Seyfarth B, Kuse R, Sonnen R, Glass B, Schmitz N, Dreger P
Second Department of Medicine, University of Kiel, Germany.
Ann Hematol. 2001 Jul;80(7):398-405. doi: 10.1007/s002770100321.
Autologous stem cell transplantation (SCT) is widely used as salvage treatment for patients with relapsed follicular lymphoma (FL). Although SCT can induce prolonged remissions, it does not appear to be curative in the vast majority of patients. The purpose of this study was to investigate if incorporation of SCT into first-line therapy can improve its efficacy. Fifty-five patients underwent sequential high-dose therapy as up-front (n=33) or salvage treatment (n=22) for advanced stage FL at our institution. Treatment consisted of intensive chemotherapy with dexamethasone, carmustine (BCNU), etoposide, cytarabine, and melphalan (Dexa-BEAM) for mobilization of peripheral stem cells and reduction of tumor load, followed by one of three different myeloablative regimens and SCT. With a median follow-up of 4 years, projected event-free survival (EFS) and overall survival (OS) at 4 years post transplant was 59% and 84%, respectively, with no evidence of plateau in the survival curves. By univariate and multivariate analysis weighing age, sex, stage, BM and extranodal involvement, timing of transplant, ex vivo purging, and conditioning regimen [total body irradiation (TBI) vs non-TBI], the only significant factor predicting for superior EFS and OS was up-front vs salvage transplant (4-year EFS 76% vs 38%, p=0.02; 4-year OS 92% vs 73%, p=0.033). However, when calculated from diagnosis, EFS and OS of the up-front and salvage groups were virtually identical, implying that the longer survival post SCT in the up-front group was completely compensated by the longer interval between diagnosis and transplant in the salvage group. Median OS from diagnosis was 13.5 years. Except for one case of anaplastic large cell lymphoma, secondary neoplasms have not occurred to date. In conclusion, our data indicate that SCT might improve the prognosis of patients with disseminated FL, although it is probably not curative even if applied early during the course of the disease. The optimum timing of SCT remains to be determined by the ongoing randomized multicenter trial of the German Low-grade Lymphoma Study Group. The impact of radiotherapy on the success of SCT does not seem to be as essential as originally believed.
自体干细胞移植（SCT）被广泛用作复发滤泡性淋巴瘤（FL）患者的挽救治疗。尽管SCT可诱导长期缓解，但在绝大多数患者中似乎并非治愈性的。本研究的目的是调查将SCT纳入一线治疗是否能提高其疗效。55例患者在我们机构接受序贯大剂量治疗，作为晚期FL的一线治疗（n = 33）或挽救治疗（n = 22）。治疗包括使用地塞米松、卡莫司汀（BCNU）、依托泊苷、阿糖胞苷和美法仑（Dexa - BEAM）进行强化化疗，以动员外周干细胞并降低肿瘤负荷，随后采用三种不同的清髓方案之一并进行SCT。中位随访4年，移植后4年的预计无事件生存期（EFS）和总生存期（OS）分别为59%和84%，生存曲线无平台期迹象。通过单因素和多因素分析，权衡年龄、性别、分期、骨髓和结外受累情况、移植时间、体外净化和预处理方案[全身照射（TBI）与非TBI]，预测EFS和OS优越的唯一显著因素是一线移植与挽救移植（4年EFS 76%对38%，p = 0.02；4年OS 92%对73%，p = 0.033）。然而，从诊断开始计算时，一线组和挽救组的EFS和OS几乎相同，这意味着一线组SCT后较长的生存期被挽救组诊断与移植之间较长的间隔完全抵消。从诊断开始计算的中位OS为13.5年。除1例间变性大细胞淋巴瘤外，至今未发生继发性肿瘤。总之，我们的数据表明SCT可能改善播散性FL患者的预后，尽管即使在疾病过程早期应用可能也不是治愈性的。SCT的最佳时机仍有待德国低度淋巴瘤研究组正在进行的随机多中心试验确定。放疗对SCT成功的影响似乎不像最初认为的那样至关重要。
