Seminars in hematology
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Seminars in hematology · Jul 1993
Randomized Controlled Trial Clinical TrialEvolving approaches with interferon alfa in chronic myelogenous leukemia.
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Much progress has been made in the therapeutic use of immunotoxins since the first clinical trials, especially in the prevention and treatment of AGVHD. This is also further discussed in this symposium by Champlin. ⋯ Other obstacles to the wide use of immunotoxins are the heterogeneity of tumor cells, the shedding of tumor antigens into the circulation, and the inability to identify neoplastic renewal cell specific antigens that are not cross-reactive with normal tissues. Despite these obstacles, the early success of immunotoxins, especially in hematologic malignancies, reinforces the feasibility of designing rational targeting reagents in cancer therapy.
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Over the past 2 decades, treatment of Hodgkin's disease has evolved considerably through innovations in the management of various stages. The impact of various treatments on the 5-, 10-, and 15-year results is being balanced against delayed morbidity, such as organ damage and second malignancies, produced by the intensity of therapy or the prolonged delivery of given drugs. The results of clinical trials performed during the past decade have allowed us to reconsider the various prognostic variables that can be used in the treatment strategy. ⋯ Subtotal or total nodal radiotherapy (RT) induces a 10-year cure rate ranging from 70% to 85% in stages I and II with no bulky lymphoma. In patients with bulky disease and all three systemic symptoms, comparable results can be achieved with primary chemotherapy followed by RT. Currently, stages IIIA and IIIB disease are often managed with combined treatment modalities, although comparable results can be obtained with intensive chemotherapy alone.(ABSTRACT TRUNCATED AT 250 WORDS)
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Seminars in hematology · Apr 1986
Randomized Controlled Trial Comparative Study Clinical TrialTherapeutic recommendations in polycythemia vera based on Polycythemia Vera Study Group protocols.
The PVSG was organized in 1967 to establish effective diagnostic criteria for polycythemia vera, to study the natural history of the disease and to define the optimal treatment. Although polycythemia vera and the other myeloproliferative diseases are relatively uncommon, the PVSG was able to accumulate well over 1,000 patients with these various disorders and to study them according to a total of 15 different protocols. PVSG-01, a long-term randomized controlled study of phlebotomy alone compared with the myelosuppressive agents, 32P or chlorambucil supplemented by phlebotomy, continues to receive follow-up data on 93% of surviving patients 18 years after initiation of the study. ⋯ Nevertheless considerable progress has been made. Moreover, the group has defined more precisely than ever before the nature of the complications of the disease and the association of the risks of specific complications with specific forms of therapy. It thus has made it possible to pose the next series of therapeutic questions that must be addressed in this disorder with a greater degree of sophistication than was previously possible.