Revised text to state that clinical staging for patients with HL includes a history, physical examination, laboratory studies, and thoracic and abdominal/pelvic computerized tomographic (CT) scans with or without positron emission tomography (PET) (cited Barrington et al. as reference 2).
Revised text to state that PET scans combined with CT scans have become the standard imaging for clinical staging.
Revised text to state that at a 15-year follow-up, the risk of second solid tumors is approximately 13%; at a 20-year follow-up, the risk is approximately 17%; at a 25-year follow-up, the risk is approximately 22%; and at a 40-year follow-up, the risk is approximately 48% (cited Schaapveld et al. as reference 21).
Revised text to state that the risk appears greatest for women treated with radiation before age 30 years and especially close to menarche, and the incidence increases substantially after 15 years of follow-up (cited Cooke et al. as reference 34).
Added text to state that patients older than 60 years with HL may experience more treatment-related morbidity and mortality; maintaining dose intensity of standard chemotherapy may be difficult. Alternative therapies have been proposed for elderly patients, but no randomized trials have been conducted with these regimens (cited Kolstad et al. as reference 67). A series of 27 previously untreated patients older than 60 years, judged by the investigator to be in too poor a condition to undergo chemotherapy, received brentuximab; a 92% overall response rate and 73% complete remission rate were reported (cited Forero-Torres et al. as reference 68 and level of evidence 3iiiDiv).
Added Merli et al. as reference 11. Also revised text to state that with a median follow-up of 120 months, although progression-free survival (PFS) favored bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) over doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), there was no significant difference in overall survival (OS).
Revised text to state that for relapsing patients, response rates around 75% are seen with complete remissions around 30% to 50% and median PFS of 4 to 8 months. Added that a series of 27 previously untreated patients older than 60 years, judged by the investigator to be in too poor a condition to undergo chemotherapy, received brentuximab; a 92% overall response rate and 73% complete remission rate were reported (added level of evidence 3iiiDiv).
Revised text to state that patients who relapse after initial combination chemotherapy can undergo reinduction with the same or another chemotherapy regimen followed by high-dose chemotherapy and autologous bone marrow or peripheral stem cell or allogeneic bone marrow rescue.
Added text to state that a Cochrane meta-analysis also concluded that autologous stem cell transplantation after reinduction chemotherapy improves relapse-free survival by 20% to 30% over chemotherapy alone, but without an OS benefit (cited Rancea et al. as reference 28 and level of evidence 1iiDii).
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