לימפומה והשתלת מח עצם

אני סטודנטית לסיעוד ואני מכירה חולה עם לימפומה מסוג non hodgkins לא ידוע לי הדרגה אבל אני יודעת שגילו לה גוש בגודל 10 ס"מ ועוד מספר גושים קטנים באותו איזור. היא קיבלה טיפול כימותרפי שכלל 12 טיפולים. כחודש לאחר סיום הטיפולים גילו שוב גידול נוסף. היא סיפרה לי שהתכנון הוא כנראה טיפול כימי נוסף עם השתלת מח עצם. השאלה שלי היא האם זה יכול להיות השתלה עצמית? והאם תוכל להפנות אותי לחומר אשר ייתן לי נתונים לגבי הפרוגנוזה שלה.

שלם רב זו בהחלט יכולה להיות השתלה עצמית, אך הדבר תלוי בכמה גורמים. אחד הגורמים הוא מידת מעורבות הלימפומה במח העצם שלה. לגבי הפרוגנוזה, הדבר תלוי מאוד בסוג הלימפומה, ב- STAGE של המחלה, ברגישות התאים לכימותרפיה ועוד, כך שקשה לכוון אותך למאמרים אודות הפרוגנוזה. יש לא מעט עבודות בנושא. צרפתי כמה תקצירים בסוף התשובה. קישורים: http://cancernet.nci.nih.gov/cgi-bin/srchcgi.exe?TYPE=search&ZUI=208_00066P&DBID=pdq&SFMT=pdq_statement/1/0/0&PASSTHRU=:ip:212.179.182.81::srchform:PDQ : http://www.hematology.org/education/index.html#29# יש כמה מאמרים על לימפומה והשתלות. http://www.mc.vanderbilt.edu/cancer/cancerinfo/lymphomadiagnosis.html#treatment http://144.32.228.3/scripts/WEBC.EXE/nhscrd/fullrec תקצירים: א. J Clin Oncol 2001 Jan 15;19(2):406-413 Autologous Transplantation for Diffuse Aggressive Non-Hodgkin's Lymphoma in Patients Never Achieving Remission: A Report from the Autologous Blood and Marrow Transplant Registry. Vose JM, Zhang MJ, Rowlings PA, Lazarus HM, Bolwell BJ, Freytes CO, Pavlovsky S, Keating A, Yanes B, van Besien K, Armitage JO, Horowitz MM Lymphoma Working Committee of the Autologous Blood and Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI. [Record supplied by publisher] PURPOSE: To evaluate the results of high-dose chemotherapy and autologous hematopoietic stem-cell transplantation (autotransplants) in patients with diffuse aggressive non-Hodgkin's lymphoma (NHL) who never achieve a complete remission with conventional chemotherapy. PATIENTS AND METHODS: Detailed records from the Autologous Blood and Marrow Transplant Registry (ABMTR) on 184 patients with diffuse aggressive NHL who never achieved a complete remission with conventional chemotherapy and subsequently received an autotransplant were evaluated. Transplants were performed between 1989 and 1995 and were reported to the ABMTR by 48 centers in North and South America. RESULTS: Seventy-nine (44%) of 184 patients achieved a complete remission or a complete remission with residual imaging abnormalities of unknown significance after autotransplantation. Thirty-four (19%) of 184 had a partial remission and 55 (31%) of 184 had no response or progressive disease. Eleven patients (6%) were not assessable for response because of early death. The probabilities of progression-free and overall survival at 5 years after transplantation were 31% (95% confidence interval [CI], 24% to 38%) and 37% (95% CI, 30% to 45%), respectively. In multivariate analysis, chemotherapy resistance, Karnofsky performance status score less than 80 at transplantation, age >/= 55 years at transplantation, receiving three or more prior chemotherapy regimens, and not receiving pre- or posttransplant involved-field irradiation therapy were adverse prognostic factors for overall survival. CONCLUSION: High-dose chemotherapy and autologous hematopoietic stem-cell transplantation should be considered for patients with diffuse aggressive NHL who never achieve a complete remission but who are still chemotherapy-sensitive and are otherwise transplant candidates ב. תקציר לגבי לימפומה מסוג אחר: J Clin Oncol 2001 Feb 1;19(3):727-735 High-Dose Therapy and Autologous Stem-Cell Support for Chemosensitive Transformed Low-Grade Follicular Non-Hodgkin's Lymphoma: A Case-Matched Study From the European Bone Marrow Transplant Registry. Williams CD, Harrison CN, Lister TA, Norton AJ, Blystad AK, Coiffier B, Taghipour G, Schmitz N, Goldstone AH Department of Hematology, University College Hospital, and Departments of Medical Oncology and Histopathology, St Bartholomew's Hospital, London, United Kingdom. [Record supplied by publisher] PURPOSE: To assess the outcome of high-dose therapy with autologous stem-cell support in patients with histologic transformation of low-grade follicular non-Hodgkin's lymphoma (NHL) and identify significant prognostic factors, as well as to compare survival of these patients with that of patients with matched low-grade and de novo high- or intermediate-grade NHL undergoing the same procedure. PATIENTS AND METHODS: Fifty patients with transformed low-grade NHL have been reported to the European Bone Marrow Transplant registry. Outcome from high-dose therapy and