大剂量化疗结合自体造血干细胞移植治疗Ⅳ期神经母细胞瘤18例疗效探讨  

Therapeutic Effects of High Dose Chemotherapy Combined with Autologous Peripheral Blood Stem Cell Transplantation on 18 Cases of Stage IV Neuroblastoma in Children

作　　者：朱霞[1] 黄东生[1] 张伟令[1] 王一卓[1] 宋琦[1] 张谊[1] 杨怡平[1] 李萍[1] 张品伟[1] 洪亮[1] 

机构地区：[1]首都医科大学附属北京同仁医院儿科,北京市100176

出　　处：《中国肿瘤临床》2010年第8期467-470,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:目前采用常规化疗对Ⅳ期神经母细胞瘤患儿治疗效果欠佳,长期生存率低,本文对采用大剂量化疗结合自体外周血造血干细胞移植及免疫治疗的18例Ⅳ期神经母细胞瘤患儿疗效进行探讨。方法:选择2005年10月～2008年8月收治的Ⅳ期神经母细胞瘤患儿18例,移植时完全缓解(CR)8例,部分缓解(PR)6例,处于肿瘤进展期4例。年龄1.41～14.33岁,平均6.46±3.25岁,中位年龄6.415岁。原发部位:后腹膜5例,肾上腺9例,胸部3例,胸腹联合1例。强烈化疗4～18个疗程,平均9±3.96个疗程,期间进行外周血造血干细胞采集、手术切除,然后进行自体外周血造血干细胞移植,术后行白介素-2及维甲酸生物治疗,复发者行普通化疗及局部放疗,定期随访。结果:18例患儿自体外周血造血干细胞移植治疗结束后,1例进展期患儿于移植后5天因心肺功能衰竭死亡,17例顺利度过移植后骨髓抑制期,造血重建时间为15～19天,平均16.53±0.91天。术后随访3～34.9个月,平均15.89±10.37个月,中位随访时间为13.8个月,完全缓解期8例获得完全缓解,2例术后1年原发灶复发再行普通化疗及局部放疗仍敏感,带瘤生存;部分缓解期3例获得完全缓解,3例获得部分缓解,移植后8个月2例部分缓解期患儿因颅内转移死亡,1例部分缓解期患儿带瘤生存;进展期3例移植重建后稍缓解,分别于移植后3、4、6个月复发、重要脏器转移死亡。完全缓解期13.8个月无病生存率75%;部分缓解期13.8个月,无病生存率50%;进展期13.8个月,生存率为0。3组自体干细胞移植术后13.8个月,无病生存率有差别(P<0.05)。3组13.8个月总无病生存率50%,生存率66.7%。结论:大剂量化疗、自体外周血造血干细胞移植及白介素-2、维甲酸生物治疗相结合治疗Ⅳ期神经母细胞瘤,在移植前达到完全缓解时可取得较好疗效,部分缓解期进行自体干细胞移植可提高缓解率,进展期患儿复发率高Objective： To investigate the therapeuti effects of high dose chemotherapy combined with autologous peripheral blood stem cell transplantation and immune treatment on 18 cases of stage Ⅳ neuroblastoma in children. Methods： Eighteen children with stage IV neuroblastoma were collected. Before autologous peripheral blood stem call transplantation, 8 patients had complete remission, 6 patients had partial remission, and 4 case had progressive disease. These cases aged 1.5 -14.25 years, with the median age of 6.415 years. Primary sites of the tumors included retroperitoneal （n=5）, adrenal （n=9）, chest （n=3）, and chest-abdomen （n=1）. Before autologous peripheral blood stem cell transplantation, these patients received 6 courses of intensive induction chemotherapy. During chemotherapy the autologous peripheral blood stem cells were harvested and the tumor was excised through surgery. IL-2 immune therapy and 13-cis retinoid acid therapy were administered after transplantation. Patients with recurrence received secondary local radiation and regular chemotherapy. Results： After autologous peripheral blood stem cell transplantation, 1 progressive case died of heart-lung failure. Seventeen patients underwent reinfusion and the restrain period of bone marrow. The amount of white blood calls was recovered to 2×10^9/L at 15-19 days after transplantation. The follow-up （ranged from 3 months to 34.9 months, with an average of 15.89±10.37 months and the median of 13.8 months） revealed that 8 patients in CR had CR, 2 cases received chemotherapy and local radiation for recurrence at 1 year after transplantation, 3 patients in PR had CR, and another 3 cases in PR had PR. At 8 months after transplantation, 2 cases died of brain metastasis. Three progressive cases had partial remission but died of tumor recurrence or function failure of important organs at 3, 4, and 6 months after transplantation, respectively. The disease-free survival （DFS） was 75% in CR, 50% in PR, and 0 in PD patients. The event-fr

关 键 词：神经母细胞瘤 自体外周血干细胞移植 儿童 

分 类 号：R735.7[医药卫生—肿瘤]