大剂量依托泊苷联合自体造血干细胞移植挽救性治疗进展期淋巴瘤的临床观察

背景与目的：淋巴瘤复发是进展期淋巴瘤患者的主要死因，常规化疗疗效不佳。本研究旨在评估大剂量依托泊苷(VP16)联合自体造血干细胞移植治疗进展期淋巴瘤的疗效。方法：40例进展期淋巴瘤患者均接受大剂量VP16 10～15 mg/(kg·d)静脉滴注，持续2 d化疗，并在化疗后接受G-CSF 5～10 μg/kg皮下注射，至白细胞计数>4×109/L，采集患者干细胞并冻存于-80 ℃深低温冰箱中；40例患者均接受自体造血干细胞移植。结果：VP16治疗后中位随访时间39 d(17～172 d)，40例患者中12(30%)例对大剂量VP16无反应，28(70%)例有反应。自体干细胞移植后，中位随访28个月(4～66 d)。40例患者中，16(40%)例达到完全缓解，其中对VP16有反应的28例患者，15(53.6%)例达到完全缓解，4(14.3%)例部分缓解，9(32.1%)例死于疾病进展，对VP16无反应的12例患者，仅1(8.3%)例达到完全缓解。1(8.3%)例部分缓解，10(83.4%)例死于疾病进展。对VP16有反应的患者1年的无事件生存率(event-free survival，EFS)为56.7%，总体生存率(overall survival，OS)为69.0%，2年EFS为52.0%，OS为63.0%。无反应的患者1年EFS为16.7%，OS为25.0%，2组数据相比，差异有统计学意义(P<0.01)。结论：大剂量VP16联合自体造血干细胞移植能使对大剂量VP16有反应的患者带来较高的EFS和OS，可作为难治性淋巴瘤患者挽救性治疗的选择之一。

High-dose etoposide in mobilization for 40 patients with refractory lymphoma

Background and purpose: The patients with aggressive lymphoma who have a poor prognosis and unlikely to be cured with conventional chemotherapy. This study was aimed to evaluate the effect of high-dose etoposide in mobilization followed auto-SCT in treating refractory lymphoma. Methods: 40 patients [median age 33 (13-61) years] with refractory non-Hodgkin’s lymphoma (NHL, n=32) or Hodgkin’s lymphoma (HD, n=8) received high-dose etoposide [VP16 10-15 mg/(kg·d)×2 d] in mobilization in our center. Remission status prior to mobilization was PD (n=40). The use of such granulocyte colony-stimulating factor [G-CSF, 5-10 μg/(kg·d)] mobilized peripheral blood stem cells (PBSC) after high-dose etoposide until the end of leukapheresis. Peripheral blood stem cell was collected and frozen in -80℃ refrigerator. All these patients received auto peripheral blood stem cell transplantation (auto-PBSCT). Conditioning regimen was BEAM (n=19, 47.5%) or CBV (n=21, 52.5%). Results: Twenty-eight patients (70%) were assessable for response after high-dose etoposide at a median pretreatment time of 39 days (range 17-172 days), 12 patients (30%) had no response. Median follow-up of 28 (4-66) months, 16 patients (40%) reached CR after auto-PBSCT. Fifteen of the 28 patients (53.6%) who had response to high-dose etoposide reached CR, 4 patients (14.3%) reached PR, 9 patients (32.1%) succumb to progression of disease. One of the 12 patients (8.3%) who had no response to high-dose etoposide reached CR, 1 patients (8.3%) reached PR, 10 patients (83.4%) succumb to progression of disease. The estimated 1-year OS and EFS were 69% and 56.7% respectively, 2-years OS and EFS were 63% and 52% respectively. The prognosis of the patients who had no response to etoposide was poor. The estimated 1-year OS and EFS were 25% and 16.7% respectively. Two group of comparison differences have statistics significance (P<0.01). Conclusion: High-dose etoposide could be used in refractory lymphoma as rescue therapy in mobilization. It can increase the EFS and OS of patients who had response. The hematopoietic stem cells collection and hematopoietic reconstitution are not affected by etoposide.