Jones R J, Ambinder R F, Piantadosi S, Santos G W
Johns Hopkins Oncology Center, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Blood. 1991 Feb 1;77(3):649-53.
The existence of an immunologic antileukemia reaction associated with allogeneic bone marrow transplantation (BMT) is well established. However, a similar graft-versus-tumor effect against lymphomas has not been demonstrated. We analyzed the results of BMT in 118 consecutive patients with relapsed Hodgkin's disease or aggressive non-Hodgkin's lymphoma. The 38 patients less than 50 years of age with HLA-matched donors had allogenic marrow transplants, and the other 80 patients received purged autologous grafts. The median age was 26 years in both the allogeneic and the autologous graft recipients. The patient's response to conventional salvage therapy before transplant was the only factor that influenced the event-free survival after BMT (P less than .001). Both the patient's response to salvage therapy before BMT (P less than .001) and the type of graft (P = .02) significantly influenced the probability of relapse after BMT. The actuarial probability of relapse in patients who responded to conventional salvage therapy before BMT was only 18% after allogenic BMT compared with 46% after autologous BMT. However, the actuarial probability of event-free survival at 4 years was the same, 47% versus 41%, for patients with responsive lymphomas who received allogeneic and autologous transplants, respectively (P = .8). The beneficial antitumor effect of allogeneic BMT was offset by its higher transplant-related mortality (P = .01), largely resulting from graft-versus-host disease. Allogeneic BMT appears to induce a clinically significant graft-versus-lymphoma effect. The magnitude of this effect is similar to that reported against leukemias.
与异基因骨髓移植（BMT）相关的免疫抗白血病反应的存在已得到充分证实。然而，针对淋巴瘤的类似移植物抗肿瘤效应尚未得到证实。我们分析了118例复发性霍奇金病或侵袭性非霍奇金淋巴瘤连续患者的BMT结果。38例年龄小于50岁且有HLA匹配供体的患者接受了异基因骨髓移植，其他80例患者接受了净化的自体移植物。异基因和自体移植物受者的中位年龄均为26岁。患者移植前对传统挽救治疗的反应是影响BMT后无事件生存的唯一因素（P<0.001）。患者移植前对挽救治疗的反应（P<0.001）和移植物类型（P = 0.02）均显著影响BMT后复发的可能性。移植前对传统挽救治疗有反应的患者，异基因BMT后复发的精算概率仅为18%，而自体BMT后为46%。然而，接受异基因和自体移植的反应性淋巴瘤患者4年时无事件生存的精算概率相同，分别为47%和41%（P = 0.8）。异基因BMT的有益抗肿瘤效应被其较高的移植相关死亡率（P = 0.01）所抵消，这主要是由移植物抗宿主病导致的。异基因BMT似乎能诱导临床上显著的移植物抗淋巴瘤效应。这种效应的程度与报道的针对白血病的效应相似。
