自身造血干细胞移植治疗儿童晚期实体肿瘤

Treatment of children with advanced malignant solid tumors with autologous haematopoietic stem cell transplantation

目的 为提高儿童高危恶性实体肿瘤的疗效,对27例晚期实体肿瘤患儿进行自身造血干细胞移植。方法 13例次采集骨髓,另15例经CS-3000血细胞分离机采集外周血干细胞(其叶1例疑有肿瘤污染的Ⅳ期神经母细胞瘤患儿经CliniMACS行CD34+细胞分选的净化处理)。2例霍奇金氏淋巴瘤患儿经CTX+BCNU+VP16(CBV)方案治疗,其余患儿均采用VP16+卡铂+马法兰的预处理方案。结果 采集骨髓及外周血得到的单个核细胞分别为(5.4±2.1)×108/kg和(4.1±1.9)×108/kg。所有患儿移植后都获造血重建,中性粒细胞、血小板恢复至0.5×109/L和20×109/L的时间分别为(11.8±5.7)d和(21.0±9.3)d。本组无1例因移植相关并发症而死亡;本组病例平均随访13月,4例患儿移植后5月内因复发而死亡,1例非霍奇金氏淋巴瘤(NHL)患儿移植后3月中枢神经系统复发,但目前已带瘤生存17月,其余22例患儿均处于无病生存状态。结论 自身干细胞移植是一种比较安全且有效的救治儿童晚期恶性实体肿瘤的措施,值得推广应用。

Objective To improve the therapeutic efficacy in children with malignant solid tumors at high risk, autologous haematopoietic stem cell transplantation has been performed in 27 children with advanced solid tumors. Methods In 13 patients bone marrow was collected from the anterior CS-3000 cell seperator and in another 15 patients after G-CSF mobilization. In 13 cases peripheral mononuclear cells harvested from the bone marrow of crista of iliac in both sides involvement of neuroblastoma, the autograft in this case was purged with CliniMACS based on the CD34 positive selection. With exception to 2 children with Hodgkin's disease conditioned with CBV protocol (cyclophosphamide + BCNU +etopside), all other children were conditioned with Etopside plus Carboplatin plus Mel-phalan. Results The number of mononuclear cells collected from bone marrow or peripheral blood were equal to ( 5.4±2. 1)×108/kg, and( 4.1±1.9)×108/kg respectively. All of them achieved haematopoietic reconstitution after transplantation. The mean time fo the neutrophile count recovering to 0. 5 ×109/L was( 11.8±5. 7) days and for the platelet count recovering over 2.0×109/L was (21.0±9.3) days. None of our children died of complications associated with transplantation. The mean follow up time was 13 months in this group of patients. Four of twenty-seven children died of relapse 5 months after transplantation. One of twenty-seven children with NHL had CNS involvement 3 months after transplantation. But up to now, this child has been surviving with tumor for 17 months. Other 22 children are still in free of disease. Conclusion Autologous stem cell transplantation is a safe and effective measure in saving the life of children with malignant solid tumors and is worthy of further application.