Internal Medicine C (Hematology and Oncology, Palliative Care, Transplant Centre), University Hospital Greifswald, Ernst-Moritz-Arndt-University, Greifswald, Germany.
Exp Hematol Oncol. 2012 Oct 16;1(1):32. doi: 10.1186/2162-3619-1-32.
Therapy of indolent lymphomas with involvement of the central nervous system (CNS) has not been standardized so far. A 42-year old male patient presented with neurological signs because of leukemic splenic marginal zone lymphoma (SMZL) manifested in bone marrow, lymph nodes and CNS. Due to the aggressiveness of the disease and the young age of the patient, an intensive immunochemotherapy followed by high-dose therapy with busulfan, thiotepa and fludarabine and subsequent unrelated allogeneic stem cell transplantation (alloSCT) was performed. The haemopoietic stem cells engrafted in time and the patient is doing well (ECOG 0) without evidence for active lymphoma three years after transplantation. Highly sensitive tests by specific quantitative real-time polymerase chain reaction for presence of lymphoma cells in blood and bone marrow indicated also a molecular remission. The reported case shows the feasibility of high-dose therapy and allogeneic stem cell transplantation in high-risk patients with CNS-involvement of indolent non-Hodgkin's lymphoma. In addition, the case supports the hypothesis that the graft-versus lymphoma effect after alloSCT is also active within the CNS.
迄今为止，累及中枢神经系统（CNS）的惰性淋巴瘤的治疗尚未标准化。一位 42 岁的男性患者因表现为骨髓、淋巴结和 CNS 的白血病脾边缘区淋巴瘤（SMZL）而出现神经系统症状。由于疾病的侵袭性和患者年轻，我们对其进行了强化免疫化疗，随后进行了大剂量的白消安、噻替哌和氟达拉滨治疗，并进行了随后的无关供体异基因造血干细胞移植（alloSCT）。造血干细胞及时植入，患者情况良好（ECOG 0），移植后三年无活动性淋巴瘤的证据。通过特异性实时定量聚合酶链反应检测血液和骨髓中淋巴瘤细胞的高度敏感试验也表明存在分子缓解。该病例表明，对于 CNS 受累的惰性非霍奇金淋巴瘤高危患者，进行大剂量治疗和异基因造血干细胞移植是可行的。此外，该病例支持异基因造血干细胞移植后移植物抗淋巴瘤效应在 CNS 内也很活跃的假说。
