Long-Term Effects of High-Dose Chemotherapy and Radiation for Relapsed and Refractory Hodgkin's Lymphoma
Long-Term Effects of High-Dose Chemotherapy and Radiation for Relapsed and Refractory Hodgkin's Lymphoma
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DOI：
10.1200/jco.2007.15.5507
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发表时间：
2008-11-10
影响因子：
45.3
通讯作者：
Yahalom, Joachim
中科院分区：
文献类型：
--
作者：
Goodman, Karyn A.;Riedel, Elyn;Yahalom, Joachim
PurposeTo评估晚期发病率和死亡率的风险，并评估高剂量放化疗（HDT）和自体干细胞挽救（ASCR）后复发/难治性霍奇金淋巴瘤（HL）患者的长期健康相关生活质量（QOL）。患者和方法从1985年至1998年，218例HL患者接受HDT与ASCR挽救方案治疗。在这218例患者中，对153例（70%）ASCR后生存≥ 2年的患者进行了晚期发病率和非HL原因死亡率评估。通过自填问卷获得生活质量信息。计算风险比（RR），以比较观察到的第二恶性肿瘤（SM）率在这个队列与预期SM率从监测流行病学和最终结果（SEER）登记。结果ASCR术后中位随访时间为11.5年。在153例患者中，有53例死亡; 33例死于HL，20例死于其他原因。13例死亡是由SM引起的，从ASCR到SM诊断的中位时间为9年（范围，3至18年）。与一般人群相比，SM的RR为6.5（95% CI，3.6 - 10.7），但与HL患者相比，SM的RR为2.4（95% CI，1.4 - 4.05）。ASCR幸存者的全球生活质量与一般人群相媲美，但对于特定的领域，受访者的分数表明功能下降，症状恶化。与一般人群中的癌症风险相比，ASCR幸存者的SM风险升高，但与SEER中的HL患者相比，风险不太明显。
PurposeTo evaluate the risk of late morbidity and mortality, and to assess long-term health-related quality of life (QOL) among patients with relapsed/refractory Hodgkin's lymphoma (HL) after high-dose chemoradiotherapy (HDT) and autologous stem-cell rescue (ASCR).Patients and MethodsFrom 1985 to 1998, 218 patients with HL were treated on HDT with ASCR salvage protocols. Of these 218, 153 (70%) who survived >= 2 years after ASCR were evaluated for late morbidity and mortality from causes other than HL. QOL information was obtained through self-administered questionnaires. Risk ratios (RR) were calculated to compare observed second malignancy (SM) rates in this cohort with expected SM rates from the Surveillance Epidemiology and EndResults(SEER) registry. Results Median follow-up after ASCR was 11.5 years. Among 153 patients, there were 53 deaths; 33 from HL and 20 from other causes. Thirteen deaths were caused by SM, with median time from ASCR to SM diagnosis of 9 years (range, 3 to 18 years). The RR of SM was 6.5 (95% CI, 3.6 to 10.7) when compared with the general population, but 2.4 (95% CI, 1.4 to 4.05) when compared with patients with HL. Global QOL of ASCR survivors was comparable with the general population, but for specific domains, respondents' scores indicated reduced functioning and worse symptoms.ConclusionHL accounts for most deaths among patients surviving HDT and ASCR. Survivors of ASCR had an elevated risk of SM compared with the cancer risk in the general population, but when compared with patients with HL in SEER, the risk was less pronounced.