Stamatoullas A, Fruchart C, Khalfallah S, Buchonnet G, Contentin N, Bastit D, Tilly H
Department of Clinical Hematology, Centre Henri Becquerel, Rouen, France.
Bone Marrow Transplant. 1997 Jan;19(1):31-5. doi: 10.1038/sj.bmt.1700604.
Intensive chemotherapy with autologous bone marrow transplantation is now considered the treatment of choice for young patients with sensitive relapse of non-Hodgkin's lymphoma (NHL) but results of this procedure in older patients remain unknown. We evaluated the feasibility of two cycles of salvage therapy followed by an autologous peripheral blood stem cell (PBSC) transplantation in 13 patients aged more than 60 years (median age: 62; range 61-72) suffering from relapsed (n = 10) or refractory (n = 3) aggressive NHL. All patients had previously received first-line treatment containing doxorubicin. An association of ifosfamide, VP16, cytosine-arabinoside with or without high-dose methotrexate was used as salvage and priming therapy prior to collection of PBSC. All patients received G-CSF following salvage therapy. PBSC collection could be performed in 10 patients and yielded a median number of CFU-GM: 98.4 x 10(4)/kg (range 68-369). Nine patients underwent a transplantation using BEAM conditioning regimen. The median time to granulocyte and platelet recovery was 13 days (range respectively: 9-25 and 9-16). One patient died from sepsis after transplantation. The main adverse experience occurring after transplantation was a prolonged decline of performance status. Seven patients achieved a complete remission and one failed to respond. Three patients are still alive in CR. We conclude that PBSC collection was possible in selected patients over 60 years of age with refractory or relapsed aggressive NHL and myeloablative therapy could be used with tolerable toxicity. Hematologic recovery and organ toxicity appears to be similar to those observed in younger patients. Deterioration of performance status after transplantation is the most important factor that could limit this procedure. Further investigations are necessary to determine which patients will be able to benefit by this procedure in terms of survival and quality of life.
强化化疗联合自体骨髓移植目前被认为是年轻的非霍奇金淋巴瘤（NHL）敏感复发患者的首选治疗方法，但该方法在老年患者中的效果仍不明确。我们评估了13例年龄超过60岁（中位年龄：62岁；范围61 - 72岁）复发（n = 10）或难治性（n = 3）侵袭性NHL患者接受两个周期挽救治疗后进行自体外周血干细胞（PBSC）移植的可行性。所有患者此前均接受过含阿霉素的一线治疗。在采集PBSC之前，使用异环磷酰胺、VP16、阿糖胞苷联合或不联合大剂量甲氨蝶呤作为挽救和预处理治疗。所有患者在挽救治疗后均接受粒细胞集落刺激因子（G - CSF）。10例患者能够进行PBSC采集，中位集落形成单位 - 粒细胞 - 巨噬细胞（CFU - GM）数量为：98.4×10⁴/kg（范围68 - 369）。9例患者采用卡莫司汀、依托泊苷、阿糖胞苷、美法仑（BEAM）预处理方案进行移植。粒细胞和血小板恢复的中位时间为13天（范围分别为：9 - 25天和9 - 16天）。1例患者移植后死于败血症。移植后出现的主要不良事件是体能状态长期下降。7例患者实现完全缓解，1例无反应。3例患者仍处于完全缓解状态存活。我们得出结论，对于60岁以上难治性或复发性侵袭性NHL患者，部分患者可以进行PBSC采集，清髓性治疗的毒性可以耐受。血液学恢复和器官毒性似乎与年轻患者相似。移植后体能状态恶化是限制该治疗方法的最重要因素。有必要进一步研究以确定哪些患者在生存和生活质量方面能够从该治疗方法中获益。
