Department of Pediatric Hematology and Oncology, University Hospital Münster, Westfalian Wilhelms University Münster, Munster, Germany.
Pediatr Blood Cancer. 2014 Aug;61(8):1382-6. doi: 10.1002/pbc.25042. Epub 2014 Apr 11.
Prognosis of patients with relapsed Ewing sarcoma (ES) is poor. The 5-year overall survival (OS) is 13%. We analyzed high-dose chemotherapy (HDtx) versus conventional chemotherapy (CHtx) in patients with relapsed ES.
Data from 239 patients with first relapse, registered during 2000-2011 in the ES relapse registry of the Cooperative Ewing Sarcoma Study Group (CESS) were analyzed.
Of 239 patients, 200 received various non-HDtx second-line CHtx regimens. Seventy-three patients had additional HDtx followed by autologous stem cell rescue. The 2-year event-free survival (EFS) was 10% (SE = 0.02) in patients treated without HDtx and 45% (SE = 0.09) in patients treated with HDtx. In a second step, we focused on those patients who achieved complete remission (CR) or partial remission (PR) after four to six cycles of conventional second-line CHtx. Here, the 2-year EFS was 31% (SE = 0.08) without additional HDtx and 44% (SE = 0.09) with additional HDtx. In addition, multivariate regression analysis indicates absence of HDtx treatment, with a Hazard ratio (HR) of 2.90 (95% CI 1.41-6.0), and early relapse, with a HR of 4.76 (95% CI 2.31-9.78), as independent prognostic factors for EFS.
Additional HDtx may contribute to further reduce the risk of further events in patients who respond to conventional second-line CHtx.
复发性尤因肉瘤（Ewing sarcoma，ES）患者的预后较差，5 年总生存率（overall survival，OS）为 13%。我们分析了复发性 ES 患者接受高剂量化疗（high-dose chemotherapy，HDtx）与常规化疗（conventional chemotherapy，CHtx）的疗效。
对 2000 年至 2011 年协作尤因肉瘤研究组（Cooperative Ewing Sarcoma Study Group，CESS）复发登记处登记的 239 例首次复发患者的数据进行了分析。
在 239 例患者中，200 例接受了各种非 HDtx 的二线 CHtx 方案。73 例患者接受了额外的 HDtx 联合自体干细胞解救。未接受 HDtx 治疗的患者 2 年无事件生存率（event-free survival，EFS）为 10%（标准误 [SE] = 0.02），接受 HDtx 治疗的患者为 45%（SE = 0.09）。在第二步中，我们专注于那些在接受四到六个周期的常规二线 CHtx 后达到完全缓解（complete remission，CR）或部分缓解（partial remission，PR）的患者。在此，未接受额外 HDtx 治疗的患者 2 年 EFS 为 31%（SE = 0.08），接受额外 HDtx 治疗的患者为 44%（SE = 0.09）。此外，多变量回归分析表明，未接受 HDtx 治疗的患者复发风险增加 2.90 倍（95%CI 1.41-6.0），早期复发的患者复发风险增加 4.76 倍（95%CI 2.31-9.78），是 EFS 的独立预后因素。
对于对常规二线 CHtx 有反应的患者，额外的 HDtx 可能有助于进一步降低再次发生事件的风险。
