DA-EPOCH化疗联合G-CSF有效动员非霍奇金淋巴瘤患者自体外周血造血干细胞

DA-EPOCH Chemotherapy Combined with G-CSF Effectively Mobilizes Autologous PBHSC in NHL Patients

目的:探讨CTX+G-CSF和DA-EPOCH+G-CSF方案对非霍奇金淋巴瘤(NHL)患者外周血干细胞动员采集及造血恢复的效果。方法:回顾性分析我科收治的40例NHL患者分别采用CTX+G-CSF及DA-EPOCH+GCSF方案进行外周血造血干细胞(PBSC)动员、采集,并予BEAM方案预处理后回输自体外周血干细胞,分析动员效果、不良反应及自体移植后造血恢复情况。结果:CTX+G-CSF组动员期间1例患者外周血白细胞(WBC)计数降至0.8×10~9/L,其余WBC数最低值均>2.0×10~9/L,3例血小板数降至80×10~9/L左右,其余患者血小板数均正常,单次采集物CD34^+细胞比例中位数0.99(0.35-1.30)%,共采集单个核(MNC)数(3.80±2.05)×10~10~,累计MNC(5.84±2.48)×10~8/kg,CD34^+细胞数中位数3.84(3.91-6.5)×10~6/kg。DA-EPOCH+G-CSF组动员期间患者外周血白细胞(WBC)计数最低降至(0.2-1.4)×10~9/L,1例血小板(Plt)数最低为8×10~9/L,其余均在40×10~9/L以上,单次采集物CD34^+细胞比例中位数0.85(0.34-1.2)%,共采集MNC中位数(3.68±1.56)×10^(10),累计MNC数(6.01±2.26)×10~8/kg,CD34^+细胞数中位数4.44(2.7-7.10)×10~6/kg。2组患者采集物CD34^+细胞比例中位数、总MNC中位数,累计每公斤体重MNC数及CD34^+细胞数中位数比较无统计学差异(P>0.05)。CTX+G-CSF组自体干细胞移植后粒细胞植活平均时间为10.00(9.00-11.00)d,血小板植活平均时间为12.00(11.00-13.50)d;DA-EPOCH组自体干细胞移植后粒细胞植活平均时间为10.00(9.00-11.00)d,血小板植活平均时间为12.50(11.00-17.25)d,2组比较无统计学差异(P>0.05),在移植过程中无死亡病例。结论:DA-EPOCH联合G-CSF方案可有效动员NHL患者的外周血干细胞,安全性高,且经济实惠。

Objective： To study the effect of the DA-EPOCH chemotherapy combined with G-CSF and the CTX therapy with G-CSF on mobilizing and collecting the peripheral blood hematopoietic stem cells and the later hematopoietic recovery.Methods： Forty patients accepted mobilization and collection of peripheral blood stem cells（ PBSC） after treated by CTX ＋G-CSF and DA-EPOCH ＋ G-CSF therapy respectively,and were treated by auto-transfusion after BEAM pre-regimen. The mobilization efficacy, adverse effects and hematopoietic recovery after autologous transplantation were analyzed retrospectively. Results： During the CTX ＋ G-CSF mobilization,only one patient achieved the white blood cell（ WBC） at 0. 8 × 10^9/L,while the others were with the lowest WBC level above 2. 0 × 10^9/L. The platelet counts were all normal with the exception of 3 cases at 80 × 10^9/L. The median percentage of CD34^＋ cells in one period of collection was 0. 99（ 0. 35-1. 30） %. The median MNC was（ 3. 80 ± 2. 05） × 10^（10）. The cumulative total of mononuclear cell was（ 5. 84 ± 2. 48） ×10^8/kg,and the median CD34^＋ cell count was 3. 84（ 3. 91-6. 5） × 10^6/kg. During the DA-EPOCH ＋ G-CSF mobilization,the peripheral WBC count of patients were decreased to the lowest level at（ 0. 2-1. 4） × 10^9/L. The platelet counts were all above 40 × 10^9/L except for 1 case in which the platelet count was reduced to 8 × 10^9/L. The median percentage of CD34^＋ cells in one period of collection was 0. 85（ 0. 34-1. 2） %. The median MNC was（ 3. 68 ± 1. 56） ×10^（10）. The cumulative total of mononuclear cells was（ 6. 01 ±2. 26） × 10^8/kg,and the median CD34^＋ cell count was 4. 44（ 2. 7-7. 10） × 10^6/kg. There were no statistical differences between the 2 groups in the median percentage of CD34^＋ cells,the median MNC,the cumulative total of mononuclear cells and the median CD34^＋ cell counts（ P〉0. 05）. The average acquired time for granulocyte engraftment was 10. 00（ 9. 00-11. 00） days,and for platelet engraftment was 12. 50（ 11. 00-17. 25） days,with no statistical difference（ P〉0. 05）. No death occurred during the process of transplantation. Conclusion： DA-EPOCH therapy combined with G-CSF can effectively mobilize the peripheral blood hematopoietic stem cells in NHL patients with higher safety and lower price,and proves to be worth recommending in clinical use.