全身放疗在自体外周血造血干细胞移植治疗难治性淋巴瘤中的应用研究

目的探讨全身放疗在自体外周血造血干细胞移植治疗难治性淋巴瘤中的作用及毒副反应。方法 53例难治性淋巴瘤患者采用自体造血干细胞移植治疗,随机分成单纯大剂量化疗组(n=27)和大剂量化疗联合全身放疗组(n=26)。所有患者均采用自体外周血造血干细胞移植,干细胞移植前行干细胞动员、采集,然后行大剂量化疗或全身放疗联合大剂量化疗预处理。单纯大剂量化疗组,18例采用CBV方案(环磷酰胺1.8 g/m2,卡氮芥400 mg/m2,依托泊苷600 mg/m2),9例BEAC方案(环磷酰胺1.8 g/m2,卡氮芥400 mg/m2,依托泊苷200 mg/m2,阿糖胞苷200 mg/m2)。全身放疗联合大剂量化疗组,先行全身放疗,分2次照射,每次5 Gy,共10 Gy。之后行CE方案化疗,预处理后第5天输入造血干细胞。在舱内度过植活期,待外周血细胞达正常值后出院。随访5年以上。结果单纯大剂量化疗组,显效23例,复发7例,死亡12例,5年生存率55.6%。大剂量化疗联合全身放疗组,显效23例,复发3例,死亡5例,5年生存率80.8%。结论自体外周血造血干细胞移植在淋巴瘤治疗中作用显著,全身放疗的应用,可以提高淋巴瘤患者的生存率,而毒副作用不会增加。

Objective To explore effects and toxic and side effects of TBI Treating Refractory Lymphoma in APBSCT. Methods 53 patients with refractory lymphoma were treated with autologous hematopoiesis stem cell transplantation. All the patients were randomly divided into pure large-dose chemotherapy group （n=27） and large-dose chemotherapy combined with total body irradiation group（n=26） All the patients were treated with APBSCT with mobilization and collection having been done before the transplantation followed by pretreatment of large-dose chemotherapy or total body irradiation combined with large-dose chemotherapy. To the former group, 18 patients received CBV and 9 BEAC. To the latter group, they firstly received total body irradiation with 2 times, each time 5 Gy, and then received CE. On the fifth day after pretreatment, patients were transfused hematopoietic stem cells. They left the hospital after the planting time in the cabin and peripheral blood cell close to normal. Results Follow-up visits after treatment lasted 5 years or more with follow-up rate up to 95%. To the former group, CR 23 cases, recurrence 7 cases, death 12 cases with 5-year survival rate 55.6%. To the latter group, CR 23 cases, recurrence 3 cases, death 5 cases, 5-year survival rate 80.8%. Conclusion The effect of autologous peripheral blood stem cell transplantation is obvious to the treatment of lymphoma and the application of total body irradiation increases survival rate to the patients with lymphoma without increasing toxic and side effects.