The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21287, USA.
Leuk Lymphoma. 2011 Nov;52(11):2076-81. doi: 10.3109/10428194.2011.594191. Epub 2011 Jul 14.
Relapse after autologous stem cell transplant for low grade B-cell lymphoma is common secondary to ineffective conditioning and/or tumor autograft contamination. We investigated high-dose cyclophosphamide and rituximab without stem cell rescue as first-line or salvage therapy in lymphomas. After establishing safety, accrual was increased to evaluate event-free survival (EFS). Eighty-one adults received rituximab (375 mg/m(2) days 1, 4, 8, 11, 45, 52), cyclophosphamide (50 mg/kg days 15-18), and pegfilgrastim (day 20). Forty-two patients had low grade B-cell lymphoma [grade I/II follicular (69%), transformed lymphoma (17%), other (15%)]: 45% were treated without measurable disease. Thirty-nine patients had mantle cell lymphoma: 82% were treated without measurable disease. All achieved hematopoietic recovery; 46% required brief hospitalizations. The 5-year EFS and overall survival (OS) for patients with low grade B-cell and transformed lymphoma were 40% and 72%, respectively. The 5-year EFS and OS for patients with MCL were 39% and 62%, respectively. This low-toxicity therapeutic approach obviates the need for stem cell products and establishes a platform for future therapies.
自体干细胞移植治疗低级 B 细胞淋巴瘤后复发很常见，这主要是由于预处理无效和/或肿瘤自体移植物污染。我们研究了高剂量环磷酰胺和利妥昔单抗，无需干细胞挽救，作为淋巴瘤的一线或挽救治疗。在确定安全性后，增加入组人数以评估无事件生存（EFS）。81 名成年人接受利妥昔单抗（375mg/m2，第 1、4、8、11、45、52 天）、环磷酰胺（50mg/kg，第 15-18 天）和培非格司亭（第 20 天）。42 例患者患有低级 B 细胞淋巴瘤[I/II 级滤泡性（69%）、转化性淋巴瘤（17%）、其他（15%）]：45%的患者未经测量疾病治疗。39 例患有套细胞淋巴瘤：82%的患者未经测量疾病治疗。所有患者均实现造血恢复；46%的患者需要短暂住院。低级 B 细胞和转化性淋巴瘤患者的 5 年 EFS 和总生存率（OS）分别为 40%和 72%。MCL 患者的 5 年 EFS 和 OS 分别为 39%和 62%。这种低毒性治疗方法避免了对干细胞产品的需求，并为未来的治疗方法建立了平台。
