Ahmed T, Ciavarella D, Feldman E, Ascensao J, Hussain F, Engelking C, Gingrich S, Mittelman A, Coleman M, Arlin Z A
Department of Medicine, New York Medical College, Valhalla 10595.
Leukemia. 1989 Jan;3(1):19-22.
Twenty three patients with Hodgkin's disease were treated with BCNU (carmustine), etoposide, and cyclophosphamide at doses of 450-600 mg/m2, 1500-2000 mg/m2, and 120 mg/kg respectively. Bone marrow refrigerated at 4 degrees C for 2-5 days or cryopreserved at -80 degrees C was used to reconstitute bone marrow function. The median age was 28 (range 16-48), and the median Karnofsky performance status was 70. Nineteen patients had progressive disease while on chemotherapy. The median number of prior regimens was three (1-7), and the median number of prior chemotherapy drugs was 10 (range 4-12). Ten patients had received at least two of the drugs used in this study and four had had all three. Indicator lesions included lung (10), peripheral lymph nodes (9), retroperitoneal nodes (8), liver (3), and chest wall masses (2). Ten patients achieved a complete remission (43.5%; 95% confidence limits 23-64%), and five patients had a partial remission (21.7%; 95% confidence limits 5-39%). The median duration of complete remission was 6 months (range 2-13+ months). Responses were shorter in duration for patients with primary refractory disease. Liver function abnormalities were noted in nine (39%) cases. Post transplant, the recovery time was 18 days (range 11-43) for WBC and 24 days (11-77) for platelets. Two patients died of septic episodes while neutropenic. The median number of RBC units used was seven (range 1-45). Ten patients had evidence of pulmonary dysfunction. In seven patients there was symptomatic improvement with steroid therapy, but three patients who were not treated with steroids died as a result of interstitial pneumonia. Future programs should consider bone marrow transplantation in patients with Hodgkin's disease earlier in the course of disease, at the time of minimal residual disease, and employ newer, potentially less toxic drugs.
23例霍奇金病患者接受了卡氮芥（BCNU）、依托泊苷和环磷酰胺治疗，剂量分别为450 - 600mg/m²、1500 - 2000mg/m²和120mg/kg。4℃冷藏2 - 5天或-80℃冷冻保存的骨髓用于重建骨髓功能。中位年龄为28岁（范围16 - 48岁），中位卡诺夫斯基体能状态为70。19例患者在化疗期间病情进展。既往治疗方案的中位数为3个（1 - 7个），既往化疗药物的中位数为10种（范围4 - 12种）。10例患者至少接受过本研究中使用的两种药物治疗，4例患者接受过全部三种药物治疗。指示性病变包括肺部（10例）、外周淋巴结（9例）、腹膜后淋巴结（8例）、肝脏（3例）和胸壁肿块（2例）。10例患者达到完全缓解（43.5%；95%置信区间23 - 64%），5例患者部分缓解（21.7%；95%置信区间5 - 39%）。完全缓解的中位持续时间为6个月（范围2 - 13 +个月）。原发性难治性疾病患者的缓解持续时间较短。9例（39%）出现肝功能异常。移植后，白细胞恢复时间为18天（范围11 - 43天），血小板恢复时间为24天（11 - 77天）。2例患者在中性粒细胞减少期间死于败血症。红细胞单位使用的中位数为7个（范围1 - 45个）。10例患者有肺功能障碍的证据。7例患者经类固醇治疗后症状改善，但3例未接受类固醇治疗的患者死于间质性肺炎。未来的方案应考虑在霍奇金病患者疾病进程的早期、残留疾病最少时进行骨髓移植，并采用更新的、潜在毒性较小的药物。
