Rimner Andreas, Lovie Shona, Hsu Meier, Chelius Monica, Zhang Zhigang, Chau Karen, Moskowitz Alison J, Matasar Matthew, Moskowitz Craig H, Yahalom Joachim
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):1066-1076. doi: 10.1016/j.ijrobp.2017.01.222. Epub 2017 Feb 1.
We report the long-term results of integrated accelerated involved field radiation therapy (IFRT) followed by total lymphoid irradiation (TLI) as part of the high-dose salvage regimen followed by autologous bone marrow transplantation or autologous stem cell transplantation in patients with relapsed or refractory Hodgkin lymphoma (HL).
From November 1985 to July 2008, 186 previously unirradiated patients with relapsed or refractory HL underwent salvage therapy on 4 consecutive institutional review board-approved protocols. All patients had biopsy-proven primary refractory or relapsed HL. After standard-dose salvage chemotherapy (SC), accelerated IFRT (18-20 Gy) was given to relapsed or refractory sites, followed by TLI (15-18 Gy) and high-dose chemotherapy. Overall survival (OS) and event-free survival (EFS) were analyzed by Cox analysis and disease-specific survival (DSS) by competing-risk regression.
With a median follow-up period of 57 months among survivors, 5- and 10-year OS rates were 68% and 56%, respectively; 5- and 10-year EFS rates were 62% and 56%, respectively; and 5- and 10-year cumulative incidences of HL-related deaths were 21% and 29%, respectively. On multivariate analysis, complete response to SC was independently associated with improved OS and EFS. Primary refractory disease and extranodal disease were independently associated with poor DSS. Eight patients had grade 3 or higher cardiac toxicity, with 3 deaths. Second malignancies developed in 10 patients, 5 of whom died.
Accelerated IFRT followed by TLI and high-dose chemotherapy is an effective, feasible, and safe salvage strategy for patients with relapsed or refractory HL with excellent long-term OS, EFS, and DSS. Complete response to SC is the most important prognostic factor.
我们报告了综合加速受累野放射治疗（IFRT）后进行全淋巴照射（TLI）作为高剂量挽救方案的一部分，随后进行自体骨髓移植或自体干细胞移植治疗复发或难治性霍奇金淋巴瘤（HL）患者的长期结果。
从1985年11月至2008年7月，186例先前未接受过放疗的复发或难治性HL患者按照4个连续的机构审查委员会批准的方案接受挽救治疗。所有患者均经活检证实为原发性难治性或复发性HL。在标准剂量挽救化疗（SC）后，对复发或难治部位给予加速IFRT（18 - 20 Gy），随后进行TLI（15 - 18 Gy）和高剂量化疗。通过Cox分析评估总生存期（OS）和无事件生存期（EFS），通过竞争风险回归评估疾病特异性生存期（DSS）。
幸存者的中位随访期为57个月，5年和10年OS率分别为68%和56%；5年和10年EFS率分别为62%和56%；5年和10年HL相关死亡的累积发生率分别为21%和29%。多因素分析显示，对SC的完全缓解与改善的OS和EFS独立相关。原发性难治性疾病和结外疾病与不良的DSS独立相关。8例患者出现3级或更高等级的心脏毒性，其中3例死亡。10例患者发生第二原发恶性肿瘤，其中5例死亡。
加速IFRT后进行TLI和高剂量化疗是复发或难治性HL患者有效的、可行的且安全的挽救策略，具有出色的长期OS、EFS和DSS。对SC的完全缓解是最重要的预后因素。
