The University of Toronto, Autologous Bone Marrow Transplant Program, The Toronto Hospital, Toronto, Ontario, Canada.
Leuk Lymphoma. 1991;5(2-3):111-5. doi: 10.3109/10428199109068113.
Long-term disease-free survival after conventional dose salvage chemotherapy for relapsed or refractory non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) is rare. Intensive chemotherapy and autologous bone marrow transplantation (ABMT) is regarded by many as the treatment of choice. For lymphoma, eligibility for transplant is frequently restricted to cases with chemotherapy-sensitive disease or minimal tumour bulk. We evaluated the mini-BEAM regimen as further treatment for patients unresponsive to initial salvage therapy and thus ineligible for ABMT at our centre. Carmustine 60 mg/m(2) I.V. day one, etoposide 75 mg/m(2) I.V. days 2-5, cytosine arabinoside 100 mg/m(2) I.V. q12h days 2-5 and melphalan 30 mg/m(2) day 6 (mini-BEAM) was administered to 24 patients with lymphoma, 22 of whom were refractory to at least first-line salvage chemotherapy. Eleven had HD and 13 NHL. The complete response (CR) rate was 21% and the overall response was 59%. Febrile neutropenia occurred in 48% of treatment episodes. There were two treatment-related deaths. Thirteen patients underwent bone marrow transplantation (BMT), 11 received ABMT (8 HD, 3 NHL). Six patients did not achieve remission after transplant but 7 patients remain in continuous CR, with a follow-up of 6-17 months post-transplant. Consequently, 7 of 24 (29%) patients responded to mini-BEAM and many achieve long-term disease-free survival after BMT. Further evaluation of mini-BEAM as a salvage regimen prior to BMT is indicated.
常规剂量挽救化疗治疗复发或难治性非霍奇金淋巴瘤(NHL)或霍奇金病(HD)后,长期无病生存很少见。强化化疗和自体骨髓移植(ABMT)被许多人视为首选治疗方法。对于淋巴瘤,移植的资格通常限于化疗敏感的疾病或肿瘤体积最小的病例。我们评估了 mini-BEAM 方案作为我们中心最初挽救治疗无反应且因此不符合 ABMT 条件的患者的进一步治疗。卡莫司汀 60mg/m(2)IV 第 1 天,依托泊苷 75mg/m(2)IV 第 2-5 天,阿糖胞苷 100mg/m(2)IV q12h 第 2-5 天和马法兰 30mg/m(2)第 6 天(mini-BEAM)用于 24 例淋巴瘤患者,其中 22 例对至少一线挽救化疗耐药。11 例为 HD,13 例为 NHL。完全缓解(CR)率为 21%,总缓解率为 59%。发热性中性粒细胞减少症发生在 48%的治疗期。有 2 例治疗相关死亡。13 例患者接受了骨髓移植(BMT),11 例接受了 ABMT(8 例 HD,3 例 NHL)。6 例患者移植后未缓解,但 7 例患者持续 CR,移植后随访 6-17 个月。因此,24 例患者中有 7 例(29%)对 mini-BEAM 有反应,许多患者在 BMT 后获得长期无病生存。进一步评估 mini-BEAM 作为 BMT 前的挽救方案是必要的。