Levis A, Vitolo U, Ciocca Vasino M A, Cametti G, Urgesi A, Bertini M, Canta M, Monetti U, Bosio C, Jayme A
Divisione di Medicina E-Servizio di Ematologia, Ospedale Maggiore di San Giovanni Battista e della Cittá di Torino, Italy.
Cancer. 1987 Oct 15;60(8):1713-9. doi: 10.1002/1097-0142(19871015)60:8<1713::aid-cncr2820600804>3.0.co;2-c.
A series of 60 patients with "high risk" Stage II and III Hodgkin's disease (B symptoms, or large mediastinal mass, or E lung disease) were staged without laparotomy and treated with combined modality treatment: mechlorethamine, vincristine, procarbazine, and prednisone (6 MOPP) plus radiotherapy. Patients were restaged after the first three courses of MOPP and the status of response to therapy at that time was called early response to chemotherapy (ERC). The rate of nitrogen mustard and procarbazine delivery (MRD) during the first three cycles of chemotherapy also was assessed. At the completion of the therapy patients were restaged and the final response was assessed. Fifty-two (86.7%) patients entered complete remission (CR). Forty-eight percent of the complete responders achieved CR in the first three courses of MOPP. Eight-year survival and disease-free survival (DFS) rates of the patients achieving CR were 71% and 73%, respectively. Survival and DFS were significantly better for the patients who achieved CR in the first three cycles of chemotherapy than for patients who entered CR at a later stage of therapy: 8-year survival 90% versus 55% (P = 0.00); 8-year DFS 87% versus 59% (P = 0.01). The attainment of a complete ERC was adversely affected by lymphocyte depletion (LD) histologic type (P = 0.01) and MRD less than 65% (P = 0.04). However, when a multivariate regression analysis was used, ERC was the only significant prognostic variable for survival and DFS and its predictive value was confirmed even after correction by MRD. These data suggest that the rapidity of response to chemotherapy could be an important prognostic factor in high-risk Stage II and III Hodgkin's disease.
对60例“高危”Ⅱ期和Ⅲ期霍奇金病患者（有B症状，或纵隔大肿块，或肺部E病变）未行剖腹探查分期，并采用综合治疗：氮芥、长春新碱、丙卡巴肼和泼尼松（6个疗程的MOPP方案）加放疗。在MOPP方案的前三个疗程后对患者进行重新分期，此时的治疗反应状态称为化疗早期反应（ERC）。还评估了化疗前三个周期中氮芥和丙卡巴肼的给药率（MRD）。治疗结束时对患者进行重新分期并评估最终反应。52例（86.7%）患者进入完全缓解（CR）。48%的完全缓解者在MOPP方案的前三个疗程中达到CR。达到CR的患者的8年生存率和无病生存率（DFS）分别为71%和73%。化疗前三个周期达到CR的患者的生存率和DFS明显优于在治疗后期进入CR的患者：8年生存率90%对55%（P = 0.00）；8年DFS 87%对59%（P = 0.01）。淋巴细胞消减（LD）组织学类型（P = 0.01）和MRD低于65%（P = 0.04）对完全ERC的获得有不利影响。然而，当使用多因素回归分析时，ERC是生存和DFS的唯一重要预后变量，即使经MRD校正后其预测价值仍得到证实。这些数据表明，对化疗反应的快速性可能是高危Ⅱ期和Ⅲ期霍奇金病的一个重要预后因素。
