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目的 :评价自体外周血造血干细胞移植 (APBSCT)治疗耐药、复发及晚期恶性淋巴瘤患者的疗效及影响因素。方法 :采用 APBSCT治疗恶性淋巴瘤患者 16例 ,其中霍奇金病患者 2例 ,非霍奇金淋巴瘤患者 14例。移植时第 1次完全缓解 6例 ,第 2次完全缓解 2例 ,部分缓解 8例 ;采集外周血造血干细胞前均经动员剂动员 ,其中采用硫酸葡聚糖 (DS)动员 2例 ,惠尔血 (G- CSF)动员 9例 ,惠尔血加生白能 (G- CSF加 GM- CSF)联合动员 5例。预处理方案为联合化疗加 TBI/ TL I12例 ,单纯化疗 4例。结果 :移植后白细胞 >1.0× 10 9/ L 的中位数时间为 14d(10～ 39d) ,血小板 >2 0× 10 9/ L 的中位数时间为 15 d(11～ 5 6 d) ;患者移植后中位数生存 18个月 (4～ 5 3个月 ) ;移植前未缓解的 8例患者 ,移植后 3例死于本病 ,1例死于意外 ;移植前完全缓解的 8例患者均无病生存。结论 :APBSCT是一种治疗耐药、复发及晚期恶性淋巴瘤患者的安全有效的方法。淋巴瘤患者移植时的疾病状态与移植后长期无病生存密切相关。化疗后患者应用 G- CSF和 GM- CSF联合动员方案与 G- CSF动员方案相比 ,前者动员出的 ANC和 CD34+ 细胞数量稳定 ,波动小。
Objective: To evaluate the efficacy and influencing factors of autologous peripheral blood stem cell transplantation (APBSCT) in the treatment of drug-resistant, relapsed and advanced malignant lymphoma patients. Methods: Sixteen patients with malignant lymphoma were treated with APBSCT, including 2 patients with Hodgkin’s disease and 14 patients with non-Hodgkin’s lymphoma. At the time of transplantation, there were 6 cases of complete remission, 2 cases of complete remission, and 8 cases of partial remission. Before mobilization of peripheral blood hematopoietic stem cells, mobilization was performed by mobilization agents. Among them, 2 cases were mobilized with dextran sulfate (DS). Blood (G-CSF) was mobilized in 9 cases, and Whirlpool blood plus white blood (G-CSF plus GM-CSF) was jointly mobilized in 5 cases. The pretreatment regimen consisted of combined chemotherapy plus TBI/TL I12 cases and chemotherapy alone in 4 cases. Results: The median time of leukocyte >1.0×10 9 /L after transplantation was 14 days (10-39 days), and the median time for platelets> 2 0×10 9 /L was 15 days (11-56 days). The median survival of patients after transplantation was 18 months (4 to 53 months); in 8 patients who did not relieve before transplantation, 3 patients died of the disease after transplantation, and 1 patient died of accidents; 8 patients had complete remission before transplantation. All patients survived without disease. Conclusion: APBSCT is a safe and effective method for the treatment of drug-resistant, relapsed and advanced malignant lymphoma patients. The state of disease at the time of transplantation in lymphoma patients is closely related to long-term disease-free survival after transplantation. Compared with the G-CSF mobilization program, patients with G-CSF and GM-CSF mobilized after chemotherapy had a stable and fluctuating ANC and CD34+ cells.