Myelodysplastic syndrome after autologous transplantation for lymphoma: the price of progress.
Myelodysplastic syndrome after autologous transplantation for lymphoma: the price of progress.
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淋巴瘤自体移植后骨髓增生异常综合征：进步的代价。
DOI：
10.1182/blood.v83.12.3437.bloodjournal83123437
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发表时间：
1994
期刊：
影响因子：
20.3
通讯作者：
R. Stone
中科院分区：
文献类型：
--
作者：
R. Stone
它似乎从来没有发生过没有意想不到的或不必要的问题。例如，内燃机使交通运输发生了革命性的变化，但随之而来的是高速公路死亡人数、空气污染和商业街。医学上也必须如此吗？米勒等人对淋巴瘤高剂量治疗和自体造血干细胞拯救后发生骨髓增生异常综合征和/或急性白血病的患者的描述再次提出了这个问题。自体移植作为非霍奇金淋巴瘤和霍奇金病的治疗方式的短期安全性（< 10%的急性死亡率）以前已经建立。最重要的是，复发性非霍奇金淋巴瘤和难治性霍奇金淋巴瘤患者在接受移植后可以实现长期无病生存，这些患者通常被认为不能用常规挽救性化疗治愈。对于那些根据肿瘤对化疗的持续敏感性而选择的患者，以及那些在移植前有最小残留病变的患者，长期无病生存率可能为40%至50%。这种昂贵的技术的使用显然使许多病人受益，而且在将来还可以帮助更多的病人。清髓性治疗在这一人群中的成功使许多研究人员相信，在具有低度疾病的首次缓解的非霍奇金淋巴瘤患者或在晚期基础上具有显著复发风险的中度或高度疾病患者中，自体移植的作用是值得研究的。明尼苏达大学的移植医生描述的经验和其他几个中心的初步报告”关于骨髓增生异常作为自体移植后的晚期并发症的发展要求仔细检查。当人们得知自体骨髓移植后骨髓发育不良的确切发生率为15%时，“许多问题出现了。问题真的如此严重吗？或者这只是一个中心的异常，由一种特定的方法或统计数据不可避免的变化（即运气不好）造成的？它会不会是一个人为因素，导致移植后无法准确诊断骨髓增生异常，就像一个从街上走进来的病人，以前从未见过肿瘤学家？我们能否识别出移植后发生骨髓增生异常的高危患者？骨髓增生异常真的是移植的“并发症”，还是仅仅是成功的抗淋巴瘤治疗的结果？更多的淋巴瘤患者接受了许多含烷化剂的化疗方案，现在可能是长期生存者。我们对晚期或预后不良淋巴瘤患者的治疗方法是否应该基于这种医源性白血病潜在新环境的描述而改变？我刚开始问。淋巴瘤自体移植后的骨髓增生异常，如果不是一个真实的问题，肯定是越来越多的报道，
P ROGRESS, IT SEEMS, never occurs without unintended or unwanted problems. For example, the internal combustion engine revolutionized transportation, but with it came highway fatalities, air pollution, and the strip mall. Must it be the same in medicine? Miller et al’s description’ of patients who developed myelodysplastic syndrome and/or acute leukemia after high-dose therapy and autologous hematopoietic stem cell rescue for lymphoma brings up the issue again. The short-term safety (< 10% acute mortality) of autologous transplantation as a treatment modality for non-Hodgkin’s lymphoma and Hodgkin’s disease has been previously e~tablished.’.~ Most importantly, patients with relapsed non-Hodgkin’s lymph~ma’~~ and refractory Hodgkin’s not generally considered curable with conventional salvage chemotherapy, may achieve long-term disease-free survival after undergoing transplantation. In patients who are selected on the basis of continued sensitivity of their tumors to chemotherapy and who have minimal residual disease before transplant, the long-term disease-free survival rate may be 40% to 50%.’s4 The use of this expensive technology has clearly benefited many patients and could help a great many more in the future. The success of myeloablative therapy in this population has convinced many investigators to study the role of autologous transplantation in patients with non-Hodgkin’s lymphoma in first remission who have low-grade disease or in those with intermediateor high-grade disease at significant risk to relapse on the basis of advanced stage at Therefore, the experience described by transplant physicians at the University of Minnesota’ and preliminary reports from several other centersg”’ concerning the development of myelodysplasia as a late complication after autologous transplantation mandates careful examination. When one learns of a 15% actuarial incidence of myelodysplasia after autologous bone marrow transplantation,’ many questions arise. Is the problem actually of such a significant magnitude or is this just an aberration at one center caused by one particular approach or by the inevitable vicissitudes of statistics (ie, bad luck)? Could it be an artifact caused by an inability to diagnose myelodysplasia as accurately after transplant as in the patient who walks in off the street, never having previously met a medical oncologist? Can we identify patients who are at particularly high risk to develop myelodysplasia after transplantation? Is myelodysplasia really a “complication” of transplant or is it just a consequence of successful antilymphoma therapy? More patients with lymphoma who have received many alkylating agent-containing chemotherapeutic regimens may now be long-term survivors. Should our approach to patients with advanced or poor prognosis lymphoma be altered based on this description of a potentially new setting for iatrogenic leukemia? And I’ve just begun to ask. Myelodysplasia after autologous transplant for lymphoma, if not a real problem, is certainly being reported with increas-
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识别接受 m-BACOD 或 M-BACOD 治疗的大细胞淋巴瘤患者的主要预后亚组。
影响因子：
39.2
作者：
Shipp,MA;Harrington,DP;Klatt,MM;Jochelson,MS;Pinkus,GS;Marshall,JL;Rosenthal,DS;Skarin,AT;Canellos,GP
通讯作者：
Canellos,GP
霍奇金病自体骨髓移植前骨髓细胞遗传学评估的重要性。
DOI：
10.1200/jco.1991.9.9.1575
发表时间：
1991
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Chao,NJ;Nademanee,AP;Long,GD;Schmidt,GM;Donlon,TA;Parker,P;Slovak,ML;Nagasawa,LS;Blume,KG;Forman,SJ
通讯作者：
Forman,SJ
自体骨髓移植治疗 B 细胞非霍奇金淋巴瘤：100 名敏感复发患者的治疗相关死亡率非常低。
DOI：
10.1200/jco.1990.8.5.784
发表时间：
1990
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Freedman,AS;Takvorian,T;Anderson,KC;Mauch,P;Rabinowe,SN;Blake,K;Yeap,B;Soiffer,R;Coral,F;Heflin,L
通讯作者：
Heflin,L
自体骨髓移植后的骨髓增生异常综合征：治愈性癌症治疗的另一个晚期并发症。
影响因子：
20.3
作者：
Miller,JS;Arthur,DC;Litz,CE;Neglia,JP;Miller,WJ;Weisdorf,DJ
通讯作者：
Weisdorf,DJ
影响因子：
158.5
作者：
FISHER, RI;GAYNOR, ER;MILLER, TP
通讯作者：
MILLER, TP