Salloum E, Jillella A P, Nadkarni R, Seropian S, Hu G L, D'Andrea E, Zelterman D, Cooper D L
Department of Internal Medicine, Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut 06520-8032, USA.
Cancer. 1998 Apr 15;82(8):1506-12. doi: 10.1002/(sici)1097-0142(19980415)82:8<1506::aid-cncr12>3.0.co;2-8.
Limited information is available regarding the cardiac and pulmonary effects of high dose chemotherapy (HDCT) and autologous peripheral blood progenitor cell (PBPC) transplantation.
The authors evaluated cardiac and pulmonary function after BEAM (BCNU 300 mg/m2, etoposide 400 mg/m2/day x 3 days, cytosine arabinoside 200 mg/m2/day x 4 days, and melphalan 140 mg/m2), HDCT, and PBPC transplantation in 26 patients with non-Hodgkin's lymphoma or Hodgkin's disease. Therapy prior to BEAM included doxorubicin (25 patients), bleomycin (6 patients), and mediastinal irradiation (4 patients). All patients had pulmonary function tests (PFTs) and equilibrium radionuclide angiography before and at a median of 57 weeks after transplantation.
Prior to high dose therapy, 8 patients had abnormal PFTs, including 6 with a diffusing capacity of the lung for carbon monoxide (DLCO) <70% of predicted value. At the time of reevaluation after HDCT, all patients included in the study were in complete remission, and none had received additional therapy after transplantation. At a median of 77 weeks after transplantation, none of the patients had cardiac or pulmonary symptoms. Moreover, there were no significant changes in total lung capacity, forced vital capacity, forced expiratory volume in 1 second/forced vital capacity, DLCO, or left ventricular ejection fraction values when compared with baseline studies.
The authors concluded that HDCT with BEAM and PBPC transplantation did not result in significant cardiac or pulmonary toxicity, even in patients with borderline pretransplantation PFT values. Further studies of patients undergoing HDCT and PBPC transplantation are needed.
关于大剂量化疗（HDCT）及自体外周血祖细胞（PBPC）移植对心脏和肺部的影响，目前可用信息有限。
作者评估了26例非霍奇金淋巴瘤或霍奇金病患者在接受BEAM方案（卡莫司汀300mg/m²、依托泊苷400mg/m²/天×3天、阿糖胞苷200mg/m²/天×4天、美法仑140mg/m²）、HDCT及PBPC移植后的心脏和肺功能。BEAM方案之前的治疗包括多柔比星（25例患者）、博来霉素（6例患者）及纵隔照射（4例患者）。所有患者在移植前及移植后中位时间57周时均进行了肺功能测试（PFT）和平衡放射性核素血管造影。
在大剂量治疗前，8例患者PFT异常，其中6例肺一氧化碳弥散量（DLCO）<预测值的70%。在HDCT后重新评估时，纳入研究的所有患者均处于完全缓解状态，且移植后均未接受额外治疗。移植后中位时间77周时，所有患者均无心脏或肺部症状。此外，与基线研究相比，总肺容量、用力肺活量、1秒用力呼气容积/用力肺活量、DLCO或左心室射血分数值均无显著变化。
作者得出结论，即使对于移植前PFT值处于临界状态的患者，采用BEAM方案的HDCT及PBPC移植也不会导致显著的心脏或肺部毒性。需要对接受HDCT及PBPC移植的患者进行进一步研究。
