自体造血干细胞移植支持下BEAC方案治疗晚期复发恶性淋巴瘤

目的：报告 20例恶性淋巴瘤在自体造血干细胞移植支持下接受超大剂量化疗的初步治疗经验 ,评价所用外周血造血干细胞 (peripheral blood progenitors,PBPC )动员方案的动员效果，预处理方案的远期疗效和耐受性，以及回输后造血重建情况。方法： 20例复发、晚期恶性淋巴瘤中， 1例复发霍奇金病 (Hodgkin s disease,HD),19例非霍奇金淋巴瘤 (non- Hodgkin s lymphoma,NHL）。经常规化疗获缓解后， 3例采用自体骨髓移植 (autologous bone marrow transplantation,ABMT)， 17例采用自体外周血干细胞移植 (autologous peripheral blood stem cell transplantation,APBSCT)；动员方案为环磷酰胺 (CTX)3 500 mg/m2＋ G- CSF 3.5～ 5μ g/kg＋地塞米松 10 mg，预处理方案为 BEAC(CTX 3 600～ 4 000 mg/m2,Vp- 16 1 200 mg/m2,BCNU 300 mg/m2和 Ara- C 1 500～ 2 000 mg/m2),化疗结束后 24～ 48 h回输自体造血干细胞。结果： ABMT病人回输单核细胞 (MNC)1.3(1.0～ 1.7)× 108/kg， APBSCT病人回输 MNC 1.8(1.0～ 4.4)× 108、 CFU- GM 5.1 (1.9～ 9.6 )× 105/kg和 CD34＋细胞 2.9(1.9～ 8.7)× 106/kg。回输造血干细胞后均获快速造血功能重建，中性粒细胞 (ANC)≥ 0.5× 109/L时间为 9(6～ 17)天，血小板≥

Advanced and Recurrent Malignant Lymphoma Were Treated by BEAC Regimen Supported with Autologous Hemotopoietic Stem Cells Transplantation

Objectives: High dose chemotherapy supported therapeutic outcome by AHSCT has developed dramatically in recent years and become the most effective approach to improve for the chemo-sensitive lymphoma. The purpose of this study was to evaluate the efficacy of mobilization regimen, effectiveness and tolerance of BEAC regimen in Chinese patients with advanced and recurrent lymphoma,and hemotopoietic reconstitution. Methods: After confirmed complete or partial remission from conventional chemotherapy, 20 patients with advanced or recurrent lymphoma, 1 recurrent HD and 19 NHL;14 male and 6 female with median age 28(range,13-48)years old， were enrolled into this study and treated with BEAC regimen(CTX 3600-4000 mg/m2, VP-16 1200 mg/m2. BCNU 300 mg/m2 and Ara-C 1500-2000 mg/m2). Three patients were supported by ABMT and 17 by APBSCT. Mobilization regimen for APBSCT was CTX 3500 mg/m2＋ G-CSF 3.5-5 μ g/kg＋ Dexamethasone 10 mg. Autologous hemotopoietic stem cells was re-infused 24-48 hours after completion of high dose chemotherapy. Results: MNC 1.3(range,1.0～1.7)× 108/kg and,MNC 1.8(range,1.0-4.4)× 109, CFU-GM 5.1(range,1.9-9.6)× 105/kg and CD34＋ cells 2.9 (range,1.9～8.7)× 106/kg were re-infused in the ABMT group and APBSCT group respectively. All patients obtained prompt and sustained hemotopoietic reconstitution. ANC ≥ 0.5× 109/L and Pt ≥ 2.0× 109/L were at day 9 (range,6～17) and day 10 (range,0～31) respectively. Fourteen patients were alive with median 18(range,1～67)months follow-up till end of April,2000. The 1,2,and 3 years survival rate were 61.2％ , 53.4％ and 53.4％ ,respectively. Non-hemotologic toxicity was mild and tolerable. Conclusion: High dose chemotherapy supported by AHSCT in the treatment of poor-prognostic and recurrent lymphoma is a safe and effective modality. However further investigation is warranted.