significant prognostic factors were analyzed. Their survival was also compared with that of 200 patients with matched low-grade NHL and 200 patients with matched de novo high- or intermediate-grade NHL by a case-matched analysis. RESULTS: The procedure-related death rate among the 50 transformed NHL patients was 18%. Overall survival (OS) and progression-free survival (PFS) rates were 51% and 30% at 5 years, respectively. Median PFS time was 13 months. Raised lactate dehydrogenase levels at transformation (P: =.0031) was identified as the only adverse significant predictor of PFS on multivariate analysis. A subgroup of patients with residual chemosensitive disease who attained complete remission after high-dose therapy had the best outcome, with an OS at 5 years of 69%. A comparison with matched patients with low-grade disease and with de novo high- or intermediate-grade lymphoma showed no significant difference in OS (P: =.939 and P: =.438, respectively). CONCLUSION: Patients with chemosensitive transformed lymphoma should be seriously considered for high-dose therapy and autologous stem-cell support ג. J Chemother 2000 Oct;12(5):431-4 Autologous bone marrow transplantation in relapses of chemotherapy-sensitive aggressive non-Hodgkin's lymphoma: long-term outcome. Lalle M, Montuoro A Hematology Division, San Camillo Hospital, Rome, Italy. Eleven patients with relapsed intermediate to high grade non-Hodgkin's lymphoma (NHL) responding to induction treatment were treated with high-dose chemotherapy (CBV or ICBV conditioning regimen) plus autologous bone marrow transplantation as early consolidation treatment. At 6 years, relapse-free survival is 27.3% and overall survival is 36.4%. Patients with bone marrow involvement from NHL before the induction therapy did not have a worse prognosis. Despite the long-term follow-up, no secondary myelodysplasia or acute leukemia occurred in our patients. Within the limitations of patient number and selection, our retrospective study confirms the importance of tumor responsiveness and long-term follow-up. Patients with relapsed, but chemotherapy-sensitive NHL can achieve prolonged survival after high-dose chemotherapy plus autologous bone marrow transplantation. ד. השואה בין השתלה עצמית ומתורם: Bone Marrow Transplant 2000 Oct;26(8):859-64 Allogeneic or autologous bone marrow transplantation (BMT) for non-Hodgkin's lymphoma (NHL): results of a provincial strategy. Ontario BMT Network, Canada. Schimmer AD, Jamal S, Messner H, Keating A, Meharchand J, Huebsch L, Walker I, Benger A, Gluck S, Smith A University Health Network, Princess Margaret Hospital, University of Toronto, Canada. In 1986, the bone marrow transplant centers in Ontario agreed to a strategy for the treatment of patients with NHL. Suitable patients would undergo autotransplant but be referred for allotransplant if they had persistent marrow involvement or an inadequate marrow/stem cell harvest. Data of all patients were recorded in a database. We reviewed this database to compare these transplant modalities with respect to overall survival, rate of relapse and treatment-related mortality. Between January 1986 and August 1997, 429 patients underwent BMT for NHL - 385 autotransplants and 44 allotransplants. Sixty-eight percent of patients received their transplant for aggressive NHL, while the others had indolent lymphoma. Three-year actuarial survival did not differ between allogeneic and autologous BMT: 71% vs 62%, respectively (P = 0.5330 by log-rank testing). Three-year actuarial rate of relapse was lower after allotransplant than autotransplant: 6% vs 41%, respectively (P = 0.0006 by log-rank testing). Treatment-related mortality was higher after allotransplant than autotransplant: 23% vs 6%, respectively (P = 0.001 by chi2 analysis). For further comparison, autotransplant patients were randomly matched 2:1 with the allotransplant patients for age +/- 5 years, disease status at BMT, disease histology, and year of BMT. In the matched comparison, survival did not differ (relative risk of death after allotransplant: 0.711 (95% CI: 0.309-1.637)). Relapse rate was significantly lower in the allotransplant group (relative risk of relapse for allotransplant: 0.190 (95% CI: 0.043-0.834)) and treatment-related mortality was not significantly different (relative risk for allotransplant: 1.425 (95% CI: 0.527-3.851)). In conclusion, a review of a provincial strategy for treatment of NHL, shows that survival is not different after allogeneic or autologous BMT, but the rate of relapse is lower after allotransplant. These data support continuing the current