Bonfante V, Santoro A, Viviani S, Devizzi L, Balzarotti M, Soncini F, Zanini M, Valagussa P, Bonadonna G
Division of Medical Oncology, Istituto Nazionale Tumori, Milano, Italy.
J Clin Oncol. 1997 Feb;15(2):528-34. doi: 10.1200/JCO.1997.15.2.528.
This study analyzed long-term results in patients with Hodgkin's disease who were resistant to or relapsed after first-line treatment with MOPP and ABVD. Response to salvage treatments and prognostic factors were also evaluated.
The study population included 115 refractory or relapsed patients among a total of 415 patients treated with alternating or hybrid MOPP-ABVD followed by radiotherapy (25 to 30 Gy) to initial bulky sites. The median follow-up duration of the present series was 91 months. Thirty-nine of 115 patients (34%) showed disease progression while on primary treatment (induction failures); 48 relapsed after complete remissions that lasted < or = 12 months and 28 after complete remission that lasted more than 12 months from the end of all treatments.
At 8 years, the overall survival rate was 27%, being 54% and 28% in patients whose initial complete remission was longer or shorter than 12 months, respectively, and 8% in induction failures (P < .001). Response to first-line chemotherapy and disease extent at first progression significantly influenced long-term results, as well as the incidence and duration of complete remission.
The present data confirm previous observations that showed the main prognostic factors to influence outcome after salvage treatment are response duration to first-line therapy and disease extent at relapse. The results indicate that patients who relapse after the alternating MOPP/ABVD regimen have a prognosis similar to that of patients who relapse after a four-drug regimen (MOPP or ABVD alone). Re-treatment with initial chemotherapy seems the treatment of choice for patients who relapse after an initial complete remission that lasts greater than 12 months, while the real impact of high-dose chemotherapy or new regimens should be assessed in resistant patients.
本研究分析了霍奇金淋巴瘤患者在接受MOPP和ABVD一线治疗后耐药或复发的长期结果。同时评估了挽救治疗的反应及预后因素。
研究人群包括415例接受交替或混合MOPP-ABVD方案治疗并对初始大块病灶进行放疗（25至30 Gy）的患者中的115例难治性或复发性患者。本系列患者的中位随访时间为91个月。115例患者中有39例（34%）在初始治疗时出现疾病进展（诱导失败）；48例在持续缓解≤12个月后复发，28例在所有治疗结束后持续缓解超过12个月后复发。
8年时，总生存率为27%，初始完全缓解时间长于或短于12个月的患者分别为54%和28%，诱导失败患者为8%（P<.001）。一线化疗反应及首次进展时的疾病范围对长期结果有显著影响，完全缓解的发生率和持续时间也有显著影响。
目前的数据证实了先前的观察结果，即挽救治疗后影响预后的主要预后因素是一线治疗的反应持续时间和复发时的疾病范围。结果表明，交替MOPP/ABVD方案后复发的患者预后与四药方案（单独使用MOPP或ABVD）后复发的患者相似。对于初始完全缓解持续超过12个月后复发的患者，初始化疗再治疗似乎是首选治疗方法，而对于耐药患者，应评估高剂量化疗或新方案的实际影响。
