Takasaki Hirotaka, Hashimoto Chizuko, Takemura Sachiya, Motomura Shigeki, Ishigatsubo Yoshiaki
Department of Chemotherapy, Kanagawa Cancer Center.
Rinsho Ketsueki. 2010 Jan;51(1):57-62.
Sequential high-dose chemotherapy with in vivo rituximab-purged stem cell autografting was designed for previously untreated mantle cell lymphoma (MCL). The response rate, disease-free survival (DFS), overall survival (OS) and toxicity were investigated in this trial. Between November 2001 and August 2008, five patients younger than 65 years of age with MCL at diagnosis were enrolled in this study. Initial chemotherapy consisted of 3 cycles of CHOP regimen followed by four courses of high-dose chemotherapy. During the in vivo purging phase, the patient was administered high-dose cyclophosphamide and cytarabine, and then each administration was followed by two infusions of rituximab. Molecular monitoring of minimal residual disease was performed by assessing DNA samples from bone marrow and autografted cells using PCR amplification of the bcl-1/IgH rearrangement. The complete response rate was 100%, and the 3-year OS and DFS were 100% and 100%, respectively. PCR analysis of autografted cells from four evaluable patients, 75% lymphoma-negative harvests were achieved following in vivo purging. One patient relapsed 3.2 years after treatment. The principal toxicity in the study was hematologic but there were no treatment-related deaths. Intensive high-dose sequential chemotherapy with in vivo purged stem cell support can achieve long-term disease-free survival for MCL.
序贯大剂量化疗联合体内利妥昔单抗清除的干细胞自体移植被设计用于既往未治疗的套细胞淋巴瘤（MCL）。本试验研究了缓解率、无病生存期（DFS）、总生存期（OS）及毒性。在2001年11月至2008年8月期间，5例诊断为MCL且年龄小于65岁的患者入组本研究。初始化疗包括3个周期的CHOP方案，随后进行4个疗程的大剂量化疗。在体内清除阶段，患者接受大剂量环磷酰胺和阿糖胞苷治疗，每次给药后接着输注两次利妥昔单抗。通过使用bcl-1/IgH重排的PCR扩增评估来自骨髓和自体移植细胞的DNA样本，对微小残留病进行分子监测。完全缓解率为100%，3年OS和DFS分别为100%和100%。对4例可评估患者的自体移植细胞进行PCR分析，体内清除后75%的收获物为淋巴瘤阴性。1例患者在治疗后3.2年复发。本研究中的主要毒性为血液学毒性，但无治疗相关死亡。强化大剂量序贯化疗联合体内清除的干细胞支持可使MCL患者获得长期无病生存。
