2 (9-10): 863-872

    View details for Web of Science ID A1977EJ73300004

    View details for PubMedID 591406

  • CHEMOTHERAPY OF NON-HODGKINS LYMPHOMAS - STANFORD EXPERIENCE CANCER TREATMENT REPORTS Portlock, C. S., Rosenberg, S. A. 1977; 61 (6): 1049-1055

    View details for Web of Science ID A1977DX62400014

    View details for PubMedID 332344

  • CHEMOTHERAPY OF NON-HODGKINS LYMPHOMAS CANCER TREATMENT REPORTS Frei, E., ANDERSON, T., Bertino, J. R., Bloomfield, C. D., Richardson, Coltman, C. A., DANSKER, G., Salmon, S. E., Durant, J., Bonadonna, G., COLLANIO, C., Portlock, C. S., Nissen, N. I., Rosenberg, S. A., Justice, G., Rosen, P., Johnston 1977; 61 (6): 1125-1127

    View details for Web of Science ID A1977DX62400022

  • VALUE OF SEQUENTIAL BONE-MARROW BIOPSY AND LAPAROTOMY AND SPLENECTOMY IN A SERIES OF 127 CONSECUTIVE UNTREATED PATIENTS WITH NON-HODGKINS LYMPHOMA BRITISH JOURNAL OF CANCER Rosenberg, S. A., Dorfman, R. F., KAPLAN, H. S. 1975; 31: 221-227

    View details for Web of Science ID A1975W059100025

  • BONE-MARROW INVOLVEMENT IN NON-HODGKINS LYMPHOMATA BRITISH JOURNAL OF CANCER Rosenberg, S. A. 1975; 31: 261-264

    View details for Web of Science ID A1975W059100031

  • MANAGEMENT OF HODGKINS-DISEASE CANCER KAPLAN, H. S., Rosenberg, S. A. 1975; 36 (2): 796-803

    Abstract

    This paper presents a destillation of the authors' current views concerning the optimal management of Hodgkin's disease in relation to site(s) and stage of disease, constitutional symptoms, histopathology, and prior treatment, based on experience with a series of controlled clinical trials under way at Stanford University Medical Center since 1962.

    View details for Web of Science ID A1975AQ22900024

    View details for PubMedID 1157037

  • SUMMARY OF RESULTS OF A REVIEW OF 405 PATIENTS WITH NON-HODGKINS LYMPHOMA AT STANFORD-UNIVERSITY BRITISH JOURNAL OF CANCER Rosenberg, S. A., Dorfman, R. F., KAPLAN, H. S. 1975; 31: 168-173

    View details for Web of Science ID A1975W059100019

  • CLINICAL TRIALS IN NON-HODGKINS LYMPHOMATA AT STANFORD-UNIVERSITY EXPERIMENTAL DESIGN AND PRELIMINARY RESULTS BRITISH JOURNAL OF CANCER Rosenberg, S. A., KAPLAN, H. S. 1975; 31: 456-464

    View details for Web of Science ID A1975W059100052

  • COMBINATION CHEMOTHERAPY IN HODGKINS-DISEASE - RELATION TO RADIOTHERAPY BIBLIOTHECA HAEMATOLOGICA Rosenberg, S. A. 1973: 731-735

    View details for Web of Science ID A1973AH67200081

  • Prognostic factors and patterns of failure in advanced stage Hodgkin lymphoma treated with combined modality therapy. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology Moding, E. J., Advani, R., Rosenberg, S. A., Hoppe, R. T. 2018; 129 (3): 507–12

