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. Lymphoma Working Party.
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. Lymphoma Working Party.
复制标题
对诱导化疗后未进入缓解期的霍奇金病成年患者进行高剂量治疗和自体干细胞移植：向欧洲血液和骨髓移植小组报告的 175 名患者的结果。
DOI：
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发表时间：
1999
影响因子：
45.3
通讯作者：
A. Goldstone
中科院分区：
文献类型：
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作者：
J. Sweetenham;A. Carella;G. Taghipour;D. Cunningham;R. Marcus;A. Della Volpe;D. Linch;N. Schmitz;A. Goldstone
目的
研究大剂量治疗和自体干细胞移植（ASCT）在诱导治疗后未进入缓解期的霍奇金病成人患者中的结果，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组报告的175例患者进行回顾性分析。其中男性100人，女性75人，中位年龄为26.5岁。对一线治疗的反应被定义为88例疾病进展（PD）和87例疾病稳定/最小反应（SD/MR）。75例患者在一种诱导方案失败后接受ASCT。其余100名患者接受二线治疗。二线治疗的反应为34例PD，66例SD/MR。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
对大剂量治疗和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，不良因素是使用二线化疗方案和诊断与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前立即给予化疗方案的反应没有预测价值。
结论
大剂量治疗和ASCT是诱导化疗失败的霍奇金病患者的有效治疗策略。对于在高剂量治疗前立即给予的方案中出现明显PD或SD/MR的患者，结局等同。需要前瞻性随机研究来比较这种方法与常规剂量挽救治疗。
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 to compare this approach with conventional-dose salvage therapy.