Longo D L, Duffey P L, Young R C, Hubbard S M, Ihde D C, Glatstein E, Phares J C, Jaffe E S, Urba W J, DeVita V T
Division of Cancer Treatment, National Cancer Institute, Bethesda, MD.
J Clin Oncol. 1992 Feb;10(2):210-8. doi: 10.1200/JCO.1992.10.2.210.
The study was undertaken to evaluate clinical prognostic factors, probability of response to therapy, duration of response, and overall survival of patients with Hodgkin's disease relapsing from a chemotherapy-induced complete remission.
Study population comprised 107 patients with Hodgkin's disease treated with combination chemotherapy at the National Cancer Institute who relapsed after achieving a complete remission.
Half of the relapses occurred within the first year of achieving complete remission; among patients in remission 5 years or longer, only 4% relapsed. The overall survival of the relapsed patients is projected to be 17% at 20 years, calculated from the date of relapse. Primary treatment regimen, presence of B symptoms, stage, sex, liver involvement, pleural involvement, marrow involvement, and histologic subtype did not affect the survival of relapsed patients. Only age at diagnosis (older or younger than 30 years) and length of initial remission (shorter or longer than 1 year) made a significant impact on survival. Patients whose initial remission was longer than 1 year had significantly higher complete response rates to salvage therapy, significantly more durable second remissions, and significantly longer survival than patients whose initial remission was shorter than 1 year. Survival beyond 11 years from relapse of patients with long initial remissions was 24%; for those with short initial remissions, 11% (P2 = .027). Despite the fact that with salvage therapy, patients with long initial remission had an 85% complete response rate to mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) with a disease-free survival of 45% at 20 years, acute leukemia and other treatment-related complications combined to lower the survival rate of this more favorable subset.
These data with conventional-dose salvage therapy provide results for comparison with novel salvage approaches including myeloablative therapy with autologous marrow or peripheral-blood stem-cell support.
本研究旨在评估霍奇金淋巴瘤患者化疗诱导完全缓解后复发的临床预后因素、治疗反应概率、反应持续时间及总生存期。
研究人群包括107例在国立癌症研究所接受联合化疗后复发的霍奇金淋巴瘤患者，这些患者此前已获得完全缓解。
半数复发发生在完全缓解后的第一年；在缓解5年或更长时间的患者中，仅有4%复发。从复发日期计算，复发患者的20年总生存率预计为17%。初始治疗方案、B症状的存在、分期、性别、肝脏受累、胸膜受累、骨髓受累及组织学亚型均不影响复发患者的生存。仅诊断时的年龄（30岁以上或以下）及初始缓解期的长短（短于或长于1年）对生存有显著影响。初始缓解期长于1年的患者与初始缓解期短于1年的患者相比，挽救治疗的完全缓解率显著更高，第二次缓解持续时间显著更长，生存期显著更长。初始缓解期长的患者复发后11年的生存率为24%；初始缓解期短的患者为11%（P2 = 0.027）。尽管初始缓解期长的患者接受挽救治疗时对氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）的完全缓解率为85%，20年无病生存率为45%，但急性白血病及其他治疗相关并发症共同降低了这一较有利亚组的生存率。
这些采用传统剂量挽救治疗的数据为与包括自体骨髓或外周血干细胞支持的清髓性治疗等新型挽救方法进行比较提供了结果。
