Kanaji Nobuhiro, Ishibashi Ken, Uno Hisamitsu, Hino Norihiko
Dept. of Internal Medicine, Kure Kyosai Hospital.
Gan To Kagaku Ryoho. 2002 Dec;29(13):2569-72.
The chimeric anti-CD20 monoclonal antibody rituximab was recently approved for the treatment of malignant B cell lymphoma. We report the case of a 49 year-old female with advanced mantle cell lymphoma (MCL), who successfully underwent auto-peripheral blood stem cell transplant (auto-PBSCT) in combination with in vivo purging of tumor cells using rituximab. Systemic swelling was detected in her lymph nodes, and she was histologically diagnosed with MCL. From bone marrow involvement and 28% of lymphoma cells in her peripheral blood, she was identified as stage IV of MCL. She achieved a partial response (PR) after three cycles of standard chemotherapy (ProMACE-CytaBOM) followed by 1 course of rituximab at 375 mg/m2 per week for four weeks. Prior to treatment with rituximab, IgH/bcl-1 translocation in her peripheral blood was found to be positive in 0.5% of 199 cells. After administration of rituximab, this fell to 0% in her peripheral blood and bone marrow. Stem cells were mobilized with cyclophosphamide at 2,000 mg/m2 for 2 days, followed by granulocyte colony-stimulating factor (G-CSF). On one day prior to harvest, rituximab was infused at 375 mg/m2 for in vivo purging of tumor cells. The IgH/bcl-1 translocation in the peripheral blood stem cell harvest (PBSCH) product was found to be 0%. Subsequently, a pretreatment regimen of CBDCA at 350 mg/m2 x 4, ETP at 500 mg/m2 x 3, MCNU at 200 mg/m2 x 1, and CPA at 2,000 mg/m2 x 2 was adopted to condition the transplant, followed by auto-PBSCT. After the transplant, the patient achieved an uncertain complete response (CRu). The present case suggests in vivo purging with rituximab is effective, and that this method may have a role as a first-line therapy in MCL patients who respond poorly to standard treatment.
嵌合抗CD20单克隆抗体利妥昔单抗最近被批准用于治疗恶性B细胞淋巴瘤。我们报告了一例49岁晚期套细胞淋巴瘤（MCL）女性患者的病例，该患者成功接受了自体外周血干细胞移植（auto-PBSCT），并联合使用利妥昔单抗进行体内肿瘤细胞清除。在她的淋巴结中检测到全身肿胀，经组织学诊断为MCL。根据骨髓受累情况以及外周血中28%的淋巴瘤细胞，她被确定为MCL IV期。在接受三个周期的标准化疗（ProMACE-CytaBOM），随后每周一次、每次375 mg/m²、共四周的1个疗程利妥昔单抗治疗后，她获得了部分缓解（PR）。在使用利妥昔单抗治疗前，在她外周血199个细胞中有0.5%的细胞检测到IgH/bcl-1易位呈阳性。使用利妥昔单抗治疗后，其外周血和骨髓中的这一比例降至0%。使用环磷酰胺2000 mg/m²、连续2天动员干细胞，随后使用粒细胞集落刺激因子（G-CSF）。在采集前一天，输注375 mg/m²的利妥昔单抗进行体内肿瘤细胞清除。在外周血干细胞采集（PBSCH）产物中发现IgH/bcl-1易位为0%。随后，采用了350 mg/m²×4的环磷酰胺、500 mg/m²×3的依托泊苷、200 mg/m²×1的卡莫司汀以及2000 mg/m²×2的环磷酰胺的预处理方案进行移植准备，随后进行auto-PBSCT。移植后，患者获得了不确定的完全缓解（CRu）。本病例表明，利妥昔单抗进行体内清除是有效的，并且该方法可能在对标准治疗反应不佳的MCL患者中作为一线治疗发挥作用。
