McLaughlin P, Hagemeister F B, Swan F, Cabanillas F, Romaguera J, Rodriguez M A, Lee M S, Pate O, Sarris A, Younes A
Department of Hematology, University of Texas M. D. Anderson Cancer Center, Houston.
Ann Oncol. 1994;5 Suppl 2:73-7. doi: 10.1093/annonc/5.suppl_2.s73.
Advanced-stage low-grade lymphoma is characterized by initial responsiveness to many conventional therapies but ultimate relapse. Intensive therapy approaches with non-cross-resistant regimens have not been extensively explored. The polymerase chain reaction (PCR) can be used to monitor for the presence of cells with rearrangement of bcl-2, and provides a sensitive and stringent parameter of disease activity and treatment response that may have clinical utility.
From 1988 to 1992, 138 evaluable patients were treated with 3 sequential chemotherapy regimens, as well as with interferon alfa 2b (IFN) in combination with corticosteroids. Nineteen patients had serial PCR monitoring for bcl-2 rearrangement.
Among a subset of 58 patients who had an initial phase of IFN plus prednisone, the response rate was 59%, mostly partial remissions (PR). With the chemotherapy program, 65% have achieved complete remission to date, and 30% PR. By PCR analysis, 13 of 19 tested achieved negative status ('molecular remission'), a much higher frequency of molecular remission than has been seen with standard therapies, and these molecular remissions appear to correlate with a lower likelihood of relapse.
Intensive conventional-dose chemotherapy can achieve high rates of remission, even when monitored by the stringent PCR technique.
晚期低度淋巴瘤的特点是对许多传统疗法最初有反应，但最终会复发。采用非交叉耐药方案的强化治疗方法尚未得到广泛探索。聚合酶链反应（PCR）可用于监测bcl-2重排细胞的存在，并提供疾病活动和治疗反应的敏感且严格的参数，可能具有临床应用价值。
1988年至1992年，138例可评估患者接受了3种序贯化疗方案以及干扰素α2b（IFN）联合皮质类固醇治疗。19例患者接受了bcl-2重排的系列PCR监测。
在58例初始接受IFN加泼尼松治疗阶段的患者亚组中，缓解率为59%，大多为部分缓解（PR）。采用化疗方案后，迄今为止65%的患者已实现完全缓解，30%为PR。通过PCR分析，19例检测患者中有13例达到阴性状态（“分子缓解”），分子缓解频率远高于标准疗法所见，且这些分子缓解似乎与较低的复发可能性相关。
即使通过严格的PCR技术监测，强化常规剂量化疗也可实现高缓解率。
