Brandt L, Kimby E, Nygren P, Glimelius B
Department of Oncology, University Hospital, Lund, Sweden.
Acta Oncol. 2001;40(2-3):213-23. doi: 10.1080/02841860151116286.
A systematic review of chemotherapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation the scientific literature are described separately (Acta Oncol 2001; 40: 155-65). This synthesis of the literature on chemotherapy for indolent non-Hodgkin's lymphoma (NHL), predominantly follicular lymphoma, is based on 108 scientific reports including 31 randomised studies, 38 prospective studies and 18 retrospective studies. These studies involve 8,699 patients. The conclusions reached can be summarized into the following points: In initially localized disease-- The addition of chemotherapy to radiotherapy as primary treatment has not convincingly prolonged remission duration or survival. In initially advanced disease-- Alkylating agents are useful palliative treatment options which can result in improved well-being for most patients, often for long periods. Combinations of chemotherapy have not convincingly resulted in more or longer remissions. There is no proof that initial combination chemotherapy will prolong survival in comparison with single drugs. The addition of interferon to initial combination chemotherapy may increase the response rate, significantly prolong remission duration, but prolonged survival has not been unequivocally proven. In the absence of disease-related symptoms, treatment can safely be deferred. For patients with relapsed lymphoma-- Patients may repeatedly respond to alkylating agents or combinations containing an alkylating agent, although the proportion responding decreases with each relapse. Patients relapsing after or who are refractory to treatment with alkylating agents often respond to treatment with combinations containing an anthracycline. Responses are also often seen in patients treated with purine analogues alone or in combination with other drugs. High dose chemotherapy followed by autologous or allogeneic reestablishment of bone marrow function can induce long-term remissions but it is not proven whether they are more frequent or of longer duration than with conventionally dosed therapy. The impact of the novel treatment strategies including high-dose therapy on overall survival is still uncertain. A monoclonal antibody, rituximab, is a new active substance for patients with relapsed lymphoma. It can induce remissions also in chemoresistant patients.
瑞典卫生保健技术评估委员会（SBU）对多种肿瘤类型的化疗试验进行了系统评价。评估科学文献的程序已另行描述（《肿瘤学学报》2001年；40: 155 - 165）。本关于惰性非霍奇金淋巴瘤（NHL），主要是滤泡性淋巴瘤化疗文献的综述基于108篇科学报告，包括31项随机研究、38项前瞻性研究和18项回顾性研究。这些研究涉及8699名患者。得出的结论可总结如下：在初始局限性疾病中——作为主要治疗方法，在放疗基础上加用化疗并未令人信服地延长缓解期或生存期。在初始晚期疾病中——烷化剂是有用的姑息治疗选择，可使大多数患者的健康状况得到改善，且通常能维持较长时间。联合化疗并未令人信服地带来更多或更长时间的缓解。没有证据表明初始联合化疗与单药治疗相比能延长生存期。在初始联合化疗中加用干扰素可能会提高缓解率，显著延长缓解期，但延长生存期尚未得到明确证实。在没有疾病相关症状的情况下，可以安全地推迟治疗。对于复发淋巴瘤患者——患者可能会多次对烷化剂或含烷化剂的联合方案产生反应，尽管每次复发时反应的比例会降低。在烷化剂治疗后复发或难治的患者通常对含蒽环类药物的联合治疗有反应。单独使用嘌呤类似物或与其他药物联合使用时，患者也常常出现反应。高剂量化疗后进行自体或异基因骨髓功能重建可诱导长期缓解，但与传统剂量治疗相比，是否更频繁或缓解期更长尚未得到证实。包括高剂量治疗在内的新治疗策略对总生存期的影响仍不确定。单克隆抗体利妥昔单抗是复发淋巴瘤患者的一种新的活性物质。它也能在化疗耐药患者中诱导缓解。