    Abstract

    BACKGROUND AND PURPOSE: The role of irradiation to non-bulky and bulky sites of disease in advanced stage Hodgkin lymphoma is controversial. We aimed to review the long-term outcomes of patients treated with combined modality therapy to clarify the role of consolidative radiotherapy.MATERIALS AND METHODS: Patients with stage III or IV Hodgkin lymphoma treated with Stanford V chemotherapy and consolidative radiotherapy to initial sites of disease ≥5 cm were analyzed retrospectively to determine patient outcomes, patterns of failure, and factors associated with treatment failure.RESULTS: A total of 170 patients were analyzed. Overall survival was 91.2%, freedom from progression was 80.6%, and progression-free survival was 78.9% at 10 years. 5 patients (2.9%) had refractory disease and 27 patients (15.9%) relapsed after treatment. Only an International Prognostic Score (IPS) greater than 2 predicted disease progression. 19 out of 27 relapses occurred exclusively outside of the radiation treatment field, and 17 out of 27 relapses occurred exclusively at original sites of disease. However, only 11 of 170 patients (6.5%) relapsed exclusively at original, non-bulky sites of disease not treated with radiation therapy. The cumulative incidence of local failure at 10 years was 4.6% for unirradiated sites and 2.6% for irradiated sites.CONCLUSION: Patients with advanced stage Hodgkin lymphoma treated with combined modality therapy including consolidative radiotherapy to bulky disease sites had excellent long-term outcomes. Given the low frequency of isolated failures at initial sites, our results suggest that selective radiation therapy to sites at high risk of relapse may be feasible.

    View details for PubMedID 30539763

  • No Utility of Routine Laboratory Testing during Surveillance in Detecting Relapse in Patients with Classic Hodgkin Lymphoma in First Remission Lynch, R. C., Sundaram, V., Desai, M., Henry, S., Wood, D., Daadi, S., Corbelli, K. S., Rosenberg, S., Hoppe, R. T., Advani, R. AMER SOC HEMATOLOGY. 2018

    View details for DOI 10.1182/blood-2018-99-113156

    View details for Web of Science ID 000454837601324

  • Breast Imaging in Women Previously Irradiated for Hodgkin Lymphoma. American journal of clinical oncology Horst, K. C., Fero, K. E., Hancock, S. L., Advani, R. H., Ikeda, D. M., Daniel, B., Rosenberg, S. A., Donaldson, S. S., Hoppe, R. T. 2016; 39 (2): 114-119

    Abstract

    Women treated with mantle irradiation for Hodgkin lymphoma (HL) are at an increased risk of developing breast cancer (BC). Current guidelines recommend screening breast magnetic resonance imaging (MRI) as an adjunct to mammography (M) in these patients. There are limited data, however, as to the impact of breast MRI on cancer detection rates. The aim of the current study is to evaluate the use of breast MRI in survivors of HL treated and followed at a single institution.We retrospectively reviewed 980 female patients treated with mantle irradiation for HL between 1961 and 2008. Records were reviewed to determine age at radiotherapy treatment, radiotherapy dose, breast imaging (including M and breast MRI), biopsy results if applicable, and incidence of BC.A total of 118 patients had breast imaging performed at our institution. Median age at HL diagnosis was 28 years (range, 10 to 69 y). Median radiotherapy dose was 36 Gy (range, 20 to 45 Gy). Seventy-nine patients (67%) underwent M screening only, 1 (1%) breast MRI only, and 38 (32%) both M and breast MRI. Of these 38, 19 (50%) underwent 54 screening MRI studies (range per patient=1 to 8), 13 (34%) underwent preoperative MRI for workup of BC, and 6 (16%) initiated screening MRI of the contralateral breast only after diagnosed with BC. Fifty-nine biopsies were performed: 47 were prompted by suspicious M findings only, 10 by palpable findings on physical examination (PE), and 2 by suspicious breast MRI findings. Of the 47 biopsies prompted by M, 24 revealed malignant disease, whereas 23 proved to be benign. All 10 biopsies performed by palpation were malignant. Both biopsies prompted by MRI findings were benign. With M, there were 34 true-positive findings in 32 patients, 23 false-positive findings, and 1 false-negative finding. With screening MRI, there were 2 false-positive findings, 1 false-negative finding, and no true-positive findings.The role of screening breast MRI in women previously irradiated for HL is evolving. Further education of patients and physicians is important to increase awareness of more sensitive BC screening modalities in this high-risk population. Future studies are necessary to determine the appropriate integration of screening breast MRI into the ongoing follow-up of these women.

