Cabanillas Fernando, Horning Sandra, Kaminski Mark, Champlin Richard
Hematology Am Soc Hematol Educ Program. 2000:166-179. doi: 10.1182/asheducation-2000.1.166.
The front-line management of stage IV indolent non-Hodgkin's lymphoma has ranged from the watch-and-wait approach to intensive experimental regimens such as high-dose chemotherapy and bone marrow transplant. With this broad spectrum of regimens to choose from the decision has become a challenging exercise for both patients and oncologists. With the recent introduction of new agents such as rituximab, fludarabine, and combinations based on these, the management of relapsed cases can be similarly confusing. More aggressive approaches such as high-dose chemotherapy with autologous bone marrow transplant and more recently allogeneic bone marrow transplant have also been used. Recently the technique of "mini-allo transplants" has been introduced. It utilizes a less myelosuppressive conditioning chemotherapy regimen based on fludarabine which is immunosuppressive enough to allow engraftment of the donor marrow. Since it is less myelotoxic it is better tolerated, and this has allowed us to significantly extend the age cut-off for allogeneic transplants. All these advances provide us with a more extensive armamentarium, but at the same time they confront physicians with new challenges in choosing from a large and continuously growing therapeutic menu. In this review of the alternative therapies a panel of three expert hemato-oncologists each discuss their approach to the management of a 49-year-old patient with a relapsed indolent follicular lymphoma. Dr. Horning discusses the traditional alternatives available for this patient such as standard chemotherapy combinations or the watch-and-wait approach in Section I. In Section II, Dr. Kaminski reviews the different therapeutic monoclonal antibody options such as rituximab, Bexxar (Iodine-labeled anti-CD20) and Ytrium-labeled anti-CD20 antibody. Allogeneic transplants are increasingly more popular for the treatment of indolent lymphomas because they can provide an immune-mediated graft-versus-lymphoma effect. In Section III, Dr. Richard Champlin reviews various transplant options including autologous, allogeneic and mini-allogeneic transplants.
IV期惰性非霍奇金淋巴瘤的一线治疗方案多种多样，从观察等待策略到强化实验性方案，如大剂量化疗和骨髓移植。面对如此广泛的治疗方案可供选择，这一决策对于患者和肿瘤学家而言都成为了一项具有挑战性的工作。随着利妥昔单抗、氟达拉滨等新药物以及基于这些药物的联合方案的近期引入，复发病例的治疗同样令人困惑。诸如自体骨髓移植的大剂量化疗以及最近的异基因骨髓移植等更积极的治疗方法也已被采用。最近还引入了“微型异基因移植”技术。它采用基于氟达拉滨的骨髓抑制作用较小的预处理化疗方案，该方案具有足够的免疫抑制作用以允许供体骨髓植入。由于其骨髓毒性较小，耐受性更好，这使得我们能够显著提高异基因移植的年龄上限。所有这些进展为我们提供了更为广泛的治疗手段，但与此同时，它们也使医生在从庞大且不断增加的治疗选项中进行选择时面临新的挑战。在这篇关于替代疗法的综述中，三位血液肿瘤学专家组成的小组各自讨论了他们对一名49岁复发性惰性滤泡性淋巴瘤患者的治疗方法。霍宁博士在第一部分讨论了该患者可采用的传统替代疗法，如标准化疗联合方案或观察等待策略。在第二部分，卡明斯基博士回顾了不同的治疗性单克隆抗体选项，如利妥昔单抗、Bexxar（碘标记抗CD20）和钇标记抗CD20抗体。异基因移植在惰性淋巴瘤的治疗中越来越受欢迎，因为它们可以提供免疫介导的移植物抗淋巴瘤效应。在第三部分，理查德·钱普林博士回顾了各种移植选项，包括自体、异基因和微型异基因移植。
