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Incidence and Mortality
Estimated new cases and deaths from Hodgkin lymphoma in the United States in 2012:[1]
More than 75% of all newly diagnosed patients with adult Hodgkin lymphoma (HL) can be cured with combination chemotherapy and/or radiation therapy.[2] National mortality has fallen more rapidly for adult HL than for any other malignancy over the last 5 decades.[2]
Prognosis for a given patient depends on several factors. The most important factors are the presence or absence of systemic symptoms, the stage of disease, presence of large masses, and the quality and suitability of the treatment administered. Other important factors are age (therapy for very young children requires special attention), sex, erythrocyte sedimentation rate, extent of abdominal involvement, hematocrit, and absolute number of nodal sites of involvement.[3,4]
HL is the main cause of death over the first 15 years after treatment. By 15 to 20 years after therapy, the cumulative mortality from a second malignancy will exceed the cumulative mortality from HL.[5,6,7]
Related Summaries
Other PDQ summaries containing information related to Hodgkin lymphoma include the following:
Pathologists currently use the World Health Organization (WHO) modification of the Revised European-American Lymphoma (REAL) classification for the histologic classification for adult Hodgkin lymphoma (HL).[1,2]
WHO/REAL classification
Nodular Lymphocyte–Predominant HL
Nodular lymphocyte–predominant HL is a clinicopathologic entity of B-cell origin that is distinct from classic HL.[3,4,5] The typical immunophenotype for lymphocyte-predominant disease is CD15-, CD20+, CD30-, CD45+, while the profile for classic HL is CD15+, CD20-, CD30+, CD45-. Patients with lymphocyte-predominant disease have earlier-stage disease, longer survival, and fewer treatment failures than those with classic HL.[6] Despite a usually favorable prognosis, there is a tendency for histologic transformation to diffuse large B-cell lymphoma in around 10% of patients by 10 years.[7] Lymphocyte-predominant HL is usually diagnosed in asymptomatic young males with cervical or inguinal lymph nodes but usually without mediastinal involvement. Based on retrospective analyses spanning several decades and because of the rarity of this histology, limited-field radiation therapy is the most common treatment approach for patients with early-stage disease.[8,9,10]
The REAL Classification of Lymphoid Neoplasms proposed separating nodular lymphocyte–predominant HL (CD15-, CD20+, CD30-) from lymphocyte-rich classical HL (CD15+, CD20-, CD30+), on the basis of these immunophenotypic differences.[2,11] The largest retrospective report of 426 cases showed no significant difference in clinical response or outcome to standard therapies for these two subgroups.[12][Level of evidence: 3iiiA] Of interest, with a median follow-up of 7 to 8 years, more patients died of treatment-related toxic effects (acute and long-term) than from Hodgkin recurrence. Limitation of radiation dose and fields and avoidance of leukemogenic chemotherapeutic agents, along with watchful waiting policies, should be investigated for these subgroups.[13,14] For patients with advanced-stage nodular lymphocyte–predominant HL, chemotherapy regimens designed for non-HLs may be preferred, based on a retrospective review.[15][Level of evidence: 3iiiDii]
Clinical staging for patients with Hodgkin lymphoma (HL) includes a history, physical examination, laboratory studies (including sedimentation rate), and thoracic and abdominal/pelvic computerized tomographic (CT) scans.[1]
Positron emission tomography (PET) scans, sometimes combined with CT scans, have replaced gallium scans and lymphangiography for clinical staging.[2,3,4] The use of PET scans to assess response and define the use or avoidance of further treatment is under clinical evaluation.[5,6,7,8,9,10] A prospective, multinational study of 260 newly diagnosed patients with HL obtained PET scans at baseline and after two cycles (four doses) of ABVD (doxorubicin plus bleomycin plus vinblastine plus dacarbazine); with a median follow-up of 2.2 years, the 2-year progression-free survival was 12.8% with a positive PET scan after two cycles and 95% with a negative PET scan after two cycles (P < .0001).[8] In a prospective trial of BEACOPP-based therapy—which includes the drugs bleomycin, etoposide, doxorubicin hydrochloride, cyclophosphamide, vincristine sulfate, procarbazine, and prednisone— for previously untreated patients with advanced-stage HL, patients with residual abnormalities measuring 2.5 cm or more received a PET scan at the end of therapy.[11] A negative PET scan predicted no progression or relapse within 1 year for 94% of patients (confidence interval, 91%–97%). Whether consolidation with radiation therapy can be omitted for PET-negative patients must await overall survival data at 5 years. Only further prospective studies can assess whether improved outcomes can be achieved by altering the therapeutic strategy based on PET scan results.[10]
Bone marrow involvement occurs in 5% of patients; biopsy is indicated in the presence of constitutional B symptoms or anemia, leukopenia, or thrombocytopenia. Staging laparotomy is no longer recommended; it should be considered only when the results will allow substantial reduction in treatment. It should not be done in patients who require chemotherapy. If the laparotomy is required for treatment decisions, the risks of potential morbidity should be considered.[12,13,14,15] The staging classification that is currently used for HL was adopted in 1971 at the Ann Arbor Conference [16] with some modifications 18 years later from the Cotswolds meeting.[1]
Subclassification of stage
Stages I, II, III, and IV adult HL can be subclassified into A and B categories: B for those with defined general symptoms and A for those without B symptoms. The B designation is given to patients with any of the following symptoms:
The most significant B symptoms are fevers and weight loss. Night sweats alone do not confer an adverse prognosis. Pruritus as a systemic symptom remains controversial and is not considered a B symptom in the Ann Arbor staging system. (Refer to the PDQ summary on Pruritis for more information.) This symptom is hard to define quantitatively and uniformly, but when it is recurrent, generalized, and otherwise unexplained, and when it ebbs and flows parallel to disease activity, it may be the equivalent of a B symptom.
The designation E is used when well-localized extranodal lymphoid malignancies arise in or extend to tissues beyond, but near, the major lymphatic aggregates. Stage IV refers to disease that is diffusely spread throughout an extranodal site, such as the liver. If pathologic proof of involvement of one or more extralymphatic sites has been documented, the symbol for the site of involvement, followed by a plus sign (+), is listed.
Current practice is to assign a clinical stage (CS) based on the findings of the clinical evaluation and a pathologic stage (PS) based on the findings of invasive procedures.
For example, a patient who has disease in the chest and neck, systemic symptoms, and a negative lymphangiogram might be found at laparotomy to have involvement of the spleen, liver, and bone marrow. Thus, the precise stage of such a patient would be CS IIB, PS IVB (S+)(H+)(M+).
The American Joint Committee on Cancer (AJCC) has designated staging using the Ann Arbor classification system to define adult Hodgkin lymphoma.[17]
Massive mediastinal disease has been defined by the Cotswolds meeting as a thoracic ratio of maximum transverse mass diameter of 33% or more of the internal transverse thoracic diameter measured at the T5/6 intervertebral disc level on chest radiography.[1] Some investigators have designated a lymph node mass measuring 10 cm or more in greatest dimension as massive disease.[18] Other investigators use a measurement of the maximum width of the mediastinal mass divided by the maximum intrathoracic diameter.[19]
Many investigators and many new clinical trials employ a clinical staging system that divides patients into four major groups that are also useful for the practicing physician:[20]
Drug combinations described in this section:
After initial clinical staging for Hodgkin lymphoma (HL), patients with obvious stage III or IV disease, bulky disease (defined as a 10 cm mass or mediastinal disease with a transverse diameter exceeding 33% of the transthoracic diameter), or the presence of B symptoms will require combination chemotherapy with or without additional radiation therapy.
Patients with nonbulky stage IA or IIA disease are considered to have clinical early-stage disease. These patients are candidates for chemotherapy, combined modality therapy, or radiation therapy alone.[1] Staging laparotomy is no longer recommended because it may not alter management and does not enhance ultimate outcome.[2] When chemotherapy alone or combined modality therapy is applied, laparotomy is not required.
Radiation Therapy
In adult HL, the appropriate dose of radiation alone is 25 Gy to 30 Gy to clinically uninvolved sites and 35 Gy to 44 Gy to regions of initial nodal involvement.[3,4,5,6] These recommendations are often modified in pediatric or advanced-staged adult patients who also receive chemotherapy. Treatment is usually delivered to the neck, chest, and axilla (mantle field) and then to an abdominal field to treat para-aortic nodes and the spleen (splenic pedicle). In some patients, pelvic nodes are treated with a third field. The three fields constitute total nodal radiation therapy. In some cases, the pelvic and para-aortic nodes are treated in a single field called an inverted Y. In patients with a favorable prognosis, treatment of the pelvic lymph nodes is frequently omitted, since fertility can be preserved without affecting relapse-free survival. (Refer to the PDQ summary on Sexuality and Reproductive Issues for more information on fertility.)
