Endo M, Tanosaki R
Department of Surgery, Keio University Hospital, Tokyo, Japan.
Gan To Kagaku Ryoho. 1995 Oct;22(12):1762-70.
Autologous bone marrow transplantation (ABMT) and peripheral blood stem cell transplantation (PBSCT) are increasingly used to support high-dose chemotherapy for solid tumors of childhood. In this review we described practical aspects of myeloablative chemotherapy rescued by ABMT, PBSCT or combination of ABMT and PBSCT for the treatment of children with high-risk solid tumor, involving our experiences in 15 cases. Indication, method of harvesting bone marrow and peripheral blood stem cells, cryopreservation, transplantation, selection of anti-neoplastic agents for preconditioning, nutritional and G-CSF support, engraftment and outcomes for prognosis were discussed. In comparing the engraftment of stem cells between ABMT and PBSCT, the acceleration of platelet and erythrocyte recovery is less impressive, although there is a tendency to more rapid recovery of granulocyte in PBSCT group. The outcomes are distinctly improved only in patients who showed complete remission after induction chemotherapy, radiation and surgical excision. A better prognosis will be conferred especially in neuroblastoma and entities of small round cell tumor. It is noteworthy that relapses can occur as distant metastasis considerable years after complete clinical remission. This may be largely contributed by contaminated malignant cells in both harvested bone marrow and peripheral blood stem cells. There is no significant difference between the relapse rates after ABMT and PBSCT.
自体骨髓移植（ABMT）和外周血干细胞移植（PBSCT）越来越多地用于支持儿童实体瘤的大剂量化疗。在本综述中，我们描述了通过ABMT、PBSCT或ABMT与PBSCT联合挽救性清髓化疗治疗高危实体瘤儿童的实际情况，包括我们15例病例的经验。讨论了适应证、骨髓和外周血干细胞采集方法、冷冻保存、移植、预处理抗肿瘤药物的选择、营养和粒细胞集落刺激因子支持、植入以及预后结局。在比较ABMT和PBSCT之间干细胞的植入情况时，血小板和红细胞恢复的加速效果不太明显，尽管PBSCT组粒细胞恢复有更快的趋势。仅在诱导化疗、放疗和手术切除后显示完全缓解的患者中，结局有明显改善。尤其是在神经母细胞瘤和小圆形细胞肿瘤实体中，预后会更好。值得注意的是，在完全临床缓解多年后，复发可能以远处转移的形式出现。这可能很大程度上是由于采集的骨髓和外周血干细胞中存在污染的恶性细胞。ABMT和PBSCT后的复发率之间没有显著差异。
