自体造血干细胞移植联合大剂量放化疗治疗恶性淋巴瘤32例  

Combined high dose chemotherapy with autologous stem cell transplantation and total body radiotherapy for 32 malignant lymphoma patients

作　　者：王华庆[1] 崔秀珍[1] 邵莹[1] 佟仲生[1] 任宝柱[1] 戴荣增[1] 郝希山[1] 

机构地区：[1]天津医科大学肿瘤医院内一科,300060

出　　处：《中华肿瘤杂志》2001年第5期436-438,共3页Chinese Journal of Oncology

基　　金：国家"九五"攻关基金资助项目 ( 96 90 6 0 1 12 )

摘　　要：目的　观察自体造血干细胞移植 (AHSCT)治疗恶性淋巴瘤的疗效。方法　自 1991年 6月至 2 0 0 0年 4月 ,用AHSCT治疗恶性淋巴瘤 32例。其中非霍奇金淋巴瘤 (NHL) 2 3例 ,霍奇金病 (HD)9例 ;行自体骨髓移植 (ABMT) 12例 ,自体外周血干细胞移植 (APBSCT) 2 0例。外周血干细胞动员方法均采用常规化疗 (CE或CHOP)加细胞集落刺激因子 (G CSF或GM CSF ;或G CSF +GMCSF) 10 μg·kg-1·d-1。预处理方案为BEAM方案和MEL140mg/m2 (或 +Vp 16 2 0 0mg) +单次全身照射 (TBI) 8Gy。结果　全部患者移植后均重建造血 ,随访至 2 0 0 0年 5月 30日 ,中位随访 10 2 0d。处于无病生存者 2 4例 (75 0 % ) ,1,2年无病生存分别为 78.1% (2 5 / 32 )和 46 .9% (15 / 32 ) ,最长存活 8年。 8例 (2 5 0 % )复发。全组患者无移植相关死亡。结论　AHSCT联合大剂量放化疗对预后不良复发或敏感的恶性淋巴瘤疗效佳 ,优于常规化疗。APBSCT造血恢复比ABMT快。预处理方案中含TBI的放疗组与单用联合化疗组疗效差异无显著性 ,但含放疗组副作用大。Objective To evaluate the effect of high dose chemotherapy with or without total body irradiation (TBI) supported by autologous hematopoietic stem cell transplantation(AHSCT) for malignant lymphoma.Methods From June 1991 to April 2 000, 32 malignant lymphoma (ML) patients were treated with AHSCT. Their ages ranged from 19 to 52 years (median 37). There were 23 non Hodgkin′s lymphoma(NHL) and 9 Hodgkin′s lymphoma(HD). Twelve patients received autologous bone marrow transplantation (ABMT) and 20 patients received autologous peripheral blood stem cell transplantation (APBSCT). In the latter, the mobilization plan was carboplatin and etoposide (CE) or CHOP (CTX,ADM,VCR,PDN) plus G/GM CSF 10 μg/kg/d in high dose chemotherapy. BEAM (BCNU, Vp 16,AraC,MEL) or MEL 140 mg/m 2+Vp 16 200 mg+ total body irradiation (TBI) 8 Gy.Results Up to May 2 000, hematopoietic reconstitution was reestabished in 100% (32/32) patients after AHSCT, with median follow up of 1 020 days (40 3 240). The 1 and 2 year disease free survivals (DFS) were 78.1%(25/32) and 46.9%(15/32) with the longest survival of 8 years.Even though eight patients have developed relapse, there is no transplantation related death.Conclusion High dose chemotherapy and radiotherapy supported by autologous hematopoietic stem cell transplantation (AHSCT) for high risk, relapsed or sensitive ML, being highly efficient, should be the first indication. It is better than the standard conventional treatment. The hematopoietic reconstitution of autologous peripheral blood stem cell transplantation (APBSCT) is quicker than autologous bone marrow transplantation (ABMT). No significant difference between chemotherapy alone and chemotherapy plus total body irradiation is observed. [

关 键 词：恶性淋巴瘤 药物治疗 放射治疗 自体造血干细胞移植 

分 类 号：R733.1[医药卫生—肿瘤]