超高CD34+采集的动员方案序贯二次自体造血干细胞移植治疗难治性 霍奇金淋巴瘤

目的:探讨超高CD34+采集的动员方案后序贯二次自体造血干细胞移植治疗难治性霍奇金淋巴瘤的疗效和安全性。方法:对1例经过多疗程一线、二线、新药、免疫等均难治的霍奇金淋巴瘤患者，予以IA+C方案化疗+G-CSF动员干细胞后采集出超高水平CD34+细胞，之后行自体造血干细胞移植，移植后获得完全缓解，再予序贯第二次自体造血干细胞移植进行巩固治疗。结果:总计输注单个核细胞数13.67×108/kg，CD34+细胞48.68×106/kg，第一次自体造血干细胞移植术后第7天造血功能恢复，复查全身PET-CT提示获得完全缓解，第二次自体造血干细胞移植术后第8天造血功能恢复，两次自体造血干细胞移植相关并发症均在可控范围内。结论:超高CD34+细胞采集的IA+C方案化疗+G-CSF动员可以让患者有机会进行多次自体造血干细胞移植，是临床动员的创新方案。对于难治性霍奇金淋巴瘤，序贯二次自体造血干细胞移植可达到更深层次缓解，且安全性较高，延长患者无疾病生存期及总生存期，为难治性霍奇金淋巴瘤治疗提供更多临床依据。

Treatment of refractory Hodgkin' s lymphoma by sequential twice autologous hematopoietic stem cell transplantation after mobilization of ultra-high CD34+

Objective:To investigate the efficacy and safety of sequential twice autologous hematopoietic stem cell transplantation after mobilization of ultra-high CD34+ in the treatment of refractory Hodgkin's lymphoma.Methods:A case of Hodgkin's lymphoma，which was difficult to be treated by first-line，second-line，new drugs and immunity，was treated with mobilization scheme （IA+C mobilization system） chemotherapy+G-CSF to mobilize stem cells.Than we collected extremely high CD34+stem cells.It was completely relieved after the first autologous hematopoietic stem cell transplantation.Then the second autologous hematopoietic stem cell transplantation was performed for consolidation treatment.Results:The total number of mononuclear cells was 13.67×108/kg and was 48.68×106/kg in CD34+ cells respectively.The hematopoietic function recovered on the 7th day after the first hematopoietic stem cell transplantation，and the 8th day after the second hematopoietic stem cell transplantation.The whole body PET-CT showed complete remission after the first autologous hematopoietic stem cell transplantation.The complications related of the two autologous hematopoietic stem cell transplantation were controllable.Conclusion:The mobilization plan（IA+C mobilization plan） of ultra-high CD34+ cell collection could give patients the opportunity to carry out multiple autologous hematopoietic stem cell transplantation，which was an innovative plan for clinical mobilization.For refractory Hodgkin's lymphoma，sequented second hematopoietic stem cell transplantations could achieve deeper level of remission，and the security was controllable.Twice autologous hematopoietic stem cell transplants could prolong disease-free survival and total survival of patients.This case may provide more clinical basis for the treatment of refractory Hodgkin's lymphoma.