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目的 为提高儿童高危恶性实体肿瘤的疗效,对27例晚期实体肿瘤患儿进行自身造血干细胞移植。方法 13例次采集骨髓,另15例经CS-3000血细胞分离机采集外周血干细胞(其叶1例疑有肿瘤污染的Ⅳ期神经母细胞瘤患儿经CliniMACS行CD34+细胞分选的净化处理)。2例霍奇金氏淋巴瘤患儿经CTX+BCNU+VP16(CBV)方案治疗,其余患儿均采用VP16+卡铂+马法兰的预处理方案。结果 采集骨髓及外周血得到的单个核细胞分别为(5.4±2.1)×108/kg和(4.1±1.9)×108/kg。所有患儿移植后都获造血重建,中性粒细胞、血小板恢复至0.5×109/L和20×109/L的时间分别为(11.8±5.7)d和(21.0±9.3)d。本组无1例因移植相关并发症而死亡;本组病例平均随访13月,4例患儿移植后5月内因复发而死亡,1例非霍奇金氏淋巴瘤(NHL)患儿移植后3月中枢神经系统复发,但目前已带瘤生存17月,其余22例患儿均处于无病生存状态。结论 自身干细胞移植是一种比较安全且有效的救治儿童晚期恶性实体肿瘤的措施,值得推广应用。
Objective To improve the efficacy of high-risk solid tumors in children, 27 cases of advanced solid tumors in children with their own hematopoietic stem cell transplantation. Methods 13 cases of bone marrow were harvested and 15 cases of peripheral blood stem cells were collected by CS-3000 blood cell separator (one case of stage IV neuroblastoma with unclear tumor invaded by CliniMACS CD34 + cells) . Two cases of Hodgkin’s lymphoma were treated with CTX + BCNU + VP16 (CBV) regimen, and the rest were treated with VP16 + carboplatin + melphalan. Results The number of mononuclear cells collected from bone marrow and peripheral blood was (5.4 ± 2.1) × 108 / kg and (4.1 ± 1.9) × 108 / kg, respectively. All children were hematopoietic reconstructed after transplantation. Neutrophils and platelets recovered to 0.5 × 109 / L and 20 × 109 / L for 11.8 ± 5.7 and 21.0 ± 9.3 d, respectively. None of the patients died of complications related to transplantation. The patients in this group were followed up for an average of 13 months. Four patients died of recurrence within 5 months after transplantation. One case of non-Hodgkin’s lymphoma (NHL) Central nervous system recurrence in March, but now has tumor-living in 17 months, the remaining 22 cases were in disease-free survival. Conclusion Stem cell transplantation is a safe and effective treatment of advanced solid malignant tumors in children and should be popularized and applied.