自体外周血干细胞移植治疗儿童淋巴母瘤白血病

Treatment of children non-Hodgkin lymphoma with autologus peripheral blood stem cell transplantation:a case report

目的研究自体外周血干细胞移植(auto-PBSCT)治疗淋巴母瘤白血病儿童的疗效,观察移植相关并发症的方法。方法1例10岁男性淋巴母瘤白血病儿童,化疗7疗程和放疗1疗程后行auto\|PBSCT。动员方案:环磷酰胺(CTX)+粒细胞集落刺激因子(G-CSF),其中CTX剂量为3.6g/m2。CTX用完后24小时皮下注射G-CSF150μg/次,2次/天,共8天。CS-3000Plus血细胞分离机分离外周血干细胞,采用成人采集程序、成人采集管道和成人收集夹。每次采集前加入200ml经照射后的红细胞悬液充盈分离管道,分离速度50ml/分,循环血量6L,连续采集3天。采集细胞量按患儿体重计为单个核细胞(MNC)2.7×108/kg,CD34+细胞3.2×106/kg。非程序降温至-80℃保存。预处理前患儿出层流室休息10天。预处理方案:BEAM,其中卡莫司汀(BCNU)300mg/m2,静脉注射,-6天;鬼臼乙叉甙(VP-16)75mg/次,静脉注射,12小时1次,-5天～-2天;阿糖胞苷(Ara-C)150mg/次,静脉滴注,12小时1次,-5天～-2天;马法兰(MEL)140mg,口服,-1天。冻存的干细胞回输分2天进行,用40℃恒温水浴箱快速解冻后快速回输。结果干细胞回输后第5天查外周血WBC0.2×109/L、N0.1×109/L、RBC2.08×1012/L、Hb56g/L、PLT9.0×109/L。干细胞回输后第12天查外周血WBC5.3×109/L、N3.5×109/L、PLT51×109/L。干细胞回输后第14天复查骨髓未见淋巴瘤细胞,胸、腹部CT未见淋巴结增大,血清LDH正常范围。随访6月患儿仍处于完全缓解状态。结论结合儿童自身特点,掌握好干细胞的采集方法、回输时机和护理技巧,进行auto-PBSCT是儿童恶性淋巴瘤有效的治疗方法。

Objective To explore the feasibility of autologus peripheral blood stem cell transplantation (auto-PBSCT) for the treatment of children non|Hodgkin lymphoma and its transplantation-related complications.Methods A 10 years old patient with non|Hodgkin lymphoma received auto|PBSCT. Peripheral blood stem cell mobilization regimen were CTX 3.6 g·m -2·d -1×1d and G|CSF 150μg/time,2 times/d×8d. The condition regimen included BCNU 300mg·m -2·d -1×1d, VP|16 75mg/time,q12h×3d, Ara|C150mg/time,q12h×3d and Mephalan 140mg/d×1d. The transplanted number of mono-nucleated cells (MNC) was 2.7×10+8/kg of body weight, and that of CD34++ cells was 3.2×10+6/kg.Results The white bolld cells count rose 0.2×10+9/L, the neutrophil count was 0.1×10+9/L and platelet count exceeded 9.0×10+9/L at day 5 after transplantation. The white blood cells count rose 0.2×10+9/L, the neutrophil count was 3.5×10+9/L and platelet count exceeded 51.0×10+9/L at day 12 after transplantation, the patient achieved complete remission (CR). In the follow|up of 6 months, the patient remained CR. Conclusion Autologus peripheral blood stem cell transplantation is feasible and effective in the treatment of children non|Hodgkin lymhoma.