Mey Ulrich J M, Jha Vandana, Strehl John W, Gorschlueter Marcus, Rabe Christian, Hoebert Eckfried, Popp Henning, Schmidt-Wolf Ingo G H
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Ger Med Sci. 2007 Jun 19;5:Doc02.
High-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) plays an important role in the treatment of aggressive non-Hodgkin's lymphoma (NHL). We report on a retrospective analysis of all patients with diffuse large B-cell lymphoma who were consecutively treated with HDT followed by ASCT at the University Hospital of Bonn, Germany, between 1996 and 2004.
A total of 25 patients were transplanted for biopsy-proven diffuse large B-cell lymphoma (DLBCL). Eight patients received up-front HDT as first-line therapy, four patients received HDT due to incomplete response to conventional induction chemotherapy, and six patients were treated for primary refractory disease. Seven patients had recurrent lymphoma.
A complete remission (CR) was achieved in 14 of 25 patients (56%). Estimated 3-year survival for patients treated with upfront HDT, chemosensitive patients with incomplete response to first line therapy, and patients with chemosensitive relapsed disease was 87.5%, 50.0% and 60.0%, respectively. In contrast, no patient with primary refractory disease or relapsed disease lacking chemosensitivity lived longer than 8 months. Chemosensitivity was the only significant prognostic factor for overall survival (OS) in multivariate analysis.
Our results confirm that HDT and ASCT is a highly effective therapy in patients with DLBCL leading to long-term survival in a substantial proportion of patients. Patients treated upfront for high-risk disease, incomplete response to conventional first-line therapy, or for chemosensitive relapse have a good prognosis. In contrast, patients with primary chemorefractory disease and patients with relapsed disease lacking chemosensitivity do not benefit from HDT with ASCT.
大剂量化疗（HDT）联合自体干细胞移植（ASCT）在侵袭性非霍奇金淋巴瘤（NHL）的治疗中发挥着重要作用。我们报告了对1996年至2004年间在德国波恩大学医院连续接受HDT并随后进行ASCT治疗的所有弥漫性大B细胞淋巴瘤患者的回顾性分析。
共有25例经活检证实为弥漫性大B细胞淋巴瘤（DLBCL）的患者接受了移植。8例患者接受 upfront HDT作为一线治疗，4例患者因对传统诱导化疗反应不完全而接受HDT，6例患者接受原发性难治性疾病治疗。7例患者患有复发性淋巴瘤。
25例患者中有14例（56%）实现了完全缓解（CR）。接受 upfront HDT治疗的患者、对一线治疗反应不完全的化疗敏感患者以及化疗敏感复发性疾病患者的估计3年生存率分别为87.5%、50.0%和60.0%。相比之下，原发性难治性疾病或缺乏化疗敏感性的复发性疾病患者无一例存活超过8个月。在多变量分析中，化疗敏感性是总生存（OS）的唯一显著预后因素。
我们的结果证实，HDT和ASCT是DLBCL患者的一种高效治疗方法，可使相当一部分患者长期存活。因高危疾病、对传统一线治疗反应不完全或化疗敏感复发而接受 upfront治疗的患者预后良好。相比之下，原发性化疗难治性疾病患者和缺乏化疗敏感性的复发性疾病患者无法从HDT联合ASCT中获益。
