CYTOKINES AND STEM CELL TRANSPLANTATION FOR REFRACTORY LYMPHOMAS

现代化疗治愈了大多数霍奇金病患者 和中度非霍奇金淋巴瘤。 然而，标准剂量 化疗很少能治愈那些不能达到预期效果的患者。 诱导化疗完全缓解或初始完全缓解 缓解期少于12个月。 高剂量化疗和 自体骨髓移植已经能够实现更长的 在某些患者中持续完全缓解。有明确 需要提高骨髓和外周血 在这些患者中使用清髓性方案后， 治疗。 在这项研究中，霍奇金病和非霍奇金病患者 联合化疗可以使淋巴瘤缩小。 那些患者 达到完全缓解或90%部分缓解，接受高- ICE剂量化疗（异环磷酰胺、卡铂、依托泊苷） 方案.作为干细胞的来源，骨髓和外周血 将用于 在采集外周血和骨髓之前， 患者将接受IL-1 β和G-CSF。 高剂量后 化疗和这些干细胞，患者将接受额外的G-CSF。 目前，只有6名患者登记。 一名患者没有 因淋巴瘤累及骨髓而入组; 2例患者 死于治疗相关毒性，3例患者达到 完全缓解 两名霍奇金病患者仍处于CR状态， 3+和2+年。 1例非霍奇金淋巴瘤患者CR后复发 持续了两年，目前正在接受治疗。

Modern chemotherapy cures the majority of patients with Hodgkin's disease and intermediate grade non-Hodgkin's lymphomas. However, standard dose chemotherapy is rarely curative for patients who fail to achieve a complete remission to induction chemotherapy or whose initial complete remission lasts less than 12 months. High-dose chemotherapy and autologous bone marrow transplantation have been able to achieve longer lasting complete remissions in some of these patients. There is a clear need for improving the rates at which bone marrow and peripheral blood counts recover following the myeloablative regimens used in these treatments. In this study, patients with Hodgkin's and non-Hodgkin's lymphoma are debulked with combination chemotherapy. Those patients achieving a complete remission, or 90% partial remission, receive high- dose chemotherapy with the ICE (ifosfamide, carboplatin, etoposide) regimen. As a source of stem cells, both bone marrow and peripheral blood will be used. Prior to harvesting peripheral blood and bone marrow, patients will receive IL-1beta and G-CSF. Following high-dose chemotherapy and these stem cells, patients will receive additional G-CSF. Still only six patients have been registered. One patient was not enrolled because of bone marrow involvement with lymphoma; two patients died from treatment-related toxicity and three patients achieved a complete remission. Two patients with Hodgkin's disease remain in CR at 3+ and 2+ years. One patient with non-Hodgkin's lymphoma relapsed from CR lasting 2 years and is currently undergoing therapy.