Rapoport A P, Lifton R, Constine L S, Duerst R E, Abboud C N, Liesveld J L, Packman C H, Eberly S, Raubertas R F, Martin B A, Flesher W R, Kouides P A, DiPersio J F, Rowe J M
Department of Medicine, University of Rochester, School of Medicine and Dentistry, NY, USA.
Bone Marrow Transplant. 1997 May;19(9):883-90. doi: 10.1038/sj.bmt.1700772.
One hundred and thirty-six patients autografted for relapsed or refractory non-Hodgkin's lymphoma (NHL) were evaluated to assess long-term event-free survival and to identify important prognostic factors. High-dose therapy consisted primarily of carmustine (BCNU), etoposide, cytarabine, and cyclophosphamide (BEAC) followed by unpurged autologous stem cell rescue. The 5-year Kaplan-Meier event-free survival (EFS) for the entire cohort was 34% (95% confidence interval: 24-44%) with a median follow-up of approximately 3 years (range 0-7.5 years). For patients entering with minimal disease (defined as all areas < or = 2 cm), the 5-year EFS was 40 vs 26% for those entering with bulky disease (P = 0.0004). In the multivariate analysis, minimal disease on entry and administration of involved-field XRT post-transplant were significantly associated with improved EFS; the latter association was observed mainly in the cohort of patients with bulky disease. The overall 100-day treatment-related mortality rate was 4.4% (3% for the last 71 patients). New strategies are needed to reduce the high rate of relapse (50-60%) following auto-transplantation for relapsed or refractory NHL.
对136例因复发性或难治性非霍奇金淋巴瘤（NHL）接受自体移植的患者进行评估，以评估长期无事件生存率并确定重要的预后因素。大剂量治疗主要包括卡莫司汀（BCNU）、依托泊苷、阿糖胞苷和环磷酰胺（BEAC），随后进行未净化的自体干细胞救援。整个队列的5年Kaplan-Meier无事件生存率（EFS）为34%（95%置信区间：24-44%），中位随访时间约为3年（范围0-7.5年）。对于以微小疾病（定义为所有区域≤2 cm）入组的患者，5年EFS为40%，而以大包块疾病入组的患者为26%（P = 0.0004）。在多变量分析中，入组时的微小疾病和移植后受累野XRT的应用与EFS改善显著相关；后一种关联主要在大包块疾病患者队列中观察到。总体100天治疗相关死亡率为4.4%（最后71例患者为3%）。需要新的策略来降低复发性或难治性NHL自体移植后高复发率（50-60%）。
