DA-EPOCH与MA方案在非霍奇金淋巴瘤自体外周造血干细胞动员中的临床观察

Efficiency of DA-EPOCH and MA chemotherapy in the mobilization of autologous peripheral blood stem cells in non-Hodgkin′s lymphoma

目的分析DA-EPOCH方案（剂量调整依托泊苷＋表柔比星＋长春新碱＋环磷酰胺＋地塞米松）＋重组人粒细胞集落刺激因子（G-CSF）及MA方案（甲氨蝶呤＋阿糖胞苷）＋G-CSF在非霍奇金淋巴瘤（NHL）患者行外周血干细胞动员中的作用。方法回顾性分析福建省立医院血液科收治的40例NHL患者的病例资料。患者分别采用DA-EPOCH及MA方案进行外周血造血干细胞（PBHSC）动员、采集，并行自体外周血干细胞移植，分析其动员效果、不良反应及自体移植后造血恢复情况。结果DA-EPOCH组有2例、MA组有1例患者未采集到足够干细胞，需再次单用G-CSF动员。DA-EPOCH组动员期间患者外周血最低白细胞计数[0.7（0.5，0.9）]×10^9/L，最低血小板计数[75.0（53.0，107.0）]×10^9/L，7例患者低热（37.5～38.3 ℃）, 2例患者需输注血小板补充，共采集单个核细胞（MNC）数 （5.8±1.8）×10^8/kg，CD34^＋细胞（即干细胞）数[3.7（2.8，6.7）]×10^6/kg；MA组动员期间患者外周血最低白细胞数[0.4 （0.2，0.9）]×10^9/L，最低血小板数[12.0 （6.0，16.0）]×10^9/L，8例患者高热（39.0～39.8 ℃），15例患者需输注血小板补充，4例患者需输注红细胞纠正贫血，共采集MNC数（6.0±2.9）×10^8/kg，CD34^＋细胞数[8.5（2.6，11.3）]×10^6/kg。2组患者动员期间外周血最低血小板值、CD34^＋细胞数比较差异有统计学意义（P〈0.05）。DA-EPOCH组移植后粒细胞植活时间为10（9，11） d，血小板植活时间为12（11，16） d；MA组移植后粒细胞植活时间为10（9，11） d，血小板植活时间为12（11，15） d；两组比较移植后粒细胞及血小板植活的时间比较差异无统计学意义（P〉0.05），移植过程中无死亡病例。 结论DA-EPOCH与MA方案均可有效动员合适病理类型NHL患者的外周血干细胞，安全性高，与MA方案比较，DA-EPOCH方案输血更少，发生严重感染的比例更低。

ObjectiveTo study the effect and safety of the DA-EPOCH chemotherapy combined with G-CSF and the MA chemotherapy combined with G-CSF on mobilizing and collecting the peripheral blood stem cells and the later hematopoietic recovery.MethodsA total of 40 patients accepted mobilization and collection of peripheral blood stem cells（PBSC） after being treated by DA-EPOCH＋ G-CSF and MA＋ G-CSF therapy respectively, and performed auto-transfusion. The effect of mobilization, the adverse effects and the hematopoietic recovery after autologous transplantation were analyzed retrospectively.ResultsTwo cases in DA-EPOCH group and 1 case in MA group did not achieve the collection goal and required a G-CSF mobilization therapy again. During the DA-EPOCH mobilization therapy, the lowest median WBC was[0.7（0.5, 0.9）]×10^9/L and the median lowest platelet （PLT） count was[75.0 （53.0, 107.0）]×10^9/L.Low-grade fever occurred in 7 cases （37.5-38.3 ℃） and platelet transfusion was required in 2 cases. The collection of MNC number was （5.8±1.8）×10^8/kg, and the median CD34^＋ cell number was[3.7（2.8, 6.7）]×10^6/kg; for the MA therapy groups, the numbers were[0.4 （0.2, 0.9）]×10^9/L and[12.0 （6.0, 16.0）]×10^9/L, respectively. High fever occurred in 8 cases （above 39 ℃）. PLT transfusion was required in 15 cases and red blood cell（RBC） transfusion in 4 cases. The collected number of MNC was （6.0±2.9）×10^8/kg, and CD34^＋ median cell number was[8.5（2.6, 11.2）]×10^6/kg. There are significant differences between the lowest PLT counts and CD34^＋ cell numbers in the two groups of patients（P〈0.05）. A peripheral blood leukocyte increase in 10（9, 11） days and platelet implantation in 12（11, 16） days were observed after ASCT by DA-EPOCH therapy. In MA group, the number were 10（9, 11） and 12（11, 15） days. The hematopoietic recovery in both groups were successful, without any statistically difference（P〉0.05）. No death occurred during the process of transplantation. ConclusionsDA-EPOCH and MA chemotherapy could effectively mobilize the peripheral blood stem cells in suitable NHL patients.DA-EPOCH chemotherapy was higher in safety and lower in price, and required less transfusion compared with MA therapy.