外周血干细胞移植联合大剂量化疗治疗21例乳腺癌的初步观察

An Analysis of High Dose Chemotherapy Supported by Peripheral Blood Stem Cell Transplantation for 21 Cases of Advanced Breast Cancer

目的 :研究自体外周血造血干细胞移植(APBSCT)支持下的大剂量化疗 ,治疗伴有高危复发因素的乳腺癌和转移性乳腺癌的效果。方法 :选择21例高危(区域阳性淋巴结LN≥10个)或转移性乳腺癌患者 ,采用环磷酰胺 +阿霉素 +氟脲嘧啶(CAF)为常规化疗动员方案 ,联合粒细胞刺激因子 +粒巨细胞刺激因子(G/GM -CSF)动员方案 ,应用血细胞分离机CS -3000plus(美国Baxter)采集患者自体外周血造血干细胞 ,程控冷冻降温系统 -196℃保存干细胞 ,RT -PCR方法检测采集的造血干细胞(富集血)中残存病灶上皮性粘蛋白(MUC -1)和角蛋白(K19)的表达 ,预处理方案环磷酰胺CTX60mg/kg/d×2 +卡铂CBP800～1000mg/m2/d×1 +VP -16300mg/m2/d×2 ,全环境护理直至造血功能重建。结果 :本动员方案具有较好的动员效果 ,大多数病例采集两次即可获得足够的干细胞。第一次采集即能得到45 %的单个核细胞(MNC)及50 %的粒细胞克隆形成单位(CFU -GM)。MNC、CFU -GM及爆式红细胞形成单位(BFU -E)的回收率分别为80 %、74%、71 %。造血重建较快 ,中性粒细胞≥0 5×109/L的时间为11 8±1 65天。血小板≥50×109/L的时间为14 86±1 55天。回输CFU -GM最低者为0 67×105/kg,但其造血重建时间并未延长。15例乳腺癌患者中11例高危患者至今均无病生存(DFS) 。

Purpose: To evaluate the effect of high dose chemotherapy supported by peripheral blood stem cell transplantation for high risk recurrent and metastatic breast cancer patients Methods: Twenty-one cases of high risk (regional positive lymph node≥10) or metastatic breast cancer patients were selected The mobilization plan was CAF+G/GM-CSF (cyclophosphamide 600～800mg/m2, adriamycin 30～40mg/m2, 5-fluorouracil 300mg/m2, G/GM-CSF 10ug/kg/d) The auto-peripheral blood stem cells were collected by CS-3 000plus and frozen by programmed cryopreservation system The residues of breast cancer cells were determined by RT-PCR method for MUC-1 and K-19 expression High dose chemotherapy consisterd of CTX 60mg/kg/day×2, CBP 900mg/m2/day×1, VP-16600mg/m2/day×2 Patients lived in a highly efficient participate air filtered room until to reconsitute the hematopoietic function Results:The hematopoietic stem cell mobilization was effective in all patients Two times collection was enough in most patients 45%MNC and 50%CFU-GM were obtained in the first collection The recovery rates of MNC, CFU-GM, BFU-E were 80%, 74%and 71%respectively The hematopoietic reconstitution was established quickly, the mean time of reconstitution of neutrophilic granulocytes≥0 5×10 /L was 11 8+1 65 days and blood platelet>50×109/L 14 86+1 55 days The lowest volume of CFU-GM returning to patients was 0 67×105/kg, but the time of hematopoietic function reconstitution was not prolonged The FDS of 11 cases of high risk breast cancer patients remained and the longest survival time was 27 months One of three cases of metastatic breast cancer was FDS and other 2 cases were CDS There was no transplantation related death Conclusion: High dose chemotherapy supported by auto-peripheral blood stem cell transplantation for high risk and metastatic breast cancer patient is safe and efficiency Highly effective mobilization can be obtained by CAF+G/GM-CSF The RT-PCR method for determing the residues of breast cancer is sensitive and distinctive The short-term therapeutic effect of this scheme is efficient and the long-term effect will be awaited for further observation