自体外周血造血干细胞支持下大剂量化疗治疗恶性肿瘤

High-dose chemotherapy in patients with malignant tumor supported by autologous peripheral blood stem cells

目的 :观察自体外周血造血干细胞 (autologousperipheralbloodstemcell,APBSC)支持下大剂量化疗(high dosechemotherapy ,HDC)治疗恶性肿瘤 (malignanttumor ,MT)的临床疗效及安全性。 方法 :从 1999年 10月起 ,对住院治疗的 16例高危及复发的非霍奇金淋巴瘤 (non Hodgkin’slymphoma ,NHL)、8例高危乳癌 (breastcan cer,BC)、1例多发性骨髓瘤 (multiplemyeloma ,MM)患者 ,常规治疗 4～ 6个周期后 ,行APBSC动员及采集 ,然后行HDC ,其中 1例MM行自体CD34+ 细胞移植。HDC方案 :NHL为CBV ,CTX 12 0mg/kg ,BCNU 6 0 0mg/m2 ,VP 1690 0mg/m2 ;BC为CTCb ,CTX 5 0 0 0mg/m2 ,TSPA 70 0mg/m2 ,CBP 90 0mg/m2 ;MM为HD Mel2 0 0mg/m2 。对未获CR的NHL及部分高危BC给予病灶局部放疗。结果 :16例NHL包括初治 10例、复治 6例 ,分别用CHOP、DICE方案化疗 ,获CR 9例 ,PR 7例 ,HDC后CR 9例仍为 ,PR 7例获CR 3例 ,CR率 4 2 .9% (3/ 7) ,4例仍为PR。8例高危BC术后患者 ,CAF方案化疗 4个周期后 ,获CR 7例 ,HDC后仍为CR ,1例采集APBSC后 ,出现多发骨转移 ,放弃大剂量治疗。 1例MM ,VAD方案化疗 4个周期后为PR ,HDC后为CR。造血功能重建 :移植后中性粒细胞 (ANC)≥ 1.0× 10 9L-1所需要的中位时间为 10 (+8～ +14 )d ;

Aim: To observe the effectiveness and safety of high dose chemotherapy (HDT) supported by autologous peripheral blood stem cells in the treatment of malignant tumor. Methods: A total of 16 patients with high risk and relapse non Hodgkin's lymphoma were selected, 8 patients with high risk breast cancer and 1 patients with multiple myeloma who hospitalized from October 1999. Autologous peripheral blood stem cells were mobilized and apheresised and applied for high dose chemotherapy after 4～6 cycles conventional chemotherapy. Particularly,the single multiple myeloma was performed autologous peripheral blood CD34 + cells transplantation. High dose chemotherapy regimens: CBV for patients with non Hodgkin's Lymphoma, i.e. CTX 120 mg/kg, BCNU 600 mg/m 2, and VP16 900 mg/m 2; CTCb for patients with breast cancer, i.e. CTX 5 000 mg/m 2,TSPA 700 mg/m 2, and CBP 900 mg/m 2; HD Melphalan for patient with multiple myeloma, i.e. Melphalan 200 mg/m 2.Regional radiotherapy was carried out in PR patients with non Hodgkin's lymphoma and advanced breast cancer.Results: In 16 patients with non Hodgkin's lymphoma included 10 newly diagnosed cases and 6 repetitively treated cases,9 patients achieved complete remission (CR) and 6, partial remission (PR) after treated by CHOP and DICE regimen,and 9 CR kept CR while 3 cases obtained CR and 4 case still PR in 7 PR treated by high dose chemotherapy(HDT)(CR rate 42.9%). In 8 high risk breast cancers assessed after surgical treatment, 7 patients achieved CR after 4 cycle CAF regimen and remained CR after HDT, but 1 patient gave up HDT because of multiple bone metastasis after apheresis.One patient with multiple myeloma obtained PR after 4 cycle VAD regimen and achieved CR after HDT. The median time of absolute neutrophil count ≥1.0 ×10 9/L and absolute platelet count ≥20×10 9/L were 10(+8～+14) days and 14(+9～ +17) dys,respectively. The major adverse effects included infection, mucositis, and hepatic function damage. Until Octomber 2002, the median disease free survival time for patients with non Hodgkin's lymphoma was 15(5～32) months and 18(3～36) months for patients with breast cancers.One patient with multiple myeloma died from relapse after 9 months. Conclusion:High dose chemotherapy supported by autologous peripheral blood stem cells is safe and efficacious for patients with malignant tumor, especially for non Hodgkin's lymphoma and high risk breast cancer,but its long term effectiveness on multiple myeloma is not satisfied.