异环磷酰胺、卡铂和依托泊苷方案与吉西他滨和长春瑞滨方案治疗复发或难治性霍奇金淋巴瘤儿科患者的疗效和毒性比较
Outcome and toxicity of ifosfamide, carboplatin, and etoposide versus gemcitabine and vinorelbine regimen for pediatric patients with relapsed or refractory Hodgkin's lymphoma.
作者信息
Mahdy Ahmed, Hamoda Asmaa, Zaher Ahmed, Khorshed Eman, Elwakeel Madeha, Hassanein Omneya, Sidhom Iman
机构信息
Pediatric Oncology Department, Children's Cancer Hospital Egypt, Cairo, Egypt.
Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
出版信息
Front Oncol. 2023 Jun 27;13:1153128. doi: 10.3389/fonc.2023.1153128. eCollection 2023.
BACKGROUND
Pediatric classical Hodgkin lymphoma (CHL) is a curable disease; however, the optimal salvage regimen is unclear for relapsed/refractory (R/R) disease. This study aimed to compare response rates, toxicity, event-free survival (EFS), and overall survival (OS) of ifosfamide, carboplatin, and etoposide (ICE) with gemcitabine and vinorelbine (GV) regimen after first-line doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) in pediatric patients with R/R CHL.
METHODS
This is a retrospective cohort study of 132 pediatric patients with R/R CHL treated from July 2012 to December 2020 with ICE (n = 82) or GV (n = 50).
RESULTS
The median age at relapse was 13.9 years, and 68.2% were men. Rates of complete response, partial response, and progressive disease before consolidation were 50.6%, 3.7%, and 45.7% for ICE and 28.5%, 0%, and 71.5% for GV (P = 0.011). By multivariate analysis, regimen (P = 0.002), time to relapse (P = 0.0001), and B-symptoms (P = 0.002) were independent factors to lower response rates. Hematological toxicity, electrolyte disturbance, hemorrhagic cystitis, infectious complications, and hospital admission for fever neutropenia were statistically significant higher for the ICE regimen. Treatment-related mortalities were 2.4% for ICE and 2% for GV (P = 0.86). The 3-year EFS was 39.3% ± 11.4% for ICE and 24.9% ± 12.5% for GV (P = 0.0001), while 3-year OS was 69.3% ± 10.6% and 74% ± 12.9% (P = 0.3), respectively. By multivariate analysis, regimen (P = 0.0001), time to relapse (P = 0.011), B-symptoms (P = 0.001), and leukocytosis (P = 0.007) were significant for EFS, while anemia (P = 0.008), and progressive disease on early response evaluation (P = 0.022) were significant for OS.
CONCLUSIONS
The ICE regimen had a better overall response rate and EFS, but higher toxicity, than GV; however, OS and mortality were similar.
背景
儿童经典型霍奇金淋巴瘤（CHL）是一种可治愈的疾病；然而，对于复发/难治性（R/R）疾病，最佳挽救方案尚不清楚。本研究旨在比较异环磷酰胺、卡铂和依托泊苷（ICE）与吉西他滨和长春瑞滨（GV）方案在一线使用多柔比星、博来霉素、长春碱、达卡巴嗪（ABVD）治疗后的R/R CHL儿童患者中的缓解率、毒性、无事件生存期（EFS）和总生存期（OS）。
方法
这是一项回顾性队列研究，对2012年7月至2020年12月期间接受ICE（n = 82）或GV（n = 50）治疗的132例R/R CHL儿童患者进行研究。
结果
复发时的中位年龄为13.9岁，68.2%为男性。ICE组巩固治疗前的完全缓解率、部分缓解率和疾病进展率分别为50.6%、3.7%和45.7%，GV组分别为28.5%、0%和71.5%（P = 0.011）。多因素分析显示，治疗方案（P = 0.002）、复发时间（P = 0.0001）和B症状（P = 0.002）是缓解率降低的独立因素。ICE方案的血液学毒性、电解质紊乱、出血性膀胱炎、感染并发症以及发热性中性粒细胞减少导致的住院率在统计学上显著更高。ICE组的治疗相关死亡率为2.4%，GV组为2%（P = 0.86）。ICE组的3年EFS为39.3%±11.4%，GV组为24.9%±12.5%（P = 0.0001），而3年OS分别为69.3%±10.6%和74%±12.9%（P = 0.3）。多因素分析显示，治疗方案（P = 0.0001）、复发时间（P = 0.011）、B症状（P = 0.001）和白细胞增多（P = 0.007）对EFS有显著影响，而贫血（P = 0.008）和早期缓解评估时的疾病进展（P = 0.022）对OS有显著影响。
结论
ICE方案的总体缓解率和EFS优于GV，但毒性更高；然而，OS和死亡率相似。
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