Stötzer O J, Schleuning M, Ledderose G, Hiddemann W, Kolb H J
Medizinische Klinik III der Ludwig-Maximilians-Universität München, Grosshadern.
Dtsch Med Wochenschr. 2001 Sep 28;126(39):1062-9. doi: 10.1055/s-2001-17492.
Allogeneic transplantation of bone marrow and peripheral blood stem cells is a frequently discussed therapeutic option in the treatment of malignant lymphoma. By analysing the results of our own transplant program in patients with advanced lymphoma we tried to evaluate indications for allogeneic transplantations.
Data from lymphoma patients treated at the Klinikum Grosshadern between 1985 and 2001 were analysed retrospectively.
56 patients were included. 24 patients had low grade Non-Hogdkin's lymphoma (NHL) (follicular lymphoma: n = 8, mantle cell lymphoma: n = 6) or chronic lymphocytic leukemia (CLL: n = 10), 16 patients had high grade NHL (immunoblastic/lymphoblastic: n = 5; large cell/diffuse: n = 5) and 8 patients suffered from Hodgkins's disease. Median age was 41 years, 34 patients were transplanted from an HLA-identical sibling, 19 from an HLA-id. unrelated donor and three from an HLA-mismatched related donor. 30 patients received bone marrow and 26 peripheral blood stem cells. 22 pat. were treated with an intensive 12 Gy TBI containing conditioning regimen, whereas 34 patients were treated with a dose-intensity reduced conditioning procedere. 25 patients are alive between 2 month and 15 years after transplantation. Overall survival after 2 years is 48 % for patients with low grade NHL (incl. CLL), 9.3 % for patients with high grade lymphoma and 25 % for patients with Hodgkin's disease. 1-year-transplant-related mortality (TRM) was 33.9 % in all patients. Dose-intensity-reduced conditioning was not able to reduce TRM.
Allogeneic bone marrow or stem cell transplantation is able to induce long lasting complete remissions in patients with heavily pretreated malignant lymphoma. Results of allogeneic transplantation are encouraging in patients with follicular and other low grade lymphoma. However transplant-related toxicity is high. At present the impact of reducing the intensity of conditioning is not yet clear.
骨髓和外周血干细胞的同种异体移植是恶性淋巴瘤治疗中经常讨论的一种治疗选择。通过分析我们自己针对晚期淋巴瘤患者的移植项目结果，我们试图评估同种异体移植的适应证。
对1985年至2001年在格罗斯哈登临床医院接受治疗的淋巴瘤患者的数据进行回顾性分析。
纳入56例患者。24例患者患有低度非霍奇金淋巴瘤（NHL）（滤泡性淋巴瘤：n = 8，套细胞淋巴瘤：n = 6）或慢性淋巴细胞白血病（CLL：n = 10），16例患者患有高度NHL（免疫母细胞性/淋巴母细胞性：n = 5；大细胞性/弥漫性：n = 5），8例患者患有霍奇金病。中位年龄为41岁，34例患者接受了来自HLA匹配同胞的移植，19例来自HLA匹配的无关供体，3例来自HLA不匹配的相关供体。30例患者接受了骨髓移植，26例接受了外周血干细胞移植。22例患者接受了含12 Gy全身照射的强化预处理方案，而34例患者接受了剂量强度降低的预处理程序。25例患者在移植后2个月至15年存活。低度NHL（包括CLL）患者2年后的总生存率为48%，高度淋巴瘤患者为9.3%，霍奇金病患者为25%。所有患者的1年移植相关死亡率（TRM）为33.9%。剂量强度降低的预处理未能降低TRM。
同种异体骨髓或干细胞移植能够在经过大量预处理的恶性淋巴瘤患者中诱导长期完全缓解。同种异体移植对滤泡性和其他低度淋巴瘤患者的结果令人鼓舞。然而，移植相关毒性很高。目前，降低预处理强度的影响尚不清楚。
