Treatment of primary progressive Hodgkin's and aggressive non-Hodgkin's lymphoma: Is there a chance for cure?
Treatment of primary progressive Hodgkin's and aggressive non-Hodgkin's lymphoma: Is there a chance for cure?
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DOI：
10.1200/jco.2000.18.2.332
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发表时间：
2000-01-01
影响因子：
45.3
通讯作者：
Engert, A
中科院分区：
文献类型：
--
作者：
Josting, A;Reiser, M;Engert, A
目的：探讨原发进展性霍奇金病(HD)与侵袭性非霍奇金淋巴瘤(NHL)预后的差异。方法：采用大剂量化疗联合自体干细胞支持治疗进展性淋巴瘤患者131例(HD组67例，NHL组例)。原发进展性疾病被定义为在一线化疗期间疾病进展或在诱导治疗后仅有一过性反应(完全或部分反应持续小于或等于90天)。年龄在60岁及以下的进展性淋巴瘤患者可接受HDCT联合ASCT。结果：原发进展性HD和NHL患者挽救化疗后的总有效率分别为33%和15%，25例HD患者(37%)接受了HDCT。大多数NHL患者在抢救治疗中病情进展，只有6名患者(10%)接受了HDCT检查。在这些患者中，只有两名患者在HDCT后3个月和12个月存活并持续完全缓解。无一例NHL患者在首次诊断后存活超过26个月。5年后，所有HD患者的精算OS为19%；接受HDCT的HD患者为53%，未接受HDCT的患者为0%。在HD患者中，多因素回归分析确定挽救治疗(P=.0001)和HDCT(P=.031)的化疗敏感性疾病是避免治疗失败的重要预后因素。OS的重要预后因素是化疗敏感性疾病(P=.0005)。HDCT(P=.039)和进展时的8种症状：(P=.046)。结论：进展性HD和侵袭性NHL患者的预后有显著差异。进展性非霍奇金淋巴瘤患者的预后很差。大多数患者在抢救治疗后病情进展迅速，因此被排除在HDCT计划之外。相比之下，进展性HD患者可以在HDCT后获得长期生存。(C)2000年，由美国临床肿瘤学会提供。
Purpose: To determine differences in prognosis between primary progressive Hodgkin's disease (HD) and aggressive non-Hodgkin's lymphoma (NHL), we retrospectively analyzed patients with progressive lymphoma who were treated with different salvage chemotherapy regimens including high-dose chemotherapy (HDCT) followed by autologous stem-cell support (ASCT),Patients and Methods: One hundred thirty-one patients with primary progressive lymphoma (HD, n = 67; NHL, n = 64) were enrolled. Primary progressive disease was defined as disease progression during first-line chemotherapy or only transient response (complete or partial response lasting less than or equal to 90 days) after induction treatment. patients 60 years or younger with progressive lymphoma were eligible to receive HDCT with ASCT.Results: The overall response rate after salvage chemotherapy for patients with primary progressive HD and NHL was 33% and 15%, respectively, Twenty-five HD patients (37%) received HDCT. Most patients with NHL had progressive disease under salvage treatment, with only six patients (10%) receiving HDCT. Of those, only two patients were alive and in continuous complete remission 3 and 12 months after HDCT. No patient with NHL survived longer than 26 months after first diagnosis. Actuarial OS after 5 years was 19% for all HD patients; 53% for HD patients receiving HDCT, and 0% for patients who did not receive HDCT. In HD patients, multivariate regression analysis identified chemosensitive disease on salvage treatment (P = .0001) and HDCT (P = .031) as significant prognostic factors for freedom from treatment failure. Significant prognostic factors for OS are chemosensitive disease (P = .0005). HDCT (P = .039), and 8 symptoms at the time of progress: (P = .046).Conclusion: There are striking differences in the prognosis of patients with progressive HD and aggressive NHL. The prognosis of progressive NHL patients is dismal. Most patients have rapidly progressive disease after salvage treatment and are therefore, excluded from HDCT programs. In contrast, progressive HD patients can achieve long-term survival after HDCT. (C) 2000 by American Society of Clinical Oncology.