Shepherd J D, Barnett M J, Connors J M, Spinelli J J, Sutherland H J, Kingemann H G, Nantel S H, Reece D E, Currie C J, Phillips G L
Leukemia/Bone Marrow Transplantation Program of British Columbia, BC Cancer Agency, Vancouver General Hospital, Canada.
Bone Marrow Transplant. 1993 Dec;12(6):591-6.
Twenty-one patients with non-Hodgkin's lymphoma (NHL) felt to be incurable with conventional chemotherapy underwent high-dose chemo +/- radiotherapy and allogeneic sibling donor transplant. The median patient age was 27 years (range 6-47 years); 13 were male and 8 female. By the working formulation, 6 patients at diagnosis had low-grade NHL, 8 intermediate-grade, and 7 high-grade disease. Three patients were in first remission at transplant, 3 in an advanced remission, 5 had failed to respond to initial therapy while 4 had a partial response to initial therapy, and 6 were in relapse (first or beyond). Sixteen patients were conditioned with cyclophosphamide, etoposide and total body irradiation (TBI), 4 with cyclophosphamide and TBI, and one with a combination of busulfan, melphalan and cyclophosphamide. GVHD prophylaxis was variable. At last follow-up, 8 of 21 patients remain alive and progression-free at a median of 37.5 months (range 6-58 months); actuarial event-free survival is 38% (95% confidence interval 17-58%). Thirteen patients died at a median of 2 (range 0.5-8) months post-BMT, 5 from regimen-related toxicity, 3 from acute GVHD, 2 from infections related to chronic GVHD and 3 from disease progression. Factors which were adverse predictors of progression-free survival included low-grade disease, presence of B symptoms at BMT, Karnofsky performance status at BMT and female sex. We concur with previous workers in concluding that allogeneic BMT may offer effective therapy for selected patients with incurable NHL. Major issues to be considered include timing of BMT and disease status at BMT.
21例被认为采用传统化疗无法治愈的非霍奇金淋巴瘤（NHL）患者接受了大剂量化疗及±放疗，并进行了异基因同胞供体移植。患者的中位年龄为27岁（范围6 - 47岁）；男性13例，女性8例。根据工作分类法，6例患者诊断时为低度NHL，8例为中度，7例为高度疾病。3例患者在移植时处于首次缓解期，3例处于晚期缓解期，5例对初始治疗无反应，4例对初始治疗有部分反应，6例处于复发期（首次或再次复发）。16例患者采用环磷酰胺、依托泊苷和全身照射（TBI）进行预处理，4例采用环磷酰胺和TBI，1例采用白消安、美法仑和环磷酰胺联合方案。移植物抗宿主病（GVHD）的预防措施各不相同。在最后一次随访时，21例患者中有8例存活且无疾病进展，中位随访时间为37.5个月（范围6 - 58个月）；无事件生存率为38%（95%置信区间17 - 58%）。13例患者在骨髓移植后中位2个月（范围0.5 - 8个月）死亡，5例死于与方案相关的毒性反应，3例死于急性GVHD，2例死于与慢性GVHD相关的感染，3例死于疾病进展。无进展生存的不良预测因素包括低度疾病、骨髓移植时存在B症状、骨髓移植时的卡诺夫斯基体能状态以及女性性别。我们赞同之前研究者的结论，即异基因骨髓移植可能为部分无法治愈的NHL患者提供有效的治疗方法。需要考虑的主要问题包括骨髓移植的时机和骨髓移植时的疾病状态。
