自体造血干细胞移植联合大剂量放化疗治疗恶性淋巴瘤56例临床分析

Treatment of malignant lkymphoma by autologous hematopoiectic stem cell transplantation combined with high dose radiotherapy and chemotherapy

目的 观察自体造血干细胞移植 (AHSCT)治疗恶性淋巴瘤的疗效。方法 自 1 991年6月至 2 0 0 2年 1 0月 ,用AHSCT治疗恶性淋巴瘤 56例。其中非霍奇金淋巴瘤 (NHL) 4 4例 ,霍奇金病(HD) 1 2例 ;行自体骨髓移植 (ABMT) 1 2例 ,自体外周血干细胞移植 (APBSCT) 4 4例。外周血干细胞动员方法均采用常规化疗 (CE或CHOP)加粒或巨噬细胞集落刺激因子 (G CSF或GM CSF ;或G CSF +GM CSF) 1 0 μg·kg- 1 ·d- 1 。预处理方案为BEAM方案和MEL 1 4 0mg/m2 (或加Vp1 6 2 0 0mg)+单次全身照射 (TBI) 8Cy。 结果 全部患者移植后均重建造血 ,随访至 2 0 0 2年 1 0月 30日 ,中位随访 1 82 0d。 1、2及 5年后无病生存分别为 85 7% (48/ 56)、60 7% (34/ 56)和 57 1 % (32 / 56) ,最长存活 1 1年。 1 4例 (2 5 0 % )复发。全组患者无移植相关死亡。结论 AHSCT联合大剂量放化疗对预后不良、复发或敏感的高度恶性淋巴瘤疗效佳 ,能够改善生存率并优于常规化疗。

Objective To investigate the effects of treatment of malignant lymphoma (ML) by autologous hematopoiectic stem cell transplantation (AHSCT) combined with high dose radiotherapy and chemotherapy. Methods From June 1991 to October 2002, 56 patients, aged 9～65 years, with ML, 44 non Hodgkin′s lymphoma (NHL) and 12 Hodgkin′s disease (HD) were treated with AGSCT combined with high dose radiotherapy and chemotherapy. Among them, 12 received autologous bone marrow transplantation (ABMT) and 44 received autologous peripheral blood stem cell transplantation (APBSCT), In the latter the APBSCs were mobilized by carboplatin and etoposide (CE) or CHOP (CTX, ADM, VCR, PDN) plus granulocyte colony stimulating factor (G CSF) and/or granulocyte macrophage colony stimulating factor (GM CSF) 10 μg/kg/d. Pretreatment included BEAM (BCNU, Vp 16, AraC, MEL) or MEL 140 mg/m 2+Vp 16 200 mg/L total body irradiation (TBI) 8 Gy. The patients were flowed up for 40～4 310 days with a median of 1 820 days. Results Hematopoiectic reconstruction was observed in all patients. The 1, 2, and 5 year disease free survival rates were 87.5%, 60.7%, and 57.1% respectively, with the longest survival of 11 years. Fourteen patients developed relapse. No transplantation related death was seen. Conclusion Autologous hematopoiectic stem cell transplantation combined with high dose radiotherapy and chemotherapy is effective on Ml. AHSCT shows a more rapid effect on hematopoiectic reconstruction than ABMT.