自体造血干细胞移植联合抗CD20单抗治疗B细胞非霍奇金淋巴瘤(附1例报告)

The Treatment of Autologous Hematopoietic Stem Cell Transplantation and Anti-CD20-monoclonal Antibody for Non-Hodgkin Lymphoma of B Cell—One Case Report

目的探讨自体造血干细胞移植(AHSCT)联合抗CD20单克隆抗体(利妥昔单抗)治疗B细胞非霍奇金淋巴瘤(B-NHL)的方法和疗效。方法对1例难治、复发的弥漫大B细胞淋巴瘤患者进行AHSCT同时联合使用了抗CD20单抗。采用环磷酰胺(CTX)4g/m2+阿糖胞苷(Ara-C)4g/m2化疗联合粒细胞集落刺激因子(G-CSF)5μg/kg/d动员患者的外周血干细胞,然后予去甲氧柔红霉素(IDA)10mg/d×3d+经典BEAM方案预处理后回输保存的外周血干细胞,共回输单个核细胞(MNC)4.36×108/kg,CD34+细胞2.48×106/kg,回输后分别于+1d及+8d予抗CD20单抗375mg/m2行体内净化。结果患者移植后造血恢复顺利,于+15d中性粒细胞绝对数(ANC)>0.5×109/L,+18d血小板>20×109/L。移植后1月复查腹腔淋巴结消失。随访至移植后13月,造血功能恢复良好,病情处于持续完全缓解状态,仍在继续随访中。结论AHSCT联合抗CD20单抗是治疗难治、复发B细胞NHL的有效方法之一,有利于清除移植后的微小残留病(MRD),防止复发。

Objective To explore the treatment and effect of autologous hematopoietic stem cell transplantation （AHSCT） combined with anti-CD20-monoclonal antibody （Rituximab）for non-Hodgkin lymphoma of B cell.Methods 1 patient with refractory and recrudescent diffuse large B cell lymphoma received AHSCT and anti-CD20- monoclonal antibody.Mobilization regimen was cyclophosphamide （4g/m^2） and cytosar （4g/m^2） combined with GCSF （5μg/kg/d）. The conditioning regimen of idarubicin（10mg/d× 3d） and BEAM was received.MNC 4.36× 10^8/kg and CD34^＋ cell 2.48 × 10^6/kg were infused. Rituximab 375mg/m^2 was received in ＋1d and ＋8d postAHSCT.Results The hematopoietic stem cell was transplanted successfully.The ANC and PLT were grafted respectively in ＋ 15d and ＋ 18d.The celiac lymphoid nodes were disappeared in 1 month post-AHSCT.The patient was followed for 13 months after AHSCT and the function of hemopoiesis was well.The state of illness retained continuous complete remission.Conclusions The treatment of AHSCT combined with anti-CD20-monoclonal antibody was a effective way for refractory and recrudescent non-Hodgkin lymphoma of B cell.It was effective for eliminating MRD post-AHSCT and preventing relapse.