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1.
目的 观察异基因造血干细胞移植(allo-HSCT)治疗自体造血干细胞移植(auto-HSCT)后复发的霍奇金淋巴瘤(HL)的临床疗效及安全性.方法 选取auto-HSCT后复发的HL患者4例,采用FBC预处理方案,实施allo-HSCT.结果 4例患者全部获得造血重建,发生急性移植物抗宿主病2例,发生慢性移植物抗宿主病2例,2例患者分别于移植后11个月、19个月疾病复发,另外2例尚健康生存.结论allo-HSCT对于auto-HSCT后复发的HL患者仍然是有效的.  相似文献   

2.
目的 探讨异基因造血干细胞移植(allo-HSCT)治疗复发难治性淋巴瘤的疗效和安全性.方法 北京军区总医院血液科2007年1月至2012年1月应用allo-HSCT共治疗7例复发难治性淋巴瘤患者,其中男4例,女3例,年龄18~ 48岁,平均年龄33.7岁.原发病为非霍奇金淋巴瘤6例,其中弥漫大B细胞淋巴瘤(DLBCL)2例,T淋巴母细胞淋巴瘤(T-LL)1例,皮肤结外鼻型NK/T细胞淋巴瘤(ENKTCL-N)1例,肝脾T细胞淋巴瘤(HSTCL)1例,伯基特淋巴瘤(BL)1例;霍奇金淋巴瘤1例,为混合细胞型.首次复发4例,2次及以上复发2例,原发难治1例;自体移植后复发2例(均为2次及以上复发者);移植时有3例缓解,4例未取得缓解.供受者HLA全相合3例,HLA不全相合4例,采用骨髓加外周血干细胞联合移植,预处理均采用氟达拉滨替代环磷酰胺(Cy)的改良白消安(Bu)+Cy方案,移植物抗宿主病(GVHD)的预防采用经典环孢素(CsA)和甲氨蝶呤(MTX),移植后观察患者并发症和无病生存等情况.结果 6例患者能较好耐受预处理方案,均获造血重建,植入证据检测证实100%为完全供者造血,1例预处理后死亡.全部患者中位随访29.6个月(1~70个月).共5例发生急性GVHD,4例发生慢性GVHD;死亡2例(因感染死亡1例、复发死亡1例),其余5例患者无病生存,无病生存率为71.4%,最长无病生存时间已达70个月.结论 allo-HSCT治疗复发难治性淋巴瘤安全有效,可作为挽救治疗的关键技术,可在临床广泛开展.  相似文献   

3.
 【摘要】 造血干细胞移植(HSCT)是治疗多发性骨髓瘤(MM)的一线方案。自体造血干细胞移植(auto-HSCT)可提高患者缓解率,延长生存期。首次auto-HSCT后,未获得非常好的部分缓解及以上疗效的患者,可行二次auto-HSCT进一步改善疗效。异基因造血干细胞移植(allo-HSCT)具有治愈MM的潜能,但移植相关死亡率高,患者生存并未获益。减低剂量的allo-HSCT相关死亡率低,但复发率高,也未显示出生存优势。序贯auto-HSCT及allo-HSCT也未使患者生存明显获益。总结近期HSCT的研究进展。  相似文献   

4.
血管免疫母细胞性T细胞淋巴瘤(AITL)是一种系统性、侵袭性外周T细胞淋巴瘤,目前仍然缺乏标准治疗方案.联合化疗没有明显改善预后且缓解持续时间短;靶向药物和免疫抑制治疗研究样本小,不能明确疗效;大剂量化疗联合自体造血干细胞移植(HDT-ASCT)和异基因造血干细胞移植(allo-HSCT)虽然都取得了显著疗效,但HDT-ASCT具有高复发率、远期继发肿瘤等诸多风险,allo-HSCT亦因移植相关死亡率较高而有待进一步探讨.文章就近年来AITL的治疗研究进展加以综述.  相似文献   

5.
目的:探讨化疗序贯自体造血干细胞移植(auto-HSCT)对淋巴瘤患者的疗效及影响因素.方法:回顾性分析2015年09月至2020年12月于我科接受大剂量化疗(HDC)序贯自体外周血造血干细胞移植治疗的患者,并进行疗效及不良反应评价.结果:40例患者,其中非霍奇金淋巴瘤34例,霍奇金淋巴瘤6例;男性27例,女性13例,...  相似文献   

