High-dose therapy with autologous stem cell transplantation (ASCT) has been widely proposed for patients with relapsed Hodgkin's disease (HD). From 1982 to 1993, we selected (from the French registry for bone marrow transplantation) 280 patients, who underwent ASCT for relapsed HD after initial treatment including chemotherapy. Patient characteristics at diagnosis were: sex ratio (M/F): 1.5; median age: 30 years (5-59 years), stage I, II: 43%; III, IV: 57%; 32% had chemotherapy, 68% chemo+ radiotherapy. All patients achieved complete remission after first-line therapy and subsequently relapsed. The median interval between diagnosis and high-dose therapy was 34 months. First relapse occurred in 78% of the patients at a median end-of-treatment to relapse time of 18 months. All patients received salvage chemotherapy before high-dose therapy, and the median time between relapse and high-dose therapy was 5 months. After this regimen, 84% of the patients were considered to have chemosensitive relapse. Conditioning regimens were: BEAM: 60%; CBV/BEAC: 26%. Transplant-related mortality was 6%. With a median follow-up of 3 years after high-dose therapy, overall and progression-free survivals at 4 years were 66 and 60%, respectively. Neither the conditioning regimen nor the stem cell source affected survival. Good prognostic factors for survival were: chemosensitivity of relapse (P < 0.01) and first relapse vs further relapse (P < 0.05). For 214 patients in first relapse, other significant factors for survival were: end-of-treatment to relapse interval < 12 months (P < 0.05) and nodal vs extranodal relapse (P < 0.001). These two prognostic factors were used to validate a prognostic model with three significantly different subgroups: 0 (n = 59), 1 (n = 125), or 2 factors (n = 30) with 4-year survival, respectively, at 93, 59 and 43% (P < 0.001). Salvage therapy can be tailored in patients with relapsing HD: conventional treatment in the good prognosis group (0 factor), high-dose therapy after response to second line regimen (1 factor) and more intensive treatments for the bad prognosis group (2 factors).
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【Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin's disease: analysis of 280 patients from the French registry. Société Française de Greffe de Moëlle.].
【复发性霍奇金病患者大剂量治疗和自体干细胞移植后生存的预后因素：来自法国登记处的280例患者的分析。法国兴业银行（法国）。】
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DOI：10.1038/sj.bmt.1700838文章类型：杂志文章
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：自体干细胞移植（ASCT）的高剂量治疗已被广泛推荐用于复发性霍奇金病（HD）的患者。从1982年至1993年，我们从法国骨髓移植登记机构中选择了280例接受了包括化疗在内的初始治疗后HD复发的ASCT患者。诊断时的患者特征为：性别比（M / F）：1.5；中位年龄：30岁（5-59岁），第一，第二阶段：43％；三，四：57％； 32％接受过化学疗法，68％进行了化学放疗。所有患者在一线治疗后均完全缓解，随后复发。诊断与大剂量治疗之间的中位间隔为34个月。首次复发发生在78％的患者中位，治疗中位至18个月的复发时间。所有患者在大剂量治疗之前均接受了挽救性化疗，复发和大剂量治疗之间的中位时间为5个月。在此方案之后，84％的患者被认为具有化学敏感性复发。调理方案为：BEAM：60％； CBV / BEAC：26％。移植相关死亡率为6％。高剂量治疗后的3年中位随访结果显示，4年总生存率和无进展生存率分别为66％和60％。调理方案和干细胞来源均不影响生存。生存的良好预后因素是：复发的化学敏感性（P <0.01）和首次复发vs进一步复发（P <0.05）。对于214例首次复发的患者，生存的其他重要因素是：治疗结束至复发间隔<12个月（P <0.05）和淋巴结相对于结外复发（P <0.001）。这两个预后因素用于验证具有三个显着不同的亚组的预后模型：分别为93岁，0（n = 59），1（n = 125）或2个因素（n = 30）的4年生存率， 59％和43％（P <0.001）。可以为复发性HD患者量身定制挽救疗法：预后良好的常规治疗（0因子），对二线方案有反应后的大剂量治疗（1因子）和对预后不良的患者进行更深入的治疗（2因子） 。
