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A randomized trial suggests that patients with negative PET-CT findings after two cycles of ABVD may have the bleomycin dropped from the regimen for the final four cycles. The omission of bleomycin reduced pulmonary toxic effects without reducing overall survival. The treatment of advanced-stage Hodgkin’s lymphoma with chemotherapy has produced high survival rates. A series of randomized trials has confirmed that doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), first described more than 40 years ago, 1 yields cure rates of 70 to 80%, similar to the rates observed with more complex multidrug regimens. 2 – 7 The possible exception is escalated therapy with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), with higher-than-standard doses of etoposide, doxorubicin, and cyclophosphamide. 8 This escalated regimen has been shown to yield higher progression-free survival rates than ABVD among previously untreated patients. 9 , 10 Trials in which ABVD and . . .

The risk of recurrence of gastrointestinal stromal tumour (GIST) after surgery needs to be estimated when considering adjuvant systemic therapy. We assessed prognostic factors of patients with operable GIST, to compare widely used risk-stratification schemes and to develop a new method for risk estimation. Population-based cohorts of patients diagnosed with operable GIST, who were not given adjuvant therapy, were identified from the literature. Data from ten series and 2560 patients were pooled. Risk of tumour recurrence was stratified using the National Institute of Health (NIH) consensus criteria, the modified consensus criteria, and the Armed Forces Institute of Pathology (AFIP) criteria. Prognostic factors were examined using proportional hazards and non-linear models. The results were validated in an independent centre-based cohort consisting of 920 patients with GIST. Estimated 15-year recurrence-free survival (RFS) after surgery was 59·9% (95% CI 56·2–63·6); few recurrences occurred after the first 10 years of follow-up. Large tumour size, high mitosis count, non-gastric location, presence of rupture, and male sex were independent adverse prognostic factors. In receiver operating characteristics curve analysis of 10-year RFS, the NIH consensus criteria, modified consensus criteria, and AFIP criteria resulted in an area under the curve (AUC) of 0·79 (95% CI 0·76–0·81), 0·78 (0·75–0·80), and 0·82 (0·80–0·85), respectively. The modified consensus criteria identified a single high-risk group. Since tumour size and mitosis count had a non-linear association with the risk of GIST recurrence, novel prognostic contour maps were generated using non-linear modelling of tumour size and mitosis count, and taking into account tumour site and rupture. The non-linear model accurately predicted the risk of recurrence (AUC 0·88, 0·86–0·90). The risk-stratification schemes assessed identify patients who are likely to be cured by surgery alone. Although the modified NIH classification is the best criteria to identify a single high-risk group for consideration of adjuvant therapy, the prognostic contour maps resulting from non-linear modelling are appropriate for estimation of individualised outcomes. Academy of Finland, Cancer Society of Finland, Sigrid Juselius Foundation and Helsinki University Research Funds.

We investigated treatment outcomes, relapse risk, and survival in 104 consecutive patients with non-endemic Burkitt lymphoma (BL) diagnosed and treated in Kazakhstan between 2013 and 2024 in a real-world setting. This was a retrospective, clinically based study analyzing baseline characteristics, treatment regimens, response to first-line therapy, prognostic factors, relapse, and survival. The median age was 26 years (range 2–80), with a male predominance (64%). All cases underwent MYC rearrangement assessment, and EBV status was available in 80 patients, with 28% testing positive. Curative-intent therapy was delivered to 95 patients (91%), including R-BFM (44%), R-EPOCH (23%), R-CODOX-M/R-IVAC (18%), and R-Hyper-CVAD (15%); no patient underwent autologous stem cell transplantation. After a median follow-up of 57 months, the 3-year overall survival (OS) and progression-free survival (PFS) were 57% and 56%, respectively. Patients younger than 18 years, all treated with R-BFM, had significantly superior outcomes compared with adults, with 3-year OS and PFS of 82% and 83%, respectively ( p  < 0.001). Among adults, patients treated with R-Hyper-CVAD or R-CODOX-M/R-IVAC had better OS than those treated with R-EPOCH (50% vs. 19%, p  = 0.04). In univariate analysis, age ≥ 40 years, female sex, ECOG performance status ≥ 2, and platelet count < 150 g/dL were associated with inferior prognosis. In multivariate analysis, age ≥ 40 years remained the only independent adverse prognostic factor. The adapted Burkitt Lymphoma International Prognostic Index retained prognostic value. In conclusion, this large real-world study demonstrates excellent outcomes in pediatric patients treated with intensive immunochemotherapy but substantially inferior results in adults, particularly in refractory disease, highlighting a critical unmet clinical need in this population.

