Cairoli R, Grillo G, Tedeschi A, Gargantini L, Marenco P, Tresoldi E, Barbarano L, Nosari A M, Morra E
Department of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore, 20162 Milan, Italy.
Bone Marrow Transplant. 2002 Mar;29(6):473-7. doi: 10.1038/sj.bmt.1703401.
The aim of our study was to evaluate the impact of an early intensification programme including chemotherapy (CHT), autologous stem cell transplantation (ASCT) and radiation therapy (RT) in patients with primary mediastinal large B cell lymphoma (MLCL) with sclerosis presenting with adverse prognostic factors. Between 1993 and 1999, 19 patients with MLCL were referred to our institution. Four patients were classified as low risk according to the age-adjusted International Prognostic Index (AA-IPI). Fifteen (79%) were categorised in the high-intermediate or high risk group and were considered eligible for ASCT. Induction therapy consisted of VACOP-B (etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and bleomycin) for 12 weeks. After induction therapy the four low risk patients achieved a complete remission (CR) and did not undergo ASCT. Of the 15 poor risk patients, five achieved CR, seven partial remission (PR), and three showed refractory disease (RD). All these patients received mobilising therapy consisting of high-dose cyclophosphamide. After peripheral stem cell (PSC) collection, to obtain a greater tumor mass reduction before transplantation, the seven patients in PR underwent further treatment with high-dose etoposide and those with RD received two cycles of DHAP (dexamethasone, cytarabine and cisplatin). At the time of ASCT, seven patients were in CR, six in PR and two had RD. After transplantation using BEAM as preparative regimen, all patients but one achieved a CR. Seven patients with minimal (<25%) residual mass at computed tomography scan received further mediastinal RT even if they had a negative Ga(67) scan. At a median follow-up of 35 months from transplantation the disease free survival is 93%. The outcome following this programme of early intensification in poor prognosis MLCL results in a high incidence of durable remissions even in patients with refractory disease.
我们研究的目的是评估早期强化方案对伴有硬化且存在不良预后因素的原发性纵隔大B细胞淋巴瘤（MLCL）患者的影响，该方案包括化疗（CHT）、自体干细胞移植（ASCT）和放射治疗（RT）。1993年至1999年间，19例MLCL患者被转诊至我院。根据年龄校正的国际预后指数（AA-IPI），4例患者被归类为低风险。15例（79%）被归类为高中风险或高风险组，被认为适合进行ASCT。诱导治疗采用VACOP-B方案（依托泊苷、阿霉素、环磷酰胺、长春新碱、泼尼松和博来霉素），为期12周。诱导治疗后，4例低风险患者实现完全缓解（CR），未接受ASCT。15例高风险患者中，5例实现CR，7例部分缓解（PR），3例显示难治性疾病（RD）。所有这些患者均接受了大剂量环磷酰胺的动员治疗。在外周血干细胞（PSC）采集后，为了在移植前更大程度地减少肿瘤体积，7例PR患者接受了大剂量依托泊苷的进一步治疗，RD患者接受了两个周期的DHAP（地塞米松、阿糖胞苷和顺铂）治疗。在进行ASCT时，7例患者处于CR，6例处于PR，2例患有RD。采用BEAM作为预处理方案进行移植后，除1例患者外，所有患者均实现CR。7例计算机断层扫描显示残留肿块最小（<25%）的患者，即使镓（67）扫描为阴性，也接受了进一步的纵隔RT。移植后中位随访35个月，无病生存率为93%。该早期强化方案应用于预后不良的MLCL患者，即使是难治性疾病患者，也能产生高比例的持久缓解。
