BEAM方案预处理自体外周血干细胞移植治疗侵袭性非霍奇金淋巴瘤

Treatment of aggressive non-Hodgkin lymphoma by autologous peripheral blood stem-cell transplantation following conditioning with BEAM regimen

目的:探讨以BEAM方案为主的预处理后行自体外周血干细胞移植(APBSCT)对侵袭性非霍奇金淋巴瘤(NHL)的疗效。方法:诊断为侵袭性NHL患者54例,其中难治、复发NHL的挽救治疗41例,作为高危侵袭性NHL的一线缓解后治疗13例;经环磷酰胺加VP-16动员后行BEAM方案(51例)或CBV方案(3例)预处理的APBSCT。结果:1例未植活,3个月后行半相合异基因干细胞移植;2例患者死于移植相关的并发症,其余患者均获得造血功能重建;移植后外周血中性粒细胞绝对计数(ANC)≥0.5×109/L的中位时间为10d(平均8～25d);血小板≥20×109/L的中位时间为15d(平均6～36d)。随访时间为6～102个月,中位随访时间为42.5个月。中位生存时间为35个月(2～100个月),3年总生存率为66.6%,3年无病生存率为66.4%;Cox多因素分析显示,疾病的分期和血小板植活的时间与NHL患者APBSCT后的生存相关。结论:BEAM为主的预处理方案的APBSCT无论作为侵袭型NHL的挽救治疗或高危侵袭型NHL的一线缓解后治疗安全,疗效肯定。

Objective：To evaluate the therapeutic effectiveness and safety of autologous peripheral blood stem-cell transplantation（APBSCT）for patients with aggressive non-Hodgkin lymphoma（NHL）.Method：Fifty-four patients with aggressive NHL were retrospectively reviewed and followed-up after receiving APBSCT conditioned with BEAM（51 cases）or CBV（3 cases）.Result：One patient who failed to engraft received second transplant using haplo-identical donor;Two patients died from treatment related toxicity（TRM）;The time of ANC≥0.5×109/L and platelet count≥20×109/L were at 10d（8-25 d）and 15 d（6-36 d）respectively.The median follow-up time was 42.5 months（6-102 months）;The estimated 3-year overall survival（OS）is 66.6%;The estimated 3-year disease-free survival（DFS）is 66.4%;Cox multivariate analysis showed that the disease stage and the platelet engraftment time were correlated with survival of high risk aggressive NHL following APBSCT conditioned with BEAM.Conclusion：APBSCT using BEAM as conditioning regimens is a safe and effective therapy for aggressive non-Hodgkin lymphoma.It can be used either as salvage treatment or first-line consolidation for high risk aggressive non-Hodgkin lymphoma.