LONG-TERM GONADAL TOXICITY AFTER THERAPY FOR HODGKINS AND NON-HODGKINS-LYMPHOMA
LONG-TERM GONADAL TOXICITY AFTER THERAPY FOR HODGKINS AND NON-HODGKINS-LYMPHOMA
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DOI：
10.1007/bf01727413
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发表时间：
1994-03-01
影响因子：
3.5
通讯作者：
POLIWODA, H
中科院分区：
文献类型：
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作者：
BOKEMEYER, C;SCHMOLL, HJ;POLIWODA, H
随着霍奇金淋巴瘤和非霍奇金淋巴瘤患者治愈率的提高，对性腺功能的远期效应的评估仍然是一个重要的问题。为研究高级别非霍奇金淋巴瘤(NHL)和霍奇金病(HD)长期无复发生存者的性腺功能，将汉诺威大学医学院1980~1990年收治的119例NHL患者中的24例和1975~1990年间收治的364例HD患者中的66例纳入分析，这些患者年龄在45岁以下，且在评估治疗结束后至少24个月后完全缓解。在24例NHL患者中，1/10的女性(10%)和3/14的男性(21%)有性腺功能障碍的迹象。在这4名患者中，有3名患者在维持COP化疗后接受了综合治疗，导致环磷酰胺累积剂量高(范围12-43g)。相比之下，I-ID女性中有13/26(50%)出现卵巢早衰，而男性中有26/40(65%)出现性腺功能障碍的迹象，并伴有明显的FSH升高。在接受联合治疗的患者中，性腺毒性的发生率没有显著差异(70%对62%)，这些患者接受了横隔上或下放射野的放射治疗并结合化疗。对NHL或HD患者使用的化疗方案的比较显示，两组患者都接受了类似的环磷酰胺、长春新碱和阿霉素的中位累积剂量，但只有HD患者额外接受了每名患者13.3克的普鲁卡巴肼。在HD患者中，随着丙卡巴肼累积剂量的增加，性腺毒性的发生率更高。接受非霍奇金淋巴瘤治疗的患者性腺功能障碍的发生率明显低于接受霍奇金病治疗的患者，霍奇金病患者中约有一半将受到长期性腺毒性的影响。虽然与非霍奇金淋巴瘤患者相比，HD患者使用更强的放射治疗使评估放疗对性腺毒性的影响更加困难，但目前的回顾分析提出了这样的担忧，即除了横隔膜下放射治疗外，在HD的治疗方案中使用丙卡巴肼，如COPP或MOPP，可能是HD患者和NHL患者性腺毒性差异的一个可能解释。对于想要保留生育能力的患者，应该避免使用包括丙卡巴肼在内的方案，因为至少有同等疗效的替代化疗方法可用。
With the increasing cure rate of patients treated for Hodgkin's and non-Hodgkin's lymphoma, the evaluation of late effects on gonadal function remains an important issue. The gonadal function of relapse-free long-term survivors with high-grade non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD) were studied; 24 of 119 patients with NHL treated between 1980 and 1990 and 66 of 364 patients with HD treated between 1975 and 1990 at Hannover University Medical School, who were younger than 45 years of age and in complete remission at the time of evaluation for at least 24 months after completion of therapy, were included into the analysis. Of 24 patients with NHL, 1/10 women (10%) and only 3/14 men (21%) showed signs of gonadal dysfunction. Three of these four patients had been treated with combined modality therapy followed by maintenance COP chemotherapy, resulting in high cumulative doses of cyclophosphamide (range: 12-43g). In comparison, 13/26 (50%) women with I-ID suffered from premature ovarian failure, and 26/40 (65%) men showed signs of gonadal dysfunction with significant FSH elevations. No significant difference in the incidence of gonadal toxicity existed in patients treated with combined modality who received irradiation to either supra- or infradiaphragmatic radiation fields in combination with chemotherapy (70% versus 62%). A comparison of the chemotherapy regimens used in patients with NHL or HD shows that patients from both groups had received comparable median cumulative doses of cyclophosphamide, vincristine, and adriamycin, but only patients with HD had additionally received a median cumulative dose of 13.3 g of procarbazine per patient. A tendency towards a higher incidence of gonadal toxicity with higher cumulative doses of procarbazine received was found in patients with HD. The frequency of gonadal dysfunctions is markedly lower in patients treated for non-Hodgkin's lymphoma than in patients treated for Hodgkin's disease, approximately half of whom will be affected by long-term gonadal toxicity. Although the use of more intensive radiotherapy in patients with HD compared with NHL patients makes the evaluation of the influence of radiotherapy on gonadal toxicity more difficult, the current retrospective analysis raises the concern that, in addition to infradiaphragmatic radiotherapy, the use of procarbazine in regimens for the treatment of HD, like COPP or MOPP, may be a possible explanation for the differences in gonadal toxicity observed between patients with HD and those with NHL. Regimens including procarbazine should be avoided in patients wanting to preserve fertility since alternative chemotherapies with at least equal efficacy are available.