Gorin N C, Najman A, Douay L, Salmon C, David R, Stachowiak J, Parlier Y, Oppenheimer M, Lecomte D, Lopez M
Presse Med. 1983 Sep 10;12(31):1917-23.
Twelve patients with non-Hodgkin malignant lymphoma of poor prognosis were treated with heavy chemotherapy of the TACC type (cyclophosphamide 45 mg/kg/day i.v. X 4; cytosine arabinoside 200 mg/m2/12 hours i.v. X 7; 6-thioguanidine 100 mg/m2/12-hourly p.o X 7 and CCNU 200 or 250 mg/m2 p.o. single dose) followed by autologus bone marrow transplantation (853 to 20.000 CFUc/kg). The patients were divided into 2 groups depending on whether they received an induction treatment for large visible tumoral mass (group I: 3 initial presentations, 3 relapses) or a consolidation treatment for small residual tumour (group II: 6 complete and 1 partial remissions). The results show that autologous bone marrow transplantation shortens the duration of the therapeutic aplasia. White cell (greater than 10(9)/l) and platelet (greater than 50.10(9)/l) recovery was observed on days 12 (range 9-19) and 14 (range 8-27) respectively. In group I, 1 patient died of myocardial TACC toxity and acute renal failure on tumoral kidney; there were 2 failures and 3 complete remissions (8, 21, 45 + months). Remissions occurred in patients treated initially; the overall survival since diagnosis was 48+, 48+ and 60+ months. In group II patients there were 1 failure and 5 complete remissions persisting after a 2+ months to 30+ months follow-up; the overall survival was 23+, 24+, 27+, 42+ and 70+ months. The 3 failures in the series occurred in circumstances suggesting contamination of the cryopreserved bone marrow by tumoral cells. The toxicity, largely due to infection, of the TACC-bone marrow transplantation combination was tolerable. It was clearly lower in group II (6 patients, no septicaemia) than in group I (5/6 patients with septicaemia). These preliminary results confirm that there is room for autologous bone marrow transplantation in highly malignant non-Hodgkin lymphomas, particularly during complete remissions to facilitate the use of an aggressive consolidation chemotherapy.
12例预后不良的非霍奇金恶性淋巴瘤患者接受了TACC方案的强烈化疗（环磷酰胺45mg/kg/天静脉注射×4天；阿糖胞苷200mg/m²/12小时静脉注射×7天；6-硫鸟嘌呤100mg/m²/12小时口服×7天，以及CCNU200或250mg/m²口服单剂量），随后进行自体骨髓移植（853至20000个集落形成单位/千克）。根据患者是接受针对明显大肿块的诱导治疗（I组：3例初治患者，3例复发患者）还是针对小残留肿瘤的巩固治疗（II组：6例完全缓解和1例部分缓解患者），将患者分为两组。结果显示，自体骨髓移植缩短了治疗性再生障碍期的持续时间。分别在第12天（范围9 - 19天）和第14天（范围8 - 27天）观察到白细胞（大于10⁹/L）和血小板（大于50×10⁹/L）恢复。在I组中，1例患者死于心肌TACC毒性和肿瘤肾导致的急性肾衰竭；有2例治疗失败和3例完全缓解（8、21、45 + 个月）。初治患者出现缓解；自诊断以来的总生存期为48 +、48 + 和60 + 个月。在II组患者中，经过2 + 个月至30 + 个月的随访，有1例治疗失败和5例持续完全缓解；总生存期为23 +、24 +、27 +、42 + 和70 + 个月。该系列中的3例治疗失败发生在提示冷冻保存的骨髓被肿瘤细胞污染的情况下。TACC - 骨髓移植联合治疗的毒性主要由于感染，是可耐受的。II组（6例患者，无败血症）的毒性明显低于I组（5/6例患者有败血症）。这些初步结果证实，自体骨髓移植在高度恶性的非霍奇金淋巴瘤中具有应用空间，特别是在完全缓解期以利于使用积极的巩固化疗。
