Kaizer H, Chow H S
Cancer Invest. 1984;2(3):203-13. doi: 10.3109/07357908409104373.
Clinical trials in autologous BMT to date have indicated that significant salvage and potential cures can be obtained in patients with high grade non-Hodgkin's lymphoma (NHL) who have failed primary therapy and are treated with high dose chemoradiotherapy and autologous marrow rescue. The major need in NHL is to better define those patients who might benefit by autologous BMT and to reduce the relapse rate by improved pre- or post-transplant therapy. Similar results to those in NHL could be obtained in acute leukemia if occult tumor cells could be eliminated from autologous marrow. Animal model experiments have shown that it is feasible to eliminate low level contamination with tumor cells by in vitro immunologic or pharmacologic treatment. While it is too early to accurately assess the efficacy of ongoing clinical trials using those marrow purging techniques, a few patients have exhibited encouraging durations of CCR. Should these approaches prove to be effective in only a fraction of cases, combination in vitro treatment or the use of more efficient effector mechanisms for cell killing (e.g., ricin conjugated antibody) may very well clear occult tumor from the marrow of most patients. The encouraging results with autologous BMT in leukemia and lymphoma stand in sharp contrast to the disappointing results so far achieved with the non-hematologic solid tumors. It is, however, possible that those cancers have not been subjected to the most rigorous test for successful autologous BMT and that the search for newer agents which can produce operationally irreversible aplasia may provide a fairer test of this approach. It is to be hoped that future research will settle this point.
迄今为止，自体骨髓移植的临床试验表明，对于一线治疗失败且接受大剂量放化疗及自体骨髓挽救治疗的高级别非霍奇金淋巴瘤（NHL）患者，可实现显著的挽救效果并有可能治愈。NHL的主要需求是更好地确定哪些患者可能从自体骨髓移植中获益，并通过改进移植前或移植后的治疗来降低复发率。如果能从自体骨髓中清除隐匿的肿瘤细胞，急性白血病也可能获得与NHL类似的结果。动物模型实验表明，通过体外免疫或药物治疗消除肿瘤细胞的低水平污染是可行的。虽然现在准确评估使用这些骨髓净化技术的正在进行的临床试验的疗效还为时过早，但已有少数患者表现出令人鼓舞的完全缓解持续时间。如果这些方法仅在部分病例中证明有效，那么体外联合治疗或使用更有效的细胞杀伤效应机制（如蓖麻毒素偶联抗体）很可能清除大多数患者骨髓中的隐匿肿瘤。自体骨髓移植在白血病和淋巴瘤中取得的令人鼓舞的结果与非血液系统实体瘤迄今为止令人失望的结果形成了鲜明对比。然而，有可能这些癌症尚未接受自体骨髓移植成功的最严格测试，并且寻找能够产生手术上不可逆再生障碍的新型药物可能会为这种方法提供更公平的测试。希望未来的研究能解决这一问题。