    View details for DOI 10.1097/COC.0000000000000025

    View details for PubMedID 24390271

  • Treatment of Hodgkin Lymphoma: A 50-Year Perspective JOURNAL OF CLINICAL ONCOLOGY Canellos, G. P., Rosenberg, S. A., Friedberg, J. W., Lister, T. A., DeVita, V. T. 2014; 32 (3): 163-?

    View details for DOI 10.1200/JCO.2013.53.1194

    View details for Web of Science ID 000330627900001

    View details for PubMedID 24441526

  • FEMALE AND MALE-FERTILITY AFTER COMBINED MODALITY THERAPY FOR HODGKINS-DISEASE Horning, S. J., Hoppe, R. T., KAPLAN, H. S., Rosenberg, S. A. AMER ASSOC CANCER RESEARCH. 1981: 512–12

    View details for Web of Science ID A1981LH80002008

  • AN EVALUATION OF ABDOMINAL CT SCANNING IN INITIAL STAGING OF HODGKINS AND NON-HODGKINS LYMPHOMA - PROGRESS REPORT Castellino, R. A., NOON, M., Young, S., Blank, N., Hoppe, R., Rosenberg, S., KAPLAN, H. S. LIPPINCOTT-RAVEN PUBL. 1981: 415–15

    View details for Web of Science ID A1981MK56200110

  • FOLLOW-UP OBSERVATIONS ON THE EFFECT OF HUMAN-LEUKOCYTE INTERFERON IN NON-HODGKINS LYMPHOMA BLOOD Louie, A. C., Gallagher, J. G., Sikora, K., Levy, R., Rosenberg, S. A., Merigan, T. C. 1981; 58 (4): 712-718

    Abstract

    Follow-up data for 11 patients with non-Hodgkin's lymphoma treated with partially purified human leukocyte interferon is presented. The interferon preparation used was 0.1% pure and treatment consisted of 5 x 10(6) U given intramuscularly twice daily for 60 injections. One complete, three partial, and three minimal responses were observed in five of seven evaluable patients with nodular non-Hodgkin's lymphoma. Duration of response appears to be from 6 to 12 mo. One patient achieved a second partial response on retreatment with interferon in spite of having received chemotherapy in the interval between interferon treatments. No responses were seen in three patients with rapidly progressive diffuse histiocytic lymphoma. Dose-limiting toxicity is leukopenia, which necessitated modification or cessation of treatment in three patients. Nonhematologic toxicities consisted of fever, malaise, arthralgia, and loss of appetite. In conclusion, interferon has activity against non-Hodgkin's lymphoma, and prior treatment with chemotherapy does not preclude a response to interferon.

    View details for Web of Science ID A1981MJ81300010

    View details for PubMedID 6168319

  • HODGKINS-DISEASE (HD), PATHOLOGIC STAGE (PS) I-II - THE PROGNOSTIC IMPORTANCE OF INITIAL SITES OF DISEASE AND EXTENT OF MEDIASTINAL (MED) INVOLVEMENT Hoppe, R. T., Coleman, C. N., KAPLAN, H. S., Rosenberg, S. A. AMER ASSOC CANCER RESEARCH. 1980: 471–71

    View details for Web of Science ID A1980JP67101839

  • PROGNOSTIC FACTORS AFTER RELAPSE IN NON-HODGKINS LYMPHOMA OF FAVORABLE HISTOLOGIC TYPE ACKER, B. D., Hoppe, R. T., Rosenberg, S. A., KAPLAN, H. S. PERGAMON-ELSEVIER SCIENCE LTD. 1980: 1349–49

    View details for Web of Science ID A1980KK81500021

  • SPONTANEOUS REGRESSION OF NON-HODGKINS LYMPHOMA - A REPORT OF 9 CASES CANCER KRIKORIAN, J. G., Portlock, C. S., Cooney, D. P., Rosenberg, S. A. 1980; 46 (9): 2093-2099

