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This large trial showed that chemotherapy plus involved-field radiotherapy was superior to subtotal nodal radiotherapy alone in patients with localized stage supradiaphragmatic Hodgkin's disease and risk factors for a good outcome. In patients with early-stage Hodgkin's disease and risk factors for a poor outcome, limited chemotherapy was as effective as a more aggressive course. Chemotherapy plus involved-field radiotherapy was superior in patients with Hodgkin's disease and a good prognosis. In patients with a poor prognosis, limited chemotherapy was as effective as a more aggressive course. During the past two decades, the treatment of Hodgkin's disease has evolved considerably. Staging laparotomy has been abandoned, management has been adjusted to reduce the risk of treatment failure, and clinical trials have defined the value of radiation therapy alone, chemotherapy alone, and therapy that combines the two approaches. The goal of current treatment is a maximum cure rate with a minimum of long-term toxic effects. The results of the European Organization for Research and Treatment of Cancer (EORTC) Lymphoma Group H7 trial (1988–1993), 1 which was based on clinical prognostic factors, 2 led to three major conclusions: clinical staging is sufficient . . .

THE introduction of MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) was a seminal event in the treatment of Hodgkin's disease, demonstrating the principles and success of combination chemotherapy when effective drugs are given in a cyclic schedule and leading to subsequent successful trials in non-Hodgkin's lymphoma and other cancers. 1 The long-term results achieved with MOPP were influenced by the quantity of tumor, the performance status, and accompanying constitutional symptoms, as well as by previous chemotherapy, age, tolerance by bone marrow, and the dose intensity of the active agents. 2 3 4 5 6 7 MOPP was found to have substantial toxic effects, including sterilization in both sexes, . . .

Patients with advanced Hodgkin's lymphoma who were in complete remission after chemotherapy were assigned to receive involved-field radiotherapy or no further treatment. After a median follow-up of more than six years, survival was similar in the two groups. The outcome of treatment for advanced Hodgkin's lymphoma has improved dramatically over the past two decades. Cure rates of more than 70 percent are now possible 1 – 10 with a hybrid regimen of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP-ABV); a regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); or a regimen of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP). The potential role of radiotherapy after the completion of chemotherapy in patients with advanced Hodgkin's lymphoma stems from the observations that relapses usually occur at initially involved sites and that radiotherapy lowers the rates of recurrence. 11 The . . .

Background Chlormethine/mechlorethamine gel is a skin-directed therapy for patients with mycosis fungoides cutaneous T-cell lymphoma. Currently, real-world data on chlormethine gel are lacking. Objective Our objective was to analyze the effect of chlormethine gel in combination with other therapies on efficacy, safety, and health-related quality of life in a real-world setting. Methods This prospective, observational study enrolled adult patients actively using chlormethine gel. Patients were monitored for up to 2 years during standard-of-care clinic visits. No specific visit schedules or clinical assessments, with the exception of patient-completed questionnaires, were mandated because of the expected variability in practice patterns. The primary efficacy endpoint was the proportion of patients with stage IA–IB disease receiving chlormethine + topical corticosteroids + other with ≥ 50% decrease in body surface area from baseline to 12 months. Response was assessed at each visit using by-time analysis, which investigates the trend to treatment response and allows assessment of response over time. Health-related quality of life was assessed with the Skindex-29 questionnaire. Results In total, 298 patients were monitored. At 12 months post-treatment initiation, 44.4% (chlormethine + topical corticosteroids + other) and 45.1% (patients receiving chlormethine + other treatment) of efficacy-evaluable patients were responders. By-time analysis demonstrated that peak response occurred (chlormethine + other; 66.7%) at 18 months. There was a significant correlation between responder status and lower post-baseline Skindex-29 scores. Conclusions This real-world study confirmed that chlormethine gel is an important therapeutic option for patients with mycosis fungoides and contributes to reducing the severity of skin lesions and improving health-related quality of life. Infographic

Nitrogen mustard is a chemotherapeutic agent that has a well-documented safety and efficacy profile in the treatment of cutaneous T-cell lymphoma. Development of nitrogen mustard formulations and treatment regimens has been studied extensively over the last 40 years. In the last 5 years, a new gel formulation has been developed that is associated with a decrease in delayed hypersensitivity reactions. The authors in this review found that while the gel formulation may result in a decrease of allergic contact dermatitis, this advantage has been replaced by a higher number of irritant contact reactions and a decrease in complete response rate. The gel formulation has a complete response rate of 13.8%, which is a decrease in efficacy when compared to aqueous-based preparations of similar concentrations.

