大剂量化疗联合应用G-CSF治疗难治或复发性非霍奇金淋巴瘤的临床观察

A Clinical Study of High Dose Chemotherapy Combined with G-CSF Treating Refractory or Relapsed Non-Hodgkin's Lymphoma

目的:观察大剂量化疗联合应用粒细胞集落刺激因子在没有干细胞支持情况下,治疗难治或复发性非霍奇金淋巴瘤的疗效和不良反应。方法:采用大剂量化疗。MIE方案:异环磷酰胺1500mg/m2,iv,d1～6;美斯纳800mg/次,于异环磷酰胺后0、4、8小时,iv,并同时水化;足叶乙甙250mg/m2,iv,d1～6;粒细胞集落刺激因子5～10μg·kg-1·d-1,于末次化疗结束后24小时开始应用,至白细胞达2.0×109/L持续3天停用,4周重复下1个疗程。17例患者共接受化疗24个疗程。结果:大剂量化疗总有效率76.5%(13/17),其中6例(35.3%)获完全缓解,7例(41.2%)获部分缓解,稳定1例(5.9%),无效和恶化2例(11.8%),1例(5.9%)于大剂量化疗后第7天死于颅内出血。大剂量化疗主要不良反应为骨髓抑制,白细胞和血小板降到最低的中位时间分别为6天和5天,其恢复时间分别为10天和12天;13例(76.5%)为发热性粒细胞减少,中位时间为6天,应用抗生素的中位时间为7天,应用粒细胞集落刺激因子的中位时间为7天。结论:在无干细胞支持的情况下,采用大剂量化疗辅以粒细胞集落刺激因子支持是治疗难治或复发性非霍奇金淋巴瘤的有效措施,具有疗效高,早期死亡率低,不良反应能够耐受,无需全环境保护,费用较低的特点,是值得临床推广的治疗模式。

Objective:To observe the effect and toxic effect of high dose chemotherapy combined with G-CSF on refractory and relapsed non-Hodgkin's lymphoma (NHL)Methods:HDC regimen:IFO1500mg /m 2 ,iV,d 1-6 ;mesna800mg /time,0?4?8hours after IFO given,iv,with enough fluid supplement;Vp-16250mg /m 2 ,iv,d 1-6 ;G-CSF5～10μg·kg -1 ·d -1 was given at24hours after the end of chemotherapy and was discontined when WBC count reached2×10 9 /L and persisted for3days.A cycle was repeated every4weeks.We gave24chemotherapy regimens to17cases.Results:The total response rate was76.5%(13/17cases)of HDC,including which6cas-es(35.3%)achieved CR,7cases(41.2%)achieved PR,1case(5.9%)remained stabe,2cases(11.8%)advanced,1case died of intracerebral hemorrahage after7days with HDC application.The main toxic effect of HDC is bone marrow suppression.The median time of leukopenia and platelet re-duction were6days and5days,the recovery time were10days and12days respectively.13cases(76.5%)were leukopenia induced fever,the median time were6days.The median time were7days when antibiotics were used;it was also7days with G-CSF application.Conclusion:It is a effective regimen treating refractory and relapsed NHL of HDC combined with G-CSF with out stem cell support.It have the characteristics of high response rate;earyly low death rate, the readily overcome toxic effect,needing no total enviromental protection,low cost.So it is need fur ther investigation.