Second Malignancies
Acute nonlymphocytic leukemia may occur in patients treated with combined modality therapy or with combination chemotherapy alone.[7,8,9] At 10 years following therapy with regimens containing MOPP, the risk of acute myelogenous leukemia (AML) is approximately 3%, with the peak incidence occurring 5 to 9 years after therapy. The risk of acute leukemia at 10 years following therapy with ABVD appears to be less than 1%.[7] A population-based study of more than 35,000 survivors during a 30-year time span identified 217 patients who developed AML; the excess absolute risk is significantly higher (9.9 vs. 4.2 after 1984, P < .001) for older patients (i.e., >35 years at diagnosis) versus younger survivors.[10]
An increase in second solid tumors has also been observed, especially cancers of the lung, breast, thyroid, bone/soft tissue, stomach, esophagus, colon and rectum, uterine cervix, head and neck, and mesothelioma.[8,11,12,13,14,15,16] These tumors occur primarily after radiation therapy or with combined modality treatment, and approximately 75% occur within radiation ports. At a 15-year follow-up, the risk of second solid tumors is approximately 13%;[8,12] at a 20-year follow-up, the risk is approximately 17%;[17] and at a 25-year follow-up, the risk is approximately 22%.[11,18] In a cohort of 18,862 5-year survivors from 13 population-based registries, the younger patients had elevated risks for breast, colon, and rectal cancer for 10 to 25 years before the age when routine screening would be recommended in the general population.[16] Even with involved-field doses of 15 Gy to 25 Gy, sarcomas, breast cancers, and thyroid cancers occurred with similar incidence in young patients receiving higher-dose radiation.[17]
Lung cancer is seen with increased frequency, even after chemotherapy alone, and the risk of this cancer is increased with cigarette smoking.[19,20,21,22] Breast cancer is seen with increased frequency after radiation therapy or combined modality therapy.[11,13,15,23,24,25,26] The risk appears greatest for women treated with radiation before age 30 years, and the incidence increases substantially after 15 years of follow-up.[11,14,27,28,29] In a case control study of 106 patients who developed breast cancer after therapy for HL, cumulative absolute risks for developing breast cancer were calculated as a function of radiation therapy dose and the use of chemotherapy.[30] With a 30-year follow-up, cumulative absolute risks of breast cancer with exposure to radiation range from 8.5% to 39.6%, depending on the age at diagnosis. A family history of breast cancer or ovarian cancer does not confer a greater increased risk than that of radiation therapy for this cohort.[31] In a nested case control study and subsequent cohort study, patients who received both chemotherapy and radiation therapy had a statistically significant lower risk of developing breast cancer than those treated with radiation therapy alone.[24,32] Reaching early menopause with less than 10 years of intact ovarian function appeared to account for the reduction in risk among patients who received combined modality therapy.[32] Reduction of radiation volume also decreased the risk of breast cancer after HL.[32] The risk of non-HL is also increased, but this risk is not clearly related to type or extent of treatment.[12]
Several studies suggest that splenic-field radiation therapy and splenectomy increase the risk of a treatment-related second cancer.[33,34,35] Late effects after autologous stem cell transplantation that is given for failure of induction chemotherapy include second malignancies, hypothyroidism, hypogonadism, herpes zoster, depression, and cardiac disease.[36]
Adverse Effects of Therapy
A toxic effect that is primarily related to chemotherapy is infertility, usually after MOPP-containing or BEACOPP-containing regimens;[12,37,38,39] ABVD appears to spare long-term testicular and ovarian function.[38,40] Late complications primarily related to radiation therapy include hypothyroidism and cardiac disease, which may persist through to 25 years after first treatment.[41,42,43,44,45,46] The absolute excess risk of fatal cardiovascular disease ranges from 11.9 to 48.9 per 10,000 patient years and is mostly attributable to fatal myocardial infarction (MI).[42,43,44,46] The use of subcarinal blocking did not reduce the incidence of fatal MI in a retrospective review, perhaps because of the exposure of the proximal coronary arteries to radiation.[43] In a cohort of 7,033 HL patients, MI mortality risk persisted through to 25 years after first treatment with supradiaphragmatic radiation therapy (dependent on the details of treatment planning), doxorubicin, or vincristine.[46] HL patients treated with mediastinal radiation compared with a normal-matched population have been reported to be at increased risk with the use of cardiac procedures.[47] Impairment of pulmonary function may occur as a result of mantle-field radiation therapy; this impairment is not usually clinically evident, and recovery in pulmonary testing often occurs after 2 to 3 years.[48] Pulmonary toxic effects from bleomycin as used in ABVD are seen in older patients (especially those older than 40 years).[49] Avascular necrosis of bone has been observed in patients treated with chemotherapy and is most likely related to corticosteroid therapy.[50] Bacterial sepsis may occur rarely after splenectomy performed during staging laparotomy for HL;[51] it is much more frequent in children than in adults. The Advisory Committee on Immunization Practices recommends that all patients with HL, whether or not they have had a splenectomy, should be immunized with Haemophilusinfluenzae type b conjugate, meningococcal, and pneumococcal vaccines at least 1 week before treatment.[52] Some investigators recommend reimmunization with all three vaccines 2 years after completion of treatment and with pneumococcal vaccine every 6 years thereafter.[53]
Fatigue is a commonly reported symptom of patients who have completed chemotherapy. In a case-control study design, a majority of HL survivors reported significant fatigue lasting for more than 6 months after therapy compared to age-matched controls.[54]
Patients older than 60 years with HL experience more treatment-related morbidity and mortality and typically receive a lower dose intensity of chemotherapy because of poorer tolerance of treatment than comparably staged younger patients.[55,56]
Patients are designated as having early favorable Hodgkin lymphoma (HL) if they have clinical stage I or stage II disease and no adverse risk factors. Adverse risk factors include:
Historically, radiation therapy alone had been the primary treatment for patients with early favorable HL, often after confirmatory negative staging laparotomy. A randomized, prospective trial involving 542 patients with early favorable HL compared MOPP-ABV for three cycles plus involved-field radiation therapy (IF-XRT) with subtotal nodal radiation; with a median follow-up of 7.7 years, combined modality was favored in terms of 5-year event-free survival (98% vs. 74%, P < .001) and 10-year overall survival (97% vs. 92%, P = .001).[1][Level of evidence: 1iiA] The late mortality from solid tumors, especially in the lung, breast, gastrointestinal tract, and connective tissue, and from cardiovascular disease makes radiation therapy a less attractive option for the best-risk patients, who have the highest probability of cure and long-term survival.[2,3,4,5,6] Recent clinical trials have focused on regimens with chemotherapy and IF-XRT or with chemotherapy alone.[7]
A randomized, prospective trial from the National Cancer Institute of Canada involving 123 patients with early favorable HL compared ABVD for four to six cycles to subtotal nodal radiation; with a median follow-up of 11.3 years, no difference was observed in event-free survival (89% vs. 86%; P = .64) or in overall survival (OS) (98% vs. 98%; P = 0.95).[8][Level of evidence: 1iiA]
In a randomized study from the Milan Cancer Institute of patients with clinical early-stage HL, 4 months of ABVD followed by either IF-XRT or extended-field radiation therapy (EF-XRT) showed similar OS and freedom-from-progression with a 10-year median follow-up, but the study had inadequate statistical power to determine noninferiority of IF-XRT versus EF-XRT.[9][Level of evidence: 1iiDii]
The German Hodgkin Lymphoma Study Group (GHSG) randomly assigned 1,190 patients with early favorable HL to the following:
With a 7.6-year median follow-up, no differences were observed in freedom-from-progression (97%) or OS (98%) for all four groups.[10][Level of evidence: 1iiA]
The ongoing GHSG study is comparing reduced chemotherapy schedules while maintaining IF-XRT at 30 Gy: two cycles of ABVD, two cycles of ABV, two cycles of AVD, or two cycles of AV.
A specialized approach to therapy can be taken when patients with nonbulky lymphocyte–predominant disease presenting in unilateral high neck (above the thyroid notch) or epitrochlear locations require only IF-XRT after clinical staging.[11] A retrospective report of 426 cases of lymphocyte-predominant HL (including the so-called nodular lymphocyte–predominant and lymphocyte-rich classical subtypes) showed that more patients died of treatment-related toxicity (both acute and long term) than from recurrence of HL.[12][Level of evidence: 3iiiA] Limitation of radiation dose and radiation fields and avoidance of leukemogenic chemotherapeutic agents, along with watchful waiting policies, should be investigated for these subgroups.[13] Patients with nonbulky nodular sclerosing disease presenting in the anterior mediastinum only after clinical staging also do well with mantle radiation alone.[14]
Treatment options:
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I adult Hodgkin lymphoma and stage II adult Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
Patients are designated as having early unfavorable Hodgkin lymphoma (HL) if they have clinical stage I or stage II disease and one or more of the following risk factors:
Patients with early unfavorable HL showed relapse rates over 30% at 5 years with radiation therapy alone, prompting evaluation of chemotherapy plus involved-field radiation therapy (IF-XRT) versus chemotherapy alone.[1] The late mortality from solid tumors, especially in the lung, breast, gastrointestinal tract, and connective tissue, and from cardiovascular disease makes radiation therapy a less attractive option unless therapeutic benefits exceed the long-term complications.[2,3,4,5,6]
A randomized, prospective trial from the National Cancer Institute of Canada involving 276 patients with early unfavorable HL compared ABVD for four to six cycles to ABVD for two cycles plus extended-field radiation therapy (EF-XRT); with a median follow-up of 11.3 years, the freedom-from-progression favored combined modality therapy (86% vs. 94%; P = .006), but the overall survival was better for ABVD alone (92% vs. 81%; P = .04).[7][Level of evidence: 1iiA] The trend toward a worse survival for the combined modality arm was attributed to excess secondary malignancies and cardiovascular deaths. In this trial, the extended-field radiation used higher doses and significantly larger exposure to body sites than are employed in current practice.