To verify whether absolute monocyte count (AMC) and lymphocyte- monocyte ratio (LMR) at diagnosis are valid prognostic parameters in classical Hodgkin lymphoma (cHL). Data were collected from 1450 patients with cHL treated in Israel and Italy from January 1, 1988, through December 31, 2007. The median age of the patients was 33 years (range, 17-72 years), and 70% (1017) of the patients had nodular sclerosis (NS); the median follow-up duration was 87 months. The best cutoff value for AMC was 750 cells/mm3, and the best ratio for LMR was 2.1. The adverse prognostic impact of an AMC of more than 750 cells/mm3 was confirmed for the entire cohort, and its clinical significance was particularly evident in patients with NS histology. The progression-free survival (PFS) at 10 years for an AMC of more than 750 cells/mm3 was 65% (56%-72%), and the PFS at 10 years for an AMC of 750 cells/mm3 or less was 81% (76%-84%; P<.001). The overall survival (OS) at 10 years for an AMC of more than 750 cells/mm3 was 78% (70%-85%), and the OS at 10 years for an AMC of 750 cells/mm3 or less was 88% (84%-90%; P=.01). In multivariate analysis, both AMC and LMR maintained prognostic significance for PFS (hazard ratio [HR], 1.54, P=.006, and HR, 1.50, P=.006) after adjusting for the international prognostic score, whereas the impact on OS was confirmed (HR, 1.56; P=.04) only in patients with NS and an AMC of more than 750 cells/mm3. This study confirms that AMC has prognostic value in cHL that is particularly significant in patients with NS subtype histology. This finding links the known impact of macrophages and monocytes in Hodgkin lymphoma with routine clinical practice.

Purpose We explored the potential overall survival (OS) benefit of bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone (BEACOPP) over doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) in a pooled analysis of four randomized trials. Patients and methods Primary objective was to evaluate the OS impact of BEACOPP using individual patient data. Secondary objectives were progression‐free survival (PFS), secondary cancers, and use of autologous stem cell transplantation (ASCT). Results About 1227 patients were included. The 7‐year OS was 84.3% (95% CI 80.8‐87.2) for ABVD vs 87.7% (95% CI 84.5‐90.2) for BEACOPP. Two follow‐up periods were identified based on survival curves and hazard ratio (HR) over time. For the first 18 months, there was no difference. For the second period of ≥18 months, ABVD patients had a higher death risk (HRABVD vs BEACOPP = 1.59; 95% CI 1.09‐2.33). A Cox model stratified by trial and evaluating the effect of treatment and International Prognostic Index (IPI) score as fixed effects showed that both were statistically significant (treatment, P = .0185; IPI score, P = .0107). The 7‐year PFS was 71.1% (95% CI 67.1‐74.6) for ABVD vs 81.1% (95% CI 77.5‐84.2) for BEACOPP (P < .001). After ABVD, 25 secondary cancers (4.0%) were reported with no myelodysplasia (MDS)/acute myeloid leukemia (AML) compared to 36 (6.5%) after BEACOPP, which included 13 patients with MDS/AML. Following ABVD, 86 patients (13.8%) received ASCT vs 39 (6.4%) for BEACOPP. Conclusions This analysis showed a slight improvement in OS for BEACOPP and confirmed a PFS benefit. Frontline use of BEACOPP instead of ABVD increased secondary leukemia incidence but halved the requirement for ASCT. Advanced Hodgkin lymphoma (HL) are treated with two different chemotherapy regimens (doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine [ABVD] or bleomycin, etoposide, doxorubicin [Adriamycin], cyclophosphamide, vincristine [Oncovin], procarbazine, and prednisone [BEACOPP]) that have two different toxicity profiles. In this pooled analysis of four randomized trials comparing these two regimens, and with a median follow‐up of 7 years, progression‐free survival is significantly superior with the BEACOPP regimen. The 7 years overall survival was 84.3% for ABVD and 87.7% for BEACOPP. The main cause of death after ABVD is HL, but second malignancy including 10 myeloid malignancies after BEACOPP.

