择时化疗联合自体骨髓移植治疗非霍奇金淋巴瘤

目的：探讨在自体骨髓（造血干细胞）移植技术支持下应用选择给药时间的高剂量的环磷酰胺、依托泊苷、阿糖胞苷和表柔比星等组成COAE预处理化疗方案治疗预后差的中高度恶性非霍奇金淋巴瘤（NHL）的疗效。方法：观察11例患者应用本方案治疗后造血与免疫功能重建、长期无病生存率、毒副作用及移植相关死亡等，选用Kaplan-Meier生存曲线评估移植后五年无病生存率，COX回归模型分析性别、年龄、预处理方案、移植时状态等对无病重存时间的影响。结果：所有病人均获得造血与免疫功能重建，除3例在移植后1年内复发外，其余病人至2000年5月持续完全缓解（CR）期分别为73、63、35、30、27、20、16、8月。预期5年无病生存率为73%。结论：本法在给药时间上进行了创新，使疗效提高，并减低了高剂量化疗的毒副作用。本法作为有不良预后因素的中高度恶性NHL患者诱导化疗达CR后强化治疗手段的远期疗效显著。

Long-term follow-up of high-dose chronochemotherapy with autologous bone marrow transplantation for non-Hodgkin's lymphoma

Purpose:To explore the effectiveness on the patients with poor prognosis and intermediate or high-grade non-Hodgkin's lymphoma (NHL) chronology of high-dose chemotherapy, including cyolophosphamide,etoposide etoposide cytosine arabinoside and epirubicin(COAE) , following autologous bone marrow transplantation (ABMT).Methods:11 NHL patients were treated by this method. The reconstitution of hematopoiesis and immunity was observed post-transplantation. The long-term survival, the side effects and transplantation-related-death of all the patients were investigated. Kaplan-Meier survival analysis model was used to estimate the disease-free-survival (DFS) at 5 years post-transplantation and COX regression model to analyze the factors influencing the DFS, which included sex, age, kinds of pathology, conditioning regimen,etc. Results:All the patients reconstituted hematopiesis and immunity. Except for 3 patients who had relapse one year after-transplantation, others remained in CR for 73, 63, 35, 30,27, 20, 16, 8 months until May, 2000. The actuarial 5 years DFS in patients with NHL was 73%.Conclusions:This high-dose COAE regimen with changes in chronology of chemotherapy reduces the relapse and toxicity , and increases the long-term-survival. Its long-term effect is significant for the patients with poor prognosis and intermediate or high-grade NHL after CR.