自体造血干细胞移植联合利妥昔单抗治疗非霍奇金淋巴瘤6例☆

背景：利妥昔单抗单用或联合CHOP方案化疗治疗CD20阳性非霍奇金淋巴瘤已取得较好疗效，非霍奇金淋巴瘤经自体造血干细胞移植治疗同样可以提高患者的疗效和生存率，而将两种方法联合的效果尚存在争论。目的：探讨自体造血干细胞移植联合利妥昔单抗对CD20阳性非霍奇金淋巴瘤的有效性。方法：对6例CD20阳性非霍奇金淋巴瘤Ⅳ期患者进行自体造血干细胞移植的同时，联合使用利妥昔单抗，分别于移植前给予2~4次，动员和预处理前后各2次，移植后每3个月维持治疗1次，利妥昔单抗用量为 375 mg/m2静滴。结果与结论：平均采集单个核细胞数为5.13× 10-8/kg，CD34+细胞数为4.75×10-6/kg。6例患者自体造血干细胞移植后，造血功能均恢复顺利，中性粒细胞计数大于0.5×10-9L-1为移植后9~15 d，血小板计数大于20×10-9L-1为移植后12~19 d。6例患者在移植过程中均未发生出血性膀胱炎、间质性肺炎、巨细胞病毒感染和肝静脉阻塞等并发症。利妥昔单抗使用过程中，无发热、寒战、皮疹等不良反应发生。移植后6~32个月，患者均处于完全缓解状态。提示自体造血干细胞移植并利妥昔单抗治疗CD20阳性非霍奇金淋巴瘤是一种较好的方法，可维持治疗效果，有利于防止复发。

Rituximab combined with autologous hematopoietic stem cell transplantation for therapy of non-Hodgkin lymphoma

BACKGROUND: Rituximab single or in combination with CHOP regimen for treatment of CD20-positive non-Hodgkin lymphoma has achieved good curative effects. Autologous hematopoietic stem cell transplantation (AHSCT) has been shown to improve the curative effects and increase survival rate of patients with non-Hodgkin lymphoma. However, the curative effects of these two methods remain disputed. OBJECTIVE: To investigate the efficiency of rituximab in combination with AHSCT on CD 20-positive non-Hodgkin lymphoma. METHODS: Six patients with CD 20-positive non-Hodgkin lymphoma (stage IV) underwent AHSCT and rituximab administration. 375 mg/m2 rituximab was intravenously administered 2-4 times prior to AHSCT, twice prior to and after peripheral blood stem cells mobilization and preprocessing, respectively, as well as once every 3 months after AHSCT. RESULTS AND CONCLUSION: The mean number of mononuclear cells and CD 34-positive cells was 5.13×10-8/kg and 4.75×10-6/kg, respectively. Following AHSCT, all 6 patients presented normal hematopoietic functions, neutrophils exceeded 0.5×10-9/L at 9-15 days and blood platelet counts exceeded 20×10-9/L at 12-19 days. Hemorrhagic cystitis, interstitial pneumonia, cytomegalovirus infection, or hepatic venous obstruction was not observed during the whole process of AHSCT in each patient. At 6-32 months, patients completely recovered. These results indicate that rituximab in combination with AHSCT is a good method for treatment of CD20-positive non-Hodgkin lymphoma and rituximab maintenance therapy could prevent disease recurrence.