Lazarus H M, Rowlings P A, Zhang M J, Vose J M, Armitage J O, Bierman P J, Gajewski J L, Gale R P, Keating A, Klein J P, Miller C B, Phillips G L, Reece D E, Sobocinski K A, van Besien K, Horowitz M M
Lymphoma Working Committee of the Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, USA.
J Clin Oncol. 1999 Feb;17(2):534-45. doi: 10.1200/JCO.1999.17.2.534.
Hodgkin's disease patients who never achieve complete remission with conventional chemotherapy (i.e., those with primary induction failure) have a poor prognosis. Some subjects who receive high-dose therapy with autologous hematopoietic progenitor-cell infusion experience prolonged progression-free survival.
Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 122 Hodgkin's disease patients who failed to achieve complete remission after one or more conventional therapy regimens and subsequently received an autotransplant between 1989 and 1995 were reviewed.
Median age was 27 years (range, 7 to 57 years). Median time from diagnosis to transplantation was 14 months (range, 5 to 38 months). Most patients received high-dose chemotherapy without radiation for pretransplantation conditioning (n = 107). The regimen most frequently used was cyclophosphamide, carmustine, and etoposide (n = 47). Fifteen patients received total-body irradiation (n = 15). The graft consisted of bone marrow (n = 86), blood stem cells (n = 25), or both (n = 11). The 100-day mortality was 12% (95% confidence interval, 7% to 19%). Sixty patients (50%) were considered to have achieved complete remission after autotransplantation; 37 of these had negative imaging studies, whereas scan abnormalities of unknown significance persisted in 23 patients. Twenty-seven patients (22%) had no response or progressive disease after transplantation. Probabilities of progression-free and overall survival at 3 years were 38% (95% confidence interval, 28% to 48%) and 50% (95% confidence interval, 39% to 60%), respectively. In multivariate analysis, "B" symptoms at diagnosis and poor performance score at transplantation were adverse prognostic factors for outcome.
Autotransplants should be considered for patients with Hodgkin's disease who do not achieve complete remission with conventional therapy.
霍奇金淋巴瘤患者若无法通过传统化疗实现完全缓解（即原发性诱导失败患者），其预后较差。一些接受高剂量疗法并自体造血祖细胞输注的患者可实现较长时间的无进展生存期。
回顾了自体血液与骨髓移植登记处（ABMTR）的详细记录，这些记录涉及122例霍奇金淋巴瘤患者，他们在接受一种或多种传统治疗方案后未能实现完全缓解，并于1989年至1995年间接受了自体移植。
中位年龄为27岁（范围为7至57岁）。从诊断到移植的中位时间为14个月（范围为5至38个月）。大多数患者在移植前预处理时接受了不含放疗的高剂量化疗（n = 107）。最常使用的方案是环磷酰胺、卡莫司汀和依托泊苷（n = 47）。15例患者接受了全身照射（n = 15）。移植物包括骨髓（n = 86）、血液干细胞（n = 25）或两者皆有（n = 11）。100天死亡率为12%（95%置信区间，7%至19%）。60例患者（50%）在自体移植后被认为实现了完全缓解；其中37例影像学检查呈阴性，而23例患者扫描结果存在意义不明的异常。27例患者（22%）在移植后无反应或疾病进展。3年时无进展生存期和总生存期的概率分别为38%（95%置信区间，28%至48%）和50%（95%置信区间，39%至60%）。在多变量分析中，诊断时出现“B”症状和移植时体能状态评分差是预后不良的因素。
对于无法通过传统疗法实现完全缓解的霍奇金淋巴瘤患者，应考虑自体移植。
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