Buske Christian, Dreyling Martin, Unterhalt Michael, Hiddemann Wolfgang
Department of Internal Medicine III, University of Munich, Grobhadern, Germany.
Curr Opin Hematol. 2005 Jul;12(4):266-72. doi: 10.1097/01.moh.0000166499.72138.57.
This review summarizes the current status and new developments in autologous and allogeneic transplantation strategies for patients with follicular lymphoma including novel concepts of myeloablative radioimmunotherapy, allogeneic transplantation with dose-reduced conditioning, and in-vivo purging strategies using B-cell-specific antibodies.
Substantial progress has been made in the clinical management of follicular lymphoma. Besides immunochemotherapeutic approaches combining the B-cell antibody rituximab with conventional chemotherapy regimens, myeloablative chemotherapy or radiochemotherapy supported by autologous peripheral blood stem cell transplantation has been shown to be a highly effective treatment for advanced-stage disease. Dose-reduced conditioning regimens followed by allogeneic transplantation have substantially reduced treatment-related mortality of this approach and ongoing studies are evaluating whether the therapeutic benefit outweighs morbidity and mortality of this potentially curative treatment. Emerging concepts include the use of rituximab for in-vivo purging before reinfusion of autologous stem cells or the application of myeloablative radioimmunotherapy as part of myeloablative consolidation.
The data on myeloablative therapy followed by autologous stem cell transplantation or allogeneic transplantation are encouraging. Allogeneic transplantation with dose-reduced conditioning should be further evaluated within clinical trials, however, in particular for patients with relapsed or refractory lymphoma. Future prospective randomized clinical trials should reevaluate the role of autologous stem cell transplantation in the era of antibody-based therapy and define the role of radioimmunotherapy and of reduced-intensity allogeneic transplantation.
本综述总结了滤泡性淋巴瘤患者自体和异基因移植策略的现状及新进展，包括清髓性放射免疫疗法的新概念、采用降低剂量预处理的异基因移植以及使用B细胞特异性抗体的体内净化策略。
滤泡性淋巴瘤的临床管理已取得重大进展。除了将B细胞抗体利妥昔单抗与传统化疗方案相结合的免疫化疗方法外，自体外周血干细胞移植支持的清髓性化疗或放化疗已被证明是晚期疾病的一种高效治疗方法。采用降低剂量预处理方案后进行异基因移植已大幅降低了该方法的治疗相关死亡率，正在进行的研究正在评估这种潜在治愈性治疗的疗效是否超过其发病率和死亡率。新出现的概念包括在回输自体干细胞前使用利妥昔单抗进行体内净化，或将清髓性放射免疫疗法作为清髓巩固治疗的一部分应用。
清髓性治疗后进行自体干细胞移植或异基因移植的数据令人鼓舞。然而，采用降低剂量预处理的异基因移植应在临床试验中进一步评估，特别是对于复发或难治性淋巴瘤患者。未来的前瞻性随机临床试验应重新评估自体干细胞移植在基于抗体治疗时代的作用，并确定放射免疫疗法和降低强度异基因移植的作用。
