Bolwell B, Goormastic M, Andresen S
Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, OH, USA.
Bone Marrow Transplant. 1997 Mar;19(5):443-8. doi: 10.1038/sj.bmt.1700678.
Few series describing the results of autologous bone marrow transplantation (ABMT) for the treatment of non-Hodgkin's lymphoma report mature follow-up. We retrospectively reviewed 110 adults with NHL treated with ABMT from 1988 to 1993. Overall survival and relapse-free survival were 50% and 35%, respectively. Estimated median relapse-free survival was 16 months. There was no statistically significant difference in relapse-free or overall survival by low, intermediate, and high-grade histologies, as defined by the International Working Formulation. The most powerful negative prognostic variable was an elevated LDH at the time of transplant (relapse-free survival 17% vs 42% for those with a normal LDH). Forty-seven patients were in complete remission 2 years after transplant. Extended follow-up revealed that 100% of patients with high-grade histologies remained in complete remission, whereas patients with intermediate-grade and low-grade histologies remained at risk of relapse with longer follow-up. Of 22 patients with diffuse large cell lymphoma (LCL) or immunoblastic (IBL) histologies, eight of eight with IBL remain in continued remission, while four of 14 with LCL relapsed 24-48 months after ABMT. We conclude that patients with high-grade histologic subtypes of NHL who are in complete remission 2 years after ABMT are likely to be cured. However, patients with intermediate and low-grade histologic subtypes are at continued risk of relapse and require appropriate clinical surveillance for at least 48 months after ABMT.
很少有系列研究描述自体骨髓移植（ABMT）治疗非霍奇金淋巴瘤的结果并报告成熟的随访情况。我们回顾性分析了1988年至1993年接受ABMT治疗的110例成年非霍奇金淋巴瘤患者。总生存率和无复发生存率分别为50%和35%。估计的无复发生存期中位数为16个月。按照国际工作分类法定义，低、中、高分级组织学类型在无复发生存率或总生存率方面无统计学显著差异。最有力的负面预后变量是移植时乳酸脱氢酶（LDH）升高（LDH正常者无复发生存率为42%，而LDH升高者为17%）。47例患者在移植后2年处于完全缓解状态。延长随访发现，高分级组织学类型的患者100%仍处于完全缓解状态，而中分级和低分级组织学类型的患者在更长时间随访后仍有复发风险。在22例弥漫性大细胞淋巴瘤（LCL）或免疫母细胞淋巴瘤（IBL）组织学类型的患者中，8例IBL患者均持续缓解，而14例LCL患者中有4例在ABMT后24 - 48个月复发。我们得出结论，ABMT后2年处于完全缓解状态的非霍奇金淋巴瘤高分级组织学亚型患者可能治愈。然而，中分级和低分级组织学亚型的患者仍有持续复发风险，在ABMT后至少48个月需要进行适当的临床监测。
