Division of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Leuk Lymphoma. 2010 Jul;51(7):1251-9. doi: 10.3109/10428194.2010.486090.
The introduction of high-dose (HD) chemotherapy (CT) and autologous stem cell (ASCT) or bone marrow transplant (ABMT) in the last two decades has improved the prognosis of patients with refractory or relapsed Hodgkin lymphoma (HL) over conventional-dose salvage CT. To evaluate the outcome of adult patients with HL treated with HD CT and ASCT or ABMT after failure or relapse from first-line treatment with CT +/- radiotherapy, we report the results of a retrospective analysis in 82 consecutive patients given HD CT and autologous transplant as second-line therapy between October 1984 and December 2006. Thirty-two patients were given sequential high-dose cytoreductive therapy while 50 received other conventional induction regimens. Seventy-three patients with chemoresponsive disease underwent the myeloablative phase, while eight patients had progressive disease during cytoreductive CT. After a median follow-up of 73 months, the 10-year progression-free survival (PFS) and overall survival (OS) were 57% and 51%, respectively. According to response to first-line treatment, PFS and OS were, respectively, 54% and 82% for patients with complete remission (CR) lasting 12 months or more; 49% and 51% for patients with CR less than 12 months; and 47% and 50% for patients who never achieved CR or progressed during first-line CT (induction failure). Response to cytoreductive CT significantly influenced outcome, with PFS and OS being, respectively, 56% and 68% vs. 44% and 47% (p = 0.009) in patients in CR versus patients not in CR after induction therapy. Treatment was well tolerated, and therapy related mortality was only 3.7%. These long-term results confirm that HD CT and ASCT or ABMT was feasible, safe, and very effective. Therefore, this therapeutic strategy may represent an active salvage approach even in the unfavorable group of patients with induction failure.
在过去的二十年中，高剂量（HD）化疗（CT）和自体干细胞（ASCT）或骨髓移植（ABMT）的引入改善了难治性或复发性霍奇金淋巴瘤（HL）患者的预后，优于常规剂量挽救性 CT。为了评估一线 CT +/- 放疗治疗后复发或难治的 HL 成人患者接受 HD CT 和 ASCT 或 ABMT 的治疗结果，我们报告了 82 例连续患者的回顾性分析结果，这些患者在 1984 年 10 月至 2006 年 12 月期间接受了 HD CT 和自体移植作为二线治疗。32 例患者接受序贯高剂量细胞减灭治疗，50 例患者接受其他常规诱导方案。73 例有化疗反应的患者接受了清髓性阶段，而 8 例患者在细胞减灭 CT 期间疾病进展。中位随访 73 个月后，10 年无进展生存（PFS）和总生存（OS）分别为 57%和 51%。根据一线治疗的反应，持续 12 个月或更长时间的完全缓解（CR）患者的 PFS 和 OS 分别为 54%和 82%；CR 持续时间小于 12 个月的患者分别为 49%和 51%；一线 CT（诱导失败）期间从未达到 CR 或进展的患者分别为 47%和 50%。细胞减灭 CT 的反应显著影响了结果，CR 患者的 PFS 和 OS 分别为 56%和 68%，而诱导治疗后未达到 CR 的患者分别为 44%和 47%（p = 0.009）。治疗耐受性良好，治疗相关死亡率仅为 3.7%。这些长期结果证实，HD CT 和 ASCT 或 ABMT 是可行的、安全的且非常有效的。因此，即使在诱导失败的不利患者组中，这种治疗策略也可能代表一种积极的挽救方法。
