André M, Brice P, Cazals D, Hennequin C, Fermé C, Kerneis Y, Rousselot P, Zini J M, Lepage E, Gisselbrecht C
Institut d'Hématologie, Hopital Saint-Louis, France.
Hematol Cell Ther. 1997 Apr;39(2):59-65. doi: 10.1007/s00282-997-0059-7.
To evaluate in a prospective trial three courses of an ABVD-like chemotherapy (CT) regimen given before radiation therapy (RT) (subtotal nodal irradiation (STNI) in favorable stage Hodgkin's disease (HD). The efficacy, risk factors and medium-term toxicities are reported.
Stage I or II with at least one of the following factors, mediastinal involvement, histological type 3, age > 40 years, ESR rate > 50 mm, or stage IIIA. 189 patients with newly diagnosed HD were treated between 01/89 and 01/94 (stage I, n = 33; stage II, n = 129, stage IIIA, n = 27). Three courses of an ABVD-like regimen (adriamycin 25 mg/m2, bleomycin 10 mg, vindesine 2 mg/m2 and dacarbazine 250 mg/m2 day 1 and 8) were given before STNI at 36/40 grays. At diagnosis, prognostic factors were distributed as follows: B symptoms (n = 54), bulky mediastinum (n = 41), hemoglobin < 12 g/dl (n = 37), ESR > 50 (n = 65), age > 45 (n = 24).
After chemotherapy, 90% had an objective response (partial response > 75%) and 98% were in complete remission (CR) at the end of RT. Three patients had primary refractory disease and 13 patients (7%) relapsed, 3 at the initial site, 4 at previously uninvolved sites and 6 at both. With a median follow-up of 60 months, 170 patients are in 1st CR, 5 in 2nd or greater CR and 11/14 patients have died from HD. Bulky mediastinum (p = 0.009), age > 45 years (p = 0.03) and EST > 50 mm (p = 0.05) were adverse prognostic factors for survival. Bulky mediastinum (p = 0.009) was the only prognostic factor for freedom from progression. TOXICITIES: Two patients died from treatment related toxicity and one patient died with an osteogenic sarcoma. No secondary leukemia has so far been detected. 24 pregnancies were reported. Cardiopulmonary toxicity was always < grade 1 (WHO) in 95 patients evaluated. Two patients over 45 years old had a myocardial infarction.
With an acceptable medium-term toxicity, this treatment achieved 85% survival at 5 years.
在一项前瞻性试验中评估在放射治疗（RT）（对预后良好的霍奇金淋巴瘤（HD）进行次全淋巴结照射（STNI））之前给予三个疗程类似ABVD的化疗（CT）方案的效果。报告了疗效、危险因素和中期毒性。
I期或II期且具有以下至少一项因素，纵隔受累、组织学类型3、年龄>40岁、血沉率>50mm，或III A期。189例新诊断的HD患者在1989年1月至1994年1月期间接受治疗（I期，n = 33；II期，n = 129，III A期，n = 27）。在36/40格雷的STNI之前给予三个疗程类似ABVD的方案（阿霉素25mg/m²、博来霉素10mg、长春地辛2mg/m²和达卡巴嗪250mg/m²，第1天和第8天）。诊断时，预后因素分布如下：B症状（n = 54）、巨大纵隔（n = 41）、血红蛋白<12g/dl（n = 37）、血沉>50（n = 65）、年龄>45（n = 24）。
化疗后，90%有客观缓解（部分缓解>75%），放疗结束时98%完全缓解（CR）。3例患者为原发性难治性疾病，13例患者（7%）复发，3例在初始部位，4例在先前未受累部位，6例在两者均有。中位随访60个月，170例患者处于首次CR，5例处于第二次或更高次CR，11/14例患者死于HD。巨大纵隔（p = 0.009）、年龄>45岁（p = 0.03）和血沉>50mm（p = 0.05）是生存的不良预后因素。巨大纵隔（p = 0.009）是无进展生存的唯一预后因素。毒性：2例患者死于治疗相关毒性，1例患者死于骨肉瘤。迄今为止未检测到继发性白血病。报告了24例妊娠。在评估的95例患者中，心肺毒性始终<1级（WHO）。2例45岁以上患者发生心肌梗死。
该治疗具有可接受的中期毒性，5年生存率达到85%。
