MARROW GRAFTING FOR THE LYMPHOMAS

我们研究的目的是提高无病生存率和总生存率， 恶性淋巴瘤和霍奇金病患者的亚组， 使用高剂量治疗和干细胞移植。 临床研究 拟议的04 - 08年将测试1）相对功效和毒性 高剂量依托泊苷治疗高危霍奇金淋巴瘤 疾病，2）高剂量依托泊苷制备的治疗潜力 复发性中高度恶性淋巴瘤的化疗方案， 移植后主动免疫治疗，以进一步降低 在前瞻性随机试验中评估的淋巴瘤复发，以及3） 巩固大剂量放化疗延长缓解期的能力 晚期低度恶性淋巴瘤持续时间。 为了确认 在第二阶段研究中，我们的结果的有效性，我们将采用一个案例- 将比较治疗结局的对照统计分析 与从 斯坦福大学淋巴瘤数据库。 我们的研究采用了新的方法来解决后- 移植复发，这是成功使用的最大障碍， 恶性淋巴瘤的消融治疗和干细胞移植。 独特型 疫苗接种，这是由研究人员开发和研究的， 计划项目，将在一个最低限度的疾病状态后， B细胞淋巴瘤患者的移植。 一种新的分馏方法， 导致移植物抗淋巴瘤效应的同种异体骨髓， 没有移植物抗宿主病，已经开发的研究人员在 项目IV，这种方法将在临床试验中进行研究， 05 - 08年 使用高纯度干细胞的临床试验 通过阳性干细胞选择获得的制剂代表了 减少骨髓移植物污染相关复发的方法 (see项目四）。 此外，我们将评估检测方法， 最小残留病，由计划项目中的研究人员开发 (see项目三）。

The goal of our studies is to improve disease-free and overall survival in subsets of patients with malignant lymphoma and Hodgkin's disease through the use of high dose therapy and stem cell grafting. The clinical studies proposed for years 04-08 will test 1) the relative efficacy and toxicity of high dose etoposide-containing preparative regimens in poor risk Hodgkin's disease, 2) the curative potential of high dose etoposide preparative regimens in recurrent intermediate and high grade lymphoma and the ability of post-transplant active immunotherapy to further decrease the rate of lymphoma relapse as assessed in a prospective randomized trial, and 3) the ability of consolidative high dose radiochemotherapy to prolong remission duration in advanced stage low grade lymphoma. In order to confirm the validity of our results in the phase II studies, we will employ a case- control statistical analysis in which therapeutic outcome will be compared to individually matched clusters of historical controls obtained from the Stanford Lymphoma Databank. Our studies incorporate novel methods to approach the problem of post- transplant relapse, which is the greatest obstacle to the successful use of ablative therapy and stem cell transplant in malignant lymphomas. Idiotype vaccination, which has been developed and studied by investigators in this Program Project, will be employed in a minimal disease state post- transplant in B-cell lymphoma patients. A novel method of fractionation of allogeneic bone marrow which results in a graft-versus-lymphoma effect, without graft-versus-host disease, has been developed by investigators in Project IV, and this approach will be studied in a clinical trial during the years 05-08. A clinical trial using highly purified stem cell preparations obtained through positive stem cell selection represents an approach to reduce relapse related to contamination of the marrow graft (see: Project IV). In addition, we will evaluate methods of detection of minimal residual disease, developed by investigators in the Program Project (see: Project III).