科隆高剂量序贯化疗用于复发难治性霍奇金淋巴瘤：德国霍奇金淋巴瘤研究组（GHSG）一项大型多中心研究的结果

Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG).

作者信息

Josting A, Rudolph C, Mapara M, Glossmann J-P, Sieniawski M, Sieber M, Kirchner H H, Dörken B, Hossfeld D K, Kisro J, Metzner B, Berdel W E, Diehl V, Engert A

机构信息

First Department of Internal Medicine, University Hospital Cologne, Germany.

出版信息

Ann Oncol. 2005 Jan;16(1):116-23. doi: 10.1093/annonc/mdi003.

DOI:10.1093/annonc/mdi003

PMID:15598948

Abstract

BACKGROUND

We designed a dose- and time-intensified high-dose sequential chemotherapy regimen for patients with relapsed and refractory Hodgkin lymphoma (HD).

PATIENTS AND METHODS

Eligibility criteria included age 18-65 years, histologically proven primary progressive (PD) or relapsed HD. Treatment consisted of two cycles DHAP (dexamethasone, high-dose cytarabine, cisplatinum); patients with chemosensitive disease received cyclophosphamide followed by peripheral blood stem cell harvest; methotrexate plus vincristine, etoposide and BEAM plus peripheral blood stem cell transplantation (PBSCT).

RESULTS

A total of 102 patients (median age 34 years, range 18-64) were enrolled. The response rate was 80% (72% complete response, 8% partial response). With a median follow-up of 30 months (range 3-61 months), freedom from second failure (FF2F) and overall survival (OS) were 59% and 78% for all patients, respectively. FF2F and OS for patients with early relapse were 62% and 81%, for late relapse 65% and 81%; for PD 41% and 48%, and for multiple relapse 39% and 48%, respectively. In multivariate analysis response after DHAP (P <0.0001) and duration of first remission (PD and multiple relapse versus early and late relapse; P=0.0127) were prognostic factors for FF2F. Response after DHAP (P <0.0081), duration of first remission (P=0.0017) and anemia (P=0.019) were significant for OS.

CONCLUSION

Based on the promising results of this study, a prospective randomized European intergroup study was started comparing this intensified regimen with two courses of DHAP followed by BEAM (HD-R2 protocol).

摘要

背景

我们为复发难治性霍奇金淋巴瘤（HD）患者设计了一种剂量和时间强化的大剂量序贯化疗方案。

患者与方法

入选标准包括年龄18 - 65岁，组织学确诊的原发性进行性（PD）或复发HD。治疗包括两个周期的DHAP（地塞米松、大剂量阿糖胞苷、顺铂）；化疗敏感疾病患者接受环磷酰胺治疗，随后进行外周血干细胞采集；甲氨蝶呤加长春新碱、依托泊苷以及BEAM加外周血干细胞移植（PBSCT）。

结果

共纳入102例患者（中位年龄34岁，范围18 - 64岁）。缓解率为80%（完全缓解72%，部分缓解8%）。中位随访30个月（范围3 - 61个月），所有患者的无二次失败生存率（FF2F）和总生存率（OS）分别为59%和78%。早期复发患者的FF2F和OS分别为62%和81%，晚期复发患者分别为65%和81%；PD患者分别为41%和48%，多次复发患者分别为39%和48%。多因素分析显示，DHAP治疗后的缓解情况（P <0.0001）以及首次缓解持续时间（PD和多次复发与早期和晚期复发相比；P = 0.0127）是FF2F的预后因素。DHAP治疗后的缓解情况（P <0.0081）、首次缓解持续时间（P = 0.0017）和贫血（P = 0.019）对OS有显著影响。