Milgrom Sarah A, Jauhari Shekeab, Plastaras John P, Nieto Yago, Dabaja Bouthaina S, Pinnix Chelsea C, Smith Grace L, Allen Pamela K, Lukens J Nicholas, Maity Amit, Oki Yasuhiro, Fanale Michelle A, Nasta Sunita D
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Cancer. 2017 Apr 15;123(8):1363-1371. doi: 10.1002/cncr.30482. Epub 2016 Dec 16.
No consensus exists regarding the use of radiotherapy (RT) in conjunction with high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) for patients with relapsed/refractory classical Hodgkin lymphoma (HL). The objectives of the current study were to characterize practice patterns and assess the efficacy and toxicity of RT at 2 major transplantation centers.
Eligible patients underwent HDC/ASCT from 2006 through 2015 using the combination of either carmustine (BCNU), etoposide, cytarabine, and melphalan (BEAM) or cyclophosphamide, BCNU, and etoposide (CBV).
For the cohort of 189 patients, the 4-year overall survival rate was 80%, the progression-free survival rate was 67%, and the local control (LC) rate was 68%. RT was used within 4 months of ASCT for 22 patients (12%) and was given more often for disease that was early stage, primary refractory, or [ F]fluorodeoxyglucose (FDG)-avid at the time of HDC/ASCT. Disease recurrence occurring after HDC/ASCT was associated with primary refractory disease and FDG-avidity at the time of HDC/ASCT. RT was not found to be associated with LC, progression-free survival, or overall survival on univariate analysis. In a model incorporating primary refractory HL and FDG-avid disease at the time of HDC/ASCT, RT was found to be associated with a decreased risk of local disease recurrence (hazard ratio, 0.3; P = .02). In patients with primary refractory HL and/or FDG-avid disease at the time of HDC/ASCT, the 4-year LC rate was 81% with RT versus 49% without RT (P = .03). There was one case of Common Terminology Criteria for Adverse Events grade ≥ 3 RT-related toxicity (acute grade 3 pancytopenia).
In patients undergoing ASCT for relapsed/refractory HL, peritransplantation RT was used more often for disease that was early stage, primary refractory, or FDG-avid after salvage conventional-dose chemotherapy. RT was associated with improved LC of high-risk localized disease and was well tolerated with modern techniques. Cancer 2017;123:1363-1371. © 2016 American Cancer Society.
对于复发/难治性经典型霍奇金淋巴瘤（HL）患者，在高剂量化疗及自体干细胞移植（HDC/ASCT）中联合使用放疗（RT）尚无共识。本研究的目的是描述两个主要移植中心的实践模式，并评估放疗的疗效和毒性。
符合条件的患者在2006年至2015年期间接受HDC/ASCT，采用卡莫司汀（BCNU）、依托泊苷、阿糖胞苷和马法兰（BEAM）或环磷酰胺、BCNU和依托泊苷（CBV）联合方案。
189例患者队列中，4年总生存率为80%，无进展生存率为67%，局部控制（LC）率为68%。22例患者（12%）在ASCT后4个月内接受了放疗，且早期疾病、原发难治性疾病或HDC/ASCT时[F]氟脱氧葡萄糖（FDG）摄取阳性的疾病接受放疗更为频繁。HDC/ASCT后疾病复发与原发难治性疾病及HDC/ASCT时的FDG摄取阳性有关。单因素分析未发现放疗与LC、无进展生存率或总生存率相关。在纳入原发难治性HL及HDC/ASCT时FDG摄取阳性疾病的模型中，发现放疗与局部疾病复发风险降低相关（风险比，0.3；P = 0.02）。在HDC/ASCT时患有原发难治性HL和/或FDG摄取阳性疾病的患者中，接受放疗的患者4年LC率为81%，未接受放疗的患者为49%（P = 0.03）。有1例不良事件通用术语标准≥3级的放疗相关毒性（急性3级全血细胞减少）。
在接受ASCT治疗复发/难治性HL的患者中，挽救性常规剂量化疗后，对于早期疾病、原发难治性疾病或FDG摄取阳性的疾病，移植周围放疗更为常用。放疗与高危局限性疾病的LC改善相关，且现代技术对其耐受性良好。《癌症》2017年；123:1363 - 1371。©2016美国癌症协会
