利妥昔单抗联合自体外周血造血干细胞移植治疗高危侵袭及难治复发性B-NHL的疗效分析

目的:探讨利妥昔单抗(R)联合自体外周血造血干细胞移植(auto-HSCT)治疗高危侵袭性及难治复发CD20+B细胞非霍奇金淋巴瘤(B-NHL)的疗效.方法:选取本中心2005年1月-2013年12月确诊为高危侵袭性及难治复发CD20+B-NHL、并行auto-HSCT治疗的患者资料83例.联合R治疗的患者为观察组,共...     

利妥昔单抗联合化疗治疗非霍奇金淋巴瘤6例临床护理

2007年1月-6月，我们采用利妥昔单抗联合化疗治疗6例非霍奇金淋巴瘤患者，经精心护理，效果满意。现报告如下。     

利妥昔单抗联合化疗治疗B细胞性非霍奇金淋巴瘤的临床研究

目的 评价利妥昔单抗联合化疗治疗B细胞性非霍奇金淋巴瘤的有效性和安全性.方法 将52例入组患者分为两组,联合组使用利妥昔单抗联合化疗,对照组单纯进行化疗.结果 联合组临床有效率为92.3%,化疗组为65.4%,两组相比具有统计学意义(P＜0.05).不良反应发生率两组相比无统计学差异.结论 利妥昔单抗联合化疗治疗B细胞性非霍奇金淋巴瘤的有效率显著提高,且安全性好.     

异基因造血干细胞移植治疗自体造血干细胞移植后复发的非霍奇金淋巴瘤临床观察

目的 探讨对自体造血干细胞移植(autologous hematopoietic stem cell transplantation,auto-HSCT)后复发的非霍奇金淋巴瘤患者再进行异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-...     

利妥昔单抗联合CHOP化疗方案治疗非霍奇金淋巴瘤

目的：观察用利妥昔单抗联合CHOP化疗方案和单用CHOP化疗方案治疗B细胞系CD20阳性非霍奇金淋巴瘤患者的疗效及不良反应。方法：共23例B细胞系非霍奇金淋巴瘤患者,11例（R-CHOP组）采用利妥昔单抗联合CHOP化疗方案,12例（CHOP组）单用CHOP化疗方案。结果：在R-CHOP组中,完全缓解（CR）7例,部分缓解（PR）2例,有效率为81.8%;在CHOP组中,CR2例,PR3例,有效率为41.7%,两组有显著差异（P〈0.05）。胃肠道反应的发生率R-CHOP组为18.2%,CHOP组为16.7%,两组无显著差异（P〉0.05）;白细胞减少的发生率R-CHOP组为36.4%,CHOP组为41.7%,两组无显著差异（P〉0.05）;发热的发生率R-CHOP组为45.5%,CHOP组为8.3%,两组有显著差异（P〈0.05）。结论：用利妥昔单抗联合CHOP方案治疗B细胞系CD20阳性非霍奇金淋巴瘤患者疗效较好;化疗最明显的不良反应是发热,患者可以耐受,它可以做为临床一线治疗方案。     

利妥昔单抗注射液联合化疗治疗非霍奇金淋巴瘤病人不良反应的护理

[目的]总结利妥昔单抗注射液联合化疗治疗非霍奇金淋巴瘤病人不良反应的护理。[方法]24例非霍奇金淋巴瘤病人均采用利妥昔单抗注射液联合CHOP方案化疗,加强用药前的预处理和药物的配制及输注过程的护理,并针对并发症给予心理护理、对症护理。[结果]发生变态反应3例,消化系统反应4例,心律失常1例,不同程度的骨髓抑制17例,大多为暂时性,病人经对症处理后均好转,顺利完成治疗。[结论]加强非霍奇金淋巴瘤病人行利妥昔单抗注射液联合化疗的护理可预防或减少不良反应的发生。     

利妥昔单抗联合化疗治疗非霍奇金淋巴瘤引起间质性肺炎的护理体会

【摘要】 本文总结了9例非霍奇金淋巴瘤患者在接受利妥昔单抗联合化疗期间并发间质性肺炎的护理体会。回顾了化疗期间间质性肺炎的症状体征的观察及对症护理,而其中间质性肺炎患者生命体征的观察,糖皮质激素使用时的作用和副作用的观察是护理的重点。 关键词： 利妥昔单抗 非霍奇金淋巴瘤 间质性肺炎 护理     

自体造血干细胞移植联合抗CD20单抗治疗B细胞非霍奇金淋巴瘤(附1例报告)

目的探讨自体造血干细胞移植(AHSCT)联合抗CD20单克隆抗体(利妥昔单抗)治疗B细胞非霍奇金淋巴瘤(B-NHL)的方法和疗效。方法对1例难治、复发的弥漫大B细胞淋巴瘤患者进行AHSCT同时联合使用了抗CD20单抗。采用环磷酰胺(CTX)4g/m2 阿糖胞苷(Ara-C)4g/m2化疗联合粒细胞集落刺激因子(G-CSF)5μg/kg/d动员患者的外周血干细胞,然后予去甲氧柔红霉素(IDA)10mg/d×3d 经典BEAM方案预处理后回输保存的外周血干细胞,共回输单个核细胞(MNC)4.36×108/kg,CD34 细胞2.48×106/kg,回输后分别于 1d及 8d予抗CD20单抗375mg/m2行体内净化。结果患者移植后造血恢复顺利,于 15d中性粒细胞绝对数(ANC)>0.5×109/L, 18d血小板>20×109/L。移植后1月复查腹腔淋巴结消失。随访至移植后13月,造血功能恢复良好,病情处于持续完全缓解状态,仍在继续随访中。结论AHSCT联合抗CD20单抗是治疗难治、复发B细胞NHL的有效方法之一,有利于清除移植后的微小残留病(MRD),防止复发。     

利妥昔单抗注射液治疗非霍奇金淋巴瘤的不良反应观察及护理

利妥昔单抗是一种嵌合鼠/人的单克隆抗体,与B淋巴细胞上的CD20抗原结合而引发B细胞溶解免疫反应,主要用于B细胞非霍奇金淋巴瘤,治疗方法包括单药治疗、联合其他化学药物治疗以及联合靶向放射免疫治疗。但使用利妥昔单抗易发生诸多不良反应,其中多见于首次注射。2009年2月至12月,本院化疗科对12例非霍奇金淋巴瘤患者使用利妥昔单抗注射液治疗,现将药物不良反应观察及护理报告如下。     

利妥昔单抗联合化疗方案治疗B细胞淋巴瘤

目的：探讨利妥昔单抗（美罗华）联合化疗方案治疗CD20阳性B细胞非霍奇金淋巴瘤（B-NHL）本地区患者的疗效及安全性,尤其是乙肝病毒表面抗原（HBsAg）阳性者的安全性,并分析影响疗效的相关因素。方法：回顾总结美罗华联合化疗方案治疗67例B-NHL患者的疗效、不良反应,比较HBsAg阳性与阴性患者在肝功能受损上的差别,分析年龄、分期、B症状、乳酸脱氨酶（LDH）、IPI评分及巨块等因素对疗效的影响。结果：67例中完全缓解44例（65.7%）,部分缓解17例（25.4%）,无变化＋进展6例（9%）,总有效率91%;初治患者42例,总有效率（完全缓解＋部分缓解）95.2%,完全缓解32例（76.2%）,部分缓解8例（19%）,无变化＋进展2例（4.8%）。IPI评分（P=0.006）、分期（P=0.023）、血清LDH水平（P=0.016）对疗效均有明显影响;而B症状（P=0.593）、巨块（P=0.160）、年龄（P=0.442）对疗效无明显影响。主要不良反应为骨髓抑制及肝功能受损,Ⅰ、Ⅱ度骨髓抑制50.7%,Ⅲ、Ⅳ度骨髓抑制44.7%;HBsAg阴性者Ⅱ～Ⅳ度肝功能损害10.2%,HBsAg阳性者（抗病毒治疗）Ⅱ～Ⅳ度肝功能损害16.6%,HBsAg阳性者（未抗病毒治疗）Ⅱ～Ⅳ度肝功能损害50%。结论：美罗华联合化疗方案治疗本地区B-NHL同样疗效确切、安全;肿瘤期别、血清LDH水平及IPI评分对疗效有明显影响;对HBsAg阳性者需提前予抗乙肝病毒治疗,免疫化疗仍然安全、有效。     

The role of hematopoietic stem cell transplantation in non-Hodgkin lymphoma

Hematopoietic stem cell transplantation has become an increasingly important treatment modality for hematologic malignancies. Autologous stem cell transplantation has become the standard of care in relapsed high-risk diffuse large B-cell lymphoma (DLBCL) patients who respond to reinduction therapy. The exact role of allogeneic transplantation in DLBCL is still unknown and it appears to be useful in only a select group of patients. The exact role of hematopoietic stem cell transplant in follicular lymphoma is evolving. The treatment of mantle cell lymphoma is challenging and stem cell transplantation may play an important role, as our understanding of the biology and natural history of this disease improves. This review focuses on studies evaluating the role of stem cell transplantation in non-Hodgkin lymphoma.     

自体外周血造血干细胞移植治疗恶性淋巴瘤的生存预后分析

目的回顾性分析自体外周血造血干细胞移植(APBSCT)治疗恶性淋巴瘤的临床相关指标,以及影响预后的因素。方法收集2012年1月至2013年12月在该院确诊的31例恶性淋巴瘤患者的临床资料进行回顾性分析,采用Kaplan-Meier法进行生存分析,Log-Rank法进行单因素分析患者预后。结果 31例患者移植成功,无移植相关死亡;截至随访时间,移植后3年及5年总生存率分别为85.1%和78.5%,3年及5年无进展生存率分别为84.9%和75.5%。单因素预后分析结果显示,年龄≥60岁、IPI评分>2~5分、肝脾肿大患者3年生存率明显低于年龄<60岁、IPI评分1~2分,无肝脾肿大患者,差异有统计学意义(P <0.05)。结论恶性淋巴瘤患者行APBSCT安全有效,APBSCT可改善患者长期生存率,而年龄、IPI评分、肝脾肿大影响患者预后。     

自体外周血造血干细胞移植术治疗弥漫大B细胞淋巴瘤的临床研究

目的观察自体外周血造血干细胞移植术(Auto-PBSCT)治疗弥漫大B细胞淋巴瘤(DLBCL)的疗效及毒副反应,并探讨术后维持治疗、国际预后指数(IPI)积分等对疗效的影响。方法 21例Ann Arbor分期Ⅲ、Ⅳ期的DLBCL患者在大剂量化疗后行Auto-PBSCT,术后予干扰素或利妥昔单抗维持治疗,观察术后临床疗效、毒副反应及随访结果。结果移植术后总有效率为81.0%。随访至2014年12月,1年总存活率为81.0%、无事件存活率为66.7%;3年总存活率为47.6%、无事件存活率为33.3%。IPI评分高中危及高危患者术后均复发或进展,5例行二次Auto-PBSCT强化治疗,术后均达CR。结论大剂量化疗+Auto-PBSCT是Ⅲ、Ⅳ期DLBCL患者的有效治疗方案,术后是否维持治疗、IPI积分的高低可能对术后疗效产生影响,复发、难治或具有高复发危险因素的患者,可考虑行二次Auto-PBSCT。     

硼替佐米联合自体外周血造血干细胞移植治疗多发性骨髓瘤

本研究探讨硼替佐米联合自体外周血造血干细胞移植(APBSCT)治疗多发性骨髓瘤(MM)的疗效。对5例MM患者行自体外周血造血干细胞移植,在APBSCT前和预处理中以及移植后的维持治疗中均应用硼替佐咪治疗。选择预处理方案为:硼替佐米(bortezomib)+马法兰(melphalan)。输注的外周血单个核细胞(PBMNC)数为4.06×108(4.09×108-4.37×108)/kg,CD34+细胞数为3.98×106(2.49×106-8.2×106)/kg。结果表明:5例患者造血完全重建,中性粒细胞(ANC)大于0.5×109/L中位时间为14(13-25)天,Plt大于50×109/L中位时间为28(21-58)天。无移植相关死亡病例,5例患者均无病生存。结论:硼替佐米联合自体外周血造血干细胞移植是治疗MM的有效方法,移植后给予硼替佐米维持治疗可能是患者延长生存时间、提高生活质量的较好方法。     

自体造血干细胞移植治疗淋巴瘤的进展

背景:自体造血干细胞移植是治疗淋巴瘤的积极有效方案。目的:综述自体造血干细胞移植治疗淋巴瘤的研究进展。方法:应用计算机检索2000-01/2011-08PudMed、CNKI数据库、万方数据库、维普数据库及中华医学会数字期刊数据库及Google网络数据库自体造血干细胞移植治疗淋巴瘤的相关文章,检索词为"autologous hematopoietic stem cell transplantation,lymphoma,自体造血干细胞移植,淋巴瘤"。共检索到文献371篇,最终纳入符合标准的文献31篇。结果与结论:自体造血干细胞移植自20世纪80年代兴起以来,成千上万的淋巴瘤患者获益。其移植前的治疗从最初以单纯大剂量放化疗作为预处理方案发展到联合利妥昔单抗甚至联合同位素标记的单抗作为预处理方案;利妥昔单抗也从仅作为预处理前的净化用药发展到利妥昔单抗在移植前后长期序贯用药。但是无论移植前后的治疗如何进展改变,自体造血干细胞移植为患者备份造血系统,促进患者在接受大剂量的预处理后造血系统功能快速恢复的本质作用始终没有发生改变。随着研究的进一步发展,自体造血干细胞移植将成为淋巴瘤治疗的重要方案。     

Autologous stem cell transplantation and stem cell mobilization kinetics in elderly patients with B cell non-Hodgkin lymphoma

As known, the world population is aging and as the life span increases the number of advanced-age lymphomas also shows an upward trend. Autologous hematopoietic stem cell transplantation (HSCT) is the standard treatment modality in chemotherapy-sensitive relapsed or refractory aggressive lymphomas. Increased morbidity and mortality related to both the transplant itself and comorbid diseases can be observed in elderly lymphoma patients. Patients who are 65 years or older and underwent autologous HSCT with B-cell non-Hodgkin lymphoma were retrospectively included in our study. In terms of survival analysis, median follow-up was 34.5 months (8–159) while the overall survival (OS) was 58%. In the univariate analysis of prognostic data in OS, patients who were referred to transplantation with complete response had a statistically significant survival advantage (p = 0.043). In terms of the effect of pre-transplant conditioning regimens on survival, BEAM regimen yielded better results, though not statistically significant. Age, number of chemotherapy cycles received before mobilization and radiation therapy had no significant effect on the CD34 (+) cell count in the final product (p = 0.492, 0.746 and 0.078 respectively). In conclusion, autologous HSCT is a practicable treatment modality that provides survival advantage in suitable advanced-age patients with a diagnosis of B-cell non-Hodgkin lymphoma.     

自体造血干细胞移植治疗原发中枢神经系统淋巴瘤

原发中枢神经系统淋巴瘤(PCNSL)由于发生率较低,不少医生对整体治疗流程中自体造血干细胞移植(ASCT)的作用还不甚了解。大剂量甲氨蝶呤(HD-MTX)为基础的诱导治疗使得PCNSL的早期控制率明显提高,但不少患者缓解深度不够,国际上大型临床研究提示完全缓解(CR)率多低于50%;缓解维持时间短,多在1年内复发。ASCT作为巩固治疗措施应用于初治或复发难治PCNSL使得CR率明显提高,长期无病生存率(PFS)显著提高;初治PCNSL患者长期PFS可达70%,复发难治PCNSL患者长期PFS可达50%。目前的临床实践证实,PCNSL多见于老年人,器官功能状态良好的老年PCNSL患者仍然可以耐受ASCT,并明显获益于ASCT。PCNSL的ASCT预处理方案以含大剂量塞替派的方案为佳,年轻、身体转态较好、前期诱导治疗未获得CR的患者,以预处理强度更强的TBC方案为佳;年龄偏大的患者可以选择TT-BCNU或减量的TBC预处理方案。     

Assessing the charges associated with hematopoietic stem cell mobilization and remobilization in patients with lymphoma and multiple myeloma undergoing autologous hematopoietic peripheral blood stem cell transplantation

BACKGROUND: The purpose of this study was to perform a detailed analysis of the charges associated with chemomobilization and remobilization of autologous hematopoietic stem cells (HSCs) and to quantify medical costs and resource utilization associated with these procedures. STUDY DESIGN AND METHODS: Patients with lymphoma underwent chemomobilization with ifosfamide and etoposide with or without rituximab (IE ± R). Patients with multiple myeloma (MM) received a modified hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone (hyper‐CVAD) regimen after failing to mobilize with growth factors only. RESULTS: Between January 2004 and October 2006, 98 patients with lymphoma underwent HSC mobilization with IE ± R. Mobilization with IE ± R was effective, with 90.8% of patients collecting at least 2 × 10⁶ CD34+ cells/kg. The total charges for treatment were $27,996 and $37,667 for patients mobilized with IE and IE + R, respectively. Hospital readmission for complications occurred in 26.5% of patients, resulting in additional charges of $10,356. The preapheresis procedure charge was estimated to be $2522, the charge for a 2‐day apheresis session was $5160, and the postapheresis phase resulted in charges of $8040. Our analysis determined that reducing apheresis by 1 day has the potential to save $6600. We also performed a retrospective analysis of 16 patients with MM remobilized with a modified hyper‐CVAD regimen. Remobilization was successful, with 87.5% of patients. Our analysis determined that mobilization, preapheresis, apheresis, and postapheresis phase charges were $24,968, $2522, $6158, and $12,060, respectively. CONCLUSIONS: Optimization of HSC mobilization regimens to reduce failure rates would not only benefit patients but also reduce the overall medical costs.     

自体骨髓间充质干细胞联合外周血干细胞移植治疗非霍奇金淋巴瘤2例（英文）

背景：为了解决造血微环境受损导致造血重建延迟或失败这一常见难题,国内外研究开始尝试外周血干细胞移植联合骨髓间充质干细胞治疗。目的：探讨自体骨髓间充质干细胞联合外周血干细胞移植治疗非霍奇金淋巴瘤的安全性和疗效。方法：对2例确诊为非霍奇金淋巴瘤的患者,采用R-CHOP方案（利妥昔单抗、环磷酰胺、长春新碱、泼尼松）化疗5或6个周期。在自体外周血干细胞动员前取自体骨髓培养骨髓间充质干细胞。动员方案为环磷酰胺、粒细胞集落刺激因子或利妥昔单抗、环磷酰胺、粒细胞集落刺激因子。预处理方案为利妥昔单抗、环磷酰胺、足叶乙甙或利妥昔单抗、环磷酰胺、脂质体阿霉素、地塞米松。回输单个核细胞2.98×106/kg,3.84×108/kg,骨髓间充质干细胞为3.8×106/kg,3.96×106/kg。结果与结论：例1移植后10d白细胞下降至最低值,为0.1×109L-1,中性粒细胞为0×109L-1,移植后12d血小板下降至最低值45×109L-1,外周血象恢复正常时间为移植后15d。例2移植后白细胞和血小板低谷时间为移植后5d,外周血象恢复正常时间为移植后9d。移植相关并发症为急性上呼吸道感染,外痔感染,经过相应处理感染控制。结果说明自体骨髓间充质干细胞联合外周血干细胞移植治疗后造血重建快,肿块或肿大淋巴结消失,近期疗效可,长期疗效有待进一步观察。     

Oral status of patients submitted to autologous hematopoietic stem cell transplantation

Purpose

Oral infection may be a source of bacteremia in patients undergoing hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the relationship between patients with poor periodontal status and complications after HSCT.

Methods

A cohort of patients with hematological malignancies candidates for autologous HSCT was observed before and during the neutropenic phase of HSCT. A primary evaluation was performed before the HSCT procedure, including medical and socio-demographic data and physical examination (number of teeth and decayed, missing and filled teeth index (DMFT), oral mucosa, and full mouth periodontal assessment). During the neutropenic phase, data regarding the development of febrile neutropenia, bacteremia, and mucositis were also prospectively obtained.

Results

Forty-eight patients were included. The most common baseline disease was multiple myeloma (70 %). In the primary evaluations, the median DMFT was 13 (ranging 0–27), and periodontitis and gingivitis were present in 29 and 60 % of the patients, respectively. During the neutropenic phase of HSCT, fever occurred in 96 % of patients, and bacteremia was documented in 29 %. Coagulase-negative Staphylococcus was the most common isolated bacteria. Patients who developed bacteremia had a higher frequency of oral disorders compared with those without bacteremia, but it was not statistically significant. Oral mucositis affected 89.6 % of the patients, and patients with gingivitis or periodontal disorders had a high frequency of mucositis.

Conclusions

The prevalence of oral pathologic conditions previous to HSCT procedures was very high in the studied population. A possible association was noted between previous gingivitis and the development of mucositis during the neutropenia of HSCT.