大剂量化疗结合外周血干细胞移植治疗横纹肌肉瘤疗效分析

Analysis on the clinic effects of high dose chemotherapy combined with autologous peripheral blood stem cell transplantation in 3 cases of stage III Rhabdomysacoma in children

目的对采用大剂量化疗结合自体外周血造血干细胞移植及免疫治疗的3例横纹肌肉瘤患儿的疗效进行观察。方法 3例横纹肌肉瘤患儿,年龄为3、10、14岁,强烈化疗5、6、11个周期,平均(7.33±3.21)个疗程;期间进行外周血造血干细胞采集、手术切除,然后进行自体外周血造血干细胞移植,术后行白介素-2治疗,复发者行普通化疗及局部放疗,定期随访。结果均顺利度过移植后骨髓抑制期,造血重建时间为13、14、15d,平均(13.33±0.58)d。术后随访8、12、17个月,3例患儿无病生存2/3,总生存率3/3。结论大剂量化疗、自体外周血造血干细胞移植及白介素-2相结合治疗横纹肌肉瘤,在移植前达到部分缓解时可取得较好疗效,长期生存率较高。

Objective The regular chemotherapy has a very poor long-term therapeuti effects to advanced rhabdomyoma normally. This paper aims to investigate the therapeuti effects of high dose chemotherapy combined with autologous peripheral blood stem cell transplantation and immune treatment in 3 cases of stage III rhabdomyoma in children. Methods 3 children with stage III rhabdomyoma, according to the transformation of the tumor before autologous peripheralblood stem cell transplantation, were grouped for completely remission. These cases aged 3, 10, 14 years [ mean （9 ±5. 56） years], were employed for the study. Primary sites of the tumors included nasopharynx （n = 1 ）, supraorbital （ n = 1 ）, nasopharynx and supraorbital （n = 1 ）. Before autologous peripheral blood stem cell transplantation the patients received 5, 6, 11 courses [mean （7.33±3.21） courses] of intensive induction chemotherapy. During chemotherapy the autologous peripheral blood stem ceils were harvested and the tumor excision was done. After transplantation IL-2 immune therapy was administered. When some children were recurrent, the local radiation and the regular chemotherapy were given again. Results After the autologous peripheral- blood stem cell transplantation, 3 patients successfully underwent reinfusion and the restrain period of bone marrow. The amount of whiteblood ceils was recovered to over 2 × 10^9/L after about 13, 14, 15 days of transplantation, average is （ 13.33 ±0. 58） days. The follow-up visit （ranging from 8 months to 17 months, average is （ 12. 33±4. 51 ） months, median is 12 months） revealed that 2 patients in PR had achieved CR. The case, pimary sites of the tumors included nasopharynx, was recurrent after 6 months of APBSCT, but it was sensitive to regular chemotherapy and ray-therapy. An average 12 months follow-up showed that the disease-free seriod（DFS） of the PR is 2/3,1/3 in PR, and its total survival rate is 3/3. Conclusion High dose chemotherapy combined with autologous peripheralstem cell transplantation and IL- 2 immune treatment can have good outcome of patients with stage Ⅲ rhabdomyoma in PR before Auto-PBSCT.