Brusamolino E, Orlandi E, Canevari A, Morra E, Castelli G, Alessandrino E P, Pagnucco G, Bernasconi P, Astori C, Lazzarino M
Cattedra di Ematologia, Università di Pavia, Policlinico San Matteo IRCCS, Italy.
Ann Oncol. 1994 May;5(5):427-32. doi: 10.1093/oxfordjournals.annonc.a058874.
A prospective study was conducted to assess the efficacy and toxicity of a salvage regimen consisting of CCNU, Melphalan, and VP-16 (CAV) given at 28-day intervals in patients with Hodgkin's disease (HD) relapsing after primary therapy or refractory to the alternating MOPP/ABVD regimen.
This study included 58 patients (median age: 34 years), with resistant or relapsing HD. Primary therapy had consisted of alternating MOPP/ABVD (81%) or MOPP alone (19%); 38% of patients were relapsing from prior complete remission (CR) while 62% had resistant disease. Extranodal disease was present in 55% and B-symptoms in 72% of patients; one-fifth had bulky disease and/or bone marrow involvement. The CAV was used as first salvage in half of the patients.
Complete remission was obtained in 17 patients (29%); unfavorable factors for CR in univariate analysis were the presence of bulky disease and the failure to achieve CR with prior therapy. Nine patients (53% of remitters) have subsequently relapsed with a 10-month median duration of CR. The 3-year overall survival after CAV was 25% with an 18-month median survival; significant differences in survival were found according to the extent of disease, the presence of B-symptoms and the HD status (prior sensitive or resistant disease, first or subsequent relapse). Seven patients are long-term remitters (12%), and one of them has been given high-dose chemotherapy and autologous bone marrow transplantation at relapse after CAV. The CAV toxicity was mostly hematological; severe pancytopenia occurred in six cases with two cases of fatal infections and one of fatal hemorrhage.
CAV therapy was moderately effective as third-line salvage in patients with HD resistant to alternating MOPP/ABVD or previously given two different regimens for relapse; the toxicity was mostly hematological and supportive therapy was needed in one-third of the patients.
开展了一项前瞻性研究，以评估在接受过初始治疗后复发或对交替MOPP/ABVD方案难治的霍奇金淋巴瘤（HD）患者中，每28天给予洛莫司汀（CCNU）、美法仑和依托泊苷（CAV）组成的挽救方案的疗效和毒性。
本研究纳入了58例（中位年龄：34岁）耐药或复发的HD患者。初始治疗包括交替MOPP/ABVD（81%）或单纯MOPP（19%）；38%的患者从先前的完全缓解（CR）复发，而62%的患者患有耐药疾病。55%的患者存在结外病变，72%的患者有B症状；五分之一的患者有巨大肿块疾病和/或骨髓受累。一半的患者将CAV用作首次挽救治疗。
17例患者（29%）获得完全缓解；单因素分析中CR的不利因素是存在巨大肿块疾病以及先前治疗未达到CR。9例患者（缓解者的53%）随后复发，CR的中位持续时间为10个月。CAV治疗后的3年总生存率为25%，中位生存期为18个月；根据疾病范围、B症状的存在以及HD状态（先前敏感或耐药疾病、首次或后续复发）发现生存存在显著差异。7例患者为长期缓解者（12%），其中1例在CAV治疗后复发时接受了大剂量化疗和自体骨髓移植。CAV毒性主要为血液学毒性；6例发生严重全血细胞减少，2例死于感染，1例死于出血。
CAV治疗作为对交替MOPP/ABVD耐药或先前接受过两种不同复发方案治疗的HD患者的三线挽救治疗，疗效中等；毒性主要为血液学毒性，三分之一的患者需要支持治疗。
