Damon L, Damon L E, Gaensler K, Kaplan L, Martin T, Rubenstein J, Linker C
Division of Hematology/Oncology, University of California, San Francisco, CA 94143-0324, USA.
Bone Marrow Transplant. 2008 Nov;42(10):649-57. doi: 10.1038/bmt.2008.236. Epub 2008 Aug 4.
The best method to mobilize PBSCs in patients with non-Hodgkin's Lymphoma (NHL) is uncertain. We hypothesized that PBSC mobilization using an intensive chemotherapy regimen would improve outcomes after autologous hematopoietic stem cell transplantation (ASCT) in NHL patients at high risk for relapse. Fifty NHL patients were prospectively allocated to intense mobilization with high-dose etoposide plus either high-dose cytarabine or CY if they were 'high risk' for relapse, whereas 30 patients were allocated to nonintense mobilization with CY if they were 'standard risk' (all patients, +/-rituximab). All intensely mobilized patients were hospitalized compared with one-third of nonintensely mobilized patients. The EFS after ASCT was the same between the two groups, but overall survival (OS) was better for intensely mobilized patients (<0.01), including the diffuse large B-cell subgroup (P<0.04). We conclude that the intense mobilization of PBSCs in patients with NHL is more efficient than nonintense mobilization, but with greater toxicity. The equalization of EFS and superiority of OS in patients intensely mobilized to those nonintensely mobilized suggests that a treatment strategy using intensive chemotherapy for mobilization may be improving NHL outcomes after ASCT.
在非霍奇金淋巴瘤（NHL）患者中动员外周血干细胞（PBSC）的最佳方法尚不确定。我们假设，对于复发风险高的NHL患者，采用强化化疗方案进行PBSC动员可改善自体造血干细胞移植（ASCT）后的预后。50例NHL患者被前瞻性地分配至强化动员组，若为复发“高风险”患者，则接受大剂量依托泊苷联合大剂量阿糖胞苷或环磷酰胺（CY）进行强化动员；而30例患者若为“标准风险”，则分配至非强化动员组，接受CY进行动员（所有患者，±利妥昔单抗）。与三分之一的非强化动员患者相比，所有强化动员患者均需住院治疗。两组患者ASCT后的无事件生存期（EFS）相同，但强化动员患者的总生存期（OS）更好（<0.01），包括弥漫性大B细胞亚组（P<0.04）。我们得出结论，NHL患者中强化动员PBSC比非强化动员更有效，但毒性更大。强化动员患者与非强化动员患者的EFS相当且OS更优，这表明采用强化化疗进行动员的治疗策略可能会改善NHL患者ASCT后的预后。
