Sharp J G, Joshi S S, Armitage J O, Bierman P, Coccia P F, Harrington D S, Kessinger A, Crouse D A, Mann S L, Weisenburger D D
Department of Anatomy, University of Nebraska Medical Center, Omaha 68198-6395.
Blood. 1992 Feb 15;79(4):1074-80.
Prolonged disease-free survival of patients with recurrent or resistant non-Hodgkin's lymphoma (NHL) has been achieved with high-dose therapy followed by autologous bone marrow transplantation (ABMT). A concern with the use of ABMT is that the marrow that is reinfused may contain undetected NHL cells with the potential to reestablish metastatic disease in the recipient. Using a culture technique that is sensitive for detecting occult lymphoma cells in BM, we analyzed histologically normal marrow harvests from 59 consecutive patients with intermediate- or high-grade NHL who were candidates for high-dose therapy and ABMT. The culture results indicated that 22 of the patients had occult lymphoma in their marrow. Forty-three patients underwent high-dose therapy followed by ABMT. Twenty-four achieved a complete clinical remission. Those with occult lymphoma in their harvests (11 patients) continued to relapse for up to 3 years, whereas no relapses were observed beyond 8 months in 13 patients receiving marrow that did not contain detectable lymphoma cells using the culture technique. The relapses in the patients who achieved a complete remission occurred at sites of prior bulky disease rather than at new sites, suggesting that the ability to detect occult lymphoma cells in marrow is a marker of biologic aggressiveness and/or resistance to therapy, or that the reinfused cells could only grow in previously involved sites. The detection of lymphoma cells in marrow used for ABMT is an important adverse prognostic factor, and appears to be independent of other clinical predictors of outcome such as sensitivity or resistance of disease to prior chemotherapy.
复发性或难治性非霍奇金淋巴瘤（NHL）患者通过大剂量治疗后进行自体骨髓移植（ABMT）已实现了长期无病生存。使用ABMT的一个担忧是回输的骨髓可能含有未检测到的NHL细胞，这些细胞有可能在受者体内重新建立转移性疾病。我们采用一种对检测骨髓中隐匿性淋巴瘤细胞敏感的培养技术，分析了59例连续的中、高级别NHL患者的组织学正常骨髓采集样本，这些患者均为大剂量治疗和ABMT的候选者。培养结果显示，22例患者的骨髓中有隐匿性淋巴瘤。43例患者接受了大剂量治疗后进行ABMT。24例实现了完全临床缓解。采集样本中有隐匿性淋巴瘤的患者（11例）持续复发长达3年，而使用培养技术未检测到淋巴瘤细胞的13例接受骨髓移植的患者在8个月后未观察到复发。实现完全缓解的患者复发发生在先前有大块病灶的部位而非新部位，这表明检测骨髓中隐匿性淋巴瘤细胞的能力是生物学侵袭性和/或对治疗耐药性的一个标志物，或者回输的细胞只能在先前受累的部位生长。用于ABMT的骨髓中淋巴瘤细胞的检测是一个重要的不良预后因素，并且似乎独立于其他临床预后预测因素，如疾病对先前化疗的敏感性或耐药性。
