Skip to main content
SpringerLink
Log in

Hochdosistherapie bei malignen Lymphomen

Eine Standortbestimmung

High-dose therapy in malignant lymphomas

The status quo

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

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.

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  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: 172–183

    Article  PubMed  Google Scholar 

  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: 100–101

    Google Scholar 

  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: 1691–1698

    Article  PubMed  CAS  Google Scholar 

  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: 235–242

    Article  PubMed  CAS  Google Scholar 

  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: 3817–3823

    Article  PubMed  CAS  Google Scholar 

  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: 2386–2395

    Article  PubMed  CAS  Google Scholar 

  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: 2677–2684

    Article  PubMed  CAS  Google Scholar 

  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: 2320–2325

    Article  PubMed  CAS  Google Scholar 

  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: 1290–1297

    Article  PubMed  CAS  Google Scholar 

  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: 2472–2479

    Article  PubMed  CAS  Google Scholar 

  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]: O239

  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: 3025–3030

    PubMed  CAS  Google Scholar 

  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: 3725–3732

    Article  PubMed  CAS  Google Scholar 

  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: 1141–1152

    PubMed  CAS  Google Scholar 

  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: 4413–4419

    Article  PubMed  CAS  Google Scholar 

  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: 22–30

    Article  PubMed  CAS  Google Scholar 

  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: 4926–4933

    Article  PubMed  Google Scholar 

  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: 1051–1054

    Article  PubMed  CAS  Google Scholar 

  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: 1255–1262

    Article  PubMed  Google Scholar 

  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: 1287–1295

    Article  PubMed  CAS  Google Scholar 

  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: 1934–1941

    Article  PubMed  Google Scholar 

  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: 667–678

    Article  PubMed  CAS  Google Scholar 

  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: 3121–3127

    Article  PubMed  CAS  Google Scholar 

  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 379–391

  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: 1540–1545

    Article  PubMed  CAS  Google Scholar 

  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: 4310–4316

    Article  PubMed  CAS  Google Scholar 

  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 s

    Google Scholar 

  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: 2065–2071

    Article  PubMed  CAS  Google Scholar 

  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: 3918–3927

    Article  PubMed  CAS  Google Scholar 

  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: 354a

    Google Scholar 

  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]: 198a

    Google Scholar 

  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: 1045–1051

    Article  PubMed  CAS  Google Scholar 

  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]: 891

    Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

  1. Abt. Hämatologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099 , Hamburg, Deutschland

    N. Schmitz & M. Nickelsen

  2. Hospital de la Santa Creu i Sant Pau, Barcelona, -, España

    A. Sureda

Authors
  1. N. Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Nickelsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Sureda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Schmitz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmitz, N., Nickelsen, M. & Sureda, A. Hochdosistherapie bei malignen Lymphomen. Onkologe 13, 427–433 (2007). https://doi.org/10.1007/s00761-006-1118-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-006-1118-3

Schlüsselwörter

Keywords

Search

Navigation