Sureda A, Arranz R, Iriondo A, Carreras E, Lahuerta J J, García-Conde J, Jarque I, Caballero M D, Ferrà C, López A, García-Laraña J, Cabrera R, Carrera D, Ruiz-Romero M D, León A, Rifón J, Díaz-Mediavilla J, Mataix R, Morey M, Moraleda J M, Altés A, López-Guillermo A, de la Serna J, Fernández-Rañada J M, Sierra J, Conde E
Clinical Hematolgy Division, Hospital de la Santa Creu i Sant Pau, St Antoni Maria Claret, Barcelona, Spain.
J Clin Oncol. 2001 Mar 1;19(5):1395-404. doi: 10.1200/JCO.2001.19.5.1395.
To analyze clinical outcome and significant prognostic factors for overall (OS) and time to treatment failure (TTF) in a group of 494 patients with Hodgkin's disease (HD) undergoing autologous stem-cell transplantation (ASCT).
Detailed records from the Grupo Español de Linfomas/Transplante Autólogo de Médula Osea Spanish Cooperative Group Database on 494 HD patients who received an ASCT between January 1984 and May 1998 were reviewed. Two hundred ninety-eight males and 196 females with a median age of 27 years (range, 1 to 63 years) received autografts while in complete remission (n = 203) or when they had sensitive disease (n = 206) or resistant disease (n = 75) at a median time of 26 months (range, 4 to 259 months) after diagnosis. Most patients received high-dose chemotherapy without radiation for conditioning (n = 443). The graft consisted of bone marrow (n = 244) or peripheral blood (n = 250).
The 100-day mortality rate was 9%. The 5-year actuarial TTF and OS rates were 45.0% (95% confidence interval [CI], 39.5% to 50.5%) and 54.5% (95% CI, 48.4% to 60.6%), respectively. In multivariate analysis, the presence of active disease at transplantation, transplantation before 1992, and two or more lines of therapy before transplantation were adverse prognostic factors for outcome. Sixteen patients developed a secondary malignancy (5-year cumulative incidence of 4.3%) after transplantation. Adjuvant radiotherapy before transplantation, the use of total-body irradiation (TBI) in the conditioning regimen, and age > or = 40 years were found to be predictive factors for the development of second cancers after ASCT.
ASCT achieves long-term disease-free survival in HD patients. Disease status before ASCT is the most important prognostic factor for final outcome; thus, transplantation should be considered in early stages of the disease. TBI must be avoided in the conditioning regimen because of a significantly higher rate of late complications, including secondary malignancies.
分析494例接受自体干细胞移植（ASCT）的霍奇金淋巴瘤（HD）患者的总生存期（OS）和治疗失败时间（TTF）的临床结局及重要预后因素。
回顾了西班牙淋巴瘤/自体骨髓移植协作组数据库中494例于1984年1月至1998年5月接受ASCT的HD患者的详细记录。298例男性和196例女性，中位年龄27岁（范围1至63岁），在完全缓解期（n = 203）或疾病敏感（n = 206）或耐药（n = 75）时接受自体移植，诊断后中位时间为26个月（范围4至259个月）。大多数患者接受不含放疗的大剂量化疗进行预处理（n = 443）。移植物包括骨髓（n = 244）或外周血（n = 250）。
100天死亡率为9%。5年精算TTF率和OS率分别为45.0%（95%置信区间[CI]，39.5%至50.5%）和54.5%（95%CI，48.4%至60.6%）。多因素分析显示，移植时存在活动性疾病、1992年前进行移植以及移植前接受过两线或更多线治疗是不良预后因素。16例患者移植后发生了第二原发恶性肿瘤（5年累积发病率为4.3%）。移植前辅助放疗、预处理方案中使用全身照射（TBI）以及年龄≥40岁被发现是ASCT后发生第二原发癌的预测因素。
ASCT可使HD患者获得长期无病生存。ASCT前的疾病状态是最终结局的最重要预后因素；因此，应在疾病早期考虑进行移植。预处理方案中必须避免使用TBI，因为其晚期并发症发生率显著更高，包括第二原发恶性肿瘤。
