自体干细胞移植（ASCT）治疗预后不良的霍奇金淋巴瘤（HD）：两种CBV方案的比较结果及移植时疾病状态的重要性。

Autologous stem cell transplantation (ASCT) for poor prognostic Hodgkin's disease (HD): comparative results with two CBV regimens and importance of disease status at transplant.

作者信息

Arranz R, Tomás J F, Gil-Fernández J J, Martínez-Chamorro C, Granados E, Alegre A, Figuera A, Vázquez L, Cámara R, Fernández-Rañada J M

机构信息

Department of Hematology, Hospital Universitario de la Princesa, Madrid, Spain.

出版信息

Bone Marrow Transplant. 1998 Apr;21(8):779-86. doi: 10.1038/sj.bmt.1701186.

DOI:10.1038/sj.bmt.1701186

PMID:9603401

Abstract

Clinical outcome of 47 consecutive patients with advanced HD who underwent ASCT in our Department was analyzed retrospectively. Median age was 28 years (28 males and 19 females). At transplant, 15 (32%) patients were in CR (five in first CR after two chemotherapy regimens and 10 in second CR), eight (17%) in PR (seven without a prior CR), 22 (51%) had relapsing disease (19 with sensitive relapse) and two had primary refractory disease. The CVB regimen with two different schedules was used: 22 (47%) patients received standard CBV (CY 6 g/m2, BCNU 300 mg/m2 and etoposide 600 mg/m2) and 25 (53%) received an increased CBV dose (CY 7.2 g/m2, BCNU 440 mg/m2 and etoposide 2 g/m2). Antitumor response for 28 evaluable patients was similar for both CBV regimens: 87 and 75% (P=0.39). At 7.2 years, actuarial overall survival (OS), progression-free survival (PFS) and event-free survival (EFS) for the whole series were 51.7+/-8%, 34+/-9% and 28+/-8%, with a median follow-up for the surviving patients of 3 years (0.7-7.6). No differences in these survival functions according to the CBV regimen used were observed (P=0.57). A history of a prior CR (P=0.003), duration of first CR >1 year (P=0.04), absence of bulky nodal disease at transplant (P=0.054), absence of extranodal disease at transplant (P=0.01), and a CR status at transplant (P=0.0006) were associated with a better PFS on univariant analysis. On multivariate analysis, only CR status at transplant remained significant (P=0.05). When patients in second CR at transplant and those in first sensitive relapse were analyzed separately, no differences in clinical characteristics or in treatment received pretransplant were observed; however, PFS was significantly different (P=0.01). In conclusion, CR status at transplant is useful in identifying 'good risk' patients and is necessary to obtain the greatest benefit from ASCT independent of the CBV regimen used.

摘要

回顾性分析了在我科接受自体干细胞移植（ASCT）的47例晚期霍奇金淋巴瘤（HD）患者的临床结局。中位年龄为28岁（男性28例，女性19例）。移植时，15例（32%）患者处于完全缓解（CR）状态（5例在接受两个化疗方案后达到首次CR，10例为第二次CR），8例（17%）部分缓解（PR）（7例既往未达到CR），22例（51%）疾病复发（19例为敏感复发），2例为原发性难治性疾病。采用了两种不同方案的环磷酰胺、卡莫司汀和依托泊苷（CVB）方案：22例（47%）患者接受标准CVB方案（环磷酰胺6 g/m²、卡莫司汀300 mg/m²和依托泊苷600 mg/m²），25例（53%）接受增加剂量的CVB方案（环磷酰胺7.2 g/m²、卡莫司汀440 mg/m²和依托泊苷2 g/m²）。两种CVB方案对28例可评估患者的抗肿瘤反应相似：分别为87%和75%（P = 0.39）。在7.2年时，整个队列的精算总生存（OS）率、无进展生存（PFS）率和无事件生存（EFS）率分别为51.7±8%、34±9%和28±8%，存活患者的中位随访时间为3年（0.7 - 7.6年）。未观察到根据所使用的CVB方案在这些生存指标上存在差异（P = 0.57）。单因素分析显示，既往CR史（P = 0.003）、首次CR持续时间>1年（P = 0.04）、移植时无巨大淋巴结病（P = 0.054）、移植时无结外疾病（P = 0.01）以及移植时的CR状态（P = 0.0006）与更好的PFS相关。多因素分析显示，仅移植时的CR状态仍具有显著性（P = 0.05）。当分别分析移植时处于第二次CR的患者和首次敏感复发的患者时，未观察到临床特征或移植前接受治疗方面的差异；然而，PFS存在显著差异（P = 0.01）。总之，移植时的CR状态有助于识别“低危”患者，并且对于从ASCT中获得最大益处而言，无论使用何种CVB方案，移植时的CR状态都是必要的。