A randomized study from the Southwest Oncology Group of clinically staged patients (no laparotomy) compared subtotal lymphoid radiation to 3 months of AV followed by subtotal lymphoid radiation therapy; the combined modality arm showed superior failure-free survival (94% vs. 81%; P < .001) but not OS at 3.3 years' median follow-up.[8][Level of evidence: 1iiDiii]
In a randomized study from the Milan Cancer Institute of patients with clinical early-stage Hodgkin lymphoma, 4 months of ABVD followed by either IF-XRT or EF-XRT showed similar OS and freedom-from-progression with 10 years' median follow-up, but the study had inadequate statistical power to determine noninferiority of IF-XRT versus EF-XRT.[9][Level of evidence: 1iiDii] Similarly, in a randomized study from the German Hodgkin Lymphoma Study Group (GHSG) of more than 1,000 patients with early unfavorable HL, 4 months of COPP plus ABVD followed by IF-XRT versus EF-XRT showed equivalent OS and freedom-from-treatment failure (FFTF) with 5 years' median follow-up.[10][Level of evidence: 1iiA] Another randomized study of 996 patients with early unfavorable HL also showed no difference in OS and event-free survival at 10 years comparing four to six cycles of MOPP-ABV plus IF-XRT versus the same chemotherapy plus subtotal nodal radiation therapy.[11][Level of evidence: 1iiA]
In the HDII trial, the GHSG randomly assigned 1,395 patients with early unfavorable HL to:
With a 6.8 year median follow-up no differences were observed in OS (93%–96%) for all four groups.[12,13][Level of evidence: 1iiA] In the arms of the study with 30 Gy of IF-XRT, there was no difference in FFTF between BEACOPP and ABVD (P = .65), but a significant difference in favor of BEACOPP was seen for FFTF when 20 Gy of IF-XRT was used (P = .02).[13][Level of evidence: 1iiD]
A prospective, randomized trial from the European Organization for Research and Treatment of Cancer and Groupe d'Etudes de Lymphomes de L'Adulte of 808 patients with early unfavorable HL compared:
With a 64-month median follow-up, in a preliminary report in abstract form, no differences were observed in event-free survival (89%–92%; P = .38) or OS (91%–96%; P = .98).[14][Level of evidence: 1iiA]
In summary, these randomized trials support the use of ABVD for four cycles with 20 Gy to 30 Gy IF-XRT. Could the radiation therapy be omitted to minimize late morbidity and mortality from secondary solid tumors and from cardiovascular disease?[15] The NCIC study is the only trial to address this question in patients with early unfavorable HL; although four to six cycles of ABVD alone has improved OS compared with a combined modality approach, the use of EF-XRT in the combined modality arm is excessive by current standards, and late effects will be magnified with these larger fields.[7] In addition, chemotherapy alone was 8% worse in freedom-from-progression compared to the combined modality approach. How can we balance an improvement in freedom-from-progression using radiation therapy with chemotherapy against late morbidity and mortality from late effects?[15,16] Randomized studies with or without IF-XRT would be required, but no such studies are currently under way.[15] A Cochrane meta-analysis of 1,245 patients in five randomized, clinical trials suggested improved survival for combined modality therapy versus chemotherapy alone (HR, 0.40; 95% CI, 0.27–0.61), but long-term follow-up, which would account for late toxicities and deaths from therapy, will not be forthcoming from most of these trials.[17]
Patients with bulky disease (≥10 cm) or massive mediastinal involvement were excluded from most of the aforementioned trials. Based on historical comparisons to chemotherapy or radiation therapy alone, these patients currently receive combined modality therapy.[18,19][Level of evidence: 3iiiDiii]
Patients are designated as having advanced favorable Hodgkin lymphoma (HL) if they have clinical stage III or stage IV disease and three or fewer risk factors on the International Prognostic Index for HL, which corresponds to a freedom-from-progression at greater than 60% at 5 years with combination chemotherapy.[1]
ABVD therapy for 6 to 8 months is as effective as 12 months of MOPP alternating with ABVD, and both are superior to MOPP alone in terms of failure-free survival (FFS) (50% vs. 36% with a 14-year median follow-up; P = .03).[2,3][Level of evidence: 1iiA] The Intergroup trial comparing ABVD with MOPP/ABV hybrid showed equivalent efficacy in FFS and overall survival (OS), but increased toxic effects in the hybrid arm, especially from second malignancies.[4][Level of evidence: 1iiA]
A prospective, randomized study, from the Medical Research Council (MRC) (MRC-UKLG-LY09), of 807 patients compared ABVD with two multidrug regimens also incorporating etoposide, chlorambucil, vincristine, and procarbazine. With 52 months' median follow-up, the 3-year event-free survival was 75% (confidence interval [CI], 71%–79%) for all three regimens, and 88% to 90% OS (CI, 84%–93%) for all three regimens, but there were significantly fewer toxic effects with ABVD.[5][Level of evidence: 1iiA]
A prospective, randomized study of 331 patients compared ABVD with escalated BEACOPP, along with a planned autologous stem cell transplantation after reinduction chemotherapy for relapsed or resistant disease. With 61 months' median follow-up, although 7-year freedom from first progression favored escalated BEACOPP (73% vs. 85%, P = .004), 7-year OS was not statistically different (84% vs. 89%, P = .39).[6][Level of evidence: 1iiA] Escalated BEACOPP is associated with increased rates of myelodysplasia and acute myelogenous leukemia (3%–4%).[7] Stanford V is an alternative drug combination with mandated radiation consolidation for most patients and survival rates comparable to those with ABVD.[8,9][Level of evidence: 1iiA]
A prospective, randomized trial of 307 patients with advanced-stage disease, including IIB disease and advanced-favorable Hodgkin lymphoma patients, compared ABVD, BEACOPP (four escalated courses plus two standard courses), and CEC.[10] With a median follow-up of 41 months, although progression-free survival favored BEACOPP over ABVD (78% vs. 68%, P = .038), there was no significant difference in OS.[10][Level of evidence: 1iiDiii] Further follow-up is required to assess rates of secondary malignancies with these regimens.
In a meta-analysis of 1,740 patients treated on 14 different trials, no improvement was observed in 10-years' OS for patients with advanced-stage HL who received combined modality therapy versus chemotherapy alone.[11][Level of evidence: 1iiA] Three prospective, randomized trials and a meta-analysis did not show a benefit in OS from the addition of consolidative radiation therapy to chemotherapy for patients with advanced-stage disease.[12,13,14,15] The lack of difference in OS was attributed to a greater number of second malignancies and poorer response and survival after relapse among patients who received combined modality therapy.
Proposed clinical trials will explore consolidation for patients with positive positron emission tomography testing after four cycles of ABVD.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III adult Hodgkin lymphoma and stage IV adult Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Patients are designated as having advanced unfavorable Hodgkin lymphoma (HL) if they have clinical stage III or stage IV disease and four or more risk factors on the International Prognostic Index for HL, which corresponds to a freedom-from-progression at worse than 50% at 5 years with combination chemotherapy.[1]
ABVD therapy for 6 to 8 months is as effective as 12 months of MOPP alternating with ABVD, and both are superior to MOPP alone in terms of failure-free survival (FFS) (50% vs. 36% with a 14-year median follow-up; P = .03).[2,3][Level of evidence: 1iiA] The Intergroup trial comparing ABVD with MOPP/ABV hybrid showed equivalent efficacy in FFS and overall survival (OS), but increased toxic effects in the hybrid arm, especially from second malignancies.[4][Level of evidence: 1iiA]
The German Hodgkin Lymphoma Study Group (HD9 trial) randomly assigned 1,201 patients with advanced-stage disease to COPP/ABVD, BEACOPP, or to increased-dose BEACOPP, with most patients receiving consolidative radiation therapy to sites of initial bulky disease (≥5 cm).[5] The 10-year OS rates from time of treatment were 75% for COPP/ABVD, 80% for BEACOPP, and 86% for increased-dose BEACOPP (P = .19 for the comparison of COPP/ABVD with BEACOPP, P = .005 for the comparison of BEACOPP with increased-dose BEACOPP, and P < .001 for the comparison of COPP/ABVD with increased-dose BEACOPP).[5][Level of evidence: 1iiA] The actuarial rate of secondary acute leukemias 10 years after diagnosis of HL was 0.4% for COPP/ABVD, 1.5% for BEACOPP, and 3.0% for increased-dose BEACOPP (P = .03).
