自体外周血造血干细胞联合自体骨髓移植治疗难治性淋巴瘤的临床分析

本研究通过回顾性分析自体外周造血干细胞移植、自体骨髓移植及二者联合移植在治疗难治性恶性淋巴瘤的疗效、毒副作用、造血和免疫功能恢复速度等临床方面的差异，总结归纳三种不同移植方式在治疗难治性淋巴瘤方面的优劣。68例难治性恶性淋巴瘤患者接受了大剂量放化疗结合自体造血干细胞移植治疗，其中10例患者为单一自体骨髓移植（autologous bone marrow transplantation，ABMT），46例患者为单一自体外周血造血干细胞移植（autologous peripheral blood hematopoietic stem cell transplantation，APBHSCT），12例患者为自体外周血造血干细胞联合自体骨髓移植（autologous peripheral blood hematopoietic stem cells transplantation combined with autologous bone marrow transplantation，APBHSCT＋ABMT）。结果表明：ABMT、APBHSCT、APBHSCT＋ABMT的治疗有效率和1、3、5年生存率分别为（90％和75％、57．1％、33．3％）；（86．4％和74．4％、54．2％、38．1％）；（83．3％和72．7％、55．6％、40％）。白细胞恢复时间分别为13天、11天、8天，血小板恢复时间分别为17天、14天、9天。在移植后3个月、6个月、1年时检测ABMT、APBHSCT、APBHSCT＋ABMT患者T细胞亚群正常率分别为（0％、33．3％、60％），（10．8％、32％、73．9％），（27．3％、55．6％、85．7％）。结论：自体外周血造血干细胞联合自体骨髓移植与单一自体外周造血干细胞移植治疗难治性恶性淋巴瘤的临床疗效和毒副作用当，但联合造血干细胞移植（APBHSCT＋ABMT）患者的造血功能恢复略快，有利于拓宽年龄偏大和造血功能受损患者移植方式的选择。

Autologous Peripheral Blood Stem Cell Transplantation Combined with Autologous Bone Marrow Transplantation for Treating Refractory Lymphoma

This study was aimed to investigate the differences of therapeutic efficiencies, side effects and recovery rates of immune function in refractory lymphoma patients treated with autologous peripheral blood hematopoietic stem cell transplantation （APBHSCT）, autologous bone marrow transplantation （ABMT） and combination of APBHSCT with ABMT （APBHSCT＋ABMT） by retrospective analysis, and to evaluate the merits and demerits of 3 kinds of transplantation for treatment of refractory lymphoma. 68 patients with malignant lymphoma were treated with autologous hematopoietic stem cells transplantation. Out of 68 patients 10 cases were treated with autologous bone marrow transplantation （ABMT）, 46 cases were treated with autologous peripheral blood hematopoietic stem cell transplantation （ APBHSCT）, and 12 cases were treated with autologous peripheral blood hematopoietic stem cells transplantation combined with autologous bone marrow transplantation （APBHSCT＋ABMT）. The results indicated that the therapeutic response rates and survival rates at 1, 3,5 years for each transplant regimen were 90% and 75% ,57.1% ,33.3% ; 86.4% and 74. 4% ,54.2% ,38.1% ; 83.3% and 72.7% ,55.6% ,40%. The times of ANC≥0.5 × 10^9/L were 13,11 and 9 days, times of platelet ≥20 × 10^9/L were 17,14 and 10 days. The recovery rates of T cell subtypes in patients received ABMT, APBHSCT and APBHSCT＋ABMT on 3 months, 6 months, 1 year were （0% ,33.3% ,60% ）, （10.8% ,32% ,73.9% ）, （27.3% ,55.6% ,85.7% ） respectively. In conclusion, the efficacy and side effects of APBHSCT ＋ ABMT as compared with ABMT and APBHSCT are roughly the same, but ABMT ＋ APBHSCT can result in more rapid hematopoietic reconstitution and less restrictions with contributes to widen choice of transplant regimen for patients with alder age and impaired hematopoietic functons.