Brice P, Marolleau J P, Pautier P, Makke J, Cazals D, Dombret H, D'Agay M F, Benbunan M, Gisselbrecht C
Institut d'Hématologie, Hopital Saint-Louis, Paris, France.
Leuk Lymphoma. 1996 Aug;22(5-6):449-56. doi: 10.3109/10428199609054783.
Autologous stem-cell transplantation is widely used as part of the treatment of poor prognosis lymphoma patients. Since 1986, peripheral blood progenitor cells (PBPC) mobilized by chemotherapy and/or hematopoietic growth factors have progressively been used instead of autologous bone marrow (BM) cells. Toxicity, engraftment and long-term outcome were compared in a population of relapsing or refractory lymphoma patients given high-dose therapy. During 1986 to 1993, 150 patients with refractory or relapsed non-Hodgkin's lymphomas (n = 93) or Hodgkin's disease (n = 57) received intensive therapy followed by the reinjection of BM (n = 72) or PBPC (n = 78). PBPC were collected by aphereses during the phase of hematologic recovery after mobilization by chemotherapy alone (n = 36) or associated with GCSF (n = 43). Conditioning regimens included chemotherapy alone in 77%, associated with total body irradiation (TBI) in 23%. After stem-cell reinfusion, 55% of the PBPC group received GCSF versus 24% in the BM group. Results show that the median time to neutrophil counts > 500/microliters and platelets > 50,000/microliters was significantly shorter in the PBPC than the BM group, respectively 13 versus 23 days and 18 versus 26 days (P < 0.05). This difference remained significant (P < 0.05) when patients were stratified according to the administration or not of GCSF after transplantation. PBPC grafting after high-dose therapy was associated with a median reduction of the hospital stay of 10 days. The majority of patients (90%) maintained normal blood counts at 3 months, and no secondary graft failure was observed in either group. The use of TBI in the conditioning regimen was the only significant factor affecting long-term hematologic recovery. For relapsing patients with histologically aggressive lymphomas, overall survival and failure-free survival were similar in both groups. In conclusion, PBPC transplantation is a safe procedure associated with improvement of hematopoietic recovery and a shortened hospital stay.
自体干细胞移植被广泛用作预后不良淋巴瘤患者治疗的一部分。自1986年以来，通过化疗和/或造血生长因子动员的外周血祖细胞（PBPC）逐渐被用于替代自体骨髓（BM）细胞。对接受高剂量治疗的复发或难治性淋巴瘤患者群体的毒性、植入情况和长期预后进行了比较。在1986年至1993年期间，150例难治性或复发性非霍奇金淋巴瘤（n = 93）或霍奇金病（n = 57）患者接受了强化治疗，随后回输BM（n = 72）或PBPC（n = 78）。PBPC在单独化疗动员后的血液学恢复阶段通过血细胞分离术采集（n = 36），或与粒细胞集落刺激因子（GCSF）联合采集（n = 43）。预处理方案中77%为单纯化疗，23%联合全身照射（TBI）。干细胞回输后，PBPC组55%的患者接受了GCSF，而BM组为24%。结果显示，PBPC组中性粒细胞计数>500/微升和血小板计数>50,000/微升的中位时间分别显著短于BM组，分别为13天对23天和18天对26天（P < 0.05）。当根据移植后是否使用GCSF对患者进行分层时，这种差异仍然显著（P < 0.05）。高剂量治疗后PBPC移植使住院时间中位数减少了10天。大多数患者（90%）在3个月时维持正常血细胞计数，两组均未观察到继发性移植失败。预处理方案中使用TBI是影响长期血液学恢复的唯一显著因素。对于组织学上侵袭性淋巴瘤的复发患者，两组的总生存率和无失败生存率相似。总之，PBPC移植是一种安全的操作，可改善造血恢复并缩短住院时间。
