Nemet D
Zavod za hematologiju, Klinika za unutarnje bolesti s poliklinikom, Klinicki bolnicki centar, Medicinski fakultet Sveucilista u Zagrebu.
Lijec Vjesn. 1990 Jan-Feb;112(1-2):53-8.
In this second part of the review the clinical significance of autologous bone marrow transplantation (ABMT) as treatment for acute leukemias (AL) and malignant lymphomas is described. In most adult patients with AL in complete remission treated with conventional maintenance therapy relapse usually occurs within one year. However, the results of ABMT, as an intensive consolidation treatment in patients with AL in remission show long-term disease-free survival in a proportion of 40% of patients. Even better results have been reported in patients with purged bone marrow, although the difference is not statistically significant. A major problem of ABMT is still the high percentage of relapse (50%), while the probability of treatment related mortality is relatively low (up to 10%). ABMT is also showing good results in the treatment of non-Hodgkin's lymphomas of intermediate and high-grade histology and in Hodgkin's disease in cases refractory to the first line therapy and in sensitive relapse. However, in refractory cases the results are poor. It is noteworthy, that in all disorders treated with ABMT, prospective randomised controlled trials are missing and current data are based on heterogenous groups of patients. In the majority of solid tumors, even escalated doses of radiochemotherapy with ABMT are not able to eradicate malignant disease. In contrast, the results are very good in neuroblastoma. Although ABMT is a relatively complex and aggressive method, it is being increasingly applied to the treatment of haematological malignant diseases and the results obtained so far, are encouraging and showing that ABMT, besides allogeneic BMT, represents a promising potentially curative treatment for selected group of patients.
在本综述的第二部分,描述了自体骨髓移植(ABMT)作为急性白血病(AL)和恶性淋巴瘤治疗方法的临床意义。在大多数接受传统维持治疗且处于完全缓解期的成年AL患者中,复发通常在一年内发生。然而,ABMT作为缓解期AL患者的强化巩固治疗方法,有40%的患者实现了长期无病生存。对于经过净化骨髓的患者,报告的结果更好,尽管差异无统计学意义。ABMT的一个主要问题仍然是高复发率(50%),而治疗相关死亡率相对较低(高达10%)。ABMT在治疗中高分级组织学的非霍奇金淋巴瘤以及一线治疗难治或敏感复发的霍奇金病方面也显示出良好效果。然而,在难治性病例中结果较差。值得注意的是,在所有接受ABMT治疗的疾病中,缺乏前瞻性随机对照试验,目前的数据基于异质性患者群体。在大多数实体瘤中,即使联合ABMT增加放化疗剂量也无法根除恶性疾病。相比之下,神经母细胞瘤的治疗结果非常好。尽管ABMT是一种相对复杂且激进的方法,但它正越来越多地应用于血液系统恶性疾病的治疗,目前所取得的结果令人鼓舞,表明ABMT除了异基因骨髓移植外,对特定患者群体而言是一种有前景的潜在治愈性治疗方法。