Neben K, Hohaus S, Goldschmidt H, Egerer G, Voso M T, Ho A D, Haas R
Department of Internal Medicine V, University of Heidelberg, Germany.
Ann Hematol. 2000 Oct;79(10):547-55. doi: 10.1007/s002770000190.
From March 1986 to March 1998, 82 patients with relapsed or refractory Hodgkin's disease underwent high-dose chemotherapy (HDCT) with peripheral blood stem cell (PBSC) transplantation in our center. This is a retrospective analysis of the long-term clinical outcome. There were 52 males and 30 females with a median age of 32 years (range 18-59 years). Prior to transplantation, 36 patients were in complete remission (CR), 34 in partial remission (PR), and 12 had refractory disease after salvage therapy. For HDCT, 78 patients were treated with CBV (cyclophosphamide, 6.0-6.8 g/ m2; etoposide, 1.0-1.6 g/m2; carmustine, 0.45-0.8 g/m2), while four patients received different regimens. Probability of freedom from progression (FFP), overall survival (OS), and event-free survival (EFS) at 5 years of the entire group was 63%, 61%, and 54%, respectively. Early mortality rate ( < or = 100 days) declined from 17% to 6% after 1992. Five patients died of late transplant-related complications (> 100 days), including secondary lymphoma and leukemia in two patients. None of the refractory patients survived beyond 3.5 years. Multivariate analyses identified extranodal sites of disease at relapse and refractory disease status prior to transplantation as significant prognostic factors for FFP, EFS, and OS. As we have shown in our study, remarkable progress was achieved in reducing early morbidity and mortality over time, but this was associated with only a slight, not significant improvement of long-term outcome (OS 66% vs 57% at 5 years for patients undergoing PBSC transplantation before and after 1992, P = 0.26). Although the results as a whole are encouraging for chemosensitive patients, new therapeutic strategies are needed to reduce toxicity and improve the clinical outcome of patients, especially of those with a less favorable prognosis.
1986年3月至1998年3月，82例复发或难治性霍奇金淋巴瘤患者在本中心接受了高剂量化疗（HDCT）及外周血干细胞（PBSC）移植。这是一项关于长期临床结局的回顾性分析。患者中男性52例，女性30例，中位年龄32岁（范围18 - 59岁）。移植前，36例患者处于完全缓解（CR），34例部分缓解（PR），12例在挽救治疗后疾病难治。对于HDCT，78例患者接受CBV方案治疗（环磷酰胺，6.0 - 6.8 g/m²；依托泊苷，1.0 - 1.6 g/m²；卡莫司汀，0.45 - 0.8 g/m²），另有4例患者接受不同方案。整个组5年时无进展生存率（FFP）、总生存率（OS）和无事件生存率（EFS）分别为63%、61%和54%。1992年后早期死亡率（≤100天）从17%降至6%。5例患者死于移植相关晚期并发症（>100天），包括2例继发性淋巴瘤和白血病。难治性患者无一例存活超过3.5年。多因素分析确定复发时的结外病变部位及移植前的难治性疾病状态是FFP、EFS和OS的重要预后因素。正如我们在研究中所示，随着时间推移，在降低早期发病率和死亡率方面取得了显著进展，但这仅伴随着长期结局的轻微改善，并不显著（1992年前后接受PBSC移植的患者5年OS分别为66%和57%，P = 0.26）。尽管总体结果对化疗敏感患者令人鼓舞，但仍需要新的治疗策略来降低毒性并改善患者的临床结局，尤其是预后较差的患者。
