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Answer 4
  1. High-dose chemotherapy in conjunction with autologous stem cell transplantation with curative intent. Because this patient was initially treated with mantle radiation, repeated use of radiotherapy would be limited in terms of dosing; radiation therapy to the axilla is therefore not an option. Single-agent chemotherapy could be palliative, but better options exist. Combination chemotherapy might return the patient to remission and would be the second-best choice, but the chance of a long-term response to such therapy is slight. If the only treatment options were palliative, no therapy of an asymptomatic patient would be acceptable. However, in this patient with Hodgkin’s disease, reaching a cure is still possible; since the bone marrow is negative for the disease, high-dose chemotherapy in conjunction with autologous stem cell transplantation is an excellent option.5

     Vose JM, Bierman PJ, Armitage JO. Hodgkin’s disease: the role of bone marrow transplantation. Semin Oncol 1990;17:749-57.

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