Radman I, Basić N, Labar B, Kovacević J, Aurer I, Bogdanić V, Zupancić-Salek S, Nemet D, Jakić-Razumović J, Mrsić M, Santek F, Grgić-Markulin L, Boban D
Department of Internal Medicine, Division of Hematology, Clinical Hospital Center Rebro, Zagreb, Croatia.
Ann Oncol. 2002 Oct;13(10):1650-5. doi: 10.1093/annonc/mdf271.
The aim of this study was to analyze outcome of patients with Hodgkin's disease (HD) in whom first-line chemotherapy with mustine/vincristine/procarbazine/prednisone (MOPP) had failed.
From January 1982 to December 1989 among 210 patients treated with MOPP and radiotherapy to initial bulky sites, 65 patients were primary refractory to or relapsed after initial treatment.
Twenty-nine of 65 patients (44%) were primary refractory to initial chemotherapy, 20 relapsed within 12 months after complete remission (CR) and 16 relapsed after CR that lasted more than 12 months. Patients with primary refractory HD and early relapse (<12 months after CR) were treated with doxorubicin/bleomycin/vinblastine/darcarbazine. In patients with late relapse (>12 months after CR) MOPP was repeated. The median follow-up for all patients was 115 months. The overall response rate was 63%. Thirty-three patients (51%) achieved a second CR and eight patients (12%) partial response. Remission rate was greatest in patients with late relapse (CR >12 months) (75 versus 55% for early relapse versus 35% for primary refractory HD) (P <0.01). At 10 years, overall and failure-free survival rates were 21 and 16%, respectively. Patients who were in first remission longer than 12 months had a superior overall survival (37 versus 18% for early relapse) and failure-free survival (24 versus 10% for early relapse). No patient with primary refractory HD was alive beyond 52 months after initial treatment failure (P <0.01). Main prognostic factors were duration of the first remission and tumor bulk at relapse.
Our results confirm previous observations that a significant proportion of patients with HD who experience induction treatment failure cannot be cured with conventional treatment and probably need more aggressive therapy.
本研究旨在分析接受氮芥/长春新碱/丙卡巴肼/泼尼松（MOPP）一线化疗失败的霍奇金淋巴瘤（HD）患者的预后。
1982年1月至1989年12月期间，210例接受MOPP化疗及对初始大包块部位进行放疗的患者中，65例患者对初始治疗原发难治或复发。
65例患者中有29例（44%）对初始化疗原发难治，20例在完全缓解（CR）后12个月内复发，16例在CR持续超过12个月后复发。原发难治性HD和早期复发（CR后<12个月）的患者接受多柔比星/博来霉素/长春花碱/达卡巴嗪治疗。晚期复发（CR后>12个月）的患者重复使用MOPP。所有患者的中位随访时间为115个月。总缓解率为63%。33例患者（51%）实现第二次CR，8例患者（12%）部分缓解。晚期复发（CR>12个月）患者的缓解率最高（早期复发为55%，原发难治性HD为35%，分别为75%）（P<0.01）。10年时，总生存率和无失败生存率分别为21%和16%。首次缓解超过12个月的患者总生存率更高（早期复发为18%，分别为37%），无失败生存率更高（早期复发为10%，分别为24%）。初始治疗失败后，没有原发难治性HD患者存活超过52个月（P<0.01）。主要预后因素是首次缓解持续时间和复发时肿瘤体积。
我们的结果证实了先前的观察结果，即相当一部分诱导治疗失败的HD患者无法通过传统治疗治愈，可能需要更积极的治疗。
