两次自体外周血造血干细胞移植治疗复发难治性非霍奇金淋巴瘤的临床研究

Tandem double autologous peripheral blood stem cell in the treatment of recurrence or refractory non-Hodgkin′s lymphoma

目的探讨两次自体外周血造血干细胞移植（auto-PBSCT）治疗复发难治性非霍淋巴瘤的疗效和安全性。方法确诊的复发难治性非霍奇金淋巴瘤（NHL）患者6例,其中男5例,女1例,年龄34-67岁,平均52岁。患者选择标准：经一次auto-PBSCT术后复发或未达完全缓解,予以再次动员干细胞行第二次移植;分期Ⅲ-Ⅳ期的侵袭性淋巴瘤患者,首次auto-PBSCT不能达完全缓解,或复发可能性大,于第一次动员干细胞达两次移植所需,且第一次移植术后半年行第二次auto-PBSCT移植。结果 6例患者均能耐受预处理,并获得造血功能重建,移植后外周血中性粒细胞计数（ANC）〉0.5×10^9/L的中位时间为15d（10-25d）;血小板计数（BPC）大于20×10^9/L的中位时间25.8d（12-57d）。全部患者中位随访时间22.7个月（3-50个月）,1例患者两次移植术后半年因病毒性肝炎肝功能衰竭死亡,1例18个月后再次复发,二线治疗方案仍有效,其余4例患者无病生存,无病生存率66.7%,最长无病生存时间已达50个月。结论两次auto-PBSCT治疗复发难治性NHL安全有效,患者耐受良好,值得在临床上进一步推广应用。

Objective To evaluate the efficiency and safety of tandem double autologous peripheral blood stem cell transplants（auto-PBSCT）for recurrence or refractory non-Hodgkin′s lymphoma（NHL）treatment.Methods The clinical data of 6patients（5male,1female）treated by tandem double auto-PBSCT were analyzed retrospectively.Patients enrollment criteria：（1）For the patients who relapsed or imcomplete remission after first auto-PBSCT,we remobilized their stem cell to do transplantation again.（2）For invasive lymphoma patients staged ⅢtoⅣ,with a high risk to relatpse or couldn′t reach complete remission,and for whom their first time mobilized stem cell rich enough to do the twice transplantation,we did auto-PBSCT again half a year after the first auto-PBSCT.Results All patients could tolerate regimens well and gained promoption and sustained hematopoietic reconstitution.After second transplantation,the mean time of neutrophil count（ANC）≥0.5×10^9/L was 15d（10to 25d）,the mean time of platelet count≥20×1^09/L was 25.8d（12to 57d）.The median follow-up time was 22.7months（3to 50months）.One of these patients died of hepatic failure caused by viral hepatitis at the 6th month after auto-PBSCT,one of them relapsed at the 18 th month after auto-PBSCT and four patients gained complete remission.Of the 4patients,the disease-free survival rates（DFSR）was 66.7%and the disease-free survival time（DFST）was over 50 months.Conclusion The method of tandem double auto-PBSCT is secure and effective for recurrence refractory non-Hodgkin′s lymphoma（NHL）therapy.