超大剂量化学药物和外周血干细胞移植治疗晚期妇科恶性肿瘤5例分析

High-dose Chemotherapy with Peripheral-blood Stem Cells Transplantation in Patients with Advanced Gynecological Malignant Tumors

目的 探讨超大剂量化学药物和外周血干细胞移植治疗晚期妇科恶性肿瘤的临床疗效。方法 对 4例卵巢癌 ,1例输卵管癌 ,在肿瘤基本切净后行超大剂量化学治疗 (HDC)及外周血干细胞移植术 (PBSCT) (其中 4例为复发病例 ,1例为初治Ⅲ期卵巢癌 ) ,观察疗效及副反应发生情况。结果 5例患者接受HDC和PBSCT治疗后 ,4例临床缓解 ,1例卵巢幼年型颗粒细胞瘤疾病进展死亡。4例患者临床无瘤缓解期平均为 9个月 ;平均存活时间 2 1个月。超HDC治疗副反应主要为骨髓严重抑制 ,外周血白细胞最低降到 0 .0 5× 10 9/L～ 0 .2× 10 9/L ;血小板降到 7× 10 9/L～ 8× 10 9/L ;粒细胞恢复到 >0 .5× 10 9/L的时间平均为 14d ;血小板恢复到 5 0× 10 9/L的时间平均为 17d。 5例患者无一例出现其他的严重并发症。结论 超HDC和PBSCT治疗晚期卵巢癌 ,虽副反应较严重 ,但严格掌握病例选择标准 ,还是安全、可行的。对于耐药复发病例的疗效 ,还有待于进一步观察。

Objective To evaluate the clinical effectiveness of high dose chemotherapy(HDC)with peripheral blood stem cells transplantation(PBSCT)in the patients with advanced malignant tumors. Methods Four patients with advanced or refractory ovarian carcinoma and 1 patient with recurrent fallopian tube carcinoma received the HDC with PBSCT after optimal tumor debulking. Of whom 4 patients were with the recurrent or progressive tumors,1 patient received HDC as primary chemotherapy. The response and toxicity were assessed after treatment. Results Among 5 patients, four patients are survival. One case died from the recurrence of juvenile granulosa cell tumor. The average survival periods were 21 months. The tumors were all recurrent among the 4 survival patients. The average periods of recurrence after HDC treatment was 9 months. The main toxicity of HDC was severe marrow suppression. The lowest value of the neutrophil count and platelet count was 0.05 0.2×10 9/L and 7×10 9/L～8×10 9/L respectively. The median time to recover a neutrophil count greater than 0.5×10 9/L was 14 days and a platelet count greater than 50×10 9/L was 17 days. None of the patients was complicated with severe complications. Conclusions HDC and PBSCT used for ovarian carcinoma was flexibility and security if the patient was selected strictly though its toxicity was severe. Further study among the chemorefactory recurrent patients need to try in the future.