provincial strategy. ה. Blood 2000 Oct 1;96(7):2399-404 High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis. Kewalramani T, Zelenetz AD, Hedrick EE, Donnelly GB, Hunte S, Priovolos AC, Qin J, Lyons NC, Yahalom J, Nimer SD, Moskowitz CH Memorial Sloan-Kettering Cancer Center, New York, NY, USA. High-dose chemoradiotherapy (HDT) with autologous stem cell transplantation (ASCT) is the treatment of choice for patients with relapsed aggressive non-Hodgkin lymphoma (NHL). However, its role in the treatment of patients with primary refractory disease is not well defined. The outcomes of 85 patients with primary refractory aggressive NHL who underwent second-line chemotherapy with ICE with the intent of administering HDT/ASCT to those patients with chemosensitive disease were reviewed. Patients were retrospectively classified as induction partial responders (IPR) if they attained a partial response to doxorubicin-based front-line therapy or as induction failures (IF) if they had less than partial response. Forty-three patients (50.6%) had ICE-chemosensitive disease; there was no difference in the response rate between the IPR and the IF groups. Intention-to-treat analysis revealed that 25% of the patients were alive and 21.9% were event-free at a median follow-up of 35 months. Among 42 patients who underwent transplantation, the 3-year overall and event-free survival rates were 52.5% and 44.2%, respectively, similar to the outcomes for patients with chemosensitive relapsed disease. No differences were observed between the IPR and IF groups, and there were no transplantation-related deaths. More than one extranodal site of disease and a second-line age-adjusted International Prognostic Index of 3 or 4 before ICE chemotherapy were predictive of poor survival. These results suggest that patients with primary refractory aggressive NHL should receive second-line chemotherapy, with the intent of administering HDT/ASCT to those with chemosensitive disease. Newer therapies are needed to improve the outcomes of patients with poor-risk primary refractory disease. ו. Eur J Haematol 2000 Jul;65(1):17-22 Long-term follow-up of autologous stem-cell transplantation for follicular and transformed follicular lymphoma. Berglund A, Enblad G, Carlson K, Glimelius B, Hagberg H Department of Oncology, Uppsala University, Akademiska sjukhuset, Sweden. [email protected] Despite the fact that follicular lymphomas are both chemo- and radiosensitive, the disease is generally non-curable. These lymphomas often undergo transformation to a more malignant state. In order to improve the prognosis, high-dose treatment with stem cell support has been tested, but its role in the treatment of this disease is still unclear. Fourteen men and eight women with a median age of 45 yr (34-59) were treated with high-dose therapy with autologous stem cell transplantation between 1987 and 1996. The patients were selected to undergo intensive therapy because of an estimated short survival (median < 3 yr), even though they had chemosensitive disease and adequate performance status. Eleven patients' lymphomas had transformed, and the other eleven patients had one or more unfavourable prognostic signs such as advanced stage, bulky disease, multiple relapses, or short remission duration. The conditioning regimen has varied over the period, but BEAC (Becenum, etoposide, cytarabine, cyclophosphamide) or etoposide/cyclophosphamide with or without total body irradiation (TBI) was used in most patients. Nine patients had their stem cells purged. After a median follow-up time of 74 months overall survival was 81% and disease-free survival 72%. One toxic procedure-related death occured. There was no difference in outcome between patients with a transformed lymphoma compared to those without transformation. The patients treated with TBI had a significantly worse outcome. Toxicity was also much higher in TBI-treated patients, including four cases of secondary malignancy (three myelodysplastic syndrome (MDS) cases and one patient with breast carcinoma). This retrospective study, with the longest follow-up time so far reported, shows a promising 6-yr DFS of 72% in a group of follicular lymphoma patients with a bad prognosis. The outcome of patients with transformed lymphoma compared to historical controls is especially encouraging. The high incidence of MDS is worrying. The role of TBI should be questioned because this and other studies have not shown any advantage of using TBI. In the absence of randomised trials the role of high-dose treatment for patients with follicular lymphoma is still not defined.