A prospective, randomized trial of 307 patients with advanced-stage disease, including IIB disease and advanced-favorable HL patients, compared ABVD, BEACOPP (four escalated courses plus two standard courses), and CEC.[6] With a median follow-up of 41 months, although progression-free survival (PFS) favored BEACOPP over ABVD (78% vs. 68%, P = .038), there was no significant difference in OS.[6][Level of evidence: 1iiDiii]
A prospective, randomized study of 331 patients compared ABVD with escalated BEACOPP, along with a planned autologous stem cell transplantation after reinduction chemotherapy for relapsed or resistant disease. With 61 months' median follow-up, although 7-year freedom from first progression favored escalated BEACOPP (73% vs. 85%, P = .004), 7-year OS was not statistically different (84% vs. 89%, P = .39).[7][Level of evidence: 1iiA] Escalated BEACOPP is associated with increased rates of myelodysplasia and acute myelogenous leukemia (3%–4%).[8]
Further follow-up is required to assess rates of secondary malignancies with these regimens. Stanford V is an alternative drug combination with mandated radiation therapy consolidation for most patients and survival rates comparable to those with ABVD.[9,10][Level of evidence: 1iiA]
Three prospective, randomized trials did not show a benefit in OS from the addition of consolidative radiation therapy to chemotherapy for patients with advanced-stage disease.[11,12,13][Level of evidence: 1iiA] In a meta-analysis of 1,740 patients treated on 14 different trials, no improvement was observed in 10-years' OS for patients with advanced-stage HL who received combined modality therapy versus chemotherapy alone.[14][Level of evidence: 3iiiA] The German Hodgkin Lymphoma Study Group HD15 trial showed that a negative positive–emission tomographic (PET) scan after BEACOPP induction therapy was highly predictive for a good outcome even with omission of consolidative radiation therapy (negative predictive value for PET was 94% [95% confidence interval, 91%–97%]).[15] No survival advantage is known for the use of radiation consolidation for patients with massive mediastinal disease and advanced stage disease, though differences exist in sites of first relapse.[16]
Clinical trials are addressing the role of more intensive regimens for patients with advanced-stage disease and poor prognostic factors. Early chemotherapy intensification resulting from an interim, PET-positive scan after two cycles of ABVD has also been proposed.[17] Controversy exists about whether the optimal strategy should involve early dose intensification, with subsequent risks of increased late toxic effects (such as leukemia) or whether ABVD should be employed and patients who relapse be salvaged with high-dose treatment and autografting. In a prospective, randomized trial of 163 patients with unfavorable advanced-stage disease who attained a complete or partial remission after four cycles of ABVD, no difference was observed in OS or FFS either with high-dose therapy with autologous stem cell transplant or with four more cycles of ABVD.[18][Level of evidence: 1iiA]
Patients who experience a relapse after initial wide-field, high-dose radiation therapy have a good prognosis. Combination chemotherapy results in 10-year disease-free survival (DFS) and overall survival (OS) rates of 57% to 81% and 57% to 89%, respectively.[1,2,3,4] For patients who experience a relapse after initial combination chemotherapy, prognosis is determined more by the duration of the first remission than by the specific induction or salvage combination chemotherapy regimen. Patients whose initial remission after chemotherapy was longer than 1 year (late relapse) have long-term survival with salvage chemotherapy of 22% to 71%.[4,5,6,7,8,9] Patients whose initial remission after chemotherapy was shorter than 1 year (early relapse) do much worse and have long-term survival of 11% to 46%.[4,8,10]
Patients who relapse after initial combination chemotherapy usually 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.[11,12,13,14] This therapy has resulted in a 3- to 4-year DFS rate of 27% to 48%. Patients who are responsive to reinduction chemotherapy may have a better prognosis. Two randomized trials have compared aggressive conventional chemotherapy versus high-dose chemotherapy with autologous hematopoietic stem cell transplantation for relapsed chemosensitive Hodgkin lymphoma (HL). Both trials show improvement in freedom from treatment failure at 3 years for the transplantation arm (75% vs. 45% and 55% vs. 34%, respectively); but no difference was observed in OS.[15,16][Level of evidence: 1iiDii] In two retrospective reviews of patients who underwent autologous bone marrow transplantation (ABMT) for relapsed or refractory disease, a comparison was made of those who received involved-field radiation therapy (IF-XRT) for residual masses after high-dose therapy versus no further treatment.[17,18] Those who received IF-XRT had improved progression-free survival. The use of human leukocyte antigen-matched sibling marrow (allogeneic transplantation) results in a lower relapse rate, but the benefit may be offset by increased toxic effects.[13,19,20] Reduced-intensity conditioning for allogeneic stem cell transplantation is also under clinical evaluation.[21,22,23,24,25] For patients with recurrent disease after ABMT, weekly vinblastine therapy has provided palliation with minimal toxic effects.[26][Level of evidence: 3iiiDiv]
For the small subgroup of patients with only limited nodal recurrence following initial chemotherapy, radiation therapy with or without additional chemotherapy may provide long-term survival for about 50% of these highly selected patients.[27,28]
Patients who do not respond to induction chemotherapy (about 10%–20% of all presenting patients) have less than a 10% survival rate at 8 years.[8] For these patients, high-dose chemotherapy and autologous bone marrow or peripheral stem cell or allogeneic bone marrow rescue are under clinical evaluation.[13,14,29,30,31,32,33,34,35] These trials have resulted in a 3- to 5-year DFS rate of 17% to 48%.[11,12,13,14,34]
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent adult Hodgkin lymphoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
Since Hodgkin lymphoma affects primarily young adults, most oncologists will eventually face the dilemma of how to provide therapy to a pregnant woman while minimizing the risk to the fetus. Treatment choice must be individualized, taking into consideration the mother's wishes, the severity and pace of the Hodgkin lymphoma (HL), and the length of the remaining pregnancy. Since general guidelines can never substitute for clinical judgment, oncologists should be prepared to alter the initial plans when necessary.
Stage Information
To avoid exposure to ionizing radiation, magnetic resonance imaging is the preferred tool for staging evaluation.[1] The presenting stage, clinical behavior, prognosis, and histologic subtypes of HL during pregnancy do not differ from those of nonpregnant women during their childbearing years.[2] See the Stage Information section for more information.
Treatment Option Overview
HL that is diagnosed in the first trimester of pregnancy does not constitute an absolute indication for therapeutic abortion. Each patient must be looked at individually to take into account the stage and rapidity of growth of the lymphoma and the patient's wishes.[3] If the HL presents in early stage above the diaphragm and appears to be growing slowly, patients can be followed carefully with plans to induce delivery early and proceed with definitive therapy.[4] Alternatively, these patients can receive radiation therapy with proper shielding.[5,6,7,8] Investigators at M.D. Anderson reported no congenital abnormalities in 16 babies delivered after the mothers had received supradiaphragmatic radiation while shielding the uterus with five half-value layers of lead.[9] Because of theoretical risks that the fetus might develop future malignancies from even minimal scattered radiation doses outside the radiation field, radiation therapy should be postponed, if possible, until after delivery.[10]
Chemotherapy that is administered in the first trimester has been associated with congenital abnormalities in as many as 33% of infants.[11,12] However, in one series, there were no adverse effects in 14 children of mothers who received a combination of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or a combination of doxorubicin, plus bleomycin, plus vinblastine, and dacarbazine (ABVD) during gestation, five of whom began treatment during the first trimester.[13] Consequently, some women may opt to continue the pregnancy and agree to radiation therapy or chemotherapy if immediate treatment is required.
In the second half of pregnancy, most patients can be followed carefully and can postpone therapy until induction of delivery at 32 to 36 weeks.[11,14,15] If chemotherapy is mandatory prior to delivery, such as for patients with symptomatic advanced stage disease, vinblastine alone (given at 6 mg/m² intravenously every 2 weeks until induction of delivery) may be considered because it has never been associated with fetal abnormalities in the second half of pregnancy.[14,15] Steroids are employed both for their antitumor effect and for hastening fetal pulmonary maturity. As an alternative, a short course of radiation therapy can be used prior to delivery in cases of respiratory compromise caused by the rapidly enlarging mediastinal mass. Combination chemotherapy with ABVD appears to be safe in the second half of pregnancy.[13] If chemotherapy is required after the first trimester, many clinicians prefer the combination of drugs over single-agent drugs or radiation therapy.
In one study, the 20-year survival rate of pregnant women with HL did not differ from the 20-year survival rate of nonpregnant women who were matched for similar stage of disease, age at diagnosis, and calendric year of treatment.[16] The long-term effects on progeny after chemotherapy in utero are unknown, though present evidence tends to be reassuring.[12,13,14,15,16]
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Stage Information for Adult Hodgkin Lymphoma
Updated staging information for 2010 (cited Edge et al. as reference 17).
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.
Purpose of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of adult Hodgkin lymphoma. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.
