BEAM方案预处理自体外周血干细胞移植治疗侵袭性非霍奇金淋巴瘤

尹琎; 肖毅; 隗佳; 张东华; 孟凡凯; 周剑峰; 张义成

doi:10.13201/j.issn.1004-2806.2012.02.004

BEAM方案预处理自体外周血干细胞移植治疗侵袭性非霍奇金淋巴瘤

- 华中科技大学同济医学院附属同济医院血液科(武汉, 430030)

详细信息

通讯作者: 张义成,E-mail:yczhang@tjh.tjmu.edu.cn

中图分类号: R733.4

收稿日期: 2012-02-01

Treatment of aggressive non-Hodgkin lymphoma by autologous peripheral blood stem-cell transplantation following conditioning with BEAM regimen

- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

More Information

Corresponding author: ZHANG Yicheng, E-mail: yczhang@tjh.tjmu.edu.cn

Received Date: 01 February 2012

摘要

摘要: 目的:探讨以BEAM方案为主的预处理后行自体外周血干细胞移植(APBSCT)对侵袭性非霍奇金淋巴瘤(NHL)的疗效。方法:诊断为侵袭性NHL患者54例,其中难治、复发NHL的挽救治疗41例,作为高危侵袭性NHL的一线缓解后治疗13例;经环磷酰胺加VP-16 动员后行BEAM方案(51例)或CBV方案(3例)预处理的APBSCT。结果:1例未植活,3个月后行半相合异基因干细胞移植;2例患者死于移植相关的并发症,其余患者均获得造血功能重建;移植后外周血中性粒细胞绝对计数(ANC)≥0.5×10⁹/L的中位时间为10 d(平均8~25 d);血小板≥20×10⁹/L的中位时间为15 d(平均6~36 d)。随访时间为6~102个月,中位随访时间为42.5个月。中位生存时间为35个月(2~100个月),3年总生存率为66.6%,3年无病生存率为66.4%;Cox多因素分析显示,疾病的分期和血小板植活的时间与NHL患者APBSCT后的生存相关。结论:BEAM为主的预处理方案的APBSCT无论作为侵袭型NHL的挽救治疗或高危侵袭型NHL的一线缓解后治疗安全,疗效肯定。
- 淋巴瘤,非霍奇金 /
- 外周血干细胞移植,自体 /
- 预处理方案
Abstract: Objective:To evaluate the therapeutic effectiveness and safety of autologous peripheral blood stem-cell transplantation(APBSCT)for patients with aggressive non-Hodgkin lymphoma(NHL). Method:Fifty-four patients with aggressive NHL were retrospectively reviewed