自体干细胞移植支持下的大剂量化疗一线治疗恶性淋巴瘤

High-dose chemotherapy with autologous stem cell transplantation as first-line therapy for patients with malignant lymphoma

背景与目的：目前自体干细胞移植（autologous stem cell transplantation，ASCT）支持下的大剂量化疗（high—dose chemotherapy，HDC）已成为复发或难治性恶性淋巴瘤（malignant lymphoma，ML）的标准治疗方法，但是对于一些选择的ML是否可作为一线治疗方案目前尚不明确。本文旨在通过回顾性分析探讨HDC／ASCT作为一线方案治疗ML的疗效。方法：自2000年9月至2007年6月，连续收治28例ML患者，中位年龄32岁（8～60岁），其中男性17例，女性11例。组织学类型包括24例非霍奇金淋巴瘤，4例霍奇金淋巴瘤。自体外周血干细胞动员采用化疗药物联合重组人粒细胞集落刺激因子方案。HDC方案采用BEAC（BCNU、CTX、Am—C、VP-16）方案。随访日期自干细胞回输之日期开始，末次随访日期为2007年7月30日。结果：28例患者均移植成功，重建造血功能。移植前CR14例，PR14例，移植后CR22例，PR6例。随访截止日期为2007年7月30日，中位随访时间为28个月（1．5～82个月），移植后4例病情进展，其中2例死亡，3年生存率及无进展生存率分别为89％和76％。大剂量化疗期间不良反应均可耐受，无移植相关死亡。结论：HDC／ASCT作为～线方案治疗ML是安全、可行及有效的治疗方法。

Background and purpose： Although high-dose chemotherapy followed by autologous stem cell transplantation（ASCT） has become the standard approach for patients with relapsed/refractory Hodgkin＇s disease （HD） or non- Hodgking lymphoma （NHL）, the effectiveness of HDT for selected patients with HD or NHL is not well defined. The purpose of this study was to evaluate the effectiveness of high-dose chemotherapy （HDC） with autologous stem cell transplantation（ASCT） as first-line therapy for patients with malignant lymphoma. Methods： Between September 2000 and June 2007, twenty-eight eligible patients underwent the HDC/ASCT as front-line therapy. There were 24 patients with NHL and 4 with HD. The median age in ASCT group was 32 years （ range, 8-60 years）. All patients received chemotherapy with rhG-CSF as mobilization regimen . The chemotherapeutic regimen consisted of BEAC（ BCNU,VP-16,Ara-C,CTX）. The follow up time was calculated from the day of stem cells infusion. Results： The median follow-up duration from transplantation was 28 months （ range, 1.5-82 months）. Prior to HDC, 50% of the patients achieved first complete remission （ CRI ） and 50% were in first partial remission（ PR1） . After HDC/ASCT, 22 patients achieved second complete remission （ CR2） and 6 pa- tients achieved second partial remission（PR2）. 26 patients were alive; 2 died of progressive disease. Estimated three-year o- verall survival （OS） and progression-free survival （PFS） were 89% and 76%, respectively. Conclusions： HDC/ASCT as first-line therapy is feasible , effective, and safe for patients with malignant lymphoma. A prospective randomized controlled trial is warranted to confirm these results.