自体造血干细胞移植联合大剂量放化疗治疗恶性淋巴瘤32例

目的观察自体造血干细胞移植(AHSCT)治疗恶性淋巴瘤的疗效.方法自1991年6月至2000年4月,用AHSCT治疗恶性淋巴瘤32例.其中非霍奇金淋巴瘤(NHL)23例,霍奇金病(HD)9例;行自体骨髓移植(ABMT)12例,自体外周血干细胞移植(APBSCT)20例.外周血干细胞动员方法均采用常规化疗(CE或CHOP)加细胞集落刺激因子(G-CSF或GM-CSF;或G-CSF+GMCSF)10μg*kg-1*d-1.预处理方案为BEAM方案和MEL140mg/m2(或+Vp-16200mg)+单次全身照射(TBI)8Gy.结果全部患者移植后均重建造血,随访至2000年5月30日,中位随访1020d.处于无病生存者24例(75.0%),1,2年无病生存分别为78.1%(25/32)和46.9%(15/32),最长存活8年.8例(25.0%)复发.全组患者无移植相关死亡.结论AHSCT联合大剂量放化疗对预后不良复发或敏感的恶性淋巴瘤疗效佳,优于常规化疗.APBSCT造血恢复比ABMT快.预处理方案中含TBI的放疗组与单用联合化疗组疗效差异无显著性,但含放疗组副作用大.

Combined high dose chemotherapy with autologous stem cell transplantation and total body radiotherapy for 32 malignant lymphoma patients

OBJECTIVE: To evaluate the effect of high dose chemotherapy with or without total body irradiation (TBI) supported by autologous hematopoietic stem cell transplantation (AHSCT) for malignant lymphoma. METHODS: From June 1991 to April 2000, 32 malignant lymphoma (ML) patients were treated with AHSCT. Their ages ranged from 19 to 52 years (median 37). There were 23 non-Hodgkin's lymphoma (NHL) and 9 Hodgkin's lymphom (HD). Twelve patients received autologous bone marrow transplantation (ABMT) and 20 patients received autologous peripheral blood stem cell transplantation (APBSCT). In the latter, the mobilization plan was carboplatin and etoposide (CE) or CHOP (CTX, ADM, VCR, PDN) plus G/GM-CSF 10 micrograms/kg/d in high dose chemotherapy. BEAM (BCNU, Vp-16, AraC, MEL) or MEL 140 mg/m2 + Vp-16 200 mg + total body irradiation (TBI) 8 Gy. RESULTS: Up to May 2000, hematopoietic reconstitution was reestabished in 100% (32/32) patients after AHSCT, with median follow-up of 1,020 days (40-3,240). The 1- and 2-year disease-free survivals (DFS) were 78.1%(25/32) and 46.9% (15/32) with the longest survival of 8 years. Even though eight patients have developed relapse, there is no transplantation-related death. CONCLUSION: High dose chemotherapy and radiotherapy supported by autologous hematopoietic stem cell transplantation (AHSCT) for high risk, relapsed or sensitive ML, being highly efficient, should be the first indication. It is better than the standard conventional treatment. The hematopoietic reconstitution of autologous peripheral blood stem cell transplantation (APBSCT) is quicker than autologous bone marrow transplantation (ABMT). No significant difference between chemotherapy alone and chemotherapy plus total body irradiation is observed.