Fung Henry C, Stiff Patrick, Schriber Jeff, Toor Amir, Smith Eileen, Rodriguez Tulio, Krishnan Amrita, Molina Arturo, Smith David, Ivers Barbara, Kogut Neil, Popplewell Leslie, Rodriguez Roberto, Somlo George, Forman Stephen J, Nademanee Auayporn
City of Hope Comprehensive Cancer Center, Hematology, Durante, California 91010, USA.
Biol Blood Marrow Transplant. 2007 May;13(5):594-600. doi: 10.1016/j.bbmt.2007.01.072. Epub 2007 Mar 23.
Although autologous stem cell transplantation (ASCT) for patients with relapsed/refractory Hodgkin lymphoma (HL) appears to offer a survival advantage over conventional therapy, only approximately 25% to 35% of patients with primary progressive or poor-risk recurrent HL can achieve durable remission after ASCT, with disease progressive after transplant accounting for most of the treatment failures. We conducted a pilot study to evaluate the toxicities and efficacy of a tandem transplant approach in this subgroup of patients. Between April 1998 and March 2000, 46 patients were enrolled in the study.
primary progressive (n = 28) or recurrent HL (n = 18) with at least 1 of the following poor prognostic factors: first complete remission (CR) <12 months (n = 15) or extra-nodal disease (n = 4) or B symptoms at relapse (n = 4). The first cycle consisted of melphalan (150 mg/m(2)) alone. The second cycle consisted of fractionated total body irradiation (FTBI) 1200 cGy or BCNU (450 mg/m(2)) in combination with etoposide (60 mg/kg) and cyclophosphamide (100 mg/kg). Of the 46 patients, 5 (11%) did not receive the planned tandem transplants because of inadequate stem cell collection for 2 ASCT. After a median of 64 days (25-105), 41 patients received the second ASCT. With a median follow-up of 5.3 years (1.6-8.1), the 5-year estimate of overall survival, progression-free survival, and freedom from progression were 54% (95% confidence interval [CI] 40%-69%), 49% (95% CI, 34%-63%), and 55% (95%CI, 40%-70%), respectively. Our mature results from this study suggest that in patients with primary progressive or poor risk recurrent HL, this tandem ASCT program is effective and well tolerated and compares favorably with the conventional single transplant.
尽管自体干细胞移植（ASCT）对于复发/难治性霍奇金淋巴瘤（HL）患者似乎比传统疗法具有生存优势，但只有约25%至35%的原发性进行性或高危复发HL患者在ASCT后能实现持久缓解，移植后疾病进展是大多数治疗失败的原因。我们开展了一项试点研究，以评估在该亚组患者中采用串联移植方法的毒性和疗效。1998年4月至2000年3月期间，46例患者入组该研究。
原发性进行性（n = 28）或复发性HL（n = 18），伴有以下至少1项不良预后因素：首次完全缓解（CR）<12个月（n = 15）或结外病变（n = 4）或复发时出现B症状（n = 4）。第一个周期仅包含美法仑（150 mg/m²）。第二个周期包含分次全身照射（FTBI）1200 cGy或卡莫司汀（450 mg/m²）联合依托泊苷（60 mg/kg）和环磷酰胺（100 mg/kg）。46例患者中，5例（11%）因2次ASCT的干细胞采集不足而未接受计划的串联移植。中位64天（25 - 105天）后，41例患者接受了第二次ASCT。中位随访5.3年（1.6 - 8.1年），总生存、无进展生存和无进展生存率的5年估计值分别为54%（95%置信区间[CI] 40% - 69%）、49%（95% CI，34% - 63%）和55%（95% CI，40% - 70%）。我们这项研究的成熟结果表明，对于原发性进行性或高危复发HL患者，这种串联ASCT方案有效且耐受性良好，与传统单次移植相比具有优势。