Mycosis fungoides (MF) is an extranodal non-Hodgkins lymphoma of T-cell origin. MF is the most common type and can be stratified as early (IA-IIA) or late (IIB or greater) stage disease. Patients with patch disease usually have a benign, chronic course. Patients with plaques have a worse prognosis and need more aggressive therapy. Topical nitrogen mustard ([NM]; mechlorethamine hydrochloride) has been used for MF since the 1950s. Complete response rates reported for stage IA are 76-80% and 35-68% for stage IB. Most common toxicities reported are irritant contact dermatitis, allergic reaction and hyperpigmentation. There is a potential for risk of non-melanoma skin cancers reported with NM use in patients who used multiple skin damaging therapies. This article focuses on the clinical trial that led to the US FDA approval of VALCHLOR™ for stage IA and IB MF in 2013 after one prior treatment (excluding NM within 2 years or carmustine therapy ever).

Abstract Background Dogs with multicentric lymphoma are treated with various cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)-based chemotherapy protocols with variable success. Objectives To describe the progression-free survival (PFS) time and overall survival time (OST) of dogs with T-cell lymphoma or hypercalcemic lymphoma treated with l-asparaginase and mechlorethamine, vincristine, prednisone, procarbazine (MOPP). Animals Fifty dogs with T-cell lymphoma, hypercalcemic lymphoma, or both treated at 3 referral veterinary hospitals. Methods Retrospective study. Case were selected based on histologic or cytologic diagnosis of lymphoma; presence of the T-cell phenotype, presence of hypercalcemia or both; and absence of previous chemotherapy. The T-cell phenotype was determined by flow cytometry, immunocytochemistry, immunohistochemistry, or polymerase chain reaction of antigen receptor rearrangement. Results The overall response rate was 98% (78% complete response, 20% partial response). The median PFS for the entire study population was 189 days with 25% PFS at 939 days. The median OST for the entire study population was 270 days with 25% surviving 939 days. Twenty percent of the dogs required hospitalization for treatment related complications. Conclusions and clinical importance l-Asp/MOPP chemotherapy might result in longer PFS and OST for dogs with multicentric T-cell lymphoma, dogs with hypercalcemic lymphoma or both, than achieved with CHOP.

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma (MF-CTCL). Quality nursing care is necessary for effective diagnosis and treatment of patients with MF-CTCL. Early-stage MF-CTCL (stages Ia and Ib) is most often managed in both dermatology and multidisciplinary settings. These stages can be effectively controlled by skin-directed therapies such as mechlorethamine gel (Valchlor®). Topical mechlorethamine has been used since the 1940s as an alkylating agent; however, compounded formulas have disadvantages that limit patient compliance. In contrast, newly approved mechlorethamine gel has demonstrated an efficacious and well-tolerated profile that has longer stability and is quicker to dry than its compounded counterpart. This article aims to provide recommendations for optimal nursing care of patients who have been diagnosed with stage Ia or Ib MF-CTCL. Four real-world patient cases are examined, along with practical considerations for the use of mechlorethamine gel to treat patients with MF-CTCL. Nurses can promote patient adherence through specific interventions and strategies, such as education about mechlorethamine gel, its mechanism of action, and safety and efficacy, as well as connecting patients with patient assistance programs or other supportive services.

Abstract Background Chemotherapy for multicentric canine lymphoma has favorable results. The gastrointestinal (GI) tract is the most common extranodal site of canine lymphoma, but there have been no prospective studies to determine outcome when dogs with GI lymphoma are treated with chemotherapy. Hypothesis Treatment with a multiagent chemotherapy protocol is associated with a poor outcome in dogs with GI lymphoma. Animals Eighteen dogs with histologically confirmed GI lymphoma. Methods Prospective clinical trial in which dogs with GI lymphoma were treated with a 20-week combination chemotherapy protocol consisting of induction and consolidation phases. Results Thirteen dogs had primary GI lymphoma and 5 had multicentric lymphoma with GI involvement. The majority of the lymphomas (63%) were of T-cell origin. Overall remission rate was 56%; 9 dogs achieved a complete remission for a median of 86 days (range, 22–420 days) and 1 dog achieved a partial remission for 26 days. Overall median survival time was 77 days (range, 6–700 days). Dogs that failed to achieve a remission (10 versus 117 days; P= .002) or had diarrhea at initial presentation (70 versus 700 days; P < .001) had shorter survival times. Conclusion and Clinical Importance The response and survival of dogs with GI lymphoma treated with multiagent chemotherapy is poor but long-term survival is possible.

To the Editor: In 1992, the Cancer and Leukemia Group B (CALGB) reported the results of a prospective three-group randomized trial involving 359 patients with Hodgkin's lymphoma. This trial compared the following regimens: doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for 6 to 8 months, mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) for 6 to 8 months, and MOPP alternating with ABVD for 12 months. 1 The trial was limited to patients with advanced disease (clinical stages III and IV). No radiotherapy was administered. The results, published in the Journal in 1992, indicated an event-free survival advantage of ABVD over MOPP but no . . .