7 c" v5 ]! L) v4 l2 R! q 0 t" J2 r" `* M% s # g# b9 h$ z. o) V4 T: N ) I7 i" n/ `0 i3 m8 T) H2 _# F7 N- Y : S8 z5 {1 ]3 U # T" `1 F, i% y4 l" G5 t ) _! r, j9 ~- S 【摘要】 目的:探讨自体血干细胞移植(ASCT)支持下的大剂量化疗(HDC)治疗侵袭性非霍奇金淋巴瘤(NHL)的疗效。方法: 23例侵袭性NHL患者经过3~7周期常规化疗疗效达完全或部分缓解后行自体外周血干细胞动员,大剂量化疗方案采用BEAC(BCNU 450 mg/m2, VP16 800 mg/m2,AraC 1.5 g/m2, CTX3.6 g/m2)方案。结果:23例患者均移植成功,重建造血功能,无移植相关死亡。移植前9例达CR或CRu, 14例达PR;移植后13例达CR或CRu,10例达PR。全部病例均得到随访,中位随访时间为29个月(1个~84个月),移植后3例病情进展,其中1例死亡,3年的无进展生存率为79.4%。结论:HDC/ASCT治疗侵袭性NHL是有效的治疗方法。 ; k4 q/ K8 ]8 u, H
【关键词】自体干细胞移植; 大剂量化疗; 非霍奇金淋巴瘤 7 I8 ~/ @. ]% m Treatment effect of highdose chemotherapy with autologous stem cell transplantation on patients with aggressive nonHodgkin′s lymphoma3 W, x; C/ j ~5 J3 q9 S
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JIA Cundong,YANG Shune, XU Jihong, et al ~: n+ g# Z$ a* n# U0 c
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Department of Internal Medicine, Cancer Hospital, Xinjiang Medical University, Urumqi, 830011, China) : B$ \! u6 p! m0 N: p, h1 @/ k . U4 q# P: k4 [1 ^. G2 Y Abstract: Objective: To investigate the efficacy of highdose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) for patientswithaggressivenonHodgkin′s lymphoma (NHL). Methods: Between April 2000 and July 2007, twentythree eligible patients withaggressive NHL underwent the HDC/ASCT therapy. The median age at ASCT was 32 years (range, 860 years). The conditioning consisted of BEAC (BCNU, VP16, AraC, CTX) regimen. Results: The median followup duration from transplantation was 29 months (range, 1~84 months). Prior to HDC/ASCT, Nine patients were in complete remission (CR) or complete remission unconfirmed (CRu) and Fourteen patients were in partial remission(PR). After HDC/ASCT, Thirteen patients achieved CR or CRu and Ten patients achieved PR. Twentytwo patients were alive; One patient died of progressive disease. Estimated threeyear progressionfree survival (PFS) were 79.4%. Conclusions: HDC/ASCT is effective for patients with aggressive NHL. A prospective randomized controlled trial is warranted to confirm these results.$ V6 ?' _6 f/ V
- H$ I+ z" s Y6 H, ` 2.2随访与生存全组病例均得到随访,中位随访时间为29个月,随访期间3例病情进展,其中1例死亡,3年的无进展生存率为79.4 %。 % `( z: I% d, ^* T$ d 1 C R( r* W5 c, i3 q4 h 3讨论 & }6 z/ X' M6 e1 y( l1 _9 H+ |0 K9 n3 ~
目前侵袭性NHL一线使用CHOP或CHOP类方案治疗的效果仍不满意, HDC/ASCT虽已成为复发或难治性NHL的标准治疗方案,但是复发的NHL患者即使采用HDC/ASCT治疗仍有50%再次复发[1]。因此Copelan[2]认为HDC/ASCT应用的时机太晚可能会降低NHL患者治愈的可能性。最近的研究表明, HDC/ASCT作为一线方案能够提高侵袭性NHL的疗效,Stewart等[3]将HDC/ASCT作为一线方案治疗55例预后不良的NHL患者,结果显示4年无事件生存率及总生存率分别为72%、79%;Milpied等[4]对197例侵袭性NHL患者随机分为HDC/ASCT组和常规化疗组(CHOP方案),中位随访4年,结果显示HDC/ASCT组与常规化疗组(CHOP)的5年无事件生存率分别为55%、37%(P=0.037),提示HDC/ASCT作为一线方案治疗侵袭性NHL比常规方案疗效更佳。有学者主张对凡有不良预后因素的侵袭性NHL患者,尽早施行HDC/ASCT以降低耐药的发生率并同时提高治愈率[5]。已有研究表明,对于中高危(IPI≥2)的侵袭性NHL患者, HDC/ASCT作为一线方案可提高NHL患者的无病生存率及总生存率[6]。本研究结果显示,对于具有不良预后因素的23例NHL患者移植后有13例达CR或CRu,10例达PR,全组患者3年的无进展生存率为79.4%,取得了较好的近期效果。目前仍有一些研究显示HDC/ASCT作为一线方案治疗侵袭性NHL并不比常规方案更能提高生存率。Baldissera等[7]的研究结果显示HDC/ASCT作为一线方案治疗侵袭性的NHL与常规方案相比,二者的总生存率并无显著差异。Strehl等[8] 及Greb等[9]研究表明,HDC/ASCT作为一线方案治疗侵袭性NHL与常规方案相比,无复发生存率及总生存率并未提高。 8 p1 l! T. l6 A( I5 p$ R: b. h# L8 n6 q
因此,目前将HDC/ASCT作为一线方案治疗侵袭性NHL仍缺乏循证医学证据。综上所述,本研究将HDC/ASCT作为早期方案治疗侵袭性NHL取得了较好疗效,但由于样本例数较少,随访时间较短(中位随访仅29个月),故长期疗效仍需进一步观察。 0 R. g. q& j7 a7 C b 【参考文献】& O3 r8 W9 l) L- D
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[9]Greb A, Bohlius J, Trelle S, et al. Highdose chemotherapy with autologous stem cell support in firstline treatment of aggressive nonHodgkin lymphoma results of a comprehensive meta analysis[J]. Cancer Treat Rev, 2007 ,33(4):338346.作者: 龙水生 时间: 2015-5-28 20:10