Autologous Blood and Marrow Transplant Program, Princess Margaret Hospital, Toronto, ON, Canada.
Haematologica. 2012 May;97(5):751-7. doi: 10.3324/haematol.2011.047670. Epub 2011 Dec 16.
The management of patients with relapsed or refractory Hodgkin's lymphoma who achieve less than a partial response to first-line salvage chemotherapy is unclear. The objective of this study was to evaluate response and outcomes to second-line salvage and autologous stem cell transplantation in patients not achieving a complete or partial response to platinum-containing first-line salvage chemotherapy.
Consecutively referred transplant-eligible patients with relapsed/refractory Hodgkin's lymphoma after primary chemotherapy received gemcitabine, dexamethasone, and cisplatin as first salvage chemotherapy. Those achieving a complete or partial response, and those with a negative gallium scan and stable disease with bulk <5 cm proceeded to high-dose chemotherapy and autologous stem cell transplantation. Patients with progressive disease or stable disease with a positive gallium scan or bulk ≥ 5 cm were given second salvage chemotherapy with mini-BEAM (carmustine, etoposide, cytarabine, melphalan). Patients who responded (according to the same definition) proceeded to autologous stem cell transplantation.
One hundred and thirty-one patients with relapsed/refractory Hodgkin's lymphoma received first-line salvage gemcitabine, dexamethasone, and cisplatin; of these patients 99 had at least a partial response (overall response rate 76%). One hundred and twelve (85.5%) patients proceeded to autologous stem cell transplantation, while the remaining 19 (14.5%) patients received mini-BEAM. Among these 19 patients, six had at least a partial response (overall response rate 32%), and nine proceeded to autologous stem cell transplantation. The remaining ten patients received palliative care. Seven of the nine patients transplanted after mini-BEAM had a subsequent relapse. Patients receiving second salvage mini-BEAM had poor outcomes, with a 5-year progression-free survival rate of 11% and a 5-year overall survival rate of 20%.
Patients who require a second salvage regimen to achieve disease control prior to autologous stem cell transplantation have a relatively poor outcome and should be considered for alternative treatment strategies.
对于一线挽救化疗反应不足部分缓解的复发或难治性霍奇金淋巴瘤患者的管理尚不明确。本研究旨在评估二线挽救化疗和自体干细胞移植在一线含铂挽救化疗反应不足完全或部分缓解的患者中的疗效和结局。
连续入组的初治后复发/难治性霍奇金淋巴瘤且适合移植的患者接受吉西他滨、地塞米松和顺铂作为一线挽救化疗。完全或部分缓解、镓扫描阴性且疾病稳定、肿块＜5cm 的患者接受大剂量化疗和自体干细胞移植。疾病进展或镓扫描阳性或肿块≥5cm 的患者给予小剂量 BEAM（卡莫司汀、依托泊苷、阿糖胞苷、马法兰）二线挽救化疗。有缓解（根据相同的定义）的患者接受自体干细胞移植。
131 例复发/难治性霍奇金淋巴瘤患者接受一线挽救化疗吉西他滨、地塞米松和顺铂；其中 99 例至少部分缓解（总缓解率 76%）。112 例（85.5%）患者接受自体干细胞移植，其余 19 例（14.5%）患者接受小剂量 BEAM。这 19 例患者中，6 例至少部分缓解（总缓解率 32%），9 例接受自体干细胞移植。其余 10 例患者接受姑息治疗。小剂量 BEAM 后接受挽救性移植的 9 例患者中有 7 例随后复发。接受二线挽救性小剂量 BEAM 的患者结局较差，5 年无进展生存率为 11%，5 年总生存率为 20%。
需要二线挽救治疗以控制疾病，然后才能接受自体干细胞移植的患者结局较差，应考虑替代治疗策略。
