自体造血干细胞移植治疗实体肿瘤12例

Clinical observation on 12 patients with solid tumors treated by autologous peripheral blood stem cell transplantation

目的探索和评价自体造血干细胞移植(APBSCT)治疗实体肿瘤的作用和效果。方法自2003年9月～2005年11月采用APBSCT治疗实体肿瘤患者12例,其中初治2例,经手术切除肿瘤8例;淋巴瘤2例。(1)动员方案为化疗+G-CSF,经2～3次采集获得MNC中位数为5.2×108/kg的干细胞,其CD3+4细胞为4.3×106/kg,干细胞采集后-80℃冰箱冷冻。(2)预处理方案:12例不同类型的肿瘤选择不同的高剂量化疗方案。(3)预处理后24h,回输自体造血干细胞。(4)出现低血细胞期及低免疫细胞期,给予G-CSF、EPO,静脉丙种免疫球蛋白及中药扶正固本等综合治疗。结果(1)近期疗效:12例患者CR4例(33.3%),PR8例(66.7%),在移植后的7～10d快速重建造血干细胞及免疫细胞的功能并发挥作用,无1例出现感染及出血现象。其中3例未经手术的肿瘤患者,X线胸片、CT扫描示肿瘤病灶有不同范围的缩小,肿大淋巴结消失。(2)远期疗效:每3个月为1周期,随访时间3～36个月。2例患者已死亡(其中1例转移肺癌延长生存期12个月,1例淋巴瘤IV期B延长生存期6个月)。其余患者均提高了生活质量。结论经APBSCT支持下的高剂量化疗治疗实体肿瘤是一种较安全的,能够提高缓解率的重要手段。

Objective To evaluate the therapeutic effect of autologous peripheral blood stem cell transplantation（APBSCT） on solid tumors. Methods From September 2003 to November 2005,12 patients with solid tumor were treated by APBSCT. Among 12 patients, 2 cases were primarily treated; 8 cases had been operated by tumor resection and treated by chemotherapy for 2 - 3 cycles; 2 cases were lymphoma which had been treated by chemotherapy for 6 - 8 cycles. （ 1 ） The mobilizing plan was chemotherapy plus G-CSF, after 2 - 3 times of collections, 5.2× 10^8/kg of MNC and 4.3 × 10^6/kg of CD34^＋ cells （mean counts） were obtained, then which were stored at - 80℃. （2） The pretreatment plan was that the 12 patients were treated with different high-dose chemotherapy plans according to different solid tumors. （3）After pretreatment for 24 h, autologous peripheral blood stem cell transplantation were performed. （4） If low blood cell and low immunologic cell stage appeared, the patients should be treated with complex therapy of GCSF, EPO, gamma immunoglobulin and the traditional Chinese medicine. Results （1）The recent therapeutic effect： all the 12 patients reconstructed haemopaietic stem cells and immunocytes function and produced obvious effects during 7 - 10 d. There were 4 cases （ 33.3 % ） of CR and 8 eases （66.7 % ） of PR, without infection and hemorrhage cases. Three patients with solid tumor who had not been operated by tumor resection appeared the focus growing downwards obviously, the swelled lymphaden disappeared. （2）The long-term therapeutic effect：taking 3 months as one cycle, the patients were followed-up for 3 - 36 months. Two patients were dead （one patient with metastasis lung carcinoma prolonged life span for 12 months）,one patient with lymphoma phase IV B prolonged life span for 6 months）. The life quality in other patients was improved obviously. Conclusion The high-dose chemotherapy supported by APBSCT is an importaut and safe method in the treatment of solid tumor,which could improve recovery rate obviously.