Hematology Department, Transplantation & Cell Therapy Program, Institut Paoli Calmettes, Marseille, France.
Haematologica. 2012 Jul;97(7):1073-9. doi: 10.3324/haematol.2011.056051. Epub 2012 Jan 22.
High-dose chemotherapy followed by autologous stem cell transplantation is the standard treatment for relapsed and/or refractory Hodgkin's lymphoma although half of patients relapse after transplantation. Predictive factors, such as relapse within 12 months, Ann-Arbor stage at relapse, and relapse in previously irradiated fields are classically used to identify patients with poor outcome. Recently, 18-fluorodeoxyglucose positron emission tomography has emerged as a new method for providing information to predict outcome. The aim of this study was to confirm the predictive value of positron emission tomography status after salvage therapy and to compare single versus tandem autologous stem cell transplantation in patients with relapsed and/or refractory Hodgkin's lymphoma.
We report a series of 111 consecutive patients with treatment-sensitive relapsed and/or treatment-refractory Hodgkin's lymphoma who achieved complete (positron emission tomography-negative group) or partial remission (positron emission tomography-positive group) at positron emission tomography evaluation after salvage chemotherapy and who underwent single or tandem autologous stem cell transplantation.
Five-year overall and progression-free survival rates were 81% and 64%, respectively. There were significant differences in 5-year progression-free survival (79% versus 23%; P<0.001) and 5-year overall survival (90% versus 55%, P=0.001) between the positron emission tomography-negative and -positive groups, respectively. A complete response, as determined by positron emission tomography evaluation, after salvage therapy predicted significantly better 5-year overall survival rates in both intermediate (91% versus 50%; P=0.029) and unfavorable (89% versus 58%; P=0.026) risk subgroup analyses. In the positron emission tomography-positive subgroup, tandem transplantation improved 5-year progression-free survival from 0% (in the single transplantation group) to 43% (P=0.034). Multivariate analysis showed that positron emission tomography status (hazard ratio: 5.26 [2.57-10.73]) and tandem transplantation (hazard ratio: 0.39 [0.19-0.78]) but not risk factors at relapse (hazard ratio: 1.77 [0.80-3.92]) significantly influenced progression-free survival, while only tomography status significantly influenced overall survival (hazard ratio: 4.03 [1.38-11.75]).
In patients with relapsed/refractory Hodgkin's lymphoma responding to prior salvage therapy, positron emission tomography response at time of autologous stem cell transplantation favorably influences outcome and enables identification of patients requiring single or tandem transplantation.
高剂量化疗后自体干细胞移植是复发和/或难治性霍奇金淋巴瘤的标准治疗方法，尽管半数患者在移植后会复发。12 个月内复发、复发时的 Ann-Arbor 分期和先前照射野内的复发等预测因素通常用于识别预后不良的患者。最近，18-氟脱氧葡萄糖正电子发射断层扫描已成为提供预测结果信息的新方法。本研究的目的是确认挽救治疗后正电子发射断层扫描状态的预测价值，并比较复发和/或难治性霍奇金淋巴瘤患者接受单剂量与双剂量自体干细胞移植的效果。
我们报告了 111 例经治疗敏感的复发和/或治疗耐药的霍奇金淋巴瘤患者，他们在挽救性化疗后经正电子发射断层扫描评估达到完全缓解（正电子发射断层扫描阴性组）或部分缓解（正电子发射断层扫描阳性组），并接受了单剂量或双剂量自体干细胞移植。
5 年总生存率和无进展生存率分别为 81%和 64%。正电子发射断层扫描阴性组和阳性组的 5 年无进展生存率（79%比 23%；P<0.001）和 5 年总生存率（90%比 55%，P=0.001）差异均有统计学意义。挽救治疗后正电子发射断层扫描评估的完全缓解显著预测了中危（91%比 50%；P=0.029）和高危（89%比 58%；P=0.026）亚组的 5 年总生存率。在正电子发射断层扫描阳性组中，双剂量移植将无进展生存率从单剂量移植组的 0%提高到 43%（P=0.034）。多因素分析显示，正电子发射断层扫描状态（风险比：5.26[2.57-10.73]）和双剂量移植（风险比：0.39[0.19-0.78]）而非复发时的危险因素（风险比：1.77[0.80-3.92]）显著影响无进展生存率，而只有正电子发射断层扫描状态显著影响总生存率（风险比：4.03[1.38-11.75]）。
在对先前挽救性治疗有反应的复发/难治性霍奇金淋巴瘤患者中，自体干细胞移植时的正电子发射断层扫描反应对结局有利，并能识别需要单剂量或双剂量移植的患者。
