Haematopoietic Stem Cell Transplantation for Lymphoma
AKW Lie
Hong Kong J Radiol 2011;14(Suppl):S69-76
Recent advances in chemotherapy and chemoimmunotherapy have improved the outcomes of many lymphoma patients. However, patients with relapsed or refractory disease continue to have poor outcomes. Studies show that intensive chemotherapy followed by autologous haematopoietic stem cell transplantation improves survival and is the standard of care for relapsed Hodgkin’s lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. Upfront autologous haematopoietic stem cell transplantation in first remission is considered the standard of care for mantle cell lymphoma, an aggressive disease with poor outcomes. Allogeneic haematopoietic stem cell transplantation, with a reduced intensity conditioning regimen if necessary, may be considered for the management of patients with refractory disease who relapse after autologous haematopoietic stem cell transplantation. Given the increased risk of mortality and morbidity associated with haematopoietic stem cell transplantation, it is important to perform the procedure at the appropriate time and select patients who are most likely to benefit from the procedure based on factors such as age, disease status, chemosensitivity, disease grade, histological subtype, and disease stage at diagnosis.
中文摘要
淋巴瘤的血幹細胞移植
李國維
化療及免疫化學療法新近的發展可以改善很多淋巴瘤患者的治療結果。可是復發或頑固性腫瘤患者 仍然有較差的治療結果。研究結果顯示高劑量化療及隨後的自體血幹細胞移植可改善病人存活率， 亦順理成章成為復發性霍奇金淋巴瘤、瀰漫大B細胞淋巴瘤、及濾泡性淋巴瘤的標準療法。套細胞 淋巴瘤屬於較難治療的淋巴瘤，結果往往較差，於首次緩解時進行前期自體血幹細胞移植被視為標 準療法。對於已接受自體血幹細胞移植但仍出現復發性病情的頑固性腫瘤患者來說，可考慮異體血 幹細胞移植（必要時可用減低劑量療方）。由於血幹細胞移植可能會增加患病及死亡風險，醫生必 須要為病人選擇合適的治療時間，並考慮病人的年齡、疾病狀態、藥敏、疾病等級、病理組織分類 及疾病診斷時的分期，以確保病人得到最大的治療效益。