Shanbhag Satish, Smith Mitchell R, Emmons Robert Vb
Department of Medical Oncology, Fox Chase Cancer Center, Temple University, Philadelphia, PA, USA ; Division of Bone Marrow Transplantation, Temple University, Philadelphia, PA, USA.
Stem Cells Cloning. 2010 Jul 7;3:93-102. doi: 10.2147/sccaa.s7016.
Mantle cell lymphoma (MCL) is a type of non-Hodgkins lymphoma (NHL) associated with poor progression-free and overall survival. There is a high relapse rate with conventional cytotoxic chemotherapy. Intensive combination chemotherapy including rituximab, dose intense CHOP- (cyclophosphamide-doxorubicin-vincristine-prednisone) like regimens, high dose cytarabine, and/or consolidation with autologous stem cell transplant (autoSCT) have shown promise in significantly prolonging remissions. Data from phase II studies show that even in patients with chemotherapy refractory MCL, allogeneic stem cell transplant (alloSCT) can lead to long term disease control. Most patients with MCL are not candidates for myeloablative alloSCT due to their age, comorbidities, and performance status. The advent of less toxic reduced intensity conditioning (RIC) regimens, which rely more on the graft-versus-lymphoma (GVL) effect, have expanded the population of patients who would be eligible for alloSCT. RIC regimens alter the balance of toxicity and efficacy favoring its use. Treatment decisions are complicated by introduction of novel agents which are attractive options for older, frail patients. Further studies are needed to determine the role and timing of alloSCT in MCL. Currently, for selected fit patients with chemotherapy resistant MCL or those who progress after autoSCT, alloSCT may provide long term survival.
套细胞淋巴瘤（MCL）是一种非霍奇金淋巴瘤（NHL），其无进展生存期和总生存期较差。传统细胞毒性化疗的复发率很高。包括利妥昔单抗的强化联合化疗、剂量密集的类似CHOP（环磷酰胺-阿霉素-长春新碱-泼尼松）方案、大剂量阿糖胞苷和/或自体干细胞移植（autoSCT）巩固治疗已显示出显著延长缓解期的前景。II期研究数据表明，即使是化疗难治性MCL患者，异基因干细胞移植（alloSCT）也可实现长期疾病控制。由于年龄、合并症和体能状态，大多数MCL患者不适合进行清髓性alloSCT。毒性较小的减低剂量预处理（RIC）方案的出现，更多地依赖移植物抗淋巴瘤（GVL）效应，扩大了适合alloSCT的患者群体。RIC方案改变了毒性和疗效的平衡，有利于其应用。新型药物的引入使治疗决策变得复杂，这些药物对老年体弱患者是有吸引力的选择。需要进一步研究以确定alloSCT在MCL中的作用和时机。目前，对于选定的化疗耐药MCL的合适患者或autoSCT后进展的患者，alloSCT可能提供长期生存。
