Escobar Ignacio Garcia, Barrigon Dolores Caballero, Tamayo Pilar, Perez-Simon Jose Antonio, Mateos Maria Vitoria, Garcia Jose Ramon, San Miguel Jesus F
Department of Hematology and Nuclear Medicine, Hospital Clínico Universitario de Salamanca, Spain.
Clin Lymphoma Myeloma. 2006 Nov;7(3):217-25. doi: 10.3816/CLM.2006.n.062.
The present study evaluated computed tomography (CT) and Gallium-67 scanning (67Ga) before transplantation as prognostic factors for overall survival (OS) and event-free survival (EFS) in patients with relapsed or primary refractory Hodgkin lymphoma undergoing high-dose chemotherapy and stem cell transplantation.
Forty-five patients were included. Of these, 10 (22%) had positive CT and 67Ga scan results, 21 (47%) had negative results of both techniques, 12 (27%) had positive CT/negative 67Ga scan results, and 2 (5%) had negative CT/positive 67Ga scan results.
Patients with positive CT/67Ga scan results had a significantly worse EFS and OS at 5 years than those with negative 67Ga scan results, whether it was associated with positive or negative CT scan results (0 and 25% vs. 83% and 90% vs. 74% and 83%, respectively; P < 0.001). With a median follow-up of 59 months (range, 6-150 months), no differences were observed between patients with negative CT/67Ga scan results and those with positive CT/negative 67Ga scan results, with an EFS and OS at 5 years of 74% vs. 83% and 83% vs. 90%, respectively. In multivariate analysis, the presence of pretransplantation positive CT/67Ga scan results adversely influenced EFS and OS (hazard ratio, 39; 95% confidence interval, 8-202 [P < 0.001] and hazard ratio, 24; 95% confidence interval, 4-135 [P < 0.001], respectively).
Gallium-67 scans help to identify pretransplantation CT-positive patients with a different outcome. A group of patients with positive CT/negative 67Ga scan results before transplantation who showed a favorable outcome with a low rate of relapse and another group of patients with positive CT/67Ga scan results before transplantation who showed poor prognosis did not benefit from autologous stem cell transplantation. They should be offered other therapeutic strategies.
本研究评估了复发或原发性难治性霍奇金淋巴瘤患者在接受高剂量化疗和干细胞移植前的计算机断层扫描（CT）及镓-67扫描（67Ga），以作为总生存期（OS）和无事件生存期（EFS）的预后因素。
纳入45例患者。其中，10例（22%）CT及67Ga扫描结果为阳性，21例（47%）两种检查结果均为阴性，12例（27%）CT结果阳性/67Ga扫描结果阴性，2例（5%）CT结果阴性/67Ga扫描结果阳性。
CT/67Ga扫描结果为阳性的患者5年时的EFS和OS显著差于67Ga扫描结果为阴性的患者，无论其CT扫描结果是阳性还是阴性（分别为0和25% 对比83%和90%对比74%和83%；P<0.001）。中位随访59个月（范围6 - 150个月），CT/67Ga扫描结果阴性的患者与CT结果阳性/67Ga扫描结果阴性的患者之间未观察到差异，5年时的EFS和OS分别为74%对比83%以及83%对比90%。多因素分析显示，移植前CT/67Ga扫描结果为阳性对EFS和OS有不利影响（风险比分别为39；95%置信区间8 - 202 [P<0.001]以及风险比24；95%置信区间4 - 135 [P<0.001]）。
镓-67扫描有助于识别移植前CT阳性但预后不同的患者。一组移植前CT结果阳性/67Ga扫描结果阴性且复发率低、预后良好的患者，以及另一组移植前CT/67Ga扫描结果阳性且预后差的患者未从自体干细胞移植中获益。应为他们提供其他治疗策略。
