CEM方案预处理结合自体外周血干细胞移植治疗晚期神经母细胞瘤5例观察  

Therapeutic effects of the CEM conditioning regimen combined with autologous peripheral blood stem cell transplantation on advanced neuroblastoma

作　　者：黄东生[1] 唐锁勤[1] 王建文[1] 刘英[1] 刘立真[1] 扬光[1] 吕善根[1] 

机构地区：[1]中国人民解放军总医院小儿内科,北京100853

出　　处：《中国实用儿科杂志》2004年第9期532-534,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的　常规化疗对小儿晚期神经母细胞瘤效果欠佳 ,本文探讨CEM方案 (卡铂 +依托泊苷 +马法兰 )做预处理结合自体外周血干细胞移植治疗晚期神经母细胞瘤的疗效及毒副反应。方法　 5例神经母细胞瘤患儿 ,Ⅲ期 2例 ,Ⅳ期 3例。肿瘤转移部位为骨 3例 ,骨髓 3例 ,肺转移 1例 ,肝转移 1例。移植时完全缓解 (CR) 4例 ,部分缓解 (PR) 1例。用化疗加重组人粒细胞集落刺激因子 (rhG CSF)动员。所采集单个核细胞 (MNC)为 (5 7～ 8 5 6 )× 10 8/kg。CD34+ 细胞为 (2 4 2～ 38 2 4 )× 10 6/kg。以CEM(马法兰 +卡铂 +依托泊苷 )作为预处理方案 ,未用TBI。结果　 5例患儿成功地完成了动员、采集和回输 ,渡过了危险的骨髓抑制期。无严重毒副反应 ,无移植相关死亡。 1例患儿移植术后 11个月颅内转移外 ,余 4例患儿均存活 ,并能正常生活和学习。随诊时间分别为 8、10、36及 72个月。结论　CEM方案做预处理结合自体外周血干细胞移植治疗高危晚期神经母细胞瘤毒性小、复发率低 。Objective The advanced neuroblastoma normally were not responsive to regular chemotherapy.This paper aims to study the efficacy and toxicity of the CEM conditioning regimen combined with autologous peripheral blood stem cell transplantation (APBSCT) in the treatment of high risk advanced neuroblastoma.Methods Five patients,including 2 males,3 females,aged 4 to 7,stage 2,stage 3,metastasis site 3 in bone,3 in bone marrow,1 in lung,1 in liver,were treated with myeloablative therapy followed by APBSCT after complete remission (CR) or partial remission (PR).At the time of transplant,4 patients were in CR,and 1 in PR.Mobilization of stem cells was performed with chemotherapy plus G CSF.The collecting number of MNCs,CD34 + cell and CFU GM was (5.7～8.56)× 10 8 /kg,(2.42～38.24)× 10 6 /kg and (4.4～49.0) colons/10 4 cell respectively.The conditioning regimen consisted of melphalan plus etoposide and carboplatin without TBI.Results Five patients successfully underwent mobilization,collection and reinfusion.No severe toxicity was observed.No transplant related death was found.4 patients were healthy after completion of therapy but brain metastasis occurred in 1.Follow up time was 8,10,36 and 72 months respectively.Conclusion The use of the CEM conditioning regimen combined with autologous peripheral stem cell transplantation in patients with stage 4 or high risk stage 3 neuroblastoma has resulted in acceptable toxicity,a very low local recurrence risk,and an improvement in survival.

关 键 词：晚期神经母细胞瘤 自体外周血干细胞移植 

分 类 号：R72[医药卫生—儿科]