Department of Hematology, Poznan University of Medical Sciences, Szamarzewskiego 84, 61-569 Poznan, Poland.
Med Oncol. 2013;30(3):611. doi: 10.1007/s12032-013-0611-y. Epub 2013 May 24.
Despite the well-defined role of autologous haematopoietic stem cell transplantation (autoHCT) in the treatment of patients with relapsed or refractory Hodgkin lymphoma (HL), relapse remains the main cause of transplant failure. We retrospectively evaluated long-term outcome and prognostic factors affecting survival of 132 patients with refractory (n = 89) or relapsed HL (n = 43) treated with autoHCT following modified BEAM. With a median follow-up of 68 months, the 10-year overall survival (OS) and progression-free survival (PFS) were 76 and 66 %, respectively. The 10-year cumulative incidence of second malignancies was 7 %. In multivariate analysis, age ≥45 years, more than one salvage regimens and disease status at transplant worse than CR were factors predictive for poor OS. In relapsed HL, age at transplant, response duration (<12 vs. ≥12 months) and the number of salvage regimens were independent predictors for PFS. In the refractory setting, disease status at autoHCT and the number of salvage regimens impacted PFS. The number of risk factors was inversely correlated with PFS in both relapsed and refractory HL (p = 0.003 and <0.001, respectively). The median PFS for patients with >1 risk factor in the relapsed and refractory setting was 5 and 11 months, respectively, in comparison with the median PFS not reached for patients with 0-1 risk factor in both settings. We conclude that high proportion of patients with relapsed/refractory HL can be cured with autoHCT. However, the presence of two or more risk factors helps to identify poor prognosis patients who may benefit from novel treatment strategies.
尽管自体造血干细胞移植(autoHCT)在治疗复发或难治性霍奇金淋巴瘤(HL)患者中具有明确的作用,但复发仍是移植失败的主要原因。我们回顾性评估了 132 例接受改良 BEAM 后 autoHCT 治疗的难治性(n=89)或复发性 HL(n=43)患者的长期结果和影响生存的预后因素。中位随访 68 个月后,10 年总生存率(OS)和无进展生存率(PFS)分别为 76%和 66%。10 年累积第二恶性肿瘤发生率为 7%。多因素分析显示,年龄≥45 岁、挽救性方案超过 1 个、移植时疾病状态未达完全缓解(CR)是 OS 不良的预测因素。在复发性 HL 中,移植时年龄、缓解持续时间(<12 个月与≥12 个月)和挽救性方案的数量是 PFS 的独立预测因素。在难治性 HL 中,autoHCT 时的疾病状态和挽救性方案的数量影响 PFS。复发和难治性 HL 中危险因素的数量与 PFS 呈负相关(p=0.003 和<0.001)。复发和难治性 HL 中存在>1 个危险因素的患者的中位 PFS 分别为 5 和 11 个月,而这两个组中存在 0-1 个危险因素的患者的中位 PFS 未达到。我们得出结论,复发/难治性 HL 患者中有很大比例可以通过 autoHCT 治愈。然而,存在两个或更多危险因素有助于识别预后不良的患者,这些患者可能受益于新的治疗策略。