Stewart F M
University of Massachusetts Medical Center, Worcester 01655.
Leukemia. 1993 Jul;7(7):1091-4.
High dose chemotherapy with or without total body irradiation and autologous stem cell rescue has proven to be effective treatment to cure patients with relapsed intermediate grade and high grade non-Hodgkin's lymphoma. Important factors for selection of candidates most likely to do well with these approaches include patients whose disease is responsive to conventional therapy and those who have minimal disease volume at the time of transplant. The treatment-related mortality of autologous stem cell transplantation has diminished from 20% to less than 5% with improved supportive care and selection of patients with less advanced disease. Although the treatment-related mortality of allogeneic stem cell transplantation may be as high as 20-40%, a graft versus lymphoma effect may decrease relapse with the result that overall survival is not substantially different between autologous and allogeneic transplantation. The definitive indications for stem cell transplantation include patients who have relapsed with intermediate or high grade NHL. Relative indications include intermediate/high grade non-Hodgkin's lymphoma patients, "high risk" first complete remission (CR), resistant relapse; low grade non-Hodgkin's lymphoma in sensitive or resistant relapse, advanced disease (sensitive or resistant relapse, transformation), first CR (younger patients). Relative contraindications include specific patient profiles such as bulky high grade lymphoma which progresses on appropriate conventional therapy, poor performance status, active serious infection, serious cardiac, renal, pulmonary or liver dysfunction, active, central nervous system (CNS) disease unresponsive to cranial irradiation/intrathecal therapy. For patients with previous marrow involvement or active marrow involvement at the time of harvest or transplant, "purged" autografts, peripheral blood stem cell transplantation and allografts have been used successfully.
含或不含全身照射的大剂量化疗及自体干细胞解救已被证明是治疗复发的中、高级别非霍奇金淋巴瘤患者的有效方法。选择最有可能从这些方法中获益的候选者的重要因素包括疾病对传统疗法有反应的患者以及移植时疾病体积最小的患者。随着支持治疗的改善以及对病情较轻患者的选择，自体干细胞移植的治疗相关死亡率已从20%降至5%以下。尽管异基因干细胞移植的治疗相关死亡率可能高达20%-40%，但移植物抗淋巴瘤效应可能会降低复发率，结果是自体和异基因移植后的总生存率并无显著差异。干细胞移植的确切适应证包括复发的中、高级别非霍奇金淋巴瘤患者。相对适应证包括中/高级别非霍奇金淋巴瘤患者、“高危”首次完全缓解（CR）、难治性复发；敏感或难治性复发的低级别非霍奇金淋巴瘤、晚期疾病（敏感或难治性复发、转化）、首次CR（年轻患者）。相对禁忌证包括特定的患者情况，如在适当的传统治疗下进展的巨大高级别淋巴瘤、身体状况差、活动性严重感染、严重的心、肾、肺或肝功能障碍、对头颅照射/鞘内治疗无反应的活动性中枢神经系统（CNS）疾病。对于既往有骨髓受累或在采集或移植时存在活动性骨髓受累的患者，已成功使用“净化”的自体移植物、外周血干细胞移植和同种异体移植物。
