[霍奇金淋巴瘤患者自体干细胞移植大剂量治疗：单中心治疗患者的长期随访]

[High dose therapy with autologous stem cell transplantation in patients with Hodgkin's lymphoma: long-term follow-up in patients treated in one center].

作者信息

Trnĕný M, Vacková B, Pytlík R, Cieslar P, Válková V, Gasová Z, Kobylka P, Trnková M, Krejcová H, Klener P

机构信息

Interni klinika 1. LF UK a VFN, Praha.

出版信息

Cas Lek Cesk. 2006;145(1):19-24.

PMID:16468237

Abstract

BACKGROUND

Majority of patients with Hodgkin's Lymphoma (HL) can be cured by first line therapy. The high dose therapy (HDT) with autologous stem cell transplantation (ASCT) is the option which can be used in the situation when the conventional therapy failed. METHODS AND RESULTS. Beginning 1994 till 2005 84 pts with HL who did not respond the conventional chemotherapy underwent 105 HDT procedures with ASCT. The median age at the time of HDT was 30.5 years. The reason for salvage therapy followed by HDT with ASCT was the failure to achieve 1st complete remission-- CR (n 16) or the subsequent relapse or progression (n 68). The disease status at the time of HDT after conventional salvage chemotherapy was assessed as chemosensitive in 65 pts (77.4%) and chemoresistant in 19 pts (22.6%). The most frequent HDT regimen used was BEAM (82 HDT), 22 pts entered into the tandem HDT program. Bone marrow only was used as the source of progenitor cells in 4 ASCT, peripheral blood progenitor cells (PBPC) only were used in 85 ASCT and the combination of both in 16 ASCT. The disease status after the HDT with ASCT was assessed (77 pts were qualifiable) as CR in 39 pts (50.6%), PR in 31 (40.3%) and as stable disease or progression in 7 pts (9.1%). Treatment related mortality in HDT with PBPC was 3.9%. The median follow up is 5.3 years. The five year probability of event free survival (EFS) is 43.1% and overall survival 53.2%. The EFS and OS probability respectively for the chemosensitive patients was 48.6% and 62.9% respectively. The status at HDT and the results after it have prognostic significance. There were observed 39 deaths and 26 of them were caused by disease progression. Secondary tumor was observed in 5 pts and in all of them it caused the death.

CONCLUSIONS

The HDT with ASCT allows the long-term survival without disease progression in about a half of the patients with reasonable toxicity.

摘要

背景

大多数霍奇金淋巴瘤（HL）患者可通过一线治疗治愈。高剂量治疗（HDT）联合自体干细胞移植（ASCT）可用于传统治疗失败的情况。方法与结果：从1994年至2005年，84例对传统化疗无反应的HL患者接受了105次HDT联合ASCT治疗。HDT时的中位年龄为30.5岁。进行HDT联合ASCT挽救治疗的原因是未达到首次完全缓解（CR，16例）或随后复发或进展（68例）。传统挽救化疗后HDT时的疾病状态评估为化疗敏感65例（77.4%），化疗耐药19例（22.6%）。最常用的HDT方案是BEAM（82次HDT），22例患者进入串联HDT方案。4例ASCT仅使用骨髓作为祖细胞来源，85例ASCT仅使用外周血祖细胞（PBPC），16例ASCT同时使用两者。HDT联合ASCT后的疾病状态评估（77例可评估）为CR 39例（50.6%），PR 31例（40.3%），稳定疾病或进展7例（9.1%）。PBPC的HDT相关死亡率为3.9%。中位随访时间为5.3年。无事件生存（EFS）的五年概率为43.1%，总生存为53.2%。化疗敏感患者的EFS和OS概率分别为48.6%和62.9%。HDT时的状态及其后的结果具有预后意义。观察到39例死亡，其中26例由疾病进展引起。5例患者观察到继发性肿瘤，均导致死亡。