Naparstek Elizabeth
Department of Hematology and BMT, Tel Aviv Sourasky Medical Center, 6 Weizmann Str., Tel-Aviv, 64239, Israel.
Curr Hematol Rep. 2005 Jul;4(4):276-83.
Autologous hematopoietic stem cell transplantation is widely accepted as effective therapy for patients with relapsed aggressive B-cell non-Hodgkin's lymphoma, and to a lesser extent, for indolent and mantle cell lymphoma, resulting in prolonged disease-free survival. Despite these advances, disease recurrence remains a problem and a major clinical challenge. Allogeneic transplantation has also been increasingly utilized in patients with relapsed aggressive and indolent lymphoma but is associated with high toxicity and graft-versus-host disease. Recently, nonmyeloablative preparatory regimens have shown encouraging results, attributed to graft-versus-lymphoma effects. Rituximab, a monoclonal antibody targeted against the CD20 antigen, is a potent therapeutic tool with documented efficacy in B-cell lymphomas. It is effective when used alone or in combination with chemotherapy, resulting in a significantly improved response rate compared with chemotherapy alone, in both aggressive and indolent lymphomas. Increasing evidence suggests that rituximab is also effective at in vivo purging prior to transplantation and may prevent relapse by eradication of residual disease when administered after transplantation. This review summarizes the available data on the use of rituximab and discusses the current evidence for its role in conjunction with auto- and allotransplantation.
自体造血干细胞移植被广泛认为是复发侵袭性B细胞非霍奇金淋巴瘤患者的有效治疗方法，在惰性淋巴瘤和套细胞淋巴瘤患者中的应用程度较低，可延长无病生存期。尽管取得了这些进展，但疾病复发仍然是一个问题，也是一项重大的临床挑战。异基因移植也越来越多地用于复发侵袭性和惰性淋巴瘤患者，但与高毒性和移植物抗宿主病相关。最近，非清髓性预处理方案已显示出令人鼓舞的结果，这归因于移植物抗淋巴瘤效应。利妥昔单抗是一种针对CD20抗原的单克隆抗体，是一种有效的治疗工具，在B细胞淋巴瘤中具有已证实的疗效。单独使用或与化疗联合使用时均有效，与单纯化疗相比，在侵袭性和惰性淋巴瘤中均能显著提高缓解率。越来越多的证据表明，利妥昔单抗在移植前的体内净化中也有效，并且在移植后给药时，可能通过根除残留疾病来预防复发。本综述总结了关于利妥昔单抗使用的现有数据，并讨论了其在自体和异基因移植中的作用的当前证据。
