Hotte Sébastien J, Smith Anne M, Bramwell Vivien H C, Howson-Jan Kang
Department of Medicine McMaster University and Division of Medical Oncology Hamilton Regional Cancer Centre (HRCC) 699 Concession Street Hamilton Ontario L8V 5C2 Canada.
Sarcoma. 2004;8(2-3):63-9. doi: 10.1155/2004/329273.
Few reports have been published on the evaluation of stem cell auto transplantation for chemosensitive sarcomas. Some suggest benefit, others do not. We present results of 24 patients with sarcoma undergoing autotransplantation at a Canadian institution.
Twenty-four patients were treated between 1988 and 1998: 23 were >/=18 years (median 27; range 12-56); genders were equal; 12 patients had Ewing's sarcoma. At diagnosis, 12 (50%) had metastatic disease. Prior to autotransplant, all had >/=1 chemotherapy regimen. Fourteen (58%) were in complete remission (CR) and seven (29%) had minimal residual disease. All received etoposide 60 mg/kg (Day -4), melphalan 140 mg/malpha(2) on (Day -3) and a stem cell reinfusion (Day 0).
Three patients (12.5%) were alive and disease-free with median follow-up of 92 months (80-142); one was alive with disease 32 months post-autotransplant. Twenty had died (disease, 17; transplant-related, 2; unknown, 1). Of the four alive, three had Ewing's sarcoma, one alveolar rhabdomyosarcoma, and all were in CR at transplant. Median time to relapse was 6 months (2-59). Sixteen of 18 (89%) relapsed within 1 year. Median overall survival was 10 months (0-137). A trend towards improved survival (P=0.07) was evident for patients in CR prior to autotransplant.
Stem cell autotransplantation does not benefit most patients with sarcoma. A subgroup of high-risk patients in CR may fare better and warrant further study.
关于化疗敏感肉瘤的干细胞自体移植评估的报道较少。一些研究表明有获益，另一些则不然。我们展示了在一家加拿大机构接受自体移植的24例肉瘤患者的结果。
1988年至1998年间对24例患者进行了治疗：23例年龄≥18岁（中位数27岁；范围12 - 56岁）；性别均衡；12例患者患有尤因肉瘤。诊断时，12例（50%）有转移性疾病。在自体移植前，所有患者都接受了≥1个化疗方案。14例（58%）处于完全缓解（CR），7例（29%）有微小残留病。所有患者均接受依托泊苷60 mg/kg（第-4天）、美法仑140 mg/m²（第-3天）以及干细胞回输（第0天）。
3例患者（12.5%）存活且无疾病，中位随访时间为92个月（80 - 142个月）；1例在自体移植后32个月存活且有疾病。20例患者死亡（因疾病死亡17例；与移植相关死亡2例；死因不明1例）。在存活的4例患者中，3例患有尤因肉瘤，1例患有肺泡横纹肌肉瘤，且移植时均处于CR状态。复发的中位时间为6个月（2 - 59个月）。18例中有16例（89%）在1年内复发。总生存的中位时间为10个月（0 - 137个月）。自体移植前处于CR的患者有生存改善的趋势（P = 0.07）。
干细胞自体移植对大多数肉瘤患者并无益处。处于CR的高危患者亚组可能预后较好，值得进一步研究。
