Evens A M, Altman J K, Mittal B B, Hou N, Rademaker A, Patton D, Kaminer L, Williams S, Duffey S, Variakojis D, Singhal S, Tallman M S, Mehta J, Winter J N, Gordon L I
Division of Hematology/Oncology, Hematopoietic Stem Cell Transplant Program and Lymphoma Program, Feinberg School of Medicine, Northwestern University, 676 North St. Clair, Chicago, IL 60611, USA.
Ann Oncol. 2007 Apr;18(4):679-88. doi: 10.1093/annonc/mdl496. Epub 2007 Feb 16.
The standard approach to treatment of relapsed/refractory Hodgkin's lymphoma (HL) is high-dose chemotherapy conditioning followed by autologous hematopoietic stem-cell transplantation (aHSCT). We report the results of a prospective phase I/II clinical trial of accelerated hyperfractionated total lymphoid irradiation (TLI) immediately followed by high-dose chemotherapy for relapsed/refractory HL.
Forty-eight patients underwent aHSCT with either sequential TLI/chemotherapy (n = 32) or chemotherapy-alone conditioning (n = 16), based on prior radiation exposure. The first 22 patients enrolled on trial received escalating doses of etoposide (1600-2100 mg/m(2)) with high-dose carboplatin and cyclophosphamide.
No dose-limiting toxicity was seen and TLI/chemotherapy was well tolerated. The 5-year event-free survival (EFS) estimate for all patients was 44% with overall survival (OS) of 48%. Five-year EFS and OS for the TLI/chemotherapy group was 63% and 61%, respectively, compared with 6% and 27%, respectively, for the chemotherapy-alone group (P < 0.0001 and P = 0.04, respectively). Patients with primary induction failure HL who received TLI/chemotherapy had 5-year EFS and OS rate of 83%. The 100-day treatment-related mortality was 4.2% and two secondary cancers were seen. Significant factors predicting survival by multivariate analysis included TLI/chemotherapy conditioning and B symptoms at relapse.
Sequential TLI/chemotherapy conditioning for relapsed/refractory HL is safe and associated with excellent long-term survival rates.
复发/难治性霍奇金淋巴瘤（HL）的标准治疗方法是大剂量化疗预处理，随后进行自体造血干细胞移植（aHSCT）。我们报告了一项前瞻性I/II期临床试验的结果，该试验采用加速超分割全淋巴照射（TLI），紧接着对复发/难治性HL进行大剂量化疗。
48例患者根据既往放疗情况，接受了序贯TLI/化疗（n = 32）或单纯化疗预处理（n = 16）的aHSCT。试验招募的前22例患者接受了递增剂量的依托泊苷（1600 - 2100 mg/m²）联合大剂量卡铂和环磷酰胺。
未观察到剂量限制性毒性，TLI/化疗耐受性良好。所有患者的5年无事件生存率（EFS）估计为44%，总生存率（OS）为48%。TLI/化疗组的5年EFS和OS分别为63%和61%，而单纯化疗组分别为6%和27%（P分别<0.0001和P = 0.04）。接受TLI/化疗的初次诱导失败HL患者的5年EFS和OS率为83%。100天治疗相关死亡率为4.2%，观察到2例继发性癌症。多变量分析预测生存的显著因素包括TLI/化疗预处理和复发时的B症状。
序贯TLI/化疗预处理用于复发/难治性HL是安全的，且与优异的长期生存率相关。
