大剂量放、化疗结合自身外周血造血干细胞移植治疗难治性恶性淋巴瘤21例报告  

A study of high dose chemotherapy combined with APBSCT to treat refractory malignant lymphoma: 21 cases report

作　　者：张伟京[1] 俞受程[1] 马恩普 林育松[1] 苏航[1] 刘秀珍 

机构地区：[1]军事医学科学院附属医院

出　　处：《军事医学科学院院刊》1998年第2期129-132,140,共5页Bulletin of the Academy of Military Medical Sciences

摘　　要：目的：观察大剂量放、化疗加自身外周血造血干细胞移植（ＡＰＢＳＣＴ）治疗难治性恶性淋巴瘤的疗效。方法：２１例病人接受此治疗。分别用葡聚糖硫酸酯（ＤＳ，９例）、粒细胞集落刺激因子（Ｇ－ＣＳＦ，４例）和环磷酰胺＋粒细胞集落刺激因子（ＣＴＸ＋Ｇ－ＣＳＦ，８例）动员干细胞。１７例行大剂量化疗（ＣＶＡＰ方案），其中２例加全身照射（ＴＢＩ），３例为超大剂量化疗（ＣＶＢ方案）。均于给药结束后４８ｈ回输分离细胞。１例单行全淋巴区照射（ＴＬＩ）１次。结果：移植组２１例中可评价的病人１９例，其中完全缓解（ＣＲ）１０例（５３％），部分缓解（ＰＲ）７例（３７％），稳定（ＳＤ）２例（１０％）。１、２、３年实际生存率分别为４４％（８／１８）、２７％（４／１５）和２５％（２／８）。无病生存者５例（７～４９个月，中位生存３２个月），１例ＣＲ者出院后２个月死于肺部感染，余均死于本病。疗效高于常规化疗组。骨髓抑制是主要的毒副作用，２例在化疗极期死于感染。超大剂量化疗组并发症较严重，骨髓恢复较慢。但全组绝大多数病人均安全度过骨髓抑制极期。结论：对于难治性恶性淋巴瘤，大剂量放、化疗结合ＡＰＢＳＣＴ的疗效优于常规化疗。大剂量化疗的疗效似不低于超大剂量?Objective: Refractory malignant lymphomas are very difficult to be cured by conventional therapy. We hope to improve these patients′ survival by high dose radio chemotherapy. Methods: The peripheral blood stem cells were mobilized by dextran sulfate (DS, 9 cases) or G CSF (4 cases) or high dose cyclophosphamide(CTX) plus G CSF (8 cases). Leukapheresis products were stored at 4℃ (13 cases) or in liquid nitrogen with controlled rate freezing (8 cases). The chemotherapy regimens were (1) CTX 1.6 g/d1 and 1.4 g/d2, vindesine(VDS) 2～3 mg/d(d1,d2), doxorubicin(ADM) 40～50 mg/d(d1,d2), prednisone 100 mg/d(dd1-5) (17 cases). (2) carmustine(BCNU) 250 mg/d(dd1-3),etoposide (VP 16) 300～500 mg/d (dd2-6), CTX 1.6 g/d(dd6-7) or 1.3 g/d(dd6-8) (3 cases). CTX was substituted by melphalan 150 mg in 1 case with mild abnormality on ECG. (3) 1 case treated by TLI (D T 8 Gy/1F,d1). Leukapheresis products were re infused in 48 h after radio chemotherapies were completed. Control group: conventional therapy. Results: APBSCT group: in 19 evaluable cases, 10 were CR, 7 PR, 2 SD. The actuarial overall survivals (AOS) for 1,2 and 3 years were 44% (8/18), 27% (4/15) and 25% (2/8) respectively. There were 5 with desease free survival in 7～49 months (median 32 months). Control group: in 29 cases, there were 7 CR (24%), 8 PR (28%), 5 SD (17%), 8 PD (28%). 1 ,2 and 3 year AOS were 28% (7/25), 13% (2/15) and 9% (1/11) respectively. Conclusion: High dose radio chemotherapy combined with APBSCT is more effective than conventional therapy in treating refractory malignant lymphoma.

关 键 词：淋巴瘤 造血干细胞移植 药物疗法 放射疗法 

分 类 号：R733.05[医药卫生—肿瘤]