일반적 요법으로 치료한 호즈킨병의 경과
Conventional Treatments in Patients with Hodgkin's Disease
대한암학회지 1999년 31권 4호 p.821 ~ 829
소속 상세정보
박종범
서철원/김상희/이경노/송헌호/박순서/김효정/민영주/박진희
KMID : 0360319990310040821
Abstract
서론
호즈킨병은 방사선요법과 복합화학요법으로 완치가 가능한 질환으로, 1964년 DeVita등에
의해 MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) 복합화학요법이
도입된 이래, 80% 이상의 완전관해를 보이는 질환이다. MOPP복합화학요법 이후로 약물에
의한 부작용을 줄이면서, 효과를 높이기 위해 MVPP (mechlorethamine, vinblastine,
procarbazine, and prednisone), ChlVPP (chlorambucil, vinblastine, procarbazine, and
prednisone), 그리고 LOPP (chlorambucil, vincristine, procarbazine, and prednisone)요법 등
이 도입되었으나 MOPP요법에 비해 더 나은 치료성적을 입증하지는 못하였다. 그러나
Bonadonna등에 의해 ABVD (doxorubicin, bloomycia, vinblastine, and dacarbazine) 복합화
학요법이 도입되었고, alternating MOPP/ABVD, LOPP/EYAP (etoposide, vinblastine,
doxorubicin, and prednisone), 또는 MOPP/ABV hybrid형이 도입되어 MOPP 요법보다 더
나은 치료 성적을 보고하였다. 또한 항암요법에 일차적으로 무반응이거나 재발한 환자들의
경우에는 일반적인 구제요법으로도 결과가 좋지 않아 장기 무병생존율이 5∼20% 정도로 보
고되고 있어, 최근에는 이러한 환자들을 대상으로 고용량 화학요법과 자가 조혈 모세포이식
술(autolognus stem cell transplantation)이 시행되어 더 나은 결과들이 보고되고 있고 점차
사용이 증가되고 있다.
호즈킨병은 우리나라의 경우 서구에 비하여 발생 빈도가 낮으며, 임상 경과나 치료 성적
의 보고가 드물다. 이에 저자들은 서울중앙병원에서 경험한 호즈킨병에 관한 치료성적을 분
석하고, 여러 예후인자들이 치료 결과에 미치는 영향을 파악함으로써, 예후가 불량할 것으로
생각되어 조기에 고용량 화학요법과 자가 조혈 모세포이식술이 필요한 환자들을 알아보고자
본 연구를 수행하였다.
Purpose : We conducted this study to determine the efficacy of conventional
treatments for patients with Hodgkin's disease and identify the patients who have poor
prognosis and need high-dose chemotherapy and tautologous stem cell transplantation.
Materials and Methods : Between Jun. 1989 and Dec. 1997, 50 patients were enrolled
and 39 patients were evaluable. Patients were treated with radiotherapy (5 patients) or
combination chemotherapy (21 patients) or combined chemotherapy and radiotherapy (13
patients) according to their disease stage. Chemotherapy regimens were C-MOPP
(cyclophosphamide, vincristine, procarbazine, and prednisone), MOPP (mechlorethamine,
vincristine, procarbazine, and prednisone), ABVD (doxorubicin, bleomycin, vinblastine,
and dacarbazine), alternating C-MOPP/ABVD, and MOPP/ABV hybrid. Radiation therapy
was performed when there was residual tumor after chemotherapy or bulky disease. The
response to treatments was analyzed by clinical stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ patients
group, respectively.
Results : The complete response rate was 76.9% for total patients, 83.3% for stage Ⅰ
-Ⅱ patients, and 71.4% for stage Ⅲ-Ⅳ patients. Of the 30 patients achieving complete
response, four (13.3%) relapsed at 6, 12, 22, and 28 months after complete response,
respectively. The median follow-up duration was 24 months. Nine patients died. Four
patients died of Hodgkin's disease. Three-year overall survival rate was 72.9% for total
patients, 72.5% for stage Ⅰ-Ⅱ patients, and 70% for stage Ⅲ-Ⅳ patients. Two-year
disease-free survival rate was 77.6% for total patients, 79% for stage Ⅰ-Ⅱ stage
patients, and 73.9% for stage Ⅲ-Ⅳ patients. The prognostic factor analysis showed that
performance status affected the disease-free survival rate.
Conclusion : Conventional treatments in patients with Hodgkin's disease showed
results comparable to previous studies. But we were unable to identify the patients, who
need high-dose chemotherapy and autologous stem cell transplantation, because of small
number of study patients and short follow up duration.
Conventional treatments; Hodgkin's disease; High-dose chemotherapy; Autologous stem cell transplantation;
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