自体骨髓移植治疗成人恶性淋巴瘤后的长期随访

1983年至1991年我们用高剂量长春新碱、阿糖胞苷、环已亚硝脲及环磷酰胺加全淋巴(身)照射[Hd-VCCA+TL(B)I]和自体骨髓移植(ABMT)治疗了21例中高危组成人恶性淋巴瘤患者。其中5例为晚期,6例为耐药复发,4例为部分缓解(PR),4例为首次缓解(CR_1),2例为第二次缓解(CR_2)。平均随访37个月,9年生存率在何杰金氏淋巴瘤(HL)和非何杰金氏淋巴瘤(NHL)分别预期为89%和64%,提示该方案毒性反应可以耐受。如果在患者病程早期进行,可使约70%的成人恶性淋巴瘤患者长期存活。同时提示对骨髓受累或原淋巴细胞型的患者在移植前应作适当的净化残留肿瘤细胞的处理。

Long-Term Following of Adult Patients with Malignant Lymphoma Treated by Autologous Bone Marrow Transplantation

Betweem Jun, 1983 and December, 1991, 21 adult patients with intermedi-ate or high-grade malignant lymphoma(ML)were treated by ablative chemoradiotherapy, in-cluding vincristine, cytosine arabinoside, BCNU and cyolophosphamide plus total lymphoidor body irradiation with boost irradiation over bulky and orighal tumor areas [Hd-VCCA+TL(B)I], following autologous bone marrow transplantation (ABMT). 5 patients were inadvanced stage, 6 in drug-sensitive relapse, 4 in partial remission(PR), 4 in first completeremission (CR_1)and 2 in CR_2, one with marrow involvement at ABMT. The actuarial 9years diseasefree survival in patients with non-Hodgkin's lymphoma(NHL)and HL is 64%and 89%, respectively, with a median following up to 34 months. This study demonstratedthat our Hd-VCCA+TL(B)I regimen following ABMT performed early in CR or drugsensi-tive relapse of adult poor prognosis lymphoma, may potentially cure more than 70% ofthem. In this instance, the toxity of these methods is tolerable. The results confirm the valueof ABMT in treatment of adult ML, and suggest that it is necessary to purge the residual tu-mor cells in the bone marrow before ABMT in patients with marrow infiltration, or lym-phoblastic lymphoma.