Carlson K, Smedmyr B, Hagberg H, Oberg G, Simonsson B
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Bone Marrow Transplant. 1993 Mar;11(3):205-8.
Twenty-four patients autografted for malignant lymphoma have been followed. All were conditioned with BEAC (BCNU, etoposide, ara-C, cyclophosphamide), in 10 patients combined with total body irradiation (TBI) 7.5 Gy. Within 1 month of ABMT, a capillary leak syndrome was seen in four patients (one death) and isolated pericarditis in one. Nineteen patients survive disease-free at > or = 6 months, median (range) 24 (11-48) months. In 15 of 19 patients, a decrease in glomerular filtration rate (GFR) of > 20% was observed, 6 (6-24) months after ABMT. In six of these patients (five treated with TBI), the renal dysfunction was still progressing 11-36 months after ABMT. Five patients (four conditioned with TBI) developed a haemolytic uraemic syndrome (HUS) with Coombs negative haemolytic anaemia, platelet consumption and renal impairment, with onset 3-6 months after ABMT. Haemolysis and platelet consumption, but not renal impairment, were reversible in all patients. One death from HUS was seen. Because of the adverse effects described we have abandoned the combination of BEAC with TBI.
对24例接受恶性淋巴瘤自体移植的患者进行了随访。所有患者均采用BEAC方案（卡氮芥、依托泊苷、阿糖胞苷、环磷酰胺）进行预处理，其中10例患者联合7.5 Gy全身照射（TBI）。在自体骨髓移植（ABMT）后1个月内，4例患者出现毛细血管渗漏综合征（1例死亡），1例出现孤立性心包炎。19例患者在≥6个月时无病存活，中位时间（范围）为24（11 - 48）个月。在19例患者中的15例中，ABMT后6（6 - 24）个月观察到肾小球滤过率（GFR）下降>20%。在这些患者中的6例（5例接受TBI治疗）中，ABMT后11 - 36个月肾功能仍在进展。5例患者（4例采用TBI预处理）发生了溶血尿毒综合征（HUS），伴有抗人球蛋白试验阴性的溶血性贫血、血小板消耗和肾功能损害，发病时间为ABMT后3 - 6个月。所有患者的溶血和血小板消耗可逆转，但肾功能损害不可逆转。观察到1例死于HUS。由于上述不良反应，我们已放弃BEAC与TBI的联合方案。
