Der Onkologe

, Volume 13, Issue 5, pp 427–433 | Cite as

Hochdosistherapie bei malignen Lymphomen

Eine Standortbestimmung


Hochdosistherapie (HDT) und autologe Transplantation von Blut bildenden Stammzellen sind wichtig in der Behandlung von Lymphompatienten. Daten der European Group for Blood and Marrow Transplantation (EBMT) belegen eine steigende Häufigkeit sowohl von autologen als auch von allogenen Transplantationen bei den meisten Untergruppen der Lymphome. In Anbetracht der neuen Entwicklungen der herkömmlichen Therapie, insbesondere der immer häufigeren Anwendung des monoklonen Anti-CD20-Antikörpers Rituximab sowie des Einsatzes dosisreduzierter Konditionierung vor allogener Transplantation, ist eine Neuabschätzung von HDT und Stammzellentransplantation indiziert, damit die Rolle dieser Modalität im Jahr 2006 neu definiert werden kann.


Hochdosistherapie Autologe Transplantation Morbus Hodgkin Follikuläres Lymphom Aggressives Lymphom 

High-dose therapy in malignant lymphomas

The status quo


High-dose therapy (HDT) and autologous transplantation of hematopoietic stem cells are important in the treatment of patients with lymphoma. Data from the European Group for Blood and Marrow Transplantation (EBMT) document increasing numbers of autologous and allogeneic transplants for most lymphoma subtypes. Recent developments in conventional therapy, in particular the ever-increasing use of the monoclonal anti-CD20 antibody rituximab well as the incremental use of reduced-intensity conditioning prior to allogeneic transplantation call for a re-evaluation of HDT and stem cell transplantation to allow the role of these modalities to be freshly defined in 2006.


High-dose therapy Autologous transplantation Hodgkin’s disease Follicular lymphoma Aggressive lyphoma 