Knee osteoarthritis (OA) is a major cause of global disability, necessitating cost-effective interventions. While balneotherapy and acquatic exercise (AE) are established conservative treatments, evidence regarding their combined efficacy remains limited. This study evaluated the clinical impact of a combined program that include balneotherapy and AE in natural mineral waters - compared to balneotherapy alone in patients with mild-to-moderate knee OA in Health Resorts. Primary outcomes included pain intensity, joint range of motion (AROM/PROM), and functional indices [Western Ontario and McMaster Universities (WOMAC), Lequesne's Algofunctional Index for Knee (LAI-knee)]. Secondary outcomes encompassed quality of life (Short Form-12) and psychological well-being (Pittsburgh Sleep Quality Index and Psychological General Well-Being Index). 66 patients were allocated to either an experimental group (EG), receiving a combined two-week protocol of balneotherapy and AE in salt-bromine-iodine thermal water, or a control group (CG), receiving balneotherapy alone. Both groups demonstrated significant short-term improvements in all the assessments included in study. However, the EG exhibited a superior reduction in pain intensity (31% vs. 13% in CG) and more consistent gains in bilateral active range of motion (AROM). Linear mixed-effects models confirmed significant time effects for WOMAC, LAI, and SF-12 Physical Component scores for both groups. Regression analysis revealed that higher BMI and age negatively correlated with mobility gains. A combined intervention significantly enhances the analgesic and functional benefits of standard balneotherapy. By leveraging physical properties of mineral water, the combined protocol addresses both the mechanical and biological components of knee OA. These findings support the integration of water exercise with balneotherapy in Health Resorts for degenerative joint diseases and the personalization of treatment based on patients age and BMI.

Genome-wide association studies (GWAS) have identified germline genetic variants for follicular lymphoma (FL) susceptibility. We conducted a GWAS of prognosis in FL patients to identify genetic predictors of event-free survival (EFS) as well as failure within the first 24 months after treatment initiation (EFS24) using patients treated with rituximab-based immunochemotherapy from three clinical trials and one prospective observational study ( N  = 1054). Statistical approaches consisted of a pooled GWAS of the four cohorts and a leave-one-cohort-out (LOCO) strategy to identify robust findings that replicated across the four cohorts. The top SNPs for EFS and EFS24 were marked by rs72625024 at 3q27.3 near FETUB and HRG ( P  = 9.37 × 10 −8 ) and rs114695031 at 14q32.13 near TCL6 ( P  = 1.93 × 10 −8 ), respectively. These two loci, which were discovered and validated in all 4 LOCO rounds, map near long-non-coding RNAs with putative tumor suppressor functions. Our results pinpoint potential novel biology and the contribution of host genetics to prognosis in FL.

Background Cancer incidence in the Galapagos archipelago is unknown. Aim In 2021, a task force including Ecuadorian and Italian researchers was established to estimate cancer incidence among the 25 244 Galapagos residents. Methods Registration covered all malignancies, including malignant melanoma and non‐melanoma skin cancers; case recording was based on the International Classification of Diseases for Oncology. The data collection involved an active search across all relevant health institutions on the islands and the mainland. Mortality data were obtained from the Ecuador national mortality registry. Results From January 2013 and December 2019, 174 new cancer cases were recorded, including 134 malignancies (M:F = 58:76) and 40 non‐melanoma skin cancers. The mean age at diagnosis was 48 years for males and 56 years for females. Prostate, gastric, and melanocytic malignancies were most incident among males; breast, thyroid, and cervical cancers prevailed in females. The age‐standardized incidence rates (ASR) were 80.39 for males and 99.24 for females with a mortality‐to‐incidence ratio 0.43. These ASRs were significantly lower than those reported in continental Ecuador and other South American countries. Conclusions This pilot cancer registration initiative in the Galapagos record a low incidence of malignancies and requires validation with temporal expansion of cancer registration. The environmental etiology of some of the most common cancers warrants strategic primary and secondary prevention efforts.