Prolonged disease-free survival after autologous bone marrow transplantation in patients with non-Hodgkin's lymphoma with a poor prognosis.
Prolonged disease-free survival after autologous bone marrow transplantation in patients with non-Hodgkin's lymphoma with a poor prognosis.
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预后不良的非霍奇金淋巴瘤患者自体骨髓移植后无病生存期延长。
DOI：
10.1056/nejm198706113162402
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
Yeap,B
中科院分区：
文献类型：
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作者：
Takvorian,T;Canellos,GP;Ritz,J;Freedman,AS;Anderson,KC;Mauch,P;Tarbell,N;Coral,F;Daley,H;Yeap,B
尽管非霍奇金淋巴瘤的主要治疗取得了进展，但复发是常见的，复发后的治疗也不令人满意。自体骨髓移植，虽然有时成功，但通常有令人失望的结果。我们在复发性非霍奇金淋巴瘤患者中进行了一项此类移植试验，在选择患者时使用了严格的标准;我们只包括那些在常规治疗后疾病最小的患者（淋巴结疾病<2 cm，组织学检查骨髓受累≤ 5%），并且其肿瘤细胞表达B1抗原。符合这些标准的49例患者接受环磷酰胺和全身照射支持移植的自体骨髓已在体外治疗抗B1单克隆抗体和补体。所有患者均具有预后不良的特征，包括初次化疗后复发、组织学转化为更具侵袭性的疾病和结节性播散。33例患者有骨髓受累史，其中16例在骨髓采集时受累，所有患者均获得血液学和免疫学移植。仅发生2例治疗相关死亡，分别为肝静脉闭塞性疾病和脑出血。34例患者在没有维持治疗的情况下的无疾病缓解持续了>2至>52个月（中位随访时间>11个月）。这些结果是相似的晚期，高级别的非霍奇金淋巴瘤患者接受初级联合chemotherapy.This研究表明，自体骨髓移植具有耐受的毒性和高疗效的一个子集的患者，否则无法治愈，但仍然响应于细胞减灭治疗。结果表明，这种移植在治疗新诊断的非霍奇金淋巴瘤患者中的作用。（N Engl J Med 1987; 316：1499-1505.）
Despite advances in the primary treatment of non-Hodgkin's lymphoma, relapse is common and treatment after relapse is unsatisfactory. Autologous bone marrow transplantation, although sometimes successful, has generally had disappointing results. We conducted a trial of such transplantation in patients with relapsed non-Hodgkin's lymphoma, using strict criteria in selecting patients; we included only those in whom disease was minimal after conventional treatment (nodal disease <2 cm and bone marrow involvement ≤5 percent on histologic examination) and whose tumor cells expressed the B1 antigen. Forty-nine patients meeting these criteria received cyclophosphamide and whole-body irradiation supported by transplantation of autologous bone marrow that had been treated in vitro with anti-B1 monoclonal antibody and complement. All patients had features of a poor prognosis, including relapse from primary chemotherapy, histologic conversion to more aggressive disease, and extranodal dissemination. Thirty-three patients had a history of bone marrow involvement — 16 at the time that marrow was obtained.Hematologic and immunologic engraftment was achieved in all patients. Only two treatment-related deaths occurred, from venoocclusive disease of the liver and intracerebral hemorrhage, respectively. Disease-free remission without maintenance therapy has lasted from >2 to >52 months in 34 patients (median follow-up, >11 months). These results are similar to those obtained in patients with advanced, high-grade non-Hodgkin's lymphoma treated with primary combination chemotherapy.This study demonstrates that autologous bone marrow transplantation has tolerable toxicity and high efficacy in a subset of patients who are otherwise incurable but still responsive to cytoreductive therapy. The results suggest a role for such transplantation in the treatment of selected patients with newly diagnosed non-Hodgkin's lymphoma. (N Engl J Med 1987; 316:1499–1505.)