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Shortage of Drug for Children's Cancer May Have Upped Relapse Rates
Date:12/27/2012

By Serena Gordon
HealthDay Reporter

WEDNESDAY, Dec. 26 (HealthDay News) -- When a national shortage of a cancer drug that had helped treat children with Hodgkin's lymphoma for decades forced doctors to find a substitute, they thought they had settled on a drug that would work just as well for these young cancer patients.

But a new analysis suggests they were mistaken.

Mechlorethamine, also known as nitrogen mustard, had been part of a common chemotherapy regimen for Hodgkin's since the 1960s, but experts believed the drug cyclophosphamide would perform equally well. The statistics in the analysis tell another story, however, with two-year remission rates dropping from 88 percent to 75 percent after the switch was made.

"We thought this would be an easy substitution. Cyclophosphamide has been used forever for Hodgkin's lymphoma," said analysis co-author Dr. Monica Metzger, an associate member of the department of oncology at St. Jude Children's Research Hospital in Memphis, Tenn. "We thought the equivalent dose would work just as well, but it doesn't work the same in this chemotherapy regimen. More patients relapsed."

"There are many treatments that work very well. Both mechlorethamine and cyclophosphamide are efficacious, but once you begin a regimen of medications, you have to follow the whole regimen," Metzger said. "It's like a recipe. Like any other recipe, it calls for certain ingredients, and if you make a substitution, you get different results."

The original chemotherapy regimen for Hodgkin's lymphoma, dubbed MOPP, included mechlorethamine, vincristine, procarbazine and prednisone. This combination of drugs was effective, but it also was linked to secondary leukemia and infertility.

Since then, other chemotherapy combinations have been developed to help lessen the side effects. In an effort to further improve outcomes for those with Hodgkin's lymphoma, a newer regimen called Stanford
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