Bierman P J
University of Nebraska Medical Center, Department of Internal Medicine, Omaha 68198-3330.
Med Oncol. 1994;11(2):35-41. doi: 10.1007/BF02988828.
A substantial proportion of patients with Hodgkin's disease and non-Hodgkin's lymphoma will fail to achieve a complete remission with initial chemotherapy or will relapse after attaining a complete remission. The results of conventional salvage chemotherapy regimens for these patients have been disappointing. This has led to the use of high-dose therapy regimens which can be administered with the use of hematopoietic rescue (bone marrow transplantation). The use of bone marrow transplantation for patients with relapsed and refractory lymphoma has increased rapidly. Data from the North American Autologous Bone Marrow Transplant Registry indicate that approximately 40% of autologous bone marrow transplants are being performed for patients with lymphoma. Several large series of transplantation for Hodgkin's disease and non-Hodgkin's lymphoma have been published in the last two years. The results of these series vary widely due to differences in patient selection and pre-transplant prognostic factors. Differences in supportive care and preparative regimens prior to transplant may also account for the wide range of outcomes reported after transplantation. Although these differences make it impossible to compare results of one series with another, it is clear that a significant proportion of patients can achieve long term disease free survival following high dose therapy with marrow transplantation. It is also important, however, to note that this form of therapy can be associated with substantial morbidity and mortality. Transplant-related mortality exceeds 20% in some series. However, greater experience, better patient selection, and advances in supportive care, such as hematopoietic growth factors, are allowing many institutions to perform transplantation with mortality rates under 5%.
相当一部分霍奇金病和非霍奇金淋巴瘤患者初始化疗无法实现完全缓解，或在达到完全缓解后复发。针对这些患者的传统挽救性化疗方案的结果一直令人失望。这导致了高剂量治疗方案的使用，该方案可在造血救援（骨髓移植）的情况下实施。骨髓移植在复发和难治性淋巴瘤患者中的应用迅速增加。北美自体骨髓移植登记处的数据表明，约40%的自体骨髓移植是为淋巴瘤患者进行的。在过去两年中，已经发表了几篇关于霍奇金病和非霍奇金淋巴瘤的大型移植系列研究。由于患者选择和移植前预后因素的差异，这些系列研究的结果差异很大。移植前支持治疗和预处理方案的差异也可能是移植后报告的结果差异较大的原因。尽管这些差异使得无法将一个系列的结果与另一个系列进行比较，但很明显，相当一部分患者在接受高剂量治疗和骨髓移植后可实现长期无病生存。然而，同样重要的是要注意，这种治疗形式可能会伴随着相当高的发病率和死亡率。在一些系列研究中，移植相关死亡率超过20%。然而，随着经验的增加、更好的患者选择以及支持治疗的进展，如造血生长因子的应用，许多机构进行移植的死亡率已低于5%。
