Seminars in oncology
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Seminars in oncology · Jun 1992
ReviewToward bloodless surgery: erythropoietin therapy in the surgical setting.
Issues related to blood safety and blood inventory have recently led to a much greater interest in blood conservation measures. Some of these measures have included using lower transfusion triggers (hematocrit values), directed donor programs, and autologous blood transfusions. When possible, autologous blood donation is the preferable alternative because it represents the safest blood, conserves blood inventories, and has a salutary effect on physician transfusion behavior. ⋯ Continuing medical education can be effectively used to alter physician behavior regarding underordering. Early clinical trials have suggested that recombinant human erythropoietin (r-HuEPO) can be effectively used to increase the volume of autologous blood obtained before surgery and to prevent the anemia caused by serial phlebotomy. Determining the optimal dose, route, and interval of administration of r-HuEPO is currently the object of ongoing investigations.
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Seminars in oncology · Feb 1990
ReviewCan MOPP be replaced in the treatment of advanced Hodgkin's disease?
MOPP (mechlorethamine, vincristine, procarbazine, prednisone) was the first successful regimen for the treatment of Hodgkin's disease. It has the longest period of follow-up and is best studied as to its benefits and acute and long-term side effects. The acute toxicity of the side effects, including nausea and/or vomiting, hair loss, and myelosuppression, may have been reason to modify doses of nitrogen mustard, an agent whose dose intensity may be critical in achieving long-term benefits. ⋯ Pulmonary fibrosis with radiation and bleomycin is unique to ABVD, as shown in the ABVD experience at the NCl (Milan). Can ABVD be improved? The demonstrated single-dose activity of etoposide in Hodgkin's disease has prompted its inclusion in second-line programs, such as EVA (etoposide, vincristine or vinblastine, doxorubicin). The second-line response rates in the St Bartholomew's (London, England) series (where vincristine was used) was 11 of 19 patients (58%);3 in the ongoing CALGB trial of EVA (vinblastine combination), the response rate is 67%. (ABSTRACT TRUNCATED AT 400 WORDS)