EFFECTIVENESS OF HIGH-DOSE COMBINATION CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH NON-HODGKINS LYMPHOMAS WHO ARE STILL RESPONSIVE TO CONVENTIONAL-DOSE THERAPY
EFFECTIVENESS OF HIGH-DOSE COMBINATION CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR PATIENTS WITH NON-HODGKINS LYMPHOMAS WHO ARE STILL RESPONSIVE TO CONVENTIONAL-DOSE THERAPY
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DOI：
10.1200/jco.1989.7.11.1621
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发表时间：
1989-11-01
影响因子：
45.3
通讯作者：
RICHARDS, JDM
中科院分区：
文献类型：
--
作者：
GRIBBEN, JG;GOLDSTONE, AH;RICHARDS, JDM
我们于1981年9月开始了一项研究，探讨大剂量联合化疗在常规治疗失败的非霍奇金淋巴瘤患者中的作用。50例弥漫性中、高级别非霍奇金淋巴瘤患者接受了高剂量联合化疗和自体骨髓拯救（ABMT）治疗，并至少随访1年。20例患者对常规剂量化疗仍有反应，15例对一线治疗有部分反应（PR），5例复发后对挽救治疗有PR。这些患者中有12例（60%）达到完全缓解（CR）（2例在加强放疗后），3例患者在计算机断层扫描（CT）扫描上有非进行性肿块作为唯一的异常。这些患者均未在手术过程中死亡。29例患者对常规剂量化疗无反应：19例对首次治疗无反应，10例对复发后给予的挽救治疗无反应。这些患者中只有3例达到CR，所有患者的CR持续时间都很短。该组中只有两名患者在手术后存活超过2年，并且在CT扫描上都有非进行性异常。9名患者（31%）在手术过程中死于败血症。在这些对常规剂量治疗无反应的患者中，剂量递增与高手术相关死亡率和低反应率相关。在那些仍然患有化疗反应性疾病的患者中，反应率高，死亡率低。在后一组患者中，现在需要进行一项随机试验，比较高剂量治疗和ABMT与最佳常规剂量挽救治疗。
We commenced a study in September 1981 to investigate the role of high-dose combination chemotherapy in the management of patients with non-Hodgkin''s lymphomas who had failed conventional therapy. Fifty patients with diffuse intermediate- and high-grade non-Hodgkin''s lymphomas were treated with high-dose combination chemotherapy with autologous bone marrow rescue (ABMT) and have a minimum follow-up of 1 year. Twenty patients had disease that was still responsive to conventional-dose chemotherapy, 15 had archieved a partial response (PR) to first-line therapy, and five were showing PR to salvage therapy after relapse. Twelve of these patients (60%) achieved complete remission (CR) (two following boost radiotherapy) and three patients have nonprogressive masses on computed tomographic (CT) scan as the only abnormality. None of these patients died during the procedure. Twenty-nine patients had disease not responsive to chemotherapy at conventional dosages: 19 had no response to first-time therapy and 10 showed no response to salvage therapy given after relapse. Only three of these patients achieved CR, all of short duration only. Only two patients in this group remain alive more than 2 years after the procedure and both have nonprogressive abnormalities on CT scan. Nine patients (31%) died of sepsis during the procedures. In these patients with disease not responsive to conventional-dose therapy, dose escalation is associated with a high procedure-related mortality and a low response rate. In those patients who still have chemotherapy-responsive disease the response rate is high and mortality is low. It is in this latter group of patients that there is now a need to carry out a randomized trial of high-dose therapy and ABMT versus best conventional-dose salvage therapy.