自体造血干细胞移植治疗恶性淋巴瘤

·论著·

自体造血干细胞移植治疗难治性恶性淋巴瘤

孙致信　龚敏珠　陈琳军　马骏　张志慈　华漱涯　曹晶

【摘要】　目的　观察自体造血干细胞移植(AHSCT )对难治性恶性淋巴瘤的疗效及不良反应。方法　4例对CHOP 方案为主化疗反应不良的恶性淋巴瘤,以HD -VCCA 方案化疗加TL I 预处理的自体外周血干细胞移植(APBSCT )治疗。自体骨髓移植(ABM T )两例,CTX 加VP 216联合rh G 2CSF 动员外周血干细胞的APBSCT 者两例。干细胞4℃保存,72h 内回输。结果　4例移植期间中性粒细胞计数恢复到≥0.5×109/L 的时间,血小板达≥50×109/L 的时间和网织红细胞比例达≥0.5%的时间,APBSCT 和ABM T 分别平均为+9.5d 和+11

d ;+14d 和+21.5d ;+9d 和16.5d 。不良反应主要为消化道反应,移植后血清卵泡刺激素(FSH )和黄体生成

素(L H )水平升高,雌二醇(E 2)水平降低的继发性闭经2例。4例已无病生存8～57个月。结论　干细胞不冷冻的AHSCT 治疗难治性恶性淋巴瘤安全、简便、有效。APBSCT 较ABM T 造血功能恢复快,不良反应小。预处理对性腺有损伤。

【关键词】　造血干细胞移植,自体;骨髓移植;外周血干细胞;恶性淋巴瘤,难治性

Autologous hematopoietic stem cell transplantation for refractory malignant lymphoma S UN

Zhixin ,GON G

Mingz hu ,CHEN L injun ,et al.　Depart ment of Hem atology ,S hanghai Changning Dist rict Cent ral Hospital ,

S hanghai 200336

【Abstract 】　Objective To observe the effectiveness and side effects of autologous hematopoietic stem cell trans 2

plantation (AHSCT )for refractory malignant lymphoma (ML ).Methods Four cases of ML refractory to treatment of cyclophosphamide ,doxorubicin ,vincristine and prednisone (CHOP ),received AHSCT with conditioning regimen consisted of high 2dose Vincristine ,Me 2CCNU ,Cyclophosphamide and Ara 2C (HD 2VCCA )and total lymphatic tissue irradiation (TL I ).Two received ABM T and two received APBSCT with CTX ,VP16and rh G 2CSF for APBSC mobi 2lization.The stem cell harvest was stored at 4℃without purgation after collection and retransfused to patients within 72hours.R esults All patients engrafted successfully.The patients ’granulocyte count ≥0.5×109/L on day +9.5and +11,the platelet count ≥50×109/L on day +14and +21.5,the reticulocyte reached ≥0.5%on day +9and 16.5after APBSCT and ABM T ,res pectively.The side effects of AHSCT were mainly the gastrointestinal and two women developed secondary amenorrhea with serum follicle stimulating hormone (FSH )and luteinizing hormone (L H )levels increased but estradiol (E 2)levels decreased after AHSCT.Up to now ,These four patients had survived disease free for 8～57months.Conclusion There are earlier recovery of hematopoietic function and fewer complication in APBSCT than in ABM T.AHSCT without cryopreservation is safe ,convenient and efficient ,but with some gonadal damage.(Shanghai Med J ,2000,23∶2822285)

【K ey w ords 】　Hematopoietic stem cell trans plantation ,Autologous ;Bone marrow trans plantation ;Peripheral

blood stem cell ;Malignent lymphoma ,refractory

作者单位:200366　上海长宁区中心医院血液科

自体造血干细胞移植(AHSCT )不受供者来源

的限制,患者年龄可适当放宽且疗效肯定,目前已成为治疗难治性恶性淋巴瘤(ML )的主要方法。我院于1994年9月至1998年11月,采用大剂量化疗加全身淋巴组织照射(TL I )为4例对常规化疗

反应不敏感的ML 患者分别进行干细胞不冷冻的

自体骨髓移植(ABM T )和自体外周血干细胞移植(APBSCT )治疗,取得良好的疗效,现将结果报告如下。

材料与方法

一、病例