双次自体外周血干细胞移植联合序贯大剂量CHOEP方案治疗中高度恶性淋巴瘤

Tandem Autotransplants of Peripheral Blood Stem Cells Following Sequential High-dose CHOEP Chemotherapy for Aggressive Lymphoma

为了评价CHOEP方案对外周血干细胞的动员效果、序贯化疗联合双次移植的远期疗效和患者的耐受性,对5例复发、难治中高度恶性淋巴瘤在双次自体外周血干细胞(PBSC)移植联合序贯大剂量CHOEP方案的临床结果进行了回顾性分析。5例恶性淋巴瘤患者的动员方案为CHOEP联合G-CSF5μg/(kg.d),两次移植预处理均为大剂量CHOEP,第二次移植与第一次移植的中位间隔时间为9(5~31)周,两次移植回输单个核细胞数(MNC)分别为3.05(1.91~4.14)×108/?和3.55(2.23~6.0)×108/?;CD34+细胞分别为4.11(2.59~4.94)×106/?和5.70(2.77^-10.6)×106/?;CFU-GM分别为2.97(2.01~4.54)×105/?和2.44(1.78~2.9)×105/?。研究结果表明,回输外周血造血干细胞后,所有患者的造血均快速重建,中性粒细胞(ANC)≥0.5×109/L时间为10(8~12)天和10.5(9~12)天,血小板≥20×109/L分别为11(10~14)天和12.5(10~15)天。双次移植后5例次并发Ⅲ-Ⅳ度口腔粘膜炎,无肝肾功能损害,无移植相关死亡。随访时间46(9~88)月,4例存活,其中3例无病生存,总体生存率80%,无病生存率60%。结论:双次自体外周血干细胞移植联合序贯大剂量CHOEP化疗方案是治疗复发、难治中高度恶性淋巴瘤的有效手段,动员方法简便安全,预处理方案耐受性好,值得临床进一步研究探索。

The purpose of this study was to evaluate the effecacy and safety of CHOEP mobilization regimen, and the effect and tolerance of sequential chemotherapy combined with tandem autotransplants of peripheral blood stem cells for aggressive lymphoma. The clinical data of 5 patients with recurrent, aggressive lymphoma treated with of sequential chemotherapy combined with tandem autotransplants were analyzed retrospectively. The patients included 1 HD and 4 NHL. Mobilization regimen was CHOEP combined with G-CSF 5μg/（ kg ·d ）. The conditioning regimen for the tandem transplantation was high-dose CHOEP. The interval of the tandem autotransplantation was 9 （5 - 31 ） weeks. In tandem autotransplant, the cell number of MNC transfused was 3.05 （1.91 -4.14） × 10^8/kg and 3.55 （2.23 -6.0）× 10^8/kg ; CD34^＋ cells were 4.11 （2.59 - 4.94） × 10^6/kg and 5.70 （2.77 - 10.6 ） × 10^6/kg; CFU-GM was 2.96（2.01 -4.54） ×10^5/kg and 2.44 （1.78 -2.9 ） × 10^5/kg respectively （P 〉 0.05 ）. The results showed that all patients gained prompt and sustained hemotopoietic reconstitution. The interval of ANC≥0.5 × 10^9/L was 10 （8 - 12）days and 10.5 （9-12） days; Pt≥2.0 × 10^9/L was 11 （10 -14） days and 12.5 （10 -15） days respectively （P〉0. 05 ）. Four patients survived, three patients among them were alive in disease-free for median of 46（9 -88 ） months.The overall survival was 80%, and the disease-free survival was 60%. In conclution, the method of sequential high-dose CHOEP chemotherapy combined with autotransplants of peripheral blood stem cells in tandem for aggressive lymphoma is probably safe and effective.