High-dose therapy and autologous stem-cell transplantation for adult patients with Hodgkin's disease who do not enter remission after induction chemotherapy: Results in 175 patients reported to the European Group for Blood and Marrow Transplantation
High-dose therapy and autologous stem-cell transplantation for adult patients with Hodgkin's disease who do not enter remission after induction chemotherapy: Results in 175 patients reported to the European Group for Blood and Marrow Transplantation
复制标题
DOI：
10.1200/jco.1999.17.10.3101
复制
发表时间：
1999-10-01
影响因子：
45.3
通讯作者：
Goldstone, AH
中科院分区：
文献类型：
--
作者：
Sweetenham, JW;Carella, AM;Goldstone, AH
目的：调查诱导治疗后未进入缓解期的霍奇金病成人患者的高剂量治疗和自体干细胞移植（ASCT）结果，以确定总生存期（OS）和无进展生存期（PFS），并确定预后因素。 患者和方法：对 1979 年 11 月至 1995 年 10 月期间向欧洲血液和骨髓移植小组报告的 175 名患者进行回顾性分析。其中男性75例，女性75例，中位年龄26.5岁。对一线治疗的反应被定义为 88 例疾病进展 (PD) 和 87 例稳定/最低反应疾病 (SD/MR)。 75 名患者在一次诱导方案失败后接受了 ASCT。其余100名患者接受二线治疗。二线治疗的反应为 PD（34 例）和 SD/MR（66 例）。确定 OS 和 PFS 率，并使用单变量和多变量分析研究预后因素。结果：对高剂量治疗和 ASCT 的反应为完全反应（30%）、部分反应（28%）、无反应（14%）、PD（14%）和中毒性死亡（14%）。精算 5 年 OS 和 PFS 率分别为 36% 和 32%。在 PFS 和 OS 的单变量分析中，不利因素是使用二线化疗方案以及诊断与 ASCT 之间的间隔超过 18 个月。在多变量分析中，诊断和 ASCT 之间的时间间隔对 OS 具有预后意义。 ASCT前化疗方案的反应没有预测价值。结论：高剂量治疗和ASCT是诱导化疗失败的霍奇金病患者的有效治疗策略。对于那些对高剂量治疗前立即给予的方案有明显 PD 或 SD/MR 反应的患者，结果相同。需要进行前瞻性随机研究来比较这种方法与常规剂量挽救疗法。 (C) 1999 年，美国临床肿瘤学会。
Purpose: To investigate the results of high-dose therapy and autologous stem-cell transplantation (ASCT) in adults with Hodgkin's disease who do not enter remission after induction therapy, to determine overall survival (OS) and progression free survival (PFS), and to identify prognostic factors.Patients and Methods: A retrospective analysis of 175 patients reported to the European Group for Blood and Marrow Transplantation between November 1979 and October 1995. One hundred were male and 75 were female, with a median age of 26.5 years. Responses to first-line therapy were defined as progressive disease (PD) in 88 and stable/minimally responsive disease (SD/MR) in 87. Seventy-five patients received ASCT after failure of one induction regimen. Second-line therapy was given to the remaining 100 patients. Response to second-line therapy was PD in 34 and SD/MR in 66. OS and PFS rates were determined, and prognostic factors were investigated using univariate and multivariate analyses.Results: Responses to high-dose therapy and ASCT were complete response (30%), partial response (28%), no response (14%), PD (14%), and toxic death (14%). Actuarial 5-year OS and PFS rates were 36% and 32%, respectively. In univariate analysis for PFS and OS, adverse factors were use of a second-line chemotherapy regimen and interval of more than 18 months between diagnosis and ASCT. In multivariate analysis, the interval between diagnosis and ASCT maintained prognostic significance for OS. Response to the chemotherapy regimen given immediately before ASCT had no predictive value.Conclusion: High-dose therapy and ASCT is an effective treatment strategy for patients with Hodgkin's disease for whom induction chemotherapy fails. Outcome was equivalent for those with obvious PD or SD/MR in response to the regimen given immediately before high-dose therapy. prospective randomized studies are required ta compare this approach with conventional-dose salvage therapy. (C) 1999 by American Society of Clinical Oncology.