Reviewers and Updates
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Adult Hodgkin Lymphoma Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Levels of Evidence
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
Permission to Use This Summary
PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."
The preferred citation for this PDQ summary is:
National Cancer Institute: PDQ® Adult Hodgkin Lymphoma Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/adulthodgkins/HealthProfessional. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.
Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
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For more information from the NCI, please write to this address:
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The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
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The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-08-30
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This study will examine abnormalities in mitochondria (energy-producing machinery of cells)
and in genes related to mitochondria in the blood cells, muscle, and fat of HIV-positive
patients who are taking nucleoside reverse transcriptase inhibitors (NRTIs) and in patients
not currently taking HIV medications, and compare the results to healthy volunteers. Many
patients with HIV infection take NRTIs to help control the infection. These medications may
damage cell mitochondria, possibly causing side effects such as fatigue. This study will
explore the relationship between changes in mitochondria and related genes and patient
reports of energy level, mood and quality of life.
Healthy volunteers and HIV-infected patients between 18 and 55 years of age may be eligible
for this study. Healthy volunteers must test negative for the HIV antibody. HIV-positive
patients must have been diagnosed positive for at least 1 year. Patients who are taking
antiretroviral therapy must have been taking the same drug regimen (with at least two NTRIs
and no protease inhibitors) for at least 3 months. HIV positive patients not taking
antiretroviral medication must not have had antiretroviral therapy for at least 1 year.
Candidates are screened with a medical history, brief physical examination, blood and urine
tests, and questionnaires related to mood and energy.
Qualified volunteers will undergo the following procedures during three or four study visits:
Visit 1
Complete history and physical examination, blood tests, and questionnaires about energy
level, mood, and quality of life.
Visit 2
Muscle and fat biopsy: Before the biopsy, blood is drawn to check blood counts and to test
for pregnancy in women who can become pregnant. The biopsy is done on an outpatient basis in
the operating room. The site of the biopsy (an area on the upper arm or upper leg) is numbed
with an injection under the skin. A 1-inch incision is made over the muscle to be biopsied
and a small sample of muscle tissue and small sample of fat are removed. The incision is then
closed and bandaged. Following the biopsy, you will be monitored for about 4 hours in the
clinic. Strenuous physical activity should be restricted in the week following biopsy to
allow healing.
Visit 3
Examination of biopsy site and possible apheresis: The biopsy site is examined for healing.
Apheresis may be scheduled for this visit or for an extra visit between the biopsy and the
final visit. This procedure for obtaining white blood cells for study is optional. For
apheresis, blood is withdrawn from a needle placed in a vein in the arm and the white cells
are separated from the rest of the blood. The white cells are extracted and the red cells and
plasma are then returned to the body through a second needle.
Both HIV infection and antiretroviral nucleoside analogues (nucleoside reverse transcriptase
inhibitors or NRTIs) are known to affect mitochondrial DNA content and mitochondrial
function. A number of important clinical syndromes observed in HIV-infected persons relate to
mitochondrial dysfunction including lactic acidosis, myopathy, cardiomyopathy, pancreatitis,
peripheral neuropathy, and possibly lipodystrophy. Fatigue, one of the most prevalent
complaints among persons with HIV infection, may also be the result of mitochondrial
toxicity, though this has not been clearly established.
Availability of minimally invasive tests to assess mitochondrial toxicity would greatly
facilitate understanding of the contribution of mitochondrial dysfunction to clinical
syndromes. Mitochondrial dysfunction ultimately results in lactic acidosis; however, venous
lactate measurements are neither adequately sensitive nor specific for identification of
early mitochondrial dysfunction. Muscle and liver biopsies are currently considered to be the
reference standards for the evaluation and diagnosis of mitochondrial toxicity in muscle and
liver, but these invasive tests are impractical for routine and repeated evaluations. The
recent development of a real-time polymerase chain reaction (PCR) assay to accurately
quantify the mtDNA copy numbers per cell in peripheral blood mononuclear cells (PBMCs) may
allow non-invasive assessment of mitochondrial toxicity. This technique has been applied in a
limited fashion to muscle, adipose tissue and liver samples as well.
This pilot study seeks to examine the relationship between fatigue and other clinical
parameters and markers of mitochondrial dysfunction. The goals of this study are threefold:
1) to investigate the relationship between subjective fatigue ratings and mitochondrial
dysfunction through measurements of mtDNA depletion in skeletal muscle 2) to determine
whether there is a relationship between evidence of mitochondrial dysfunction in muscle and
evidence of mitochondrial dysfunction in lymphocytes or adipose tissue suggesting that
examination of lymphocytes or adipose tissue may be adequate for the accurate diagnosis of
mitochondrial dysfunction and 3) to identify genes and proteins as potential biomarkers for
fatigue and mitochondrial toxicity. For this cross-sectional study, three groups of
participants will be enrolled: HIV positive patients on NRTI-containing and
protease-inhibitor sparing regimens (n=30), HIV patients currently taking no antiretroviral
medications (n=30) and healthy controls (n=15). HIV patients on NRTIs will be stratified
according to their fatigue level (0-3, 4-7 or 8-10). Participants will complete a battery of
questionnaires regarding fatigue and undergo muscle and adipose tissue biopsy.
Men and women, ages 18-55 years, will be considered as potential candidates for this study.
Persons older than 55 years of age are excluded because of age related declines in
mitochondrial number that may confound study results.
Ability to understand and provide informed consent.
Willing and able to comply with study requirements and procedures including storage of
blood, muscle and adipose tissue samples for use in future studies of HIV, AIDS, immune
function, muscle or adipose tissue diseases or other related diseases.
No or currently controlled depression.
Negative serum pregnancy test for females at screening and within one week prior to muscle
and adipose tissue biopsy.
Specific lab criteria:
- Absolute neutrophil count greater than 1000/mm(3).
- PT/INR less than or equal to 1.5, PTT less than 45 sec.
- Platelets greater than 75,000/mm(3).
- Hemoglobin greater than or equal to 10.0mg/dl.
- Serum creatinine less than or equal to 1.8mg/dl.
- AST and ALT less than 2 times the upper limit of normal.
- Thyroid stimulating hormone and free thyroxine within normal limits.
- Serum testosterone within normal limits or on adequate replacement.
Willing to avoid aspirin-containing medications or the non-steroidal anti-inflammatory drug
piroxicam (Feldene) for 10 days prior to muscle and adipose tissue biopsy and willing to
discontinue other nonsteroidal anti-inflammatory drugs 24 hours prior to biopsy.
For HIV negative volunteers:
Negative HIV-1 antibody testing
For HIV positive volunteers:
Established HIV diagnosis (documentation of HIV-1 infection by licensed ELISA testing and
confirmed by Western Blot).
HIV infection present greater than or equal to 1 year.
For patients in the antiretroviral treated group, on a stable combination antiretroviral
treatment regimen not containing a protease inhibitor for at least 3 months prior to
protocol screening.
For patients in the non-ART group, no antiretroviral treatment for at least one year.
Under the care of a primary care physician.
Unable to provide informed consent.
Unable to understand protocol required questionnaires including inability to comprehend
English (the fatigue questionnaires have not been validated in languages other than
Pregnant or breast-feeding.
Current treatment with an ARV regimen containing a protease inhibitor.
Opportunistic infection requiring treatment.
Concurrent malignancy requiring cytotoxic chemotherapy or radiation therapy.
History of myopathy or myositis.
Untreated or uncontrolled depression by clinical history or as indicated by a score on the
Beck's Depression Inventory of greater than or equal to 19.
Severe psychiatric disorder that would interfere with adherence to protocol requirements.
Severe sleep disturbance.
Current alcohol or substance abuse.
Diabetes mellitus requiring drug therapy.
Decompensated cardiac or pulmonary disease.
Current use or a history of treatment with interleukin-2, interferon-alpha or other
investigational agent(s) within 6 months of protocol screening.
Corticosteroid, immunosuppressive or cytotoxic agent use within 90 days of trial screening.
Any medical condition for which the principal investigator feels muscle and adipose tissue
biopsy may be contraindicated.
Allergy to lidocaine.
Principal InvestigatorCaryn G Morse, M.D.National Institutes of Health Clinical Center (CC)
Bethesda, Maryland 20892United StatesThere is no listed contact information for this specific location.Site Status: N/A
| All trademarks are property of their legal owners. | All Rights Reserved
ClinicalConnection.com is a resource that provides information on clinical trials conducted worldwide.
ClinicalConnection.com does not conduct or endorse clinical trials. Please consult your physician before participating.
© All Rights Reserved.
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subset: commoncrawl


text:
Shirt: Marshalls
Everything else: Target
Okay, so maybe I was trying to copy the first outfit in the previous post and failed miserably. MAYBE.
I really like how you recreated that outfit! I adore your shirt.ReplyDelete
Love the shirt, I have been on a search for the perfect plaid shirt without much luck. I will have to check out Target soonReplyDelete
you didn't fail!! this outfit rocks... very pretty : ) I love seeing how people style plaid shirts, and this looks great.
