以SEAM预处理方案行自体外周血干细胞移植治疗非何杰金淋巴瘤  

SEAM pretreatment plus autologous peripheral blood stem cell transplantation for treating non-Hodgkin's lymphoma

作　　者：王三斌[1] 郭坤元[1] 胡灯明[2] 刘林[2] 彭利晖[2] 尹波[2] 

机构地区：[1]南方医科大学珠江医院血液科,广东省广州市510282 [2]解放军成都军区昆明总医院血液科,云南省昆明市650032

出　　处：《中国组织工程研究与临床康复》2008年第25期4811-4814,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：解放军成都军区医学科研计划课题(MB07027)~~

摘　　要：背景：造血干细胞移植治疗非何杰金淋巴瘤前，预处理方案对移植效果至关重要。目前经典BEAM方案中的药物卡莫司汀在国内不易购得，且该方案毒副作用较大，复发率较高。目的：以司莫司汀取代卡莫司汀组成SEAM预处理方案，观察自体外周血干细胞移植治疗非何杰金淋巴瘤的效果。设计、时间及地点：病例分析，于2003—06／2006-02在解放军成都军区昆明总医院血液科进行。对象：选取同期收治的15例Ⅲ～Ⅳ期非何杰金淋巴瘤患者，男13例，女2例，平均年龄43．8岁，均经过2-8个疗程的化疗，CR14例，CR21例，部分缓解10例；病理证实T细胞淋巴瘤3例，弥漫大B细胞淋巴瘤12例；移植前复查肝肾功能及肺功能均正常。组成SEAM预处理方案的4种药物：司莫司汀（Semustine）为浙江瑞新公司产品，批号20071125；足叶乙甙（Etopside）为江苏恒瑞公司产品，批号07101231；阿糖胞苷（Ara—C）为浙江海正公司产品，批号080103A；马法兰（Mephalan）为葛兰素史克产品，批号7001。方法：皮下注射重组人粒细胞集落刺激因子动员后12d采集患者外周血干细胞，与羟乙基淀粉、人血白蛋白及二甲基亚砜配成冻存液移植备用。动员后1个月行自体外周血干细胞移植，移植前患者行SEAM预处理方案：移植前8d口服司莫司汀320mg／m^2。移植前7d～移植前4d，静滴足叶乙甙200mg／m^2，1次／d；静滴阿糖胞苷200mg／m^2，1次／12h。移植前3d～移植前2d，静滴马法兰70mg／m^2，1次／d。移植当天将预先冻存的自体外周血干细胞水浴解冻，经锁骨下静脉插管快速回输给患者，一般输注细胞量为（3．0～5．0）×10^8／kg。主要观察指标：①预处理的毒副作用。②移植后造血功能恢复。③疾病转归。结果：SEAM预处理过程中15例患者均出现不同程度消化道反应，1例出现心动过速，3例出现肝功能损害。所BACKGROUND： Before hemopoietic stem cell transplantation for treating non-Hodgkin＇s lymphoma, pretreatment is crucial to transplantation outcome. Presently, bischloro-nitrosourea in classical BEAM protocol is difficult to obtain in China, and this protocol has big side effects and a high recurrence rate. OBJECTIVE： To evaluate the efficacy of SEMA as conditioning regimen of autologous peripheral blood stem cell transplantation （ABSCT） in treatment of non-Hodgkin＇s lymphoma using semustine instead of replacing bischloro-nitrosourea. DESIGN, TIME AND SETTING： The case analysis was performed at the Department of Hematology, Kunming General Hospital, Chengdu Military Area Command of Chinese PLA from June 2003 to February 2006. PARTICIPANTS： Totally 15 patients with non-Hodgkin＇s lymphoma of Ⅲ-Ⅳ stages were enrolled, including 13 males and 2 females, with a mean age of 43.8 years, after treatment of 2 8 courses of chemotherapy. There were 4 patients in first complete remission, 1 patient in second complete remission, and 10 patients in partial remission. Pathology verified 3 patients with T cell lymphoma, 12 patients with diffuse large B-cell lymphoma. Before transplantation, hepatic and renal function and pulmonary function were normal by reexamination. The SEAM regimens consisted of semustine （S） （batch number 20071125; Ruixin, China）, etoposide （E） （batch number 07101231; Hengrui, China）, cytarabine （A） （batch number 080103A; Haizheng, China） and mephalan （M） （batch number 7001; GSK, Great Britain）, METHODS： 12 days after subcutaneously injecting recombinant human granulocyte colony-stimulating factor, peripheral blood stem cells were harvested from patients and mixed with hespander, human serum albumin and dimethyl sulphoxide, and then frozen for transplantation. One month later, ABSCT was performed subsequent to SEAM pretreatment. Eight days before transplantation, patients were orally treated with 320 mg/m^2 semustine. Four to seven days before tran

关 键 词：造血干细胞移植 预处理方案 司莫司汀 非何杰金淋巴瘤 

分 类 号：R394.2[医药卫生—医学遗传学]