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目的探讨自体造血干细胞移植(AHSCT)联合抗CD20单克隆抗体(利妥昔单抗)治疗B细胞非霍奇金淋巴瘤(B-NHL)的方法和疗效。方法对1例难治、复发的弥漫大B细胞淋巴瘤患者进行AHSCT同时联合使用了抗CD20单抗。采用环磷酰胺(CTX)4g/m2+阿糖胞苷(Ara-C)4g/m2化疗联合粒细胞集落刺激因子(G-CSF)5μg/kg/d动员患者的外周血干细胞,然后予去甲氧柔红霉素(IDA)10mg/d×3d+经典BEAM方案预处理后回输保存的外周血干细胞,共回输单个核细胞(MNC)4.36×108/kg,CD34+细胞2.48×106/kg,回输后分别于+1d及+8d予抗CD20单抗375mg/m2行体内净化。结果患者移植后造血恢复顺利,于+15d中性粒细胞绝对数(ANC)>0.5×109/L,+18d血小板>20×109/L。移植后1月复查腹腔淋巴结消失。随访至移植后13月,造血功能恢复良好,病情处于持续完全缓解状态,仍在继续随访中。结论AHSCT联合抗CD20单抗是治疗难治、复发B细胞NHL的有效方法之一,有利于清除移植后的微小残留病(MRD),防止复发。
Objective To investigate the method and efficacy of autologous hematopoietic stem cell transplantation (AHSCT) combined with anti-CD20 monoclonal antibody (rituximab) in the treatment of B-cell non-Hodgkin’s lymphoma (B-NHL). Methods AHSCT combined with anti-CD20 monoclonal antibody was performed in 1 patient with diffuse large B-cell lymphoma who was refractory or relapsed. Peripheral blood stem cells were mobilized with 5 g / kg / d of 4 g / m2 cyclophosphamide (CTX) plus 4 g / m2 of Ara-C plus granulocyte colony-stimulating factor (G-CSF) Peripheral blood stem cells were transfused after pretreatment with 10μg / d × 3d + daunorubicin (IDA) and classic BEAM regimen, with a total of 4.36 × 108 / kg of MNC and 2.48 × 106 / kg of CD34 + After transfusion, the anti-CD20 mAb 375mg / m2 was given to the body in + 1d and + 8d respectively for in vivo purification. Results The hematopoiesis recovered smoothly after transplantation, with an absolute neutrophil count (ANC) of> 0.5 × 109 / L at + 15d and a platelet count of> 20 × 109 / L at 18d. January review of abdominal lymph node disappeared after transplantation. Follow-up to 13 months after transplantation, hematopoietic function recovered well, and the condition was in continuous and complete remission, and the follow-up continued. Conclusion AHSCT combined with anti-CD20 monoclonal antibody is one of the effective methods for the treatment of refractory and recurrent B-cell NHL. It is helpful to clear the minimal residual disease (MRD) after transplantation and prevent recurrence.