Vose J M, Anderson J R, Kessinger A, Bierman P J, Coccia P, Reed E C, Gordon B, Armitage J O
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68198-3330.
J Clin Oncol. 1993 Oct;11(10):1846-51. doi: 10.1200/JCO.1993.11.10.1846.
To evaluate clinical and tumor characteristics in patients receiving high-dose chemotherapy and autologous peripheral stem-cell transplantation (PSCT) or bone marrow transplantation (ABMT) for relapsed or primary refractory non-Hodgkin's lymphoma (NHL).
One hundred fifty-eight patients with NHL received high-dose chemotherapy and ABMT or PSCT. A multivariate analysis of characteristics was performed for comparison of the long-term failure-free survival (FFS) rate.
Using a multivariate analysis, a prognostic model was constructed with patients in the good-prognosis group being those without a mass > or = 10 cm at the time of transplant, and no more than one of the following characteristics: three or more prior chemotherapy regimens, lactate dehydrogenase (LDH) level above normal, and chemotherapy resistance. Patients in the poor-prognosis group had a mass > or = 10 cm, or two of the other characteristics noted. The poor-prognosis group had a 3-year FFS rate of 10%, compared with a 45% 3-year FFS in the good-prognosis group (P < .001). Within the prognostic groups, there was no difference in the 3-year FFS rate of the poor-prognosis patients who received ABMT versus PSCT (10% v 12%; not significant). However, in the good-prognosis group, patients who received ABMT had a 3-year FFS rate of 32%, compared with 70% for those who received PSCT (P < .008).
This prognostic model can identify patients with good and poor prognoses following high-dose chemotherapy and ABMT or PSCT for aggressive NHL. In good-prognosis patients, those who received PSCT had a superior FFS rate.
评估接受大剂量化疗及自体外周干细胞移植（PSCT）或自体骨髓移植（ABMT）治疗复发或原发性难治性非霍奇金淋巴瘤（NHL）患者的临床及肿瘤特征。
158例NHL患者接受了大剂量化疗及ABMT或PSCT。对各项特征进行多因素分析以比较长期无失败生存（FFS）率。
通过多因素分析构建了一个预后模型，预后良好组患者为移植时肿块直径＜10 cm，且无以下特征中的一项以上：三种或更多先前化疗方案、乳酸脱氢酶（LDH）水平高于正常及化疗耐药。预后不良组患者有直径≥10 cm的肿块，或具备上述其他两项特征。预后不良组的3年FFS率为10%，而预后良好组为45%（P＜0.001）。在各预后组中，接受ABMT与PSCT的预后不良患者的3年FFS率无差异（10%对12%；无显著性）。然而，在预后良好组中，接受ABMT的患者3年FFS率为32%，而接受PSCT的患者为70%（P＜0.008）。
该预后模型可识别接受大剂量化疗及ABMT或PSCT治疗侵袭性NHL后预后良好和不良的患者。在预后良好的患者中，接受PSCT的患者FFS率更高。