    Abstract

    Seven previously untreated patients and two previously treated patients with advanced non-Hodgkin's lymphoma (Stages III and IV) and favorable histologic subtypes had spontaneous regression of their lymphomas. Regressions were either complete or partial and were frequently durable. Six of the seven patients who had spontaneous regression of their lymphomas prior to any therapy have yet to require treatment. Seven of the nine spontaneous regressions occurred in a group of 44 patients who were followed with initial therapy deferred. Six patients had regression of their lymphomas prior to any therapy and one patient had previously received a small field of radiation therapy. Temporary spontaneous regression of lymphoma may be common in selected patients with favorable histologies and advanced disease in whom initial therapy is deferred.

    View details for Web of Science ID A1980KN35100030

    View details for PubMedID 7427915

  • PROGNOSTIC FACTORS IN PATHOLOGIC STAGE (PS) IIIA HODGKINS-DISEASE (HD) Hoppe, R. T., Cox, R. S., Rosenberg, S. A., KAPLAN, H. S. AMER ASSOC CANCER RESEARCH. 1979: 429–29

    View details for Web of Science ID A1979GR64901708

  • OCCURRENCE OF NON-HODGKINS LYMPHOMA AFTER THERAPY FOR HODGKINS-DISEASE NEW ENGLAND JOURNAL OF MEDICINE KRIKORIAN, J. G., Burke, J. S., Rosenberg, S. A., KAPLAN, H. S. 1979; 300 (9): 452-458

    Abstract

    We studied the clinical and pathological features of six cases of non-Hodgkin's lymphoma (diffuse undifferentiated in four cases and diffuse histiocytic in two cases) occuring in patients treated for Hodgkin's disease. All six patients had received both radiation and chemotherapy. Abdominal or gastrointestinal involvement was present in five of the six cases. None of the patients had evidence of Hodgkin's disease when the diagnosis of non-Hodgkin's lymphoma was made. Five of the six patients were among a study group of 579 patients with Hodgkin's disease, prospectively followed since diagnosis. At 10 years the actuarial risk of development of non-Hodgkin's lymphoma in this study group is 4.4 per cent (1.2 to 15.0) (per cent probability with 95 per cent confidence limits) and is similar to that of developing acute leukemia: 2.0 per cent (0.3 to 12.9). Non-Hodgkin's lymphoma is a second tumor that may occur late in the course of patients treated for Hodgkin's disease--particularly in patients who have received both radiation therapy and chemotherapy. Like acute leukemia, non-Hodgkin's lymphoma may be another cancer that represents a substantial late risk of combined-modality therapy.

    View details for Web of Science ID A1979GK42600002

    View details for PubMedID 366418

  • HODGKINS-DISEASE, STAGE-I AND STAGE-II OCCURRING BELOW THE DIAPHRAGM CANCER KRIKORIAN, J. G., Portlock, C. S., Rosenberg, S. A., KAPLAN, H. S. 1979; 43 (5): 1866-1871

    Abstract

    Between February 12, 1968 and August 17, 1977, 473 consecutive patients with Hodgkin's disease were entered into protocol studies at Stanford University Medical Center (SUMC). 242 of these 473 patients were pathological Stage I or II; 223 patients had disease above the diaphragm and 19 patients had disease confined below the diaphragm. When compared to patients with disease above the diaphragm, patients with Hodgkin's disease below the diaphragm were more frequently male (74% vs. 53%, p = 0.14), were on the average older (40 vs. 27, p less than .005) and more frequently had the histologic subtype of mixed cellularity (32% vs. 12%, p = .04). There was no difference in either survival or relapse-free survival between patients with Hodgkin's disease above the diaphragm and patients with disease below the diaphragm receiving similar treatment plans.

    View details for Web of Science ID A1979GY00100040

    View details for PubMedID 445373

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