James P. Wilmot Cancer Center, University of Rochester, Rochester, New York 14642, USA.
Biol Blood Marrow Transplant. 2012 Apr;18(4):640-7. doi: 10.1016/j.bbmt.2011.08.012. Epub 2011 Aug 24.
Salvage chemotherapy followed by high-dose autologous stem cell transplantation (HD-ASCT) is the standard of care for patients who have relapsed or refractory Hodgkin's lymphoma (HL). Few trials have had long-term follow-up post-HD-ASCT in the ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) era of treatment. We reviewed 95 consecutive patients who received HD-ASCT for relapsed or refractory HL following ABVD failure between 1990 and 2006 at the University of Rochester. Median follow-up for survivors was 8.2 years. All patients received HD-ASCT following upfront ABVD (or equivalent) failure. At 5 years, overall survival (OS) and event-free survival (EFS) were 54% and 37%, respectively. In total, 54 patients have died; 37 of these patients died directly of HL. Notably, there were 19 deaths >3 years post-HD-ASCT and 13 of these late deaths are directly attributable to HL. Furthermore, there were 51 documented relapses, 9 of which occurred >3 years post-HD-ASCT. In contrast to other studies, we did not observe a plateau in EFS following transplantation. Patients appear to be at continuous risk of recurrence beyond 3 years after HD-ASCT. Our results emphasize the importance of long-term follow-up for both toxicity and recurrence, and have important implications in defining success of posttransplantation maintenance strategies.
挽救性化疗后行大剂量自体干细胞移植（HD-ASCT）是复发或难治性霍奇金淋巴瘤（HL）患者的标准治疗方法。在 ABVD（阿霉素、博来霉素、长春碱和达卡巴嗪）治疗时代，很少有试验在 HD-ASCT 后进行长期随访。我们回顾了 1990 年至 2006 年在罗切斯特大学接受 HD-ASCT 治疗复发或难治性 HL 的 95 例连续患者。幸存者的中位随访时间为 8.2 年。所有患者在 ABVD（或等效物）失败后均接受 HD-ASCT。5 年时，总生存率（OS）和无事件生存率（EFS）分别为 54%和 37%。共有 54 名患者死亡；其中 37 名患者直接死于 HL。值得注意的是，有 19 例死亡发生在 HD-ASCT 后>3 年，其中 13 例晚期死亡直接归因于 HL。此外，有 51 例记录的复发，其中 9 例发生在 HD-ASCT 后>3 年。与其他研究不同，我们在移植后未观察到 EFS 达到平台期。患者在 HD-ASCT 后 3 年以上仍有持续复发的风险。我们的结果强调了长期随访毒性和复发的重要性，对定义移植后维持治疗策略的成功具有重要意义。
