Hess G, Flohr T, Huber C, Kolbe K, Derigs H-G, Fischer T
IIIrd Department of Medicine, Johannes Gutenberg-University, Mainz, Germany.
Bone Marrow Transplant. 2003 May;31(9):775-82. doi: 10.1038/sj.bmt.1703925.
Patients with no prior chemotherapy and with advanced and progressive follicular lymphoma (FCL) or mantle cell lymphoma (MCL) were enrolled into a treatment protocol combining CHOP/rituximab-CHOP therapy with subsequent consolidation high-dose therapy (HDT) to evaluate the safety and feasibility of this treatment. Overall, 15 patients were enrolled and 13 patients completed the entire treatment protocol without major toxicities or increased infectious complications. One patient withdrew consent after achieving complete remission (CR) prior to HDT. One patient was taken off study with signs of disease progression after induction treatment. All patients showed stable engraftment after HDT. Response rates appear to be favorable, indicating an additional effect of rituximab and HDT. Overall, 12 of 13 patients achieved CR/CRu and one patient partial remission. Follow-up of immune reconstitution displayed transient severe combined immunodeficiency with slow normalization of the cellular and humoral compartments without a significant increase of infectious complications. Taken together, high-dose chemotherapy can be safely given following treatment with CHOP+rituximab. Efficacy in this small cohort of patients was encouraging with sustained remissions in both FCL and MCL patients. Upfront HDT should be considered as a therapeutic option especially in young and/or high-risk patients.
既往未接受过化疗且患有晚期进展性滤泡性淋巴瘤（FCL）或套细胞淋巴瘤（MCL）的患者被纳入一项治疗方案，该方案将CHOP/利妥昔单抗-CHOP疗法与随后的巩固性高剂量疗法（HDT）相结合，以评估该治疗的安全性和可行性。总体而言，15例患者入组，13例患者完成了整个治疗方案，未出现严重毒性反应或感染并发症增加的情况。1例患者在HDT前达到完全缓解（CR）后撤回同意书。1例患者在诱导治疗后因疾病进展迹象退出研究。所有患者在HDT后均显示植入稳定。缓解率似乎良好，表明利妥昔单抗和HDT有额外的效果。总体而言，13例患者中有12例达到CR/CRu，1例患者部分缓解。免疫重建的随访显示出现短暂的严重联合免疫缺陷，细胞和体液免疫部分缓慢恢复正常，且感染并发症无显著增加。综上所述，在CHOP+利妥昔单抗治疗后可以安全地给予高剂量化疗。在这一小群患者中，疗效令人鼓舞，FCL和MCL患者均持续缓解。对于年轻和/或高危患者，应考虑将 upfront HDT作为一种治疗选择。