  1. 1.
    Alvarez I, Sureda A, Caballero MD et al. (2006) Nonmyeloablative stem cell transplantation is an effective therapy for refractory or relapsed Hodgkin lymphoma: results of a Spanish prospective cooperative protocol. Biol Blood Marrow Transplant 12: 172–183PubMedCrossRefGoogle Scholar
  2. 2.
    Betticher D, von Rohr A, Kovacsovics T et al. (2005) Sequential high-dose chemotherapy (SHDC) with autologous stem cell transplantation (ASCT) vs standard CHOP regimen for pts with untreated aggressive NHL. Result of the mistral trial from the Swiss Group for Clinical Cancer Research (SAKK). Ann Oncol 16: 100–101Google Scholar
  3. 3.
    Brugger W, Hirsch J, Grunebach F et al. (2004) Rituximab consolidation after high-dose chemotherapy and autologous blood stem cell transplantation in follicular and mantle cell lymphoma: a prospective, multicenter phase II study. Ann Oncol 15: 1691–1698PubMedCrossRefGoogle Scholar
  4. 4.
    Coiffier B, Lepage E, Briere J et al. (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 346: 235–242PubMedCrossRefGoogle Scholar
  5. 5.
    Deconinck E, Foussard C, Milpied N et al. (2005) High dose therapy followed by autologous purged stem cell transplantation and doxorubicin based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by the GOELAMS. Blood 105: 3817–3823PubMedCrossRefGoogle Scholar
  6. 6.
    Diehl V, Franklin J, Pfreundschuh M et al. (2003) Standard and Increased-Dose BEACOPP Chemotherapy Compared with COPP-ABVD for Advanced Hodgkin’s Disease. N Engl J Med 348: 2386–2395PubMedCrossRefGoogle Scholar
  7. 7.
    Dreyling M, Lenz G, Hoster E et al. (2005) Early consolidation by myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission significantly prolongs progression-free survival in mantle-cell lymphoma: results of a prospective randomized trial of the European MCL Network. Blood 105: 2677–2684PubMedCrossRefGoogle Scholar
  8. 8.
    Federico M, Bellei M, Brice P et al. (2003) High-Dose Therapy and Autologous Stem-Cell Transplantation Versus Conventional Therapy for Patients With Advanced Hodgkin’s Lymphoma Responding to Front-Line Therapy. J Clin Oncol 21: 2320–2325PubMedCrossRefGoogle Scholar
  9. 9.
    Gianni AM, Bregni M, Siena S et al. (1997) High-dose chemotherapy and autologous bone marrow transplantation compared with MACOP-B in aggressive B-cell lymphoma. N Engl J Med 336: 1290–1297PubMedCrossRefGoogle Scholar
  10. 10.
    Gisselbrecht C, Lepage E, Molina T et al. (2002) Shortened first-line high-dose chemotherapy for patients with poor-prognosis aggressive lymphoma. J Clin Oncol 20: 2472–2479PubMedCrossRefGoogle Scholar
  11. 11.
    Glass B, Kloess M, Reiser M et al. (2006) Repetitive high-dose therapy followed by autologous stem cell trasplantation (MegaCHOEP) for primary treatment of aggressive NHL: the impact of rituximab on outcome and toxicity. Bone Marrow Transplant 37 [Suppl 1]: O239Google Scholar
  12. 12.
    Haioun C, Lepage E, Gisselbrecht C et al. (2000) Survival benefit of high-dose therapy in poor risk aggressive non-Hodgkin’s lymphoma: final analysis of the prospective LNH87–2 protocol – a groupe d’Etude des lymphomes de I’Adulte study. J Clin Oncol 18: 3025–3030PubMedGoogle Scholar
  13. 13.
    Hiddemann W, Kneba M, Dreyling M et al. (2005) Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood 106: 3725–3732PubMedCrossRefGoogle Scholar
  14. 14.
    Hunault-Berger M, Ifrah N, Solal-Celigny P, for the Group Quest-Est des Leucémies Aiguës et des Maladies du Sang (GOELAMS) (2002) Intensive therapies in follicular non-Hodgkin lymphomas. Blood 100: 1141–1152PubMedGoogle Scholar
  15. 15.
    Kaiser U, Uebelacker I, Abel U et al. (2002) Randomized study to evaluate the use of high-dose therapy as part of primary treatment for „aggressive“ lymphoma. J Clin Oncol 20: 4413–4419PubMedCrossRefGoogle Scholar
  16. 16.
    Kluin-Nelemans HC, Zagonel V, Anastasopoulou A et al. (2001) Standard chemotherapy with or without high-dose chemotherapy for aggressive non-Hodgkin’s lymphoma: randomized phase III EORTC study. J Natl Cancer Inst 93: 22–30PubMedCrossRefGoogle Scholar
  17. 17.
    Lenz G, Dreyling M, Schiegnitz E et al. (2004) Moderate increase of secondary hematologic malignancies after myeloablative radiochemotherapy and autologous stem-cell transplantation in patients with indolent lymphoma: results of a prospective randomized trial of the German Low Grade Lymphoma Study Group. J Clin Oncol 22: 4926–4933PubMedCrossRefGoogle Scholar
