序贯放化疗后自体外周血干细胞移植治疗鼻型结外NK／T细胞淋巴瘤

本研究探讨序贯放化疗后自体外周血干细胞移植治疗鼻型结外NK／T细胞淋巴瘤的疗效。2000年1月至2009年12月在我院治疗的65例经病理形态学及免疫组织化学检查确诊的鼻型结外NK／T细胞淋巴瘤患者，经交替应用CHOP方案、VDLP方案和MEOP方案各2疗程化疗后，均应用直线加速器进行原发部位的三维适形放射治疗，随后分为临床观察组（34例）和移植组（31例）；移植组患者经化疗联合重组人粒细胞集落刺激因子（rhG—CSF）方法动员自体外周血干细胞，应用TBI联合VEMAC方案实施预处理后，进行自体外周血千细胞移植；随访观察时间为3—5年。结果表明：序贯放化疗的主要不良反应为骨髓抑制及轻度局部黏膜损伤，移植组全部患者均获得造血重建，移植后4—6d中性粒细胞均降至0，中性粒细胞≥0．5×10^9／L的中位时间为14（11-17）d，白细胞≥4．0×10^8／L的中位时间为17（16—20）d，血小板≥50×10^8／L的中位时间为25（23—28）d，移植后16—21d时骨髓呈恢复期骨髓象，无特殊并发症出现；放化疗结束时，观察组总有效率91．2％，移植组总有效率90．3％，两组比较无统计学意义（P〉0．05）；随访1年时，观察组总有效率76．5％，移植组总有效率96．8％，两组比较具有统计学意义（P〈0．05）；随访3年时，观察组无病存活率占全组患者的61．3％，移植组无病存活率占全组患者的87．1％，两组比较具有统计学意义（P〈0．05）；随访5年时，观察组无病存活患者占该组随访5年患者的43．5％，移植组无病存活患者占该组随访5年患者的81．5％，两组比较具有统计学意义（P〈0．05）。结论：序贯放化疗后自体外周血干细胞移植治疗鼻型结外NK／T细胞淋巴瘤可取得满意疗效。

Curative Efficacy for Nasal Type Extranodal NK/T-Cell Lymphoma by Autologous Peripheral Blood Stem Cell Transplantation after Sequencing Chemotherapy and Radiotherapy

The purpose of this study was to explore the curative efficacy for nasal type extranodal NK/T-cell lymphoma by autologous peripheral blood stem cell transplantation （APBSCT） after sequencing chemotherapy and radiotherapy. A total 65 cases diagnosed as nasal type extranodal NK/T-cell lymphomal by pathology and immuno- histochemistry were treated with chemotherapy and radiotherapy in our hospital from January of 2000 to December of 2009. They were divided into observation group （34 cases） and transplartation group （31 cases）. The 34 cases of observation group were ceased from treatment, the 31 cases in transplantation group received APBSCT after conditioning regimen with TBI combined VEMAC. Autologous peripheral blood stem cells were mobilized with chemotherapy combined rhG-CSF. The patients were followed up for 3 - 5 years. The results showed that some side-effects such as bone marrow suppression and injure of oral cavity mucosa were found in patients after sequencing chemotherapy and radiotherapy. All patients in transplantation group obtained hematopoietic reconstruction, and there were no any special side effect such as VOD. In transplantation group, the median time of ANC ≥ 0. 5 × 109/L was 14 （ 11 - 17 ） days, median time of WBC count≥4. 0 × 109/L was 17（ 16 -20） days, median time of Plt count≥50 × 108/L were 25（23 - 28） days. After chemotherapy and radiotherapy, effective rate of treatment was 91.2% in observation group, whereas was 90. 3 % in transplantation group, there were no obvious difference between two groups （ P 〉 0.05 ）. After following upabout 1 year, effective rate of treatment was 76. 5% in observation group,whereas was 96. 8% in transplantation group, there were obvious difference between two groups （ P 〈 0. 05 ）. After following up about 3 years and 5 years the disease- free survival （DFS） was 61.3% ,43.5% and 87.1% ,81.5% in observation group and transplantation group, there was significant difference between two groups （P 〈 0.05 ）. It is concluded that treatment with APBSCT after sequencing chemotherapy and radiotherapy for nasal type extranodal NK/T-cell lymphoma may increase DFS efficiently.