Sharp J G, Kessinger A, Mann S, Crouse D A, Armitage J O, Bierman P, Weisenburger D D
Department of Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha 68198-6395, USA.
J Clin Oncol. 1996 Jan;14(1):214-9. doi: 10.1200/JCO.1996.14.1.214.
To evaluate the outcomes in 65 consecutive patients with non-Hodgkin's lymphoma (NHL) undergoing high-dose therapy (HDT) and autologous transplantation based on initial marrow involvement and the presence or absence of minimal disease in the hematopoietic harvests.
Patients with any history of histologic evidence of marrow tumor underwent autologous peripheral-blood stem-cell transplantation (PSCT), whereas others underwent autologous bone marrow transplantation (ABMT). Patients who underwent ABMT were further segregated retrospectively into two groups depending on whether there was evidence by cell culture and/or Southern analysis of minimal tumor in the marrow harvest.
Comparable proportions (58% to 60%) of patients in each of the two groups (PSCT and ABMT) achieved a complete clinical remission (CR) at 100 days. For patients who achieve a CR, the actuarial relapse-free survival rate at 5 years for PSCT patients who received a tumor-negative apheresis harvest was 64%, compared with 57% for patients who received a tumor-negative bone marrow harvest and 17% for patients who received a histologically negative but minimally contaminated bone marrow harvest. Lymphoma grade and phenotype were not significant predictors of outcome.
The observation that survival was significantly better in the groups of patients who received tumor-negative harvests and worse for patients who received minimally contaminated harvests suggests that tumor cells, even at minimal levels, reinfused in the transplanted harvest are responsible for progression in a proportion of patients who achieve a CR following HDT, although other biologic characteristics of the tumor could also be important. A relatively good outcome can be achieved with HDT and PSCT, even in patients with a significant marrow tumor burden.
基于初始骨髓受累情况以及造血干细胞采集物中是否存在微小病变，评估65例连续接受高剂量治疗（HDT）和自体移植的非霍奇金淋巴瘤（NHL）患者的治疗结果。
有任何骨髓肿瘤组织学证据病史的患者接受自体外周血干细胞移植（PSCT），而其他患者接受自体骨髓移植（ABMT）。接受ABMT的患者根据骨髓采集物中细胞培养和/或Southern分析是否有微小肿瘤证据，进一步回顾性分为两组。
两组（PSCT和ABMT）中各有相当比例（58%至60%）的患者在100天时达到完全临床缓解（CR）。对于达到CR的患者，接受肿瘤阴性单采收获物的PSCT患者5年无病生存率为64%，接受肿瘤阴性骨髓收获物的患者为57%，接受组织学阴性但有轻微污染骨髓收获物的患者为17%。淋巴瘤分级和表型不是结果的显著预测因素。
接受肿瘤阴性收获物的患者组生存明显更好，而接受有轻微污染收获物的患者生存更差，这一观察结果表明，移植收获物中回输的肿瘤细胞，即使数量极少，也是导致一部分HDT后达到CR的患者病情进展的原因，尽管肿瘤的其他生物学特征也可能很重要。即使在骨髓肿瘤负荷较大的患者中，HDT和PSCT也能取得相对较好的结果。
