Santoro Armando, Magagnoli Massimo, Spina Michele, Pinotti Graziella, Siracusano Licia, Michieli Mariagrazia, Nozza Andrea, Sarina Barbara, Morenghi Emanuela, Castagna Luca, Tirelli Umberto, Balzarotti Monica
Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, via Manzoni 56, 20089 Rozzano, Milan, Italy.
Haematologica. 2007 Jan;92(1):35-41. doi: 10.3324/haematol.10661.
Response to pre-transplant salvage chemotherapy remains the most important prognostic factor for outcome in refractory or relapsed Hodgkin's lymphoma. Results of a new induction regimen are reported in terms of response rates, toxicity, and stem cell mobilization.
Ninety-one patients with refractory or relapsed Hodgkin's lymphoma were treated prospectively with a salvage regimen consisting of ifosfamide 2000 mg/m2 on days 1 to 4, gemcitabine 800 mg/m2 on days 1 and 4, vinorelbine 20 mg/m2 on day 1, and prednisolone 100 mg on days 1 to 4 (IGEV).
Forty-nine patients (53.8%) achieved a complete remission and 25 (27.5%) a partial response for an overall response rate of 81.3%. In the multivariate analysis response to the last chemotherapy (p<0.0001) and involvement of > or =3 sites (p<0.049) were the most important prognostic factors for response. Adequate CD34+ cell collection was achieved in 78 out of 79 (98.7%) mobilized patients. So far, no treatment-related death has been documented. Thirteen (4.2%) and 27 (8.6%) out of 313 evaluated cycles had to be delayed or reduced, respectively, mainly because of neutropenia and thrombocytopenia. No grade 4 non-hematologic toxicity was observed, except for one episode of mucositis.
The high response rate, in particular the complete remission rate, the low toxicity profile, and the very high mobilizing potential of the IGEV regimen strongly suggest that patients with relapsed/refractory Hodgkin's lymphoma may benefit from the use of this salvage induction regimen.
对于难治性或复发性霍奇金淋巴瘤，移植前挽救化疗的反应仍然是影响预后的最重要因素。本文报告了一种新诱导方案在缓解率、毒性和干细胞动员方面的结果。
91例难治性或复发性霍奇金淋巴瘤患者接受了前瞻性挽救方案治疗，该方案包括第1至4天使用异环磷酰胺2000mg/m²、第1天和第4天使用吉西他滨800mg/m²、第1天使用长春瑞滨20mg/m²以及第1至4天使用泼尼松龙100mg（IGEV）。
49例患者（53.8%）达到完全缓解，25例（27.5%）达到部分缓解，总缓解率为81.3%。多因素分析显示，对末次化疗的反应（p<0.0001）和累及≥3个部位（p<0.049）是反应的最重要预后因素。79例动员患者中有78例（98.7%）成功采集到足够的CD34+细胞。迄今为止，尚无治疗相关死亡记录。在313个评估周期中，分别有13个（4.2%）和27个（8.6%）周期因中性粒细胞减少和血小板减少而不得不延迟或减量。除1例粘膜炎外，未观察到4级非血液学毒性。
IGEV方案的高缓解率，尤其是完全缓解率、低毒性以及极高的动员潜力强烈提示，复发/难治性霍奇金淋巴瘤患者可能从该挽救诱导方案中获益。
