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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10d白细胞下降至最低值,为0.1×109L-1,中性粒细胞为0×109L-1,移植后12d血小板下降至最低值45×109L-1,外周血象恢复正常时间为移植后15d。例2移植后白细胞和血小板低谷时间为移植后5d,外周血象恢复正常时间为移植后9d。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。
BACKGROUND: In order to solve the common problem of delayed or failed hematopoietic reconstitution in order to solve the problem of hematopoietic microenvironment impaired, both domestic and foreign researches begin to try peripheral blood stem cell transplantation and bone marrow mesenchymal stem cell therapy. Objective: To investigate the safety and efficacy of autologous bone marrow mesenchymal stem cells combined with peripheral blood stem cell transplantation in the treatment of non-Hodgkin’s lymphoma. METHODS: Two patients who were diagnosed with non-Hodgkin’s lymphoma were treated with R-CHOP regimen (rituximab, cyclophosphamide, vincristine, prednisone) for 5 or 6 cycles. Before autologous peripheral blood stem cell mobilization, bone marrow-derived mesenchymal stem cells were obtained from autologous bone marrow. Mobilization regimens for cyclophosphamide, granulocyte colony stimulating factor or rituximab, cyclophosphamide, granulocyte colony stimulating factor. Pretreatment regimens rituximab, cyclophosphamide, etoposide or rituximab, cyclophosphamide, liposomal doxorubicin, dexamethasone. The number of mononuclear cells transfused was 2.98 × 106 / kg and 3.84 × 108 / kg, respectively, and that of bone marrow mesenchymal stem cells was 3.8 × 106 / kg and 3.96 × 106 / kg. RESULTS AND CONCLUSION: In the first case, the number of leukocytes decreased to the lowest value of 0.1 × 109 L-1 at 10 days after transplantation, and the number of neutrophils was 0 × 109 L-1. The platelets decreased to the lowest value of 45 × 109 L-1 at 12 days after transplantation, The normal time for 15d after transplantation. Example 2 leukopenia and platelet trough time after transplantation 5d, peripheral blood returned to normal after 9d. Transplant-related complications of acute upper respiratory tract infection, external hemorrhoids infection, infection control after appropriate treatment. The results showed that autologous bone marrow mesenchymal stem cells combined with peripheral blood stem cell transplantation after hematopoietic reconstitution fast, mass or enlarged lymph nodes disappear, the recent curative effect can be long-term efficacy remains to be further observed.