I'm so digging the plaid/tartan these days. I'm on the lookout for a cute one in red like you're wearing. Great outfit!
I used to have that shirt. My sister stole it and I never got it back. Now that I see how cute it looks on you, I'm even more mad about it..


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Starting MSRP from * $86,995
New 2019 Cadillac CTS-V Sedan at Van Cadillac in Kansas City
Discover the new Cadillac CTS-V Sedan, available to buy or lease today at Van Cadillac. On this page, you will find the 2019 CTS-V Sedan vehicles that are currently available to buy or lease at our Kansas City dealership, be able to see the exterior color options, view photos, and more. If you have a question about this new CTS-V Sedan or any other new and used vehicle at Van Cadillac, please give us a call at (877) 638-8550, and our friendly staff will be happy to assist you.


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Our History
Originally, the credit union was established to serve the financial needs of Florence Public Schools, District 1. Later the credit union became federally chartered and continued to add groups to its field of membership, including District 4, Merita Bakery, two local colleges, several private schools and other select employee groups. The credit union was granted a community charter in December 2002. Anyone who lives, works, worships, or attends school in Florence County is eligible to join PDFCU.
First located in an office at Poynor Junior High School, the credit union then moved to the Investors Bank Building in 1985. In July, 1987, the credit union moved to its present location in downtown Florence at 305 West Pine Street. Pee Dee Federal Credit Union presently has assets in excess of $30 million and serves over 6,000 members.


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Westport bank settles Madoff lawsuits, wins verdict
NEW HAVEN -- A Connecticut bank has agreed to pay more than $7 million to investors who lost millions of dollars in Bernard Madoff's massive Ponzi scheme but it also won a jury verdict involving two of the investors, attorneys said Thursday.
The investors contended Westport National Bank failed at its job as custodian of their retirement accounts. The bank argued it met its obligations and was not responsible for uncovering the fraud.
The bank, whose parent company is Connecticut Community Bank, reached a $7.7 million settlement last week with about 240 account holders, attorneys said. Investors put about $12 million into the accounts over the past 20 years, including about $5 million since the bank took over the account, said David S. Golub, attorney for about one-third of the investors. The bank did not admit wrongdoing and made an economic judgment to settle, said Tracy Miner, the bank's attorney. She said the total liability could have reached $70 million to $80 million.
A federal jury in Hartford concluded Wednesday that the bank was not liable in a case involving two of the investors who reported losses of about $2 million. The jury found the bank failed to perform its duties but the investors didn't prove it resulted in losses to them.
"We're thrilled," Miner said of the verdict.
Steven Gard, attorney for the investors who lost their case, said his clients are disappointed with the verdict and they're evaluating their legal options. He declined to comment further. The Connecticut bank held the retirement accounts on behalf of the investors, whose financial adviser recommended Madoff. The bank transferred money from the investors' account to Madoff and kept track of the investors' account.
The case involved a small Connecticut bank in contrast to major financial institutions that have faced claims over Madoff losses. It was one of the first Madoff-related cases involving bank custodians to go to trial and raised the issue of what obligation custodians have in verifying investor assets.
Investors contended in the lawsuit that much of the information it received from Madoff was so far-fetched that even a casual review would have raised numerous red flags. Madoff claimed consistent profits every month, even during sharp downfalls in the market, Golub said.
The bank countered that it was not responsible for uncovering a fraud that even regulators failed to detect. Madoff is serving a 150-year prison term.
A trustee seeking to recover investor losses has secured more than $9.3 billion of the estimated $17.5 billion that thousands of investors put into Madoff's sham investment business.
After Madoff's arrest, investigators quickly determined that client statements showing they held more than $60 billion in securities were fiction. The once-respected financier made no investments, but instead was paying out principal little by little to other investors.


text:
An excerpt from a writer to Dan Savage's column Savage Love:
If your message is that we should not judge people based on their sexual preference, how do you justify judging entire groups of people for any other reason (including their faith)? There is no part of me that took any pleasure in what happened to that young man.
To that end, to imply that I would somehow encourage my children to mock, hurt, or intimidate another person for any reason is completely unfounded and offensive.
An excerpt from Dan's answer:
I'm sorry your feelings were hurt by my comments.
No, wait. I'm not. Gay kids are dying. So let's try to keep things in perspective: Fuck your feelings.
And—sorry—but you are partly responsible for the bullying and physical violence being visited on vulnerable LGBT children. The kids of people who see gay people as sinful or damaged or disordered and unworthy of full civil equality—even if those people strive to express their bigotry in the politest possible way (at least when they happen to be addressing a gay person)—learn to see gay people as sinful, damaged, disordered, and unworthy. And while there may not be any gay adults or couples where you live, or at your church, or in your workplace, I promise you that there are gay and lesbian children in your schools. And while you can only attack gays and lesbians at the ballot box, nice and impersonally, your children have the option of attacking actual gays and lesbians, in person, in real time.
You can read the entire column, entitled "In Your Image" here, as well as many of Dan's other columns, podcasts and youtube videos, especially the It Gets Better Project.


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Working Full Time
OMG!!!! I can not believe how much energy it takes to work full time at a position that requires me to be on my feet walking 8,000 to 10,000 steps a day. It is really cutting into my creative time. I fall asleep by 9 pm regardless of being in bed.
However check out the Halloween ATC's that I completed this month for the Scrapbook.com swap. I am so bad about keeping the packages that tell me what the name of products is that I used. I do remember that I found the Trick or Treat sticker at WalMart.


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bethany and i had a great time visiting charlotte this weekend and got the chance to meet the amazing steve and becky knight both at warehouse242 and at dinner afterwards. the music at 242 was amazing; baptisms on easter sunday totally rocked and the knights were just tremendous hosts. we met steve and becky after scoping out the charlotte indies allies site which i blatantly joined though i live just south of baltimore.
Wednesday, April 14, 2004
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text:
We have a great deal of as removed cores that we will feature on this page from time to time. Give us a call if you are looking for something specific.
We will consider ALL Offers.
as removed from a Cessna 414 for a conversion. Note that one spinner has been repaired previously.
Thomas Aircraft Maintenance, aircraft repair, aircraft overhaul, aircraft sales, aircraft parts, consulting, brokerage, Ministers Delegate for Maintenance, Aircraft import, Aircraft export, aircraft rebuild, Cessna for sale, Piper for sale, Bonanza for sale, Beech, Mooney for sale, Jetstream, Honeywell, Pratt and Whitney, Approved Maintenance Organization, Certified aircraft, Aircraft tooling,aircraft modifications, King Katmai, AMO, Continental, Lycoming, Cessna parts, Cessna tools, Jetstream parts, Jetstream tools, skin, rib, stringer, brake, performance, speed, short take off and landing, STOL, aircraft recovery, battery, aviation, aerospace, maintenance, annual inspection, structural repair, structural inspection, tundra, sheet metal repair, consulting, hangar, flying, aviation, propeller, magneto, aviator, performance, flight, annual inspection, supplementary inspection documents, flaps, rudder, aileron, elevator


text:
Dem cracks open in debt-limit fight
For the past several weeks, Senate Democrats and the White House have shown a remarkable amount of unity in the controversial fight surrounding the debt ceiling.
Then came shutdown Day Seven.
Story Continued Below
Just as top Senate Democrats began to lay the groundwork to raise the U.S. government's borrowing limit through 2014, senior White House officials refused to rule out a short-term increase. The divergent messages caused major heartburn for top Senate Democrats and gave Republicans fresh hope that they could defeat a yearlong debt ceiling hike and win concessions from President Barack Obama in this fall's fiscal battles.
( PHOTOS: 25 great shutdown quotes)
By late Monday afternoon, nervous Senate Democrats had reached out to the White House to ensure they were on the same page — and the concerns on Capitol Hill seemed to be alleviated after senior administration officials downplayed the idea of a short-term increase.
But the incident underscored the fear among the congressional Democratic leadership that President Barack Obama may eventually back away from the no-negotiation stance he and Senate Majority Leader Harry Reid (D-Nev.) have voiced for weeks in order to avoid a first-ever default. And it raised questions about Senate Democrats' next step in the debt ceiling debate if Republicans successfully filibuster a bill to increase the $16.7 trillion national debt ceiling.
( Also on POLITICO: Gene Sperling: White House open to short-term debt limit boost)
Democrats began to raise concerns privately that the White House appeared to be softening its iron-clad position.
"This is very disconcerting to us," a senior Senate Democratic leadership aide said on condition of anonymity, referring to comments by the president's top economic adviser, Gene Sperling, at POLITICO'S Playbook Breakfast on Monday. "All along, the president and White House have been firm on what they want, both in a [government funding bill] and debt ceiling. So we're concerned about this."
Senate Majority Whip Dick Durbin (D-Ill.) said, "What does short-term buy us? That buys us Thanksgiving in Washington."