  18. 18.
    Linch DC, Winfield D, Goldstone AH et al. (1993) Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin’s disease: results of a BNLI randomised trial. Lancet 341: 1051–1054PubMedCrossRefGoogle Scholar
  19. 19.
    Martelli M, Gherlinzoni F, De Renzo A et al. (2003) Early autologous stem-cell transplantation versus conventional chemotherapy as front-line therapy in high-risk, aggressive non-Hodgkin’s lymphoma: an Italian multicenter randomized trial. J Clin Oncol 21: 1255–1262PubMedCrossRefGoogle Scholar
  20. 20.
    Milpied N, Deconinck E, Gaillard F et al. (2004) Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 350: 1287–1295PubMedCrossRefGoogle Scholar
  21. 21.
    Peggs KS, Hunter A, Chopra R et al. (2005) Clinical evidence of a graft-versus-Hodgkin’s-lymphoma effect after reduced-intensity allogeneic transplantation. Lancet 365: 1934–1941PubMedCrossRefGoogle Scholar
  22. 22.
    Peniket AJ, Ruiz de Elvira MC, Taghipour G et al. (2003) An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation. Bone Marrow Transplant 31: 667–678PubMedCrossRefGoogle Scholar
  23. 23.
    Perez-Simon JA, Kottaridis PD, Martino R et al. (2002) Nonmyeloablative transplantation with or without alemtuzumab: comparison between 2 prospective studies in patients with lymphoproliferative disorders. Blood 100: 3121–3127PubMedCrossRefGoogle Scholar
  24. 24.
    Pfreundschuh M, Truemper L, Oesterborg A et al. (2006) CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MinT) Group. Lancet Oncol 379–391Google Scholar
  25. 25.
    Philip T, Guglielmi C, Hagenbeek A et al. (1995) Autologous Bone Marrow Transplantation As Compared With Salvage Chemotherapy In Relapses Of Chemotherapy-Sensitive Non-Hodgkin’s Lymphoma. N Engl J Med 333: 1540–1545PubMedCrossRefGoogle Scholar
  26. 26.
    Robinson SP, Goldstone AH, Mackinnon S et al. (2002) Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation. Blood 100: 4310–4316PubMedCrossRefGoogle Scholar
  27. 27.
    Schmitz N, Haverkamp H, Josting A et al. (2005) Long term follow up in relapsed Hodgkin’s disease (HD): Updated results of the HD-R1 study comparing conventional chemotherapy (cCT) to high-dose chemotherapy (HDCT) with autologous haemopoietic stem cell transplantation (ASCT) of the German Hodgkin Study Group (GHSG) and the Working Party Lymphoma of the European Group for Blood and Marrow Transplantation (EBMT). Proc ASCO 23: 562 sGoogle Scholar
  28. 28.
    Schmitz N, Pfistner B, Sextro M et al. (2002) Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haematopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet 359: 2065–2071PubMedCrossRefGoogle Scholar
  29. 29.
    Schouten HC, Qian W, Kvaloy S et al. (2003) High-Dose Therapy Improves Progression-Free Survival and Survival in Relapsed Follicular Non-Hodgkin’s Lymphoma: Results From The Randomized European CUP Trial. J Clin Oncol 21: 3918–3927PubMedCrossRefGoogle Scholar
  30. 30.
    Sebban C, Belanger C, Brousse N et al. (2003) Comparison of CHVP + interferon with CHOP followed by autologous stem cell transplantation with a TBI conditioning regimen in untreated patients with high tumor burden follicular lymphoma: results of the randomized GELF94 Trial (G.E.L.A. Study Group). Blood 102: 354aGoogle Scholar
  31. 31.
    Sureda A, Robinson S, Ruiz de Elvira C et al. (2003) Non myeloablative allogeneic stem cell transplantation reduces transplant related mortality in comparison with conventional allogeneic transplantation in relapsed or refractory Hodgkin’s Disease: Results of the European group for Blood and Marrow Transplantation. Blood 102 [Suppl 1]: 198aGoogle Scholar
  32. 32.
    Verdonck LF, van Putten WL, Hagenbeek A et al. (1995) Comparison of CHOP chemotherapy with autologous bone marrow transplantation for slowly responding patients with aggressive non-Hodgkin’s lymphoma. N Engl J Med 332: 1045–1051PubMedCrossRefGoogle Scholar
  33. 33.
    Zanni M, Di Nicola M, Patti C et al. (2004) Rituximab-Supplemented High-Dose Sequential (HDS) Chemotherapy with Autograft Is Highly Effective in High-Risk (aaIPI 2–3) Diffuse Large B-Cell Lymphoma: Results of a Prospective Multicenter Study on 91 Consecutive Patients Treated at Diagnosis. Blood 104 [Suppl 1]: 891Google Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Abt. HämatologieAsklepios Klinik St. GeorgHamburgDeutschland
  2. 2.Hospital de la Santa Creu i Sant Pau, Barcelona-España

Personalised recommendations