Reece D E, Phillips G L
Division of Hematology, Vancouver Hospital and Health Sciences Centre, British Columbia, Canada.
Stem Cells. 1994 Sep;12(5):477-93. doi: 10.1002/stem.5530120504.
Intensive therapy and autologous marrow or peripheral blood stem cell transplantation is often utilized in Hodgkin's disease patients whose disease has progressed after primary conventional chemotherapy. A number of studies have described long-term disease-free survival in up to 50% of transplanted patients. High-dose chemotherapy conditioning regimens such as "CBV" or "BEAM" have been used more often than regimens containing total body irradiation. Usually unpurged autologous bone marrow has been utilized as the source of hematopoietic stem cell reconstitution, although recently the use of "primed" peripheral blood stem cells has increased markedly. The challenges of transplant-related toxicity and recurrence of disease post-transplant are discussed, as well as possible strategies to reduce these problems. The use of autologous transplantation is discussed in three clinical settings: patients who have failed to enter a complete remission (CR) after primary chemotherapy, those who have relapsed within 12 months of attaining a CR and those who have relapsed after a longer (i.e., > or = 12 months) first CR. When compared with conventional salvage chemotherapy, transplantation appears to produce a higher long-term disease-free survival rate in all of these patient groups. However, assessment of an advantage for autotransplantation, particularly in patients with long first remissions, is difficult without a Phase III trial. On the other hand, recently updated results from our center indicate that 72% of patients relapsing after long initial remissions benefit from autotransplantation at this point in their disease course, and that transplant-related mortality is low in this setting. Other issues addressed include the potential role of autologous transplantation as consolidation therapy in selected high-risk patients in an initial CR, as well as the utility of conventional chemotherapy and involved-field radiotherapy in conjunction with autotransplantation.
强化治疗及自体骨髓或外周血干细胞移植常用于那些在初次常规化疗后病情进展的霍奇金病患者。多项研究描述了高达50%的移植患者可实现长期无病生存。高剂量化疗预处理方案，如“CBV”或“BEAM”，比包含全身照射的方案使用得更为频繁。通常未经过净化的自体骨髓被用作造血干细胞重建的来源，不过近来“动员的”外周血干细胞的使用显著增加。文中讨论了移植相关毒性及移植后疾病复发的挑战，以及减少这些问题的可能策略。自体移植的应用在三种临床情况下进行了讨论：初次化疗后未能达到完全缓解（CR）的患者、达到CR后12个月内复发的患者以及首次CR持续较长时间（即≥12个月）后复发的患者。与传统挽救性化疗相比，移植在所有这些患者组中似乎能产生更高的长期无病生存率。然而，若没有III期试验，很难评估自体移植的优势，尤其是在首次缓解期较长的患者中。另一方面，我们中心最近更新的结果表明，72%在初次长期缓解后复发的患者在疾病进程的这一阶段可从自体移植中获益，且在此情况下移植相关死亡率较低。文中还讨论了其他问题，包括自体移植在部分处于初始CR的高危患者中作为巩固治疗的潜在作用，以及传统化疗和受累野放疗与自体移植联合应用的效用。
