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Standard BEACOPP Chemotherapy Compared with COPP-ABVD for  Advanced Hodgkin's Disease Moscow State University Faculty of F...
Introduction  <ul><li>Hodgkin lymphoma  is characterized by the presence of a special type of lymphatic cell called a Reed...
Reed-Sternberg cell
population <ul><li>8510 new cases (2009)  </li></ul><ul><li>4640males and 3870 females  </li></ul><ul><li>1290 died  (800 ...
Risk factors  <ul><li>Age  </li></ul><ul><li>Family history  </li></ul><ul><li>Sex </li></ul><ul><li>Past Epstein-Barr inf...
Signs and symptom  <ul><li>(+) of B symptoms </li></ul><ul><li>Alcohol-induced pain  in the enlarged nodes  </li></ul><ul>...
Diagnosis  <ul><li>History taking and physical examination  </li></ul><ul><li>Investigation  </li></ul><ul><li>Blood cell ...
Treatment  <ul><li>Chemotherapy  </li></ul><ul><li>Radiotherapy </li></ul><ul><li>Stem cell transplant </li></ul><ul><li>S...
Chemotherapy  <ul><li>ABVD (Adriamycin, bleomycin, vinblastine and dacarbazine). </li></ul><ul><li>BEACOPP ( bleomycin, et...
The studied prognostic factors <ul><li>Age >45 year versus <45 </li></ul><ul><li>Gender </li></ul><ul><li>Type of disease:...
Aim of study  <ul><li>To identify various methods of  combination therapy in advanced Hodgkin’s lymphoma and which is best...
Research objective  <ul><li>To evaluate rate of freedom from treatment failure  at 5 years in treatment of standard BEACOP...
Methods and materials  <ul><li>Study method …  retrospective method  </li></ul><ul><li>No of patients … 49 patients(25-BEA...
55 patients recruited  28 Assigned to BEACOPP 27 Assigned to COPP-ABVD 2 Excluded  2 did not have Hodgkin’s disease  2 Exc...
Characteristics of patients
Chacteristics of patients  by stage
Acute Adverse Effects of Chemotherapy
Kaplan–Meier Analysis of the Probability of Freedom from Treatment Failure (Panel A) and Overall Survival (Panel B)
Rate of the early progression and Five year Kaplain-Meier estimates of the rate of free from treatment failure  according ...
Outcome of Treatment and Five-Year Survival Rates. Variable  COPP-ABVD (N=24) Standard  BEACOPP (N=25) percent  Complete r...
Conclusion  <ul><li>The rate   of freedom from treatment failure at five years was 69 percent   in the COPP-ABVD group, 76...
 
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  1. 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. 2. Introduction <ul><li>Hodgkin lymphoma is characterized by the presence of a special type of lymphatic cell called a Reed-Sternberg (RS) cell. </li></ul><ul><li>look like &quot;owl's eyes. </li></ul><ul><li>more common in young adults and elderly patients. </li></ul>
  3. 3. Reed-Sternberg cell
  4. 4. population <ul><li>8510 new cases (2009) </li></ul><ul><li>4640males and 3870 females </li></ul><ul><li>1290 died (800 males and 490 females in 2009) </li></ul>
  5. 5. Risk factors <ul><li>Age </li></ul><ul><li>Family history </li></ul><ul><li>Sex </li></ul><ul><li>Past Epstein-Barr infection </li></ul><ul><li>Compromised immune system </li></ul><ul><li>Geography </li></ul><ul><li>Socioeconomic status </li></ul>
  6. 6. Signs and symptom <ul><li>(+) of B symptoms </li></ul><ul><li>Alcohol-induced pain in the enlarged nodes </li></ul><ul><li>Enlarged lymph nodes (firm and rubbery) </li></ul><ul><li>Hepatosplenomegaly </li></ul><ul><li>Back pain </li></ul><ul><li>Petechiae </li></ul>
  7. 7. Diagnosis <ul><li>History taking and physical examination </li></ul><ul><li>Investigation </li></ul><ul><li>Blood cell count (ESR) </li></ul><ul><li>MRI </li></ul><ul><li>PET scan </li></ul><ul><li>Biopsy </li></ul><ul><li>BM examination </li></ul>
  8. 8. Treatment <ul><li>Chemotherapy </li></ul><ul><li>Radiotherapy </li></ul><ul><li>Stem cell transplant </li></ul><ul><li>Surgery </li></ul><ul><li>Target therapy </li></ul><ul><li>Immunotherapy </li></ul>
  9. 9. Chemotherapy <ul><li>ABVD (Adriamycin, bleomycin, vinblastine and dacarbazine). </li></ul><ul><li>BEACOPP ( bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone). </li></ul><ul><li>Stanford V ( doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin and prednisone) . </li></ul><ul><li>COPP/ABVD ( cyclophosphamide, vincristine, procarbazine , prednisone, doxorubicin, bleomycin, vinblastine and dacarbazine ) </li></ul><ul><li>MOPP ( mechlorethamine, vincristine, procarbazine and prednisone) </li></ul>
  10. 10. The studied prognostic factors <ul><li>Age >45 year versus <45 </li></ul><ul><li>Gender </li></ul><ul><li>Type of disease: early disease versus advanced disease </li></ul><ul><li>Presence of B symptoms </li></ul><ul><li>ESR > 50 or > 30 plus B symptoms versus neither </li></ul><ul><li>LDH > 500 IU/L versus < 500 IU /L </li></ul><ul><li>Extranodal involvement </li></ul><ul><li>Mediastinal involvement </li></ul><ul><li>Pathological subtypes </li></ul><ul><li>Type of chemotherapy </li></ul>
  11. 11. Aim of study <ul><li>To identify various methods of combination therapy in advanced Hodgkin’s lymphoma and which is best and less toxicity. </li></ul>
  12. 12. Research objective <ul><li>To evaluate rate of freedom from treatment failure at 5 years in treatment of standard BEACOPP and ABVD-COPP </li></ul><ul><li>To identify outcome and 5 years survival rates in standard BEACOPP and ABVD-COPP </li></ul><ul><li>To determine the toxicity of long term chemotherapy </li></ul>
  13. 13. Methods and materials <ul><li>Study method … retrospective method </li></ul><ul><li>No of patients … 49 patients(25-BEACOPP and 24-COPP-ABVD) </li></ul><ul><li>Duration of study … January 2005 to December 2009. </li></ul><ul><li>Staging … Ann Arbor clinical stage IIB or IIIA and above stage with a large mediastinal mass </li></ul><ul><li>Work-up - chest x-ray, CT of the abdomen and pelvis, and complete blood count and ESR with metabolic profile </li></ul>
  14. 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. 15. Characteristics of patients
  16. 16. Chacteristics of patients by stage
  17. 17. Acute Adverse Effects of Chemotherapy
  18. 18. Kaplan–Meier Analysis of the Probability of Freedom from Treatment Failure (Panel A) and Overall Survival (Panel B)
  19. 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. 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. 21. Conclusion <ul><li>The rate of freedom from treatment failure at five years was 69 percent in the COPP-ABVD group, 76 percent in the BEACOPP group. </li></ul><ul><li>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. </li></ul><ul><li>The incidence of acute toxicity increases with BEACOPP; grade 4 leukopenia occurred in one or more cycles. </li></ul>
  22. 23. Thank you for attention

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