6.
外周T细胞淋巴瘤作为一组异质性肿瘤,大多侵袭性强,易出现复发和耐药,预后极差.以化疗和自体造血干细胞移植(ASCT)为基础的治疗,5年无病生存率不足30%.异基因造血干细胞移植(allo-HSCT)治疗外周T细胞淋巴瘤具有移植物抗淋巴瘤效应,治疗复发难治性外周T细胞淋巴瘤的长期无病生存率达35%~50%.allo-HSCT可作为治疗外周T细胞淋巴瘤的有效手段.  相似文献   

7.
造血干细胞移植治疗慢性髓系白血病的疗效分析   总被引:3,自引:0,他引:3  
Liu QF  Sun J  Zhang Y  Liu XL  Xu D  Xu B  Feng R  Meng FY  Zhou SY 《癌症》2004,23(4):426-429
背景与目的:慢性髓系白血病(chronic myelogenous leukemia,CML)是一种常见的恶性血液疾病,造血干细胞移植(hematopoietic stem cells transplantation,HSCT)是治疗CML最主要的手段。本研究评价自体(auto-)或异体(allo-)HSCT治疗CML的临床疗效。方法:44例CML息者接受HSCT治疗,其中8例采用净化auto-HSCT,30例采用相关allo—HSCT,6例采用无关allo-HSCT;预处理方案:31例接受TBI CY(全身放疗 环磷酰胺)方案,12例采用改良BuCY(羟基脲、马利兰、阿糖胞苷、环磷酰胺)方案,1例采用MACC(马法兰、阿糖胞苷、环磷酰胺、环已亚硝脲)方案;移植物抗宿主病(GVHD)预防:相关移植采用CsA MTX(环孢素A 甲氨蝶呤)方案,无关移植采用CsA MTX MMF(霉酚酸酯) ATG(抗胸腺细胞球蛋白)方案。此外,移植前加速期和急变期患者单用CsA。Kaplan—Meier生存模型评估移植后无病生存。结果:8例接受激活骨髓(ABM)联合反义寡核苷酸或联合STI571体内外净化auto-HSCT后,除1例死于移植中相关并发症外,其余均获得部分或完全细胞或分子遗传学缓解,其中1例急变期患者血液学完全缓解(CR)后移植获分子遗传学CR达81个月。36例allo—HSCT患者除1例死于肝静脉闭塞综合征(hepatic veno-occlusive disease,VOD)和1例移植前急变患者移植后无效以外,其余患者均获CR。移植中感染发生率为38.6%,VOD发生率为9.1%,出血性膀胱炎(hemorrhagic cystitis,HC)发生率为15.9%,巨细胞病毒(CMV)性肺炎为11.4%,VOD、HC和CMV肺炎均发生在allo-HSCT患者。急性GVHD发生率在相关与无关移植中分别为40.0%与33.3%。在相关移植中慢性GVHD发生率为43.4%。移植相关死亡率在自体与异体HSCT中分别为12.5%与16.7%,auto—HSCT复发率为37.5%,相关allo-HSCT复发率为13.3%。移植后5年无病生存率在自体与相关异体移植中分别为18.7%与53.7%。移植前慢性期与加速期和急变期患者相关allo-HSCT后5年无病生存率分别为66.4%与26.7%。结论:allo—HSCT对CML患者,尤其是慢性期患者具有较高的临床治愈率;CsA MTX MMF ATG四联方案在无关allo-HSCT中应用能降低移植后急性GVHD的发生率及程度;采用净化骨髓自体移植能延长CML患者生存期,甚至少部分患者可获得临床治愈。  相似文献   

8.
造血干细胞移植(HSCT)已成为多发性骨髓瘤(MM)的一线治疗方案.早期进行自体造血干细胞移植(ASCT)已成为年轻初发MM患者的标准治疗方法.在新药时代,新型制剂在HSCT前及HSCT后的巩固维持治疗中可提高HSCT疗效.对于治疗复发难治性MM,新药对HSCT的地位构成挑战.文章将总结近期HSCT在新药时代的临床研究,旨在明确新药时代HSCT在MM治疗中的地位.  相似文献   

