Lotz J P, Pene F, Bouleuc C, André T, Gisselbrecht C, Bonnak H, Merad Z, Esteso A, Miccio-Bellaiche A, Avenin D
Service d'oncologie médicale, hôpital Tenon, Paris, France.
Rev Med Interne. 1995;16(1):43-54. doi: 10.1016/0248-8663(96)80663-1.
Autologous bone marrow transplantation for the treatment of solid tumors in adults remains an uncommon therapeutic approach. The feasibility of such high-dose therapies is clearly proved, especially with the advent of hematopoietic growth factors and the rescue by the peripheral stem cells to reduce the duration of the chemotherapy-induced myeloid aplasia. The question is to exactly define the place of high-dose therapy in the land of solid tumors. For the treatment of primary chemoresistant gonadal germ-cell tumors, the possibility to cure the patients and the interest of high-dose therapy with autologous bone marrow transplantation are clearly demonstrated. As consolidation for the treatment of poor prognosis tumors, the place of high-dose therapies remains moot. For the treatment of chemoresistant extragonadal germ-cell tumors, especially for primary mediastinal tumors, the level of resistance to cisplatin-based chemotherapy regimens is generally too high to be overcome by intensive therapies given as single course or as tandem courses. However in association with debulking surgery, this therapeutic approach has to be considered for some patients. In the treatment of poor prognosis breast cancer, high-dose therapy with autologous bone marrow transplantation or with peripheral stem cells support is able to convert some patients with partial response into complete responders. However, the consequences on overall survival and on disease-free survival are not evident. For metastatic breast cancer and for poor-prognosis tumors (inflammatory breast cancer, axillary metastatic nodes > or = 8), the interest of high-dose therapy has to be determined by randomized studies. These studies are ongoing in USA and in Europe. For the treatment of poor-prognosis ovarian cancer, the situation is more difficult to appraise. Once again, randomized studies have to be done to precisely define the place of high-dose therapy. In the land of small-cell lung carcinomas, high-dose therapy is actually forsaken by most of authors, even for limited diseases. The results of previous studies are disappointing. Moreover, occult medullary micrometastases involvement is frequent, once again even in limited diseases. However new therapeutic associations, as the ICE regimen (IFM, Carboplatin, VP-16) delivered as single or tandem therapy, have to be studied, especially as early consolidation therapy for the treatment of limited small-cell lung carcinomas.
自体骨髓移植治疗成人实体瘤仍然是一种不常见的治疗方法。这种高剂量疗法的可行性已得到明确证实，尤其是随着造血生长因子的出现以及外周干细胞救援措施的应用，从而缩短了化疗引起的骨髓抑制期。问题在于准确界定高剂量疗法在实体瘤治疗领域中的地位。对于原发性化疗耐药的性腺生殖细胞肿瘤，自体骨髓移植高剂量疗法治愈患者的可能性以及优势已得到明确证实。作为预后不良肿瘤治疗的巩固手段，高剂量疗法的地位仍存在争议。对于化疗耐药的性腺外生殖细胞肿瘤，尤其是原发性纵隔肿瘤，对基于顺铂化疗方案的耐药程度通常过高，单疗程或串联疗程的强化治疗难以克服。然而，对于某些患者，结合减瘤手术时，这种治疗方法值得考虑。在预后不良的乳腺癌治疗中，自体骨髓移植或外周干细胞支持的高剂量疗法能够使部分部分缓解的患者转变为完全缓解者。然而，对总生存期和无病生存期的影响尚不明显。对于转移性乳腺癌和预后不良的肿瘤（炎性乳腺癌、腋窝转移淋巴结≥8个），高剂量疗法的优势必须通过随机研究来确定。此类研究正在美国和欧洲进行。对于预后不良的卵巢癌治疗，情况更难评估。同样，必须通过随机研究来准确界定高剂量疗法的地位。在小细胞肺癌领域，即使对于局限性疾病，大多数作者实际上也已放弃高剂量疗法。以往研究结果令人失望。此外，即使在局限性疾病中，隐匿性骨髓微转移的情况也很常见。然而，必须研究新的治疗联合方案，如单疗程或串联疗程应用的ICE方案（异环磷酰胺、卡铂、依托泊苷），尤其是作为局限性小细胞肺癌治疗的早期巩固疗法。
