HISTOLOGIC CONVERSION IN THE NON-HODGKINS LYMPHOMAS
HISTOLOGIC CONVERSION IN THE NON-HODGKINS LYMPHOMAS
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DOI：
10.1200/jco.1983.1.1.11
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发表时间：
1983-01-01
影响因子：
45.3
通讯作者：
ROSENBERG, SA
中科院分区：
文献类型：
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作者：
ACKER, B;HOPPE, RT;ROSENBERG, SA
1971年7月1日至1978年12月31日，150例非霍奇金S淋巴瘤[结节状低分化淋巴细胞型、结节混合型或弥漫型高分化淋巴细胞型]患者进入前瞻性随机临床试验。治疗方法包括累及野、全淋巴或全身照射、单剂烷化剂化疗、环磷酰胺、长春新碱、强的松(CVP)或环磷酰胺、长春新碱、丙卡巴津、强的松(C-MOPP)联合化疗，或化疗加放疗的不同组合。初始完全缓解率(CR)为79%。在获得完全缓解的患者中，31%后来复发。有78名患者要么未能达到完全缓解，要么达到完全缓解，后来复发。78例患者中有22例(28%)组织学转化(从最初有利的转变为不利的非霍奇金S淋巴瘤亚型)。然而，转换的精算风险实际上要大得多(8年时为60%)。记录转换的中位时间为51mo。最常见的组织学类型是从NLPD转变为弥漫性组织细胞淋巴瘤。有文献记载的组织学转换通常与淋巴瘤更具侵袭性的临床行为有关，转换后的中位生存期为一年。然而，那些在转换后获得CR的患者有更有利的结果(5年精算存活率为75%)。目前尚不能确定预测组织学转化的特定危险因素。
Between July 1, 1971 and Dec. 31, 1978, 150 patients with favorable subtypes of non-Hodgkin''s lymphoma [nodular poorly differentiated lymphocytic (NLPD), nodular mixed, or diffuse well differentiated lymphocytic] were entered into prospective randomized clinical trials. Treatments included involved field, total lymphoid or whole body irradiation, single alkylating agent chemotherapy, combination chemotherapy with cyclophosphamide, vincristine and prednisone (CVP) or with cyclophosphamide, vincristine, procarbazine and prednisone (C-MOPP), or various combinations of chemotherapy and irradiation. The initial complete response rate (CR) was 79%. Among patients who achieved a CR, 31% later relapsed. There were 78 patients who either failed to achieve a CR or achieved a CR and later relapsed. Histologic conversion (change from initially favorable to an unfavorable subtype of non-Hodgkin''s lymphoma) was documented in 22 of 78 patients (28%). However, the actuarial risk for conversion was actually much greater (60% at 8 yr). The median time to documentation of conversion was 51 mo. The most common type of histologic conversion was from NLPD to diffuse histiocytic lymphoma. Documented histologic conversion was often associated with a more aggressive clinical behavior of the lymphoma, and the median survival after conversion was < 1 yr. However, those patients who achieved a CR after conversion had a more favorable outcome (actuarial survival 75% at 5 yr). No specific risk factors predictive of histologic conversion could be identified.