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目的 :研究自体外周血造血干细胞移植(APBSCT)支持下的大剂量化疗 ,治疗伴有高危复发因素的乳腺癌和转移性乳腺癌的效果。方法 :选择21例高危(区域阳性淋巴结LN≥10个)或转移性乳腺癌患者 ,采用环磷酰胺 +阿霉素 +氟脲嘧啶(CAF)为常规化疗动员方案 ,联合粒细胞刺激因子 +粒巨细胞刺激因子(G/GM -CSF)动员方案 ,应用血细胞分离机CS -3000plus(美国Baxter)采集患者自体外周血造血干细胞 ,程控冷冻降温系统 -196℃保存干细胞 ,RT -PCR方法检测采集的造血干细胞(富集血)中残存病灶上皮性粘蛋白(MUC -1)和角蛋白(K19)的表达 ,预处理方案环磷酰胺CTX60mg/kg/d×2 +卡铂CBP800～1000mg/m2/d×1 +VP -16300mg/m2/d×2 ,全环境护理直至造血功能重建。结果 :本动员方案具有较好的动员效果 ,大多数病例采集两次即可获得足够的干细胞。第一次采集即能得到45 %的单个核细胞(MNC)及50 %的粒细胞克隆形成单位(CFU -GM)。MNC、CFU -GM及爆式红细胞形成单位(BFU -E)的回收率分别为80 %、74%、71 %。造血重建较快 ,中性粒细胞≥0 5×109/L的时间为11 8±1 65天。血小板≥50×109/L的时间为14 86±1 55天。回输CFU -GM最低者为0 67×105/kg,但其造血重建时间并未延长。15例乳腺癌患者中11例高危患者至今均无病生存(DFS) ,最
Objective: To study the efficacy of high-dose chemotherapy with autologous peripheral blood hematopoietic stem cell transplantation (APBSCT) in the treatment of breast cancer and metastatic breast cancer with high-risk recurrence factors. METHODS: Twenty-one patients with high risk (regional lymph node LN ≥ 10) or metastatic breast cancer were selected. Cyclophosphamide + doxorubicin + fluorouracil (CAF) was used as a conventional chemotherapy mobilization protocol in combination with granulocyte stimulating factor + granules. Giant cell stimulating factor (G/GM-CSF) mobilization protocol. Blood cell stem cells from patient’s autologous peripheral blood were collected using a blood cell separator CS-3000plus (Baxter, USA). Programmed freezing and cooling system was used to store stem cells at -196°C. RT-PCR method was used to detect the collection of stem cells. Expression of residual epithelial mucin (MUC-1) and keratin (K19) in hematopoietic stem cells (enriched blood), pretreatment regimen cyclophosphamide CTX 60 mg/kg/d x 2 + carboplatin CBP 800–1000 mg/m2/ d × 1 + VP -16300mg/m2/d × 2 , and all environmental care was performed until hematopoiesis was reconstructed. Results: The mobilization program has a good mobilization effect. Most cases are collected twice to obtain enough stem cells. The first acquisition yielded 45% of mononuclear cells (MNC) and 50% of granulocyte colony forming units (CFU-GM). The recoveries of MNC, CFU-GM, and BFU-E were 80%, 74%, and 71%, respectively. The hematopoietic reconstitution was faster, and the time for neutrophils ≥ 0 5 × 109/L was 11 8 ± 1 65 days. The time for platelet ≥ 50 × 109/L was 1486 ± 1 55 days. The lowest return of CFU-GM was 0 67×105/kg, but the time for hematopoietic reconstitution was not prolonged. Among the 15 patients with breast cancer, 11 cases of high-risk patients have survived disease-free (DFS) so far.