Klimm Beate, Reineke Thorsten, Haverkamp Heinz, Behringer Karolin, Eich Hans T, Josting Andreas, Pfistner Beate, Diehl Volker, Engert Andreas
First Department of Internal Medicine, University Hospital Cologne, Germany.
J Clin Oncol. 2005 Nov 1;23(31):8003-11. doi: 10.1200/JCO.2005.205.60. Epub 2005 Oct 3.
Several scores have described sex as a prognostic factor in patients with Hodgkin's lymphoma (HL). However, little is known how sex-specific factors influence treatment outcome. We systematically investigated sex differences with regard to pretreatment characteristics and therapy-related variables, and examined their influence on the outcome of HL patients.
This analysis comprises 4,626 HL patients of all prognostic risk groups who were enrolled onto the multicenter studies HD4 to HD9 of the German Hodgkin Study Group. At 5.5 years, 2,050 female and 2,576 male patients were analyzed.
Male and female patients had similar prognostic factors. There was more acute chemotherapy-related hematotoxicity in women, especially more severe leucopenia (WHO grade 3/4, 69.9% female and 55.2% male; P < .0001). Importantly, this did not translate into more infections. Female patients had similar response rates but fewer relapses and deaths, leading to a significantly better freedom from treatment failure (FFTF; at 66 months, 81% female [95% CI, 79% to 82%] and 74% male [95% CI, 72% to 76%]). Severe leucopenia during chemotherapy was strongly associated with better FFTF, both for males and females. In addition, when only those patients who developed severe leucopenia within the first two cycles of chemotherapy were included, the factor maintained its protective role.
The protective role of severe leucopenia suggests the testing of a more individualized therapy. In future trials, this therapy may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.
已有多项评分将性别描述为霍奇金淋巴瘤（HL）患者的一个预后因素。然而，关于性别特异性因素如何影响治疗结果，人们知之甚少。我们系统地研究了预处理特征和治疗相关变量方面的性别差异，并检验了它们对HL患者治疗结果的影响。
本分析纳入了德国霍奇金研究组HD4至HD9多中心研究中的4626例所有预后风险组的HL患者。在5.5年时，对2050例女性患者和2576例男性患者进行了分析。
男性和女性患者具有相似的预后因素。女性患者化疗相关的急性血液毒性更多，尤其是更严重的白细胞减少（世界卫生组织3/4级，女性为69.9%，男性为55.2%；P < 0.0001）。重要的是，这并没有转化为更多的感染。女性患者的缓解率相似，但复发和死亡较少，导致无治疗失败生存期（FFTF）显著更好（在66个月时，女性为81%[95%置信区间，79%至82%]，男性为74%[95%置信区间，72%至76%]）。化疗期间的严重白细胞减少与男性和女性更好的FFTF均密切相关。此外，当仅纳入那些在化疗的前两个周期内出现严重白细胞减少的患者时，该因素仍保持其保护作用。
严重白细胞减少的保护作用提示应测试更个体化的治疗方法。在未来的试验中，这种治疗方法可能根据前几个周期内的个体毒性情况以适应反应的方式进行调整。
