University of Nebraska Medical Center, Omaha, Nebraska 68198-7680, USA.
J Natl Compr Canc Netw. 2010 Mar;8(3):337-44; quiz 345. doi: 10.6004/jnccn.2010.0022.
Substantial progress has been made in the clinical management of patients with follicular lymphoma over the past 2 decades. However, the role of autologous and allogeneic stem cell transplantation in these patients remains controversial. Myeloablative chemotherapy or radioimmunotherapy supported by autologous hematopoietic cell transplantation has been shown to lead to a longer progression-free survival and, in some studies, improved survival over standard therapy. However, in the era of rituximab-based therapies used as part of induction or salvage, these historical trials may not be representative. Allogeneic stem cell transplantation offers the advantages of a tumor-free graft and some immunologic graft-versus-lymphoma effects. However, fully myeloablative transplants have high morbidity and mortality rates. Dose-reduced conditioning regimens followed by allogeneic hematopoietic cell transplantation have substantially reduced treatment-related mortality and perhaps will produce better outcomes long-term. This article outlines some historical information regarding stem cell transplantation for follicular lymphoma and discusses recent modifications that may improve outcomes, such as adding radioimmunotherapy to autologous stem cell transplantation or using alternative dose-reduced regimens that could benefit patients with reduced toxicities.
在过去的 20 年中，滤泡性淋巴瘤患者的临床管理取得了重大进展。然而，自体和异基因造血干细胞移植在这些患者中的作用仍存在争议。大剂量化疗或放射免疫疗法联合自体造血细胞移植已被证明可导致更长的无进展生存期，并且在一些研究中，与标准治疗相比可改善生存。然而，在利妥昔单抗为基础的治疗作为诱导或挽救治疗的一部分的时代，这些历史研究可能不具有代表性。异基因造血干细胞移植具有无肿瘤移植物和某些免疫移植物抗淋巴瘤作用的优势。然而，完全大剂量预处理的移植具有较高的发病率和死亡率。随后进行异基因造血细胞移植的减低剂量预处理方案已大大降低了治疗相关死亡率，并且可能会在长期产生更好的结果。本文概述了一些关于滤泡性淋巴瘤造血干细胞移植的历史信息，并讨论了最近的一些改进，例如在自体干细胞移植中加入放射免疫疗法，或使用替代的减低剂量方案，这些方案可能会降低毒性并使患者受益。
