Arranz R, Gil-Fernández J J, Muñoz E, Acevedo A, Sobrino M P, Fernández-Rañada J M
Servicio de Hematología, Hospital Universitario de la Princesa, Madrid.
Sangre (Barc). 1998 Jun;43(3):179-84.
Retrospective analysis of 70 patients with Hodgkin's disease (HD) and treated consecutively in our center between 1979 and 1993.
All ganglionar biopsies were reviewed and finally 60 patients were selected: 43 males and 17 females with a median age of 39 years (12-79) and the following features: 55% III-IV stages, 25% extranodal involvement, 32% bulky mediastinum and 57% B-symptoms. Scheme of treatment: Only radiotherapy in 9 patients with localized stages and no adverse factors; only chemotherapy in 25 with advanced stages and combined therapy in 15 with localized stages and any adverse factor and in 7 with advanced stage and bulky disease. Chemotherapy was mainly based on MOPP until 1987 and MOPP/ABVD afterwards. Only four patients did not follow this scheme: 2 due to progression, 1 due to toxicity and 1 due to medical decision.
Fifty patients achieved complete remission (CR), 2 partial and 8 minimal response or progression under therapy. Eleven patients have died: 6 due to HD, 4 of second neoplasias and 1 of an opportunistic infection. With a median follow-up for surviving patients of 4.8 years (1-2), the estimated overall survival at 8 years is 67.7% (SD 9%), tumor mortality 82.6% (SD 7%) and progression free survival 66.7% (SD 7%). Disease free survival for CR patients is 78.4% (SD 9%). Response to treatment was the only factor significantly associated with survival (p = 0.0001). The estimated survival for CR patients who relapsed is 92.3% versus 28% for those who did not obtain a CR (p = 0.0001).
In our experience, first line therapy adjusted to clinical features at diagnosis has good results. Response to treatment has been the determinant factor for survival, mostly because salvage treatments, including high-dose chemotherapy approaches, have been of little effectiveness.
对1979年至1993年间在本中心连续接受治疗的70例霍奇金淋巴瘤（HD）患者进行回顾性分析。
对所有淋巴结活检进行复查，最终选取60例患者：43例男性和17例女性，中位年龄39岁（12 - 79岁），具有以下特征：55%为Ⅲ - Ⅳ期，25%有结外受累，32%有巨大纵隔，57%有B症状。治疗方案：9例局限性分期且无不良因素的患者仅接受放疗；25例晚期患者仅接受化疗，15例局限性分期且有任何不良因素以及7例晚期且有巨大肿块的患者接受联合治疗。1987年前化疗主要基于MOPP方案，之后为MOPP/ABVD方案。仅4例患者未遵循此方案：2例因病情进展，1例因毒性反应，1例因医疗决策。
50例患者达到完全缓解（CR），2例部分缓解，8例在治疗期间为微小反应或病情进展。11例患者死亡：6例死于HD，4例死于第二肿瘤，1例死于机会性感染。存活患者的中位随访时间为4.8年（1 - 2年），8年时的估计总生存率为67.7%（标准差9%），肿瘤死亡率为82.6%（标准差7%），无进展生存率为66.7%（标准差7%）。CR患者的无病生存率为78.4%（标准差9%）。治疗反应是与生存显著相关的唯一因素（p = 0.0001）。复发的CR患者的估计生存率为92.3%，而未达到CR的患者为28%（p = 0.0001）。
根据我们的经验，根据诊断时的临床特征调整的一线治疗效果良好。治疗反应一直是生存的决定性因素，主要是因为挽救性治疗，包括大剂量化疗方法，效果不佳。
