Avigdor A, Hardan I, Shpilberg O, Raanani P, Grotto I, Ben-Bassat I
Harefuah. 2000 Sep;139(5-6):174-9, 248, 247.
High dose chemotherapy and autologous stem cell transplantation are widely used in relapsed and primary refractory Hodgkin's disease. We transplanted 42 patients with Hodgkin's disease between 1990-1998. Median follow-up was 31 months (range 1-102). 29 (69%) were transplanted after relapse and 13 (31%) were refractory to first line therapy. Median age at transplantation was 29 years (range 19-58) and 23 (55%) were males. All were treated with the BEAM protocol (carmustine, etoposide, cytarabine and melphelan). 18 who were in remission received radiotherapy following transplantation. The source of the stem cells was bone marrow in 17% and peripheral blood in 83%. At initial diagnosis: 57% had stage III-IV disease and B symptoms were present in 52%. 75% were treated with MOPP, ABVD or with related versions. Radiotherapy followed in 52%. Prior to transplantation, 45% of the relapsed group were in the advanced stage. 33% and 12% of all patients had lung and bone involvement, respectively. The complete remission rate was 86% for the 2 groups. 2 (5%) died from transplant-related complications and MDS/AML developed in 2 (5%) after transplantation. The 3-year overall survival (OS) and disease-free survival (DFS) were 68% and 60%, respectively. The 3-year OS for the relapsed group was 64% compared with 76% for the refractory group, and the 3-year DFS for the relapsed group was 60% vs. 42% for the refractory group (neither difference significant). Radiotherapy following transplantation did not have a beneficial effect on DFS. No prognostic factors for outcome of transplantation were found, most probably due to the limited number of patients and the high variability of disease characteristics. We conclude that high dose chemotherapy and autologous stem cell transplantation are effective and relatively safe for relapsed or primary refractory Hodgkin's disease. The DFS at 3 years was longer for those transplanted after relapse than those with primary refractory disease, but not significantly. Patients with primary refractory disease can be salvaged with high dose chemotherapy.
大剂量化疗和自体干细胞移植广泛应用于复发和原发性难治性霍奇金淋巴瘤。1990年至1998年间，我们对42例霍奇金淋巴瘤患者进行了移植。中位随访时间为31个月（范围1至102个月）。29例（69%）在复发后接受移植，13例（31%）对一线治疗无效。移植时的中位年龄为29岁（范围19至58岁），23例（55%）为男性。所有患者均接受BEAM方案（卡莫司汀、依托泊苷、阿糖胞苷和美法仑）治疗。18例缓解期患者移植后接受了放疗。干细胞来源为骨髓的占17%，外周血的占83%。初诊时：57%为Ⅲ-Ⅳ期疾病，52%有B症状。75%接受MOPP、ABVD或相关方案治疗。52%随后接受放疗。移植前，复发组45%处于晚期。所有患者中33%和12%分别有肺部和骨骼受累。两组的完全缓解率为86%。2例（5%）死于移植相关并发症，2例（5%）移植后发生骨髓增生异常综合征/急性髓细胞白血病。3年总生存率（OS）和无病生存率（DFS）分别为68%和60%。复发组的3年OS为64%，难治组为76%；复发组的3年DFS为60%，难治组为42%（差异均无统计学意义）。移植后放疗对DFS无有益影响。未发现移植结局的预后因素，很可能是由于患者数量有限以及疾病特征的高度变异性。我们得出结论，大剂量化疗和自体干细胞移植对复发或原发性难治性霍奇金淋巴瘤有效且相对安全。复发后移植患者的3年DFS长于原发性难治性疾病患者，但差异无统计学意义。原发性难治性疾病患者可通过大剂量化疗挽救。
