Hurd D D, LeBien T W, Lasky L C, Haake R J, Ramsay N K, Kim T H, Levine E G, McGlave P B, Bloomfield C D, Peterson B A
Bone Marrow Transplantation Program, University of Minnesota, Minneapolis.
Am J Med. 1988 Dec;85(6):829-34. doi: 10.1016/s0002-9343(88)80029-9.
Patients with non-Hodgkin's lymphoma who fail to achieve a complete remission or who relapse are rarely cured with conventional therapies. For this group of patients, intensive therapy and bone marrow rescue may be curative. Our goal was to assess the effects of autologous transplantation in patients with B-cell lymphomas and a poor prognosis. To avoid occult or overt contamination with lymphoma, monoclonal antibodies BA-1, BA-2, and BA-3 were used for ex vivo marrow treatment.
Seventeen patients underwent intensive therapy and autologous bone marrow transplant using the aforementioned marrow. Ten of the 17 patients (Group I) had disease that was in complete or partial remission. The other seven patients either had disease that was not responsive to treatment or had bone marrow transplant as their initial therapy at relapse.
The ex vivo treatment did not adversely affect engraftment. For those patients who could be evaluated, the median time to white cell engraftment was 24 days; the median durations of red cell and platelet support were 24 and 29 days, respectively. Eleven of the 17 patients had complete remissions at the evaluation 28 days after transplant. Three patients subsequently experienced a relapse, three died while their disease was in complete remission, and five are alive and disease-free 405 to 1,674 days after transplant. Group I patients had an estimated 40 percent disease-free survival rate at three years compared with 0 percent for Group II patients (p less than 0.01).
Our data support autologous bone marrow transplantation as an important treatment modality for the non-Hodgkin's lymphomas. With the current preparative regimens available, however, its use should be limited to patients with disease that is still responding to conventional therapies.
未能实现完全缓解或复发的非霍奇金淋巴瘤患者很少能通过传统疗法治愈。对于这组患者，强化治疗和骨髓救援可能具有治愈效果。我们的目标是评估自体移植对预后不良的B细胞淋巴瘤患者的疗效。为避免淋巴瘤的隐匿或明显污染，使用单克隆抗体BA - 1、BA - 2和BA - 3进行体外骨髓处理。
17例患者接受了强化治疗，并使用上述骨髓进行自体骨髓移植。17例患者中的10例（第一组）疾病处于完全或部分缓解状态。其他7例患者要么对治疗无反应，要么在复发时将骨髓移植作为初始治疗。
体外处理未对植入产生不利影响。对于那些可以评估的患者，白细胞植入的中位时间为24天；红细胞和血小板支持的中位持续时间分别为24天和29天。17例患者中有11例在移植后28天的评估时达到完全缓解。3例患者随后复发，3例在疾病完全缓解时死亡，5例在移植后405至1674天存活且无疾病。第一组患者三年时的无病生存率估计为40%，而第二组患者为0%（p小于0.01）。
我们的数据支持自体骨髓移植作为非霍奇金淋巴瘤的一种重要治疗方式。然而，就目前可用的预处理方案而言，其应用应限于仍对传统疗法有反应的患者。
