Vose J M, Bierman P J, Lynch J C, Weisenburger D D, Kessinger A, Chan W C, Greiner T C, Armitage J O
Department of Internal Medicine, University of Nebraska Medical Center, Omaha 69198-3332, USA.
J Clin Oncol. 1998 Mar;16(3):844-9. doi: 10.1200/JCO.1998.16.3.844.
This study evaluated the outcomes of patients who received high-dose chemotherapy (HDC) and autologous hematopoietic stem-cell transplantation (ASCT) for large-cell non-Hodgkin's lymphoma (NHL) and the effect of a follicular versus a diffuse histology.
The prognostic factors in 289 patients who underwent HDC and ASCT for large-cell NHL between May 1983 and December 1996 were analyzed.
With a median follow-up duration of 24 months for surviving patients (range, 3 to 131 months), 112 of 289 (39%) were alive and 82 of 289 (28%) were failure-free. In a multivariate analysis, the factors associated with a poorer failure-free survival (FFS) included a lactic dehydrogenase (LDH) level greater than normal (P < .0001), three or more prior chemotherapy regimens received (P < .01), a mass > or = 10 cm at transplant (P < .01), and diffuse histology at the time of transplant (P = .026). Patients who received HDC and ASCT for large-cell NHL in the good-prognosis category (normal LDH, < three prior chemotherapy regimens, no large mass, and not chemotherapy-resistant) had a 5-year survival rate of 45%. Within the good-prognosis group, patients with diffuse large-cell NHL had a 5-year survival rate of 42% compared with 58% for patients with follicular large-cell (FLC) lymphoma (P = .05).
Good-prognosis patients with FLC histology who receive HDC and ASCT have an improved survival compared with good-prognosis patients with a diffuse large-cell histology.
本研究评估了接受大剂量化疗（HDC）及自体造血干细胞移植（ASCT）治疗的大细胞非霍奇金淋巴瘤（NHL）患者的预后情况以及滤泡型与弥漫型组织学类型的影响。
分析了1983年5月至1996年12月期间289例接受HDC及ASCT治疗的大细胞NHL患者的预后因素。
存活患者的中位随访时间为24个月（范围3至131个月），289例患者中有112例（39%）存活，289例中有82例（28%）无疾病进展。多因素分析显示，与无疾病进展生存期（FFS）较差相关的因素包括乳酸脱氢酶（LDH）水平高于正常（P <.0001）、接受过三种或更多先前化疗方案（P <.01）、移植时肿块≥10 cm（P <.01）以及移植时为弥漫型组织学类型（P =.026）。处于预后良好类别（LDH正常、先前化疗方案<三种、无大肿块且无化疗耐药）的大细胞NHL患者接受HDC及ASCT后的5年生存率为45%。在预后良好组中，弥漫性大细胞NHL患者的5年生存率为42%，而滤泡性大细胞（FLC）淋巴瘤患者为58%（P =.05）。
与预后良好的弥漫性大细胞组织学类型患者相比，接受HDC及ASCT的预后良好的FLC组织学类型患者生存率有所提高。
