自体造血干细胞移植治疗纵隔大B细胞非霍奇金淋巴瘤

目的 探讨高剂量放化疗联合自体外周血造血干细胞移植(APBSCT)治疗原发纵隔的、弥漫大B细胞性非霍奇金淋巴瘤(PMLBL)的疗效和安全性。方法 9例PMLBL接受了高剂量放化疗联合APBSCT的治疗,7例采用高剂量化疗(HDC)联合全身照射(TBI)或全淋巴结照射(TLI)或次全淋巴结照射(STLI)作为预处理方案,2例采用单纯高剂量化疗作为预处理方案。均于移植后进行了原发部位的补量放疗。随访10-84个月,中位24个月。诱导化疗后完全缓解(CR)5例,部分缓解(PR)3例,进展(PD)1例。结果 5例诱导化疗后获CR的患者全部无病存活;3例诱导化疗后PR者中,l例获长期无病生存,2例分别于移植后3个月和5个月死亡;l例PD者移植后6个月死亡。全组无移植相关死亡。根据寿命表法分析,全组7年累积无疾病生存率(DFS)为66．7％,7年累积总生存率(OS)为66．7％。结论 高剂量放化疗联合APBSCT治疗具有不良预后因素的PMLBL,取得较好的疗效,该方法易耐受,安全性好,但其在综合治疗中的价值,有待进一步探讨。

Autologous peripheral blood stem cell transplantation in the treatment of patients with primary large mediastinal B-cell lymphoma

Objective To evaluate the therapeutic effectiveness and safety of high dose chemoradiotherapy (HDC) combined with autologous peripheral blood stem cell transplantation (APBSCT) in the treatment of patients with primary large m ediastinal B-cell lymphoma (PMLBL). Methods Among nine patients with PMLBL treated with APBSCT, high dose chemotherapy combined with total body irradiation (TBI) o r total lymph node irradiation (TLI)/subtotal lymph node irradiation (STLI) were given to 7 patients and high dose chemotherapy only as pre-transplantation reg i men in 2 patients. All patients received supplementary irradiation at the primar y mediastinum after transplantation. Results After a median follow-up of 24 (10-8 4) months, 5 patients achieved complete remission (CR) and 3 patients partial re mission (PR) after induction chemotherapy. One patient developed progressive dis ease before transplantation. All 5 patients who achieved CR after induction chem otherapy became disease-free survivors (DFS). One of 3 patients who achieved P R af ter induction chemotherapy was DFS, the other two died in the third and fifth mo nth, respectively. The patient who relapsed before transplantation died in the s ixth month carrying the disease all along. According to the life table method, t he cumulative probability of 7-year DFS and overall survival (OS) were both 66. 7%. No transplant-related mortality was found. Conclusion High dose chemoradiothe rapy combined with autologous peripheral blood stem cell transplantation is a hi ghly potential therapeutic treatment for poor prognostic primary mediastinal lar ge B-cell lymphoma.