Ben Lakhal Raihane, Hdiji Sondos, Zriba Sami, Mokrani Amina, Laatiri Mohamed Adnen, BenYoussef Yossra, Ezzaier Faten, Toumi Nabil, Ladeb Salwa, BenSalah Hanen, Tebra Sameh, Frikha Hatem, Messai Taha, Daoued Jamel, Bouaouina Noureddine, Maalej Monji, Frikha Mounir, BenOthmen Tarek, BenAhmed Slim, Khelif Abderrahim, Msaddek Fehmi, Mezlini Amel, Elloumi Moez, Meddeb Balkis
Hôpital Aziza-Othmana, service d'hématologie clinique, Tunis, Tunisie.
Hôpital Hédi-Chaker, service d'hématologie clinique, Sfax, Tunisie.
Bull Cancer. 2018 Jun;105(6):562-572. doi: 10.1016/j.bulcan.2018.04.001. Epub 2018 Apr 27.
In Tunisia, the management of Adult Hodgkin's Lymphoma (HL) has been standardized since 1999. We propose in this study to report the therapeutic results of the national protocol of adult HL treatment (MDH2008).
Our study is prospective multicenter interesting 444 patients followed for HL between July 2008 and June 2013 and treated according to the MDH2008 protocol. The median age of our patients was 30 years. B symptoms were present in 62.8 % of our patients. According to the Ann Arbor classification, our patients were in stages I, II, III and IV in 3 %, 42 %, 26 % and 29 %, respectively. The MDH2008 protocol is based on a strategy adapted to the therapeutic response to 2 cycles of chemotherapy.
Response≥75 % to 2 courses of chemotherapy was achieved in 43 % of patients and the response rate at the end of treatment was 92.1 %. Forty-eight patients (11.4 %) had primary failure. In the multi-variant study, bulky mediastinal mass (IMT≥0.35) was an independent predictive factor of primary failure (P: 0.000). Nineteen toxic deaths (4.35 %) were reported. The relapse rate was 7.8 %. Event free survival, relapse-free survival and overall survival at 5years were 75 %, 89 % and 90 %, respectively. Adaptation of the treatment to the 2 cycles response was effective in unfavorable early stages and advanced stages.
Compared to MDH2002 (second version of Tunisian prospective protocol), the MDH2008 reduced the primary failure rate, the rate of toxic deaths with escalated BEACOPP and the rate of relapse in Tunisian patients.
在突尼斯，自1999年以来成人霍奇金淋巴瘤（HL）的管理已实现标准化。我们在本研究中报告成人HL治疗国家方案（MDH2008）的治疗结果。
我们的研究是一项前瞻性多中心研究，纳入了2008年7月至2013年6月期间接受HL治疗并按照MDH2008方案治疗的444例患者。患者的中位年龄为30岁。62.8%的患者出现B症状。根据Ann Arbor分期，患者处于I期、II期、III期和IV期的比例分别为3%、42%、26%和29%。MDH2008方案基于一种适应化疗2个周期治疗反应的策略。
43%的患者对2个疗程化疗的反应≥75%，治疗结束时的反应率为92.1%。48例患者（11.4%）出现原发性失败。在多变量研究中，巨大纵隔肿块（IMT≥0.35）是原发性失败的独立预测因素（P：0.000）。报告了19例毒性死亡（4.35%）。复发率为7.8%。5年无事件生存率、无复发生存率和总生存率分别为75%、89%和90%。根据两个周期的反应调整治疗在早期不良和晚期阶段有效。
与MDH2002（突尼斯前瞻性方案的第二版）相比，MDH2008降低了突尼斯患者的原发性失败率、强化BEACOPP的毒性死亡率和复发率。
