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Powerpoint presentation by dr sathiha

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  • 1. Standard BEACOPP Chemotherapy Compared with COPP-ABVD for Advanced Hodgkin's Disease Moscow State University Faculty of Fundamental Medicine N.N.Blokhin Cancer Research Center Presented By : Dr .Sa Thi Ha (M.B;B.S) Supervisor : Prof Dr.B.I.Polyakov Dr.D.A.Bykov 17 th may 2010
  • 2. Introduction
    • Hodgkin lymphoma is characterized by the presence of a special type of lymphatic cell called a Reed-Sternberg (RS) cell.
    • look like "owl's eyes.
    • more common in young adults and elderly patients.
  • 3. Reed-Sternberg cell
  • 4. population
    • 8510 new cases (2009)
    • 4640males and 3870 females
    • 1290 died (800 males and 490 females in 2009)
  • 5. Risk factors
    • Age
    • Family history
    • Sex
    • Past Epstein-Barr infection
    • Compromised immune system
    • Geography
    • Socioeconomic status
  • 6. Signs and symptom
    • (+) of B symptoms
    • Alcohol-induced pain in the enlarged nodes
    • Enlarged lymph nodes (firm and rubbery)
    • Hepatosplenomegaly
    • Back pain
    • Petechiae
  • 7. Diagnosis
    • History taking and physical examination
    • Investigation
    • Blood cell count (ESR)
    • MRI
    • PET scan
    • Biopsy
    • BM examination
  • 8. Treatment
    • Chemotherapy
    • Radiotherapy
    • Stem cell transplant
    • Surgery
    • Target therapy
    • Immunotherapy
  • 9. Chemotherapy
    • ABVD (Adriamycin, bleomycin, vinblastine and dacarbazine).
    • BEACOPP ( bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone).
    • Stanford V ( doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin and prednisone) .
    • COPP/ABVD ( cyclophosphamide, vincristine, procarbazine , prednisone, doxorubicin, bleomycin, vinblastine and dacarbazine )
    • MOPP ( mechlorethamine, vincristine, procarbazine and prednisone)
  • 10. The studied prognostic factors
    • Age >45 year versus <45
    • Gender
    • Type of disease: early disease versus advanced disease
    • Presence of B symptoms
    • ESR > 50 or > 30 plus B symptoms versus neither
    • LDH > 500 IU/L versus < 500 IU /L
    • Extranodal involvement
    • Mediastinal involvement
    • Pathological subtypes
    • Type of chemotherapy
  • 11. Aim of study
    • To identify various methods of combination therapy in advanced Hodgkin’s lymphoma and which is best and less toxicity.
  • 12. Research objective
    • To evaluate rate of freedom from treatment failure at 5 years in treatment of standard BEACOPP and ABVD-COPP
    • To identify outcome and 5 years survival rates in standard BEACOPP and ABVD-COPP
    • To determine the toxicity of long term chemotherapy
  • 13. Methods and materials
    • Study method … retrospective method
    • No of patients … 49 patients(25-BEACOPP and 24-COPP-ABVD)
    • Duration of study … January 2005 to December 2009.
    • Staging … Ann Arbor clinical stage IIB or IIIA and above stage with a large mediastinal mass
    • Work-up - chest x-ray, CT of the abdomen and pelvis, and complete blood count and ESR with metabolic profile
  • 14. 55 patients recruited 28 Assigned to BEACOPP 27 Assigned to COPP-ABVD 2 Excluded 2 did not have Hodgkin’s disease 2 Excluded 2 did not have Hodgkin’s disease 26 Eligible 1 lost to follow up 25 Elgible 1 lost to follow up 25 Included in the analysis 23 received full course 2 received partial course 24 Included in the analysis 20 received full course 4 received partial course Numbers of patients included in this analysis
  • 15. Characteristics of patients
  • 16. Chacteristics of patients by stage
  • 17. Acute Adverse Effects of Chemotherapy
  • 18. Kaplan–Meier Analysis of the Probability of Freedom from Treatment Failure (Panel A) and Overall Survival (Panel B)
  • 19. Rate of the early progression and Five year Kaplain-Meier estimates of the rate of free from treatment failure according to the International Prognostic Index. International Prognostic Index COPP-ABVD (%) Standard BEACOPP(%) Early progression Good (0-1) Fair (2-3) Poor (4-7) Freedom from treatment failure at 5 years Good (0-1) Fair (2-3) Poor (4-7) Overall survival at 5 years Good (0-1) Fair (2-3) Poor (4-7) 10 11 18 79 67 59 92 84 67 6 9 9 81 72 74 93 86 81
  • 20. Outcome of Treatment and Five-Year Survival Rates. Variable COPP-ABVD (N=24) Standard BEACOPP (N=25) percent Complete remission 85(80-89) 88(85-91) Early progression 10(7-15) 8(5-10) Freedom from treatment failure at 5 yr 69(63-75) 76(72-80) Overall survival at 5 yr 83(78-87) 88(85-91)
  • 21. Conclusion
    • The rate of freedom from treatment failure at five years was 69 percent in the COPP-ABVD group, 76 percent in the BEACOPP group.
    • The five-year rates of overall survival were 83percent COPP-ABVD, the comparison with 88 percent of BEACOPP group. Standard BEACOPP results in better tumor control and overall survival than did COPP-ABVD.
    • The incidence of acute toxicity increases with BEACOPP; grade 4 leukopenia occurred in one or more cycles.
  • 22.  
  • 23. Thank you for attention