自体骨髓间充质干细胞联合外周血干细胞移植治疗非霍奇金淋巴瘤2例

背景：为了解决造血微环境受损导致造血重建延迟或失败这一常见难题,国内外研究开始尝试外周血干细胞移植联合骨髓间充质干细胞治疗。 目的：探讨自体骨髓间充质干细胞联合外周血干细胞移植治疗非霍奇金淋巴瘤的安全性和疗效。 方法：对2例确诊为非霍奇金淋巴瘤的患者,采用R-CHOP方案(利妥昔单抗、环磷酰胺、长春新碱、泼尼松)化疗5或6个周期。在自体外周血干细胞动员前取自体骨髓培养骨髓间充质干细胞。动员方案为环磷酰胺、粒细胞集落刺激因子或利妥昔单抗、环磷酰胺、粒细胞集落刺激因子。预处理方案为利妥昔单抗、环磷酰胺、足叶乙甙或利妥昔单抗、环磷酰胺、脂质体阿霉素、地塞米松。回输单个核细胞2.98×10⁶/kg,3.84×10⁸/kg,骨髓间充质干细胞为3.8×10⁶/kg,3.96×10⁶/kg。 结果与结论：例1移植后10 d白细胞下降至最低值,为0.1×10⁹ L^-1,中性粒细胞为0×10⁹ L^-1,移植后12 d 血小板下降至最低值45×10⁹ L^-1,外周血象恢复正常时间为移植后15 d。例2移植后白细胞和血小板低谷时间为移植后5 d,外周血象恢复正常时间为移植后9 d。移植相关并发症为急性上呼吸道感染,外痔感染,经过相应处理感染控制。结果说明自体骨髓间充质干细胞联合外周血干细胞移植治疗后造血重建快,肿块或肿大淋巴结消失,近期疗效可,长期疗效有待进一步观察。

Autologous peripheral blood stem cell in combination with bone marrow-derived mesenchymal stem cell transplantation for two patients with non-Hodgkin lymphoma

BACKGROUND:Peripheral blood stem cell (PBSC) transplantation in combination with bone marrow-derived mesenchymal stem cell (BMSC) transplantation may minimize hematopoietic reconstruction delay or failure caused by hemopoietic microenvironment damage. OBJECTIVE:To investigate the safety and effect of BMSC+ PBSC transplantation in the treatment of non-Hodgkin lymphoma. METHODS:Two patients diagnosed as non-Hodgkin lymphoma were treated with chemotherapy for 5 or 6 cycles using R-CHOP protocols (rituximab, cyclophosphamide, Oncovin, and prednisone). BMSCs from autologous bone marrow were cultured prior to autologous PBSC mobilization using cyclophosphamide, granulocyte colony-stimulating factor or rituximab, cyclophosphamide, and granulocyte colony-stimulating factor. Preconditioning protocols used rituximab, cyclophosphamide, etoposide or rituximab, cyclophosphamide, liposome adriamycin, and dexamethasone. Mononuclear cells of 2.98×10⁶/kg, 3.84×10⁸/kg and BMSCs of 3.8×10⁶/kg, 3.96×10⁶/kg were infused. RESULTS AND CONCLUSION:In case 1, the white blood cells decreased to the lowest level, 0.1×10⁹/L, neutrophil, 0×10⁹/L, 10 days following transplantation, and the platelet reduced to the minimal level of 45×10⁹/L up to 12 days. Peripheral blood restored to normal at 15 days after transplantation. The white blood cells and platelet reduced to the lowest levels up to 5 days following transplantation in case 2 and the peripheral blood restored to normal at 9 days. Transplantation-related complications included acute upper respiratory tract infection and external hemorrhoid infection, which were controlled by treatment. Results indicated that in the treatment of malignant lymphoma, autologous BMSC+ PBSC transplantation rapidly reconstructed hematopoiesis, and the tumor or swollen lymph node disappeared. The short-term effects were evident, but the long-term effect requires further investigation.