Senapati Jayastu, Devasia Anup J, Korula Anu, Fouzia N A, Kulkarni Uday, Lakshmi Kavitha M, Lionel Sharon, Abraham Aby, Srivastava Alok, Mathews Vikram, George Biju
Department of Haematology, Christian Medical College, Vellore, Tamilnadu India.
Indian J Hematol Blood Transfus. 2022 Apr;38(2):290-298. doi: 10.1007/s12288-021-01450-9. Epub 2021 May 27.
High dose chemotherapy followed by autologous stem cell transplantation is the treatment of choice for relapsed Hodgkin lymphoma (HL). We analyzed 100 consecutive patients who underwent ASCT at our center between January 1999 and June 2019 for relapsed or refractory disease with a median age of 28 years (range: 9-65). At ASCT, 59 were in complete remission (CR) while 31 achieved partial remission (PR) and 10 had refractory disease (RD). Most had BEAM conditioning with a median infused cell dose of 4.84 × 10 CD 34 cells/kg. Prompt engraftment occurred in 97 patients at a median of 11 days. The day 100 transplant related mortality (TRM) was 5%. At a median of 37 months follow up, 79 patients are alive while 34 have relapsed. The 3-year event free survival (EFS) and overall survival (OS) are 62.3 ± 0.5% and 77.9 ± 4.4% respectively The 3-year OS for patients in CR, PR and RD were 83.0 ± 5.2%, 78.4 ± 8.1% and 38.9 ± 1.7 respectively [ = 0.007] while the 3-year EFS for CR, PR and RD were 73.1 ± 6.2%, 61.3 ± 9.2% and 25.0 ± 1.5 respectively [ = 0.005] Only disease status at time of ASCT was found to correlate with both OS and EFS. ASCT for HL is associated with good outcomes and low TRM. Disease status at ASCT impacted both OS and EFS and strategies to improve outcomes in patients with refractory disease needs to be explored.
大剂量化疗后进行自体干细胞移植是复发霍奇金淋巴瘤（HL）的首选治疗方法。我们分析了1999年1月至2019年6月期间在本中心接受自体干细胞移植（ASCT）的100例连续患者，这些患者均患有复发或难治性疾病，中位年龄为28岁（范围：9 - 65岁）。在进行ASCT时，59例处于完全缓解（CR）状态，31例达到部分缓解（PR），10例患有难治性疾病（RD）。大多数患者采用BEAM预处理，中位输注细胞剂量为4.84×10 CD 34细胞/kg。97例患者迅速植入，中位时间为11天。移植后第100天的移植相关死亡率（TRM）为5%。中位随访37个月时，79例患者存活，34例复发。3年无事件生存率（EFS）和总生存率（OS）分别为62.3±0.5%和77.9±4.4%。CR、PR和RD患者的3年总生存率分别为83.0±5.2%、78.4±8.1%和38.9±1.7%[P = 0.007]，而CR、PR和RD患者的3年无事件生存率分别为73.1±6.2%、61.3±9.2%和25.0±1.5%[P = 0.005]。仅发现ASCT时的疾病状态与总生存率和无事件生存率均相关。HL的ASCT与良好的预后和低TRM相关。ASCT时的疾病状态影响总生存率和无事件生存率，需要探索改善难治性疾病患者预后的策略。
