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目的探讨对自体造血干细胞移植(autologous hematopoietic stem cell transplantation,auto-HSCT)后复发的非霍奇金淋巴瘤患者再进行异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗的临床疗效。方法收集2000年1月2010年12月难治性恶性淋巴瘤采用auto-HSCT后复发患者11例,病程27个月～6.5年。所有患者在auto-HSCT前均为复发难治性病例,auto-HSCT后,完全缓解8例,部分缓解3例,自体移植后中位复发时间15个月,患者复发后采用异基因亲缘造血干细胞移植,人类白细胞抗原(humanleukocyte antigen,HLA)全相合(6/6)6例,5/6相合3例,4/6相合2例;性别相同6例,性别不同5例。预处理方案为FBC方案,即氟达拉滨30mg/m2 1～5d,白消安12～14mg/kg分4d口服,环磷酰胺120mg/kg分2d使用。移植物均为外周血造血干细胞加骨髓。移植物抗宿主病(graft-versus-host disease,GVHD)的预防:HLA全相合采用环孢素+短程甲氨蝶呤+吗替麦考酚酯,不全相合采用抗胸腺细胞球蛋白+环孢素+短程甲氨蝶呤+吗替麦考酚酯。结果 11例患者全部获得造血重建,急性GVHD发生6例(54.55%),其中Ⅰ度、Ⅱ度4例,Ⅲ度、Ⅳ度各1例;1例Ⅳ度GVHD因合并感染死亡,5例均得到有效控制;发生慢性GVHD 7例(63.64%),其中有2例急性GVHD转为慢性,4例局限型,3例广泛型。随访8个月～9年,有4例分别于移植后8、15、21、34个月疾病复发,另外6例仍生存。结论 allo-HSCT对于auto-HSCT后复发的非霍奇金淋巴瘤患者仍是一种有效的挽救性治疗手段。
Objective To investigate the clinical effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on patients with non-Hodgkin’s lymphoma who relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) . Methods Eleven patients with recurrent refractory malignant lymphoma after auto-HSCT were collected from January 2000 to December 2010. The course of disease ranged from 27 months to 6.5 years. All patients were refractory before auto-HSCT. After auto-HSCT, 8 cases were completely relieved and 3 cases partially relieved. The median time to recurrence after autotransplantation was 15 months. After allogeneic hematopoietic stem cell transplantation In 6 cases, 6 cases were fully matched with human leukocyte antigen (HLA), 3 cases in 5/6 phase and 2 cases in 4/6 phase. There were 6 cases of the same gender and 5 cases of different gender. Pretreatment program for the FBC program, fludarabine 30mg / m2 1 ~ 5d, busulfan 12 ~ 14mg / kg points 4d oral, cyclophosphamide 120mg / kg points 2d use. Grafts are peripheral blood hematopoietic stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA-complete combination of cyclosporine + short-range methotrexate + mycophenolate mofetil, incomplete combination of anti-thymocyte globulin + cyclosporine Supra + short-range methotrexate + mycophenolate mofetil. Results All of the 11 patients were hematopoietic reconstructed. There were 6 cases (54.55%) of acute GVHD, of which 4 cases were grade Ⅰ, Ⅱ and 1 case were grade Ⅲ, Ⅳ. One case of grade Ⅳ GVHD died of infection and 5 cases 7 cases (63.64%) of chronic GVHD occurred. Two of them were chronic GVHD, 4 were localized and 3 were extensive. During the follow-up of 8 months to 9 years, 4 cases relapsed at 8, 15, 21 and 34 months after transplantation, while the remaining 6 cases still survived. Conclusion Allo-HSCT is still an effective salvage therapy for patients with non-Hodgkin’s lymphoma who relapse after auto-HSCT.