( WATCH - Debt ceiling showdown: By the numbers)
The stakes — both political and economic — in the government funding and debt ceiling fights couldn't be higher. Obama and Hill Democrats, unwilling to relive the budget and debt fights of 2011-12, have warned Republicans for months that they wanted "clean" government funding and debt ceiling bills.
Yet House Speaker John Boehner (R-Ohio), under heavy pressure from hard-line GOP conservatives, refused to put a funding resolution on the House floor without anti-Obamacare language. When Reid and his fellow Democrats refused to accept it, the now weeklong government shutdown ensued. That shutdown shows no sign of ending soon.
The debt-ceiling fight is lining up the same way. Boehner has already said he will not put a clean debt ceiling bill on the House floor. In fact, there's no current plan for House Republicans to move on anything debt-related. Obama and Reid have so far refused to accept anything other than a long-term debt bill with no preconditions.
( WATCH: Key moments leading to shutdown deadline)
The Democratic discord started Monday morning when Sperling said the White House would be open to a two- to three-week increase to avert the Oct. 17 deadline when the U.S. government may begin to default on its $16.7 trillion debt. The comments were a shift from the position the White House took in the 2011 debt fight, when it demanded that Congress extend the debt ceiling through the 2012 elections.


text:
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text:
EBay Asks Users to Change Passwords After Cyberattack
Compromised Database Contains Encrypted Passwords, Not Financial Data
EBay Inc. on Wednesday asked the 145 million registered users of its namesake marketplace to change their passwords following a cyberattack that compromised a database containing encrypted passwords and other data.
The exposed database didn't include financial data, eBay said. Passwords for users of eBay's PayPal payments network weren't exposed, a spokeswoman said. However, some PayPal users may use the same name and password combination they use on eBay....


text:
Group fights 'gay cure' bus ad ban
A Christian group has launched a High Court "battle for free speech" after its advert suggesting that gay people can be "cured" was banned from the sides of London buses.
The Mayor of London, who is in charge of Transport for London (TfL), rejected the ad posters as "offensive to gays".
Boris Johnson has also warned that displaying the ad could lead to a retaliation against the wider Christian community.
The rejected posters say: "Not Gay! Ex-Gay, Post-Gay and Proud. Get over it!"
They are in response to a poster campaign by gay rights group Stonewall, which plastered on the sides of the capital's red buses with the message: "Some people are gay. Get over it!"
The banned ad promotes the view of the Core Issues Trust that homosexuals can be "reoriented" through therapy and prayer.
Dr Mike Davidson, the head of the trust, asked Mrs Justice Lang to rule at London's High Court that the ban was unlawful and "a deep threat" to democratic freedoms.
Paul Diamond, appearing for Mr Davidson, told the judge: "We believe this is a very important free speech case on whether a totally temperate, restrained advertisement can be put on the sides of London buses."
Before the hearing started, Mr Davidson said: "I hope this hearing will give us the opportunity to put the case for securing some kind of future for people who want to move away from homosexuality and to be recognised as a valid group with needs to be protected and respected."
A TfL spokesman said: "The advertisement breached TfL's advertising policy as in our view it contained a publicly controversial message and was likely to cause widespread offence to members of the public."
PA Media


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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.
To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.
Different ways to prevent cancer are being studied, including:
Smoking is the leading cause of cancer in the United States.
Smoking increases the risk of many types of cancer. These include:
A smoker's risk of cancer can be 2 to 10 times higher than it is for a person who never smoked. This depends on how much and how long the person smoked.
In 2007, about 22% of adult men and about 17% of adult women were smokers. Lung cancer is the leading cause of cancer death in both men and women. In the last 30 years, the total number of smokers has decreased, especially among men. Since the 1980s, deaths caused by lung cancer in men have been decreasing.
Smoking causes many other health problems.
Smoking is linked with many diseases besides cancer. These include:
Other health problems that may be linked to smoking are:
Smoking during pregnancy may cause problems such as slow growth of the fetus and low birth weight.
Being exposed to secondhand smoke increases the risk of cancer and other diseases.
Smoking can also affect the health of nonsmokers. Smoke that comes from the burning of a tobacco product or smoke that is exhaled by smokers is called secondhand smoke. Inhaling secondhand smoke is called involuntary or passive smoking.
The same cancer-causing chemicals inhaled by tobacco smokers are inhaled in lower amounts by people exposed to secondhand tobacco smoke. Nonsmokers who are exposed to secondhand smoke have a higher risk of lung cancer and coronary heart disease. Children exposed to tobacco smoke have higher risks of the following:
Quitting smoking improves health in smokers of all ages.
The risk of most health problems from smoking, including cancer and heart and lung disease, can be lowered by stopping smoking. People of all ages can improve their health if they quit smoking. Quitting at a younger age will improve a person's health even more. People who quit smoking cut their risk of lung cancer by 30% to 50% after 10 years compared to people who keep smoking, and they cut their risk of cancer of the mouth or esophagus in half within 5 years after quitting.
The damage caused by smoking is even worse for people who have had cancer. They have an increased risk of cancer recurrence, new cancers, and long-term side effects from cancer treatment. Quitting smoking and stopping other unhealthy behaviors can improve long-term health and quality of life. See the PDQ summary Smoking in Cancer Care for more information.
The Public Health Service has a set of guidelines called Treating Tobacco Use and Dependence. It asks health care professionals to talk to their patients about the health problems caused by smoking and the importance of quitting smoking.
Different ways to quit smoking have been studied. The following are the most common methods used to help smokers quit:
People who have even a short counseling session with a health care professional are more likely to quit smoking. Your doctor or other health care professional may take the following steps to help you quit:
Childhood cancer survivors who smoke may be more likely to quit when they take part in programs that use peer-counseling . In these programs, childhood cancer survivors are trained in ways to give support to other childhood cancer survivors who smoke and want to quit. More people quit smoking with peer-counseling than with self-help programs. If you are a childhood cancer survivor and you smoke, talk to your doctor about peer-counseling programs.
Drug treatment
Treatment with drugs is also used to help people quit smoking. These include nicotine replacement products and non-nicotine medicines. People who use any type of drug treatment are more likely to quit smoking after 6 months than those who use a placebo or no drug treatment at all.
Nicotine replacement products have nicotine in them. You slowly reduce the use of the nicotine product in order to reduce the amount of nicotine you take in. Using a nicotine replacement product can help break the addiction to nicotine. It lessens the side effects of nicotine withdrawal, such as feeling depressed or nervous, having trouble thinking clearly, or having trouble sleeping. Nicotine replacement products that have been shown to help people quit smoking include:
Nicotine replacement products can cause problems in some people, especially:
Other medicines that do not have nicotine in them are used to help people quit smoking. These include:
These medicines lessen nicotine craving and nicotine withdrawal symptoms.
It is important to know that bupropion and varenicline may cause serious psychiatric problems. Symptoms include:
Before starting to take bupropion or varenicline, talk to your doctor about the important health benefits of quitting smoking and the small but serious risk of problems with the use of these drugs.
Varenicline may also cause serious heart problems.
Smoking reduction
When smokers do not quit smoking completely but smoke fewer cigarettes (smoking reduction). they may still benefit. The more you smoke, the higher your risk of lung cancer and other cancers related to smoking. Studies show that smokers who cut back are more likely to stop smoking in the future.
Smoking less is not as helpful as quitting smoking altogether, and is harmful if you inhale more deeply or smoke more of each cigarette to try to control nicotine cravings. In smokers who do not plan to quit smoking completely, nicotine replacement products have been shown to help them cut down the number of cigarettes they smoke, but this effect does not appear to last over time .
The following resources can help you quit smoking:
Cancer prevention clinical trials are used to study ways to prevent cancer.
Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.
New ways to help smokers quit are being studied in clinical trials.
Clinical trials are taking place in many parts of the country. Information about clinical trials can be found in the Clinical Trials section of the NCI Web site. Check for clinical trials in NCI's PDQ Cancer Clinical Trials Registry that are accepting patients for trials to quit smoking.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. We can respond only to email messages written in English.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether a certain drug or nutrient can prevent cancer. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients and those who are at risk for cancer. During prevention clinical trials, information is collected about the effects of a new prevention method and how well it works. If a clinical trial shows that a new method is better than one currently being used, the new method may become "standard." People who are at high risk for a certain type of cancer may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-10-23
If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.
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Dorset House Backpackers
Steeped in history and situated next to beautiful Hagley Park, Dorset House Christchurch Backpacker Hostel is quiet, comfortable and charming, and is well-equipped with all that a budget traveller could need.
Dorset House provides delightful backpackers hostel accommodation from which to enjoy all that Christchurch has to offer. Set among organic flower gardens, Dorset House was built in 1871 by the wealthy timber merchant, J B Way. It once featured 27 rooms, crystal chandeliers and Italian marble fireplaces. It has been lovingly restored as backpackers hostel accommodation, boasting a range of interesting period features alongside modern conveniences such as renovated modern bathrooms and kitchen, and free unlimited WiFi internet access throughout the hostel. It is a piece of Christchurch's past that we are proud to share with our guests.
Our backpacker hostel guest rooms are comfortable, freshly cleaned, and bathed in afternoon sun. All rooms are within 3-7 metres of a bathroom. All share room beds are single beds (no bunks), and all beds are fully made with fresh linen. Extra blankets and electric blankets keep you warm in the winter months. We have a sunny kitchen available for guest use, and there's a guest laundry here too.
Free unlimited WiFi access for all guests throughout the hostel.
The lounge was once used as a chapel, and is now a very large room with plenty of comfortable couches and space for relaxing and talking. It has a free pool table, board games, TV with Freeview, a DVD player (a selection of DVDs are available free of charge from reception) , a book shelf and a stereo.
Dorset House offers a full travel and information desk - just ask at reception and let us organize your tours, day trips and onward travel including day trips, bus transport, local activities and shuttles. There's no charge for this. Our staff are locals, and they will be more than happy to help you find your way around and clue you in on some favorite spots to eat, drink and socialize.
From Dorset House, it's just a 15-minute stroll to Cathedral Square, or walk along beside the river to reach other attractions such as the Botanic Gardens, museum, the Arts Centre, art gallery, weekend markets and art-house cinemas.
Continental breakfast packs can be purchased at reception, and we are just two-minutes from some great cafes, bars and restaurants on Victoria St. Public transport is close too - just two minutes walk to the airport bus service.
Late check-ins can be organised, and free luggage storage is available. We have a custom-built lock-up to keep your bike or skis safe, and free off-street car-parking is available behind the House on a 'first come first serve basis'.
****Please note if you require a late check-in for a hostel room (for arrival at Dorset House after 6pm), we will email you your check-in instructions and door access code (or you can contact us for this information via telephone). Dorset House reception hours are 8am - 6pm, with late check-in available 24-hours. ****
Dorset House is ideally situated to provide a comfortable stay for budget travellers. We hope to see you here soon!
Dorset House has share rooms, double rooms, twins and singles. There are no bunks, and all beds are fully made. All facilities are shared, with every room within 3 - 7 metres from one or more bathrooms.
The house is located in a quiet part of the central city, with no traffic noise. It is less than 50 metres from our front gate to leafy Hagley Park, where jogging, walking, golf and garden tours are popular activities.
Regretfully, children under 10 years of age are not permitted. Children over 10 years of age are welcome with their parents or guardians.
In compliance with New Zealand law, Dorset House is fully non-smoking, although guests are welcome to smoke on the outdoor balcony off the kitchen.
Complimentary WiFi vouchers are issued daily to all guests.
Availability & RatesTo view availability and prices please select dates and click 'Update Dates'
Hostel Facilities & Policies
- Bicycle parking
- Book Exchange
- Breakfast Not Included
- Common Room
- Credit Cards Accepted
- DVDs
- Free City Maps
- Free Internet Access
- Free Parking
- Free WiFi
- Hot Showers
- Luggage Storage
- No Curfew
- Non Smoking
- Reading Light
- Tours/Travel Desk
- Towels For Hire
- Vending Machines
Cancellation PolicyThis property has a 2 day cancellation policy. Failure to cancel within this time will result in a cancellation charge equal to the first night of your stay.
Must-Read Hostel InfoThis property has specific Terms & Conditions.
Check-in time: 2pm onwards. Check-out time: 10am.
Reception hours are 9am - 5pm at Dorset House.
If you plan to arrive at Dorset House after reception closes at 5pm, please contact us prior to your arrival to let us know and to receive the door code (also in your confirmation email).
Card Pre-Authorisation:
If the total cost of your booking is over $200.00 we may pre-authorise the booking amount to your credit card. This puts a hold on the set amount to ensure that you have enough funds in your account to successfully pay for the booking. Please note, if your card has been pre-authorised the total charge of the booking must be charged to this card upon check-in as this will remove the hold on funds from the card.
All credit card transactions (Visa, Mastercard) will incure surcharge of 2.5%
In the event you need to cancel your reservation we will require '2 full days' notice. Reservations cancelled with less than 2 full days notice will be charged for the first nights' stay. For clarity - a reservation made for a Wednesday night must be cancelled prior to close of our reception (5pm) on the Sunday night to be considered outside the cancellation period.
DirectionsShow MapHide Map
General Location: Dorset Street is located between Park Avenue and Victoria St. It is directly next to Hagley Park, and is one block below Bealey Avenue.
This is the northern end of the central city, within ten minutes walk of the Canterbury Museum, Botanic Gardens and Cashel St shopping precinct. For evening dining there is plenty of restaurants and pubs in the Merivale area, a 20 minute walk or 5 minutes by bus. Or enjoy the shops, restaurants and cafes on quirky Victoria St, just a few metres from our front door.
It's easy to get around too, the airport bus is a 2 minute walk from Dorset House, or walk 15-25 minutes for national bus services.
To reach us from the airport: Catch bus 29 between 6.22am and 10.22pm, weekdays. Weekend hours: Saturday, 6.52am - 11.22pm. Sunday, 7.22am - 10.22pm. The cost of this bus service is $8.50 per adult, and services run approximately every half hour. Ask the driver to let you off at the first stop on Victoria St. From there it's about a 3 minute walk to us.
Outside these bus hours, you may choose to catch a direct shuttle from the shuttle/taxi zone at the airport. This will cost approximately $19 for one person and $5.00 for every extra person, and will drop you to our door. Please contact us at least 48 hours in advance if you would like us to book a pre-arranged shuttle pick-up for you. Shuttle transfers can also be booked to take you to the airport for outbound flights.
Taxi - the cost of a taxi from the airport to Dorset House will be approximately $45 - 50.
From the train station: Catch a shuttle service ($7), or taxi ($15-20) from the train station.
Located Near
Dorset House is ideally located on the northern end of the central city:
*30 seconds walk to Hagley Park.
*8 minutes walk along the park to the Canterbury Museum & Botanic Gardens.
*15 minutes walk to the new Cashel St shopping precinct for souvenirs and gifts.
*Enjoy quirky shops on Victoria St. Vic's Cafe is famous (have an iced chocolate!) and we can see it from our front door.
*Enjoy evening dining in the Merivale shopping and restaurant area (supermarket, restaurants, bars, pubs)


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Today's guest blog post is by AAA member, Clare Boulanger. Dr. Boulanger is a self-declared Anthropologist on the Loose. She is seeking assistance in her current research project. Please contact her directly at clareboulanger(at)gmail(dot)com with your response.
I'm conducting research into anthropology programs and faculty positions that have succumbed to program deletion and reductions in force, as well as those that faced such threats and survived (though perhaps in a different form). If you are a present or former anthropology faculty member who:
–lost your position and your program was eliminated, or
–was reduced from a program that continues to exist, or
–is teaching or has taught in a program that was in danger of elimination but was not eliminated, or
–was in danger of reduction but was, in the end, not reduced,
I would greatly appreciate hearing from you (please specify which one of the above categories most closely describes your experience; if none is close, invent your own!). I realize that those who suffered the worst of these outcomes may not consult this blog, but if readers know of someone whose experience conforms to one of the descriptions above, please give him/her my contact information. I can be reached at clareboulanger(at)gmail(dot)com
Depending on the amount and quality of data collected, the purpose of this study may be manifold. First, I would like to keep up my research skills while I too am between jobs; second, I want to know why programs fail and positions are lost; third, I want to know what strategies have succeeded in saving programs and positions. Ultimately, I would like to learn more about a changing academy in a changing United States, and how anthropology can adapt to survive in what is often advertised as the New Reality.
Standard guidelines on informed consent will apply, of course, and your identity and the identity of your institution will be protected.
Thank you!
Clare L. Boulanger


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Set of Oak Dining Chairs (4 Chairs) TCBS40309
Set of Oak Dining Chairs (4 Chairs) TCBS40309
An impressive set of 4 oak dining chairs with ornate hard-carved back rest.
These durable, ergonomic and stylish chairs would add much beauty to any dining table. Whether you want the simplicity of wooden seats with padded and upholstered comfort, these oak dining chairs will give you years of use.
There are two simple chairs and two matching armchairs.
Chair sizes:
Simple: W58cm x D50cm x H115cm (seat height: 50cm).
Armchair: W45cm x D50cm x H115cm (seat height:48cm).
Scaramanga's old, vintage, retro and antique wooden chairs are not new or made to look old. They may have small marks and scratches on them, which are consistent with their age and original use. We feel these add to their character and appeal. Please look at the photos to get an idea of their condition.
For more information see our ethical policy for wooden furniture and wooden accessories.
Furniture delivery (UK only):
Orders for furniture & some of our larger home accents ranges are usually despatched in five working days. Deliveries can take up to two working days to arrive once despatched.
Couriers require a signature on delivery of your order and where a signature is not provided the courier will hold the package and a card detailing how to arrange re-delivery will be left.
We can only deliver on weekdays, should you require delivery on Saturday please contact us for a price.
Larger items or fragile or pieces of furniture weighing over 30kg may take up to seven working days to despatch and a further five working days to be delivered.
For more information visit our Delivery Page under Customer Services