9.
目的 初步探讨自体或异体间充质干细胞(MSC)移植对造血重建的影响.方法 采用含血清培养体系培养扩增自体或供者骨髓以及来自胚胎的MSC,例1为系统性红斑狼疮(SLE);例2为非霍奇金淋巴瘤(NHL),患者在造血干细胞移植(HSCT)前先输注自体MSC,然后进行自体HSCT;例3为阵发性睡眠性血红蛋白尿(PNH),在HSCT前先输注供者MSC,然后进行同基因异体HSCT;例4为慢性粒细胞白血病(CML),行异基因HSCT;例5为淋巴瘤行自体HSCT,在移植后造血恢复缓慢(分别为+129天,+78天)移植来自胚胎的MSC.结果 例1、例2和例3患者MSC和HSCT联合无明显不良反应.中性粒细胞≥0.5×109/L和血小板≥20×109/L的时间分别为移植后1、10、10和1、8、33 d.粒细胞缺乏时间分别为0、7、12 d;输注来自胚胎MSC的患者(例4、例5),1个月内造血仍无恢复,MSC移植失败.结论 MSC移植时机掌握很重要,与HSCT同时进行,可以促进造血重建,而在移植后一些造血重建缓慢的患者再进行MSC移植的疗效还有待进一步研究.
Abstract:
Objective To investigate the impact of auto and allogenic mesenchymal stem cells (MSC) transplantation on hematopoietic reconstitution. Methods MSC from auto, donor bone marrow or embryonic tissue were cultured and expanded in vitro in the serum culture system. Five patients received hematopoietic stem cell transplantation (HSCT) were investigated. Case 1 of systemic lupus erythematosus and Case 2 of non-hodgkin' s lymphoma (NHL) received auto MSC transplant before auto-HSCT. Case 3 of paroxysmal nocturnal hemoglobinuria received HLA-identical allogenic MSC transplant before HLA-identical allo-HSCT.Case 4 of chronic myelocytic leukemia and Case 5 of NHL had delayed hematopoietic reconstitution (129th and 78th day, respectively) after allo- and auto-HSCT, respectively, and received MSC from embryonic tissue.Results Case 1, 2 and 3 had no manifested side effects after MSC transplantation combined with HSCT.Neutrophil count of case 1, 2, and 3 were over 0.5 ×109/L at 1st, 10th and 10th day, respectively, platelet count were over 20 ×109/L at 1st, 8th and 33th day, respectively, and agranulocytosis at Ost, 7th and 12th day, respectively. The treatment of embryonic tissue MSC transplant was confirmed to fail for Case 4 and 5.Conclusion The time of MSC transplant has a great impact on hematopoietic reconstitution. MSC transplantation and HSCT performed simultaneously can improve hematopoietic reconstitution. However, the impact of MSC on patients with delayed hematopoietic reconstitution after HSCT needs further study.  相似文献   

10.
复发难治淋巴瘤的治疗仍然是临床上的一大难题,目前主要以大剂量化疗联合自体造血干细胞移植及新药、细胞免疫治疗为主。近年减低强度预处理方案异基因造血干细胞移植(allo-HSCT)及替代供者的应用,使allo-HSCT成为复发难治淋巴瘤有价值的治疗选择。疾病特征、患者临床特点、替代供者的选择、预处理强度及移植相关并发症的管理等因素均影响着患者移植后的生存。allo-HSCT治疗复发难治淋巴瘤的数据主要来源于各移植中心的回顾性报道,前瞻性试验仍缺乏,移植患者的选择及移植时机的把握、移植物来源、预处理强度的选择等仍无统一的标准。文章将围绕这些方面对allo-HSCT在复发难治淋巴瘤中的应用进展进行介绍。  相似文献   

11.
造血干细胞移植治疗恶性血液病疗效分析   总被引:2,自引:0,他引:2       下载免费PDF全文
 目的 比较自体与异体造血干细胞移植 (HSCT)治疗白血病和非霍杰金氏淋巴瘤 (NHL)的疗效和移植相关死亡。方法  2 2 2例白血病和NHL中 ,112例接受自体HSCT、110例接受异体HSCT ,其中38例急性早幼粒细胞白血病 (M3 )和 36例NHL均为自体HSCT。移植预处理方案包括 :14 9例TBI +Cy、2 3例改良Bucy、5 0例MACC方案。 结果 全部患者均获得造血重建 ,在自体与异体移植后白细胞>1.0× 10 9/L和血小板 >2 0× 10 9/L的时间 ,二组分别为 (14 .3± 6 .1)d和 (17.8± 9.2 )d与 (15 .1±4 .6 )d和 (19.6± 10 .3)d ,二组比较造血重建时间无差异 (P >0 .0 1)。非M3 白血病自体与异体移植后 5年估计无病生存率为 (5 2 .0± 5 .8) %和 (6 2 .4± 6 .2 ) %、复发率为 (44 .7%和 14 .5 % ) ,M3 白血病自体移植无病生存率 (93.6± 4 .4 ) %、复发率 5 .3% ,NHL自体移植无病生存率 (6 6 .3± 8.0 ) %、复发率 2 2...  相似文献   

12.
目的:探讨自体外周血造血干细胞移植治疗淋巴瘤的临床效果。方法:回顾性分析2014年1月至2020年12月济宁医学院附属医院行自体外周血造血干细胞移植治疗的41例淋巴瘤患者临床资料,包括霍奇金淋巴瘤6例,非霍奇金淋巴瘤35例。采用化疗药物+粒细胞集落刺激因子(G-CSF)+血小板生成素(TPO)或化疗药物+G-CSF的动员方案。移植前预处理方案:26例患者采用BEAM方案+地西他滨,12例采用BEAM方案,3例采用BEAM方案+西达苯胺。观察患者无进展生存(PFS)及总生存(OS)、相关并发症、移植后转归,以及临床分期、B症状、国际预后指数(IPI)评分、结外累及部位、血红蛋白、乳酸脱氢酶(LDH)、β 2-微球蛋白(β 2-MG)、移植方案、移植前状态对移植后OS及PFS的影响。 结果:41例患者中自体外周血造血干细胞移植前疾病获得完全缓解37例(90.24%),部分缓解2例(4.88%),未评估2例(4.88%)。24例干细胞采集资料完整的患者采集的中位有核细胞计数12.74×10 8/kg[(3.91~22.68)×10 8/kg],中位CD34阳性细胞数为6.74×10 6/kg[(0.91~50.47)×10 6/kg]。全部41例患者均获得造血重建,中位血小板植入时间为11 d(7~32 d),中位粒细胞植入时间为9 d(8~16 d)。41例患者移植后疾病均获得完全缓解,无一例发生移植相关死亡。至随访结束,无疾病进展33例,死亡8例。患者移植后12、24、72个月OS率分别为93.4%、85.3%和60.9%,PFS率分别为93.3%、84.0%、84.0%。中位PFS及OS时间均为未达到。不同性别、临床分期、B症状、IPI评分、结外累及部位、血红蛋白、LDH、β 2-MG、移植前状态患者OS及PFS差异均无统计学意义(均 P>0.05),移植前预处理方案为BEAM方案+地西他滨患者PFS及OS均优于单用BEAM方案患者(均 P<0.05)。 结论:自体外周血造血干细胞移植治疗淋巴瘤具有较好的效果。BEAM方案+地西他滨预处理方案较单用BEAM方案可获得更长的生存时间。  相似文献   

13.
Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after hematopoietic stem cell transplantation (HSCT). Several studies of risk factors for PTLD have been reported; however, the probability of, and risk factors for, PTLD in patients with lymphoma is unknown. Japanese nationwide transplant registry data from 5270 patients with lymphoma after allogeneic HSCT were analyzed. Mature B-cell, T/NK-cell, and T-cell lymphoblastic subtypes accounted for 49%, 26%, and 9.6% of lymphoma cases, respectively. Rituximab was used in 1678 lymphoma patients, most of whom (89%) received HSCT for mature B-cell lymphoma. Thirty-one patients with lymphoma developed PTLD, representing a probability of 0.77% at 2 years post-HSCT, which did not differ significantly from that in patients with other diseases (P = .98). Year of HSCT after 2010 (hazard ratio [HR] = 5.6, 95% confidence interval [CI], 1.48-21.3), antithymocyte globulin (ATG) use in the conditioning regimen (HR = 4.5, 95% CI, 1.61-12.5), and no rituximab use before HSCT (HR = 3.2, 95% CI, 1.26-7.90) were identified as risk factors for PTLD. Probabilities of PTLD at 1 year post-HSCT according to rituximab and ATG use were 0.23% (rituximab+, ATG−), 0.75% (rituximab−, ATG−), 1.25% (rituximab+, ATG+), and 3.53% (rituximab−, ATG+). Regarding lymphoma subtypes, patients with mature B-cell lymphoma had the lowest incidence of PTLD (0.35% at 2 years). Among high-risk patients receiving ATG, the mortality rate due to infection was elevated in those previously treated with rituximab (22%) relative to those without (14%); however, the difference was not significant (P = .10). Rituximab use before HSCT significantly reduces the risk of PTLD. Adding rituximab to the conditioning regimen is potentially a good strategy to prevent the development of PTLD in high-risk patients.  相似文献   

14.
A 54-year-old male was diagnosed with follicular lymphoma in September 2003. Despite multiple chemotherapies, including autologous hematopoietic stem cell transplantation (HSCT) with high-dose chemotherapy, the disease eventually relapsed. Additionally, bone marrow analysis revealed the co-emergence of therapy-related myelodysplastic syndrome (t-MDS) in February 2012. In March 2012, we performed related allogeneic HSCT for the treatment of both malignancies. This strategy was successful and the patient has remained free from both malignancies for 23 months. Allogeneic HSCT is a potent curative therapeutic option for both t-MDS and refractory follicular lymphoma.Key words: Therapy-related myelodysplastic syndrome, Follicular lymphoma, Allogeneic transplantation  相似文献   

15.
The general chemotherapy for Peripheral T-cell lymphoma(PTCL) featuring an active invasion has less curative effect and worse prognosis in comparison with that for B-cell non-Hodgkin's lymphoma(NHL).Studies in recent years suggest that hematopoietic stem cell transplantation(HSCT) has better curative effect on the PTCL;however,it is significant to do more studies on some aspects such as the methodology,punctuality,preconditioning,and pretreatment intensity of the transplantation,which are crucial to the cur...  相似文献   

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17.
Objectives: This study investigated the possible prognostic factors for the long-term survival (Cure Rate) of Hodgkin Lymphoma patients who underwent HSCT. Methods: This retrospective cohort study analyzed 116 Patients diagnosed with Hodgkin Lymphoma who received autologous hematopoietic stem cell transplantation (Auto-HSCT) between the years 2007 and 2014 and followed up until 2017. The information regarding patients’ survival had been collected using phone calls, and their pre-transplant information was available in the archived documents. Prognostic effects were investigated using long-term survival models. Results: Patients with obesity had five times higher odds of long-term survival (cure) than the others (P=0.06). Also, the recurrence experience after HSCT negatively impacted the curing potential by 78% (P=0.05). Also, with 32 years as the change point, patients younger than 32 had 76% fewer odds of surviving long-term (P=0.03), and Poor transfused stem cell dose of CD34+ (<0.16 × 106 cells/ml) reduced the odds of long-term survival by 92% (P=0.01). Conclusion: According to the statistical models used in this study, obesity can increase the curing potential of Hodgkin lymphoma after transplantation. Meanwhile, aging, poor transfused CD34+ cells, and recurrence after HSCT were associated with lower survival following HSCT.  相似文献   

18.
Allogeneic hematopoietic stem cell transplantation (HSCT) has been restricted to medically fit patients under the age of 55 years due to adverse effects of the intensive conditioning regimens. Autologous HSCT has not proven to be a particularly effective treatment for patients with low-grade non-Hodgkin's lymphoma (NHL). Much of the benefit of allogeneic HSCT appears to be mediated by a graft-vs.-tumor (GVT) effect. Reduced-intensity regimens in allogeneic HSCT have been developed to minimize conditioning regimen-related toxicities and to control the malignancy until a GVT effect is established. A number of studies investigating reduced-intensity allogeneic HSCT are discussed. Results from these studies suggest that indications for allogeneic transplant include patients with low-grade NHL with a sibling or matched donor who are under 60 years of age; young patients with mantle cell lymphoma who are in first remission and have a sibling or matched donor; patients with high-grade NHL who have already failed an autograft but have chemosensitive disease, and those under 30 years of age who have poor-risk disease and are in first remission. It is concluded that reduction in treatment-related mortality with reduced-intensity HSCT and the presence of GVT effects increases the applicability of allogeneic transplantation for NHL. However, treatment will be improved by optimizating conditioning regimens and a better understanding of patient selection criteria and the immune processes involved in graft-vs.-host disease and GVT.  相似文献   

19.
Recent progress in the treatment of malignant lymphoma   总被引:2,自引:0,他引:2  
The present state of the art and developments in the treatment for Hodgkin's disease (HD), follicular lymphoma (FL), MALT lymphoma, and aggressive non-Hodgkin's lymphoma are reviewed. Four courses of ABVD therapy (ABVd therapy in Japan) followed by involved-field irradiation (IFRT), and 6 to 8 courses of ABVD (ABVd in Japan) are the current state art of the therapy for early stage HD and advanced stage HD, respectively. High-dose chemotherapy with autologous hematopoietic stem cell transplantation (auto-HSCT) is also the state of the art for refractory or relapsed HD within 1 year after complete remission (CR) produced by polychemotherapy. The prognosis of the patients with 3 or more International Prognostic Scores (IPS) is poor. New intensified polychemotherapy or auto-HSCT as up-front setting is under randomized phase III clinical trial in Europe and the USA. There is no state of the art therapy for indolent lymphoma including FL, or MALT. Promising results were reported from clinical studies using new anti-lymphoma drugs such as rituximab, iibritumomab, or purine analogs (cladribine and fludarabine), and auto-HSCT with effectively purged stem cells or allogeneic HSCT. These therapeutic strategies hold a possibility of cure for indolent lymphomas. Antibiotic treatment for Helicobacter pylori-positive localized gastric MALT lymphoma is the state of the art therapy. However, there is no standard therapy for advanced stage MALT lymphoma. Risk adapted therapy using the International Prognostic Index is essential for the treatment of aggressive NHL. Three courses of CHOP followed by IFRT for localized aggressive NHL and 8 courses of CHOP for the low-risk group of advanced stage aggressive NHL are the state of the art therapies, respectively. High-dose chemotherapy with auto-HSCT is also the state of the art for sensitive relapse patients with aggressive NHL. Although some clinical studies suggested that high-dose chemotherapy with auto-HSCT as up-front setting for high-intermediate or high-risk group aggressive NHL is more effective than conventional chemotherapy, the efficacy remains to be determined. The development of new therapeutic strategies with combined use of molecular targeting drugs such as rituximab, or new anti-lymphoma drugs such as purine analogs, and HSCT is desired for more effective therapy for refractory lymphomas.  相似文献   

20.
To select an appropriate prognostic model in the treatment of mature T- and natural killer (NK) -cell lymphoma (peripheral T-cell lymphoma (PTCL) and NK-/T-cell lymphoma (NKTCL)) is crucial. This study investigated the usefulness of Ann Arbor staging classification International prognostic index (IPI), prognostic index for T-cell lymphoma (PIT) and International peripheral T-cell lymphoma Project score (IPTCLP). Between 2000 and 2009, 176 patients (122 males) with PTCL and NKTCL were diagnosed and treated from a single institute in Taiwan. The correlation between complete response (CR) rate, 3-year overall survival (OS), early mortality rate and four prognostic models was analyzed. Thirty-one patients received hematopoietic stem cell transplantation (HSCT) and were analyzed separately. Three-year OS rate was 34.7%, and anaplastic large-cell lymphoma harbored better outcome than others. IPI score had the lowest Akaike information criterion value (1081.197) and was the best score in predicting OS and early mortality (P=0.009). Ann Arbor stage classification can predict CR rate more precisely (P=0.006). OS was significantly better in patients who received HSCT, even in patients with unfavorable features compared with chemotherapy alone. All prognostic models were useful to evaluate the outcome of patients with PTCL and NKTCL but IPI score did best in predicting OS in PTCL and PIT score in NKTCL. This study also supported the role of HSCT in patients with high-risk or refractory PTCL or NKTCL.  相似文献   

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