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  

A study of high dose radio-chemotherapy combined with APBSCT to treat refractory malignant lymphoma

作　　者：张伟京 俞受程 马恩普[2] 林育松 苏航 刘秀珍[2] 

机构地区：[1]北京北太平路医院,北京100039 [2]北京放射医学研究所,北京100850

出　　处：《中国实验血液学杂志》1998年第2期145-149,共5页Journal of Experimental Hematology

摘　　要：观察了大剂量放、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。有21例病人接受此治疗。分别用DS(9例)、G-CSF(4例)和CTX+G-CSF(8例)动员造血干细胞。17例行大剂量化疗(CVAP方案;其中2例结合TBI);3例为超大剂量化疗(CVB方案),均在给药结束后48小时回输分离细胞;1例单行TLI1次。在移植组21例中可评价的病人19例,其中CR10例(53％),PR7例(37％),SD2例(10％)。1,2,3年实际生存率分别为44％(8/18),27％(4/15),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。超大剂量化疗时并发症较严重,骨髓恢复较慢。但全组绝大多数病人均完全度过骨髓抑制极期。结论提示,对于难治性恶性淋巴瘤,大剂量放、化疗结合APBSCT的疗效优于常规治疗,大剂量化疗的疗效似不低于超大剂量化疗。Refractory malignant lymphoma is very difficult to be cured by conventional therapy. We hope to improve these patients' survival by high-dose radio-chemotherapy combined with APBSCT. The peripheral blood stem celis were mobilized by Dextron Sulfate (DS, 9 cases), G-CSF (4 cases) and high-dose CTX plus G-CSF (8 cases). Leukapheresis products were stored at 4℃ (13 cases) and liquid nitrogen with controlled rate freezing (8 cases) . The chemotherapy regimens were as following: ① CTX 1. 6 g/dl and 1. 4 g/d2, VDS 2-3 mg/d(d1, d2). ADM 40 - 50 mg/d(d1, d2), Prednisone 100 mg/d(d1 - d5) (17 cases). ② BCNU 250 mg/d(d1 - d3), Vp-16 300 - 500 mg/d (d2 - d6), CTX 1. 6 g/d(d6 - d7) and 1. 3 g/d(d6 - d8) (3 cases). CTX was substitut-ed by Melpharan 150 mg in 1 case with mild abnormality on ECG. ③ One case treated by TLI (DT 8 Gy/1F, d1) . Leukapheresis products were re-infused in 48 h after radio-chemotherapies completed. Control group: conventional therapy was used. Results revealed that 19 cases in APBSCT group were evaluable, from which 10 cases were CR, 7 cases were PR, 2 cases were SD. The percentages of actual overall survivals (AOS) for l-, 2-and 3-year were 44% (8/18), 27% (4/15) and 25% (2/8) respectively, 2 cases died of toxicity. There were 5 cases with disease-free survival in 7 - 49 months (median 32 months). Control group included 29 cases, in which there were 7 CR (24%), 8PR(28%), 5 SD(17), 8PD(28%),1-,2- and 3-year AOS were 28%(7/ 25), 13% (2/15) and 9% (1/11) respectively. It was concluded that high-dose radio-chemotherapy plus APBSCT may be more effective than conventional therapy in treating refractory malignant lyrmphoma.

关 键 词：恶性淋巴瘤 化疗 放疗 外周血造血干细胞移植 

分 类 号：R733.1[医药卫生—肿瘤]