自体造血干细胞移植治疗恶性血液病及实体瘤的临床研究

Clinical research of autologous hematopoietic stem cell transplantation for hematological malignancies and solid tumors

目的探讨自体造血干细胞移植(AHSCT)治疗恶性血液病及实体瘤的疗效。方法1996年5月至2005年2月广州医学院第一附属医院肿瘤血液中心用AHSCT治疗的白血病及恶性淋巴瘤患者共20例,年龄18～50岁。预处理化疗方案选用以下药物中任意2种或3种联合:阿糖胞苷3～4g/m2,环磷酰胺4～6g/m2,依托泊苷(VP-16)0.5～1.0g/m2,司莫司汀300mg/m2,马法兰140mg/m2,塞替哌600mg/m2,卡铂1.0g/m2,白消安(Bu)16mg/kg。除2例ALL联合全身照射(剂量为8Gy)外,其余均单用化疗。结果所有患者移植后均重建造血,无移植相关死亡;随访中位值39.5(2～109)个月,无病生存者15例,占全部移植患者的75.0%。其中无病生存1年12例(60%),2年8例(40%),3年8例(40%),最长存活9年余。结论自体造血干细胞移植可明显提高完全缓解肿瘤患者的治愈率;对于复发或难治者,可以提高完全缓解率,延长生存期,提高生活质量。

Objective To evaluate the therapeutic effect of autologous hematopoietic stern cell transplantation （AHSCT） on hematological malignancies and solid tumors. Methods Twenty patients with age from 18 to 50 years received AHSCT. Two or 3 of following agents, Cytarabine （Ara- C） 3-4 g/m^2, Cyclophosphamide （CTX） 4 -6 g/m^2, Etoposide （ VP - 16） 0. 5 - 1.0 g/m^2 , Semustine （me - CCNU） 300 mg/m^2, Melphalan （Mel） 140 mg/m^2, Thiotep a （TSPA） 600 mg/m^2 , Carhoplatin （CBP） 1.0 g/m^2, Busulfan 16mg/kg, were combined as conditioning regimen in all patients. Among them 2 patients with ALL accepted additional total body irradiation （TB1）. Results All the patients have reconstituted bone marrow hematopoiesis afi.er transplantation. None of them had the transplantation - related mortality. Among 20 patients with CML and malignant lymphoma, 15 achieved diseasefree survival （DFS） with a median survival time of 39. 5 （2 - 109） months. Conclusion AHSCT might represent an effective approach to the treatment of some patients with chemosensitive solid tumor who are complete remission or part remission. It is suggested that the patients have got a obvious survival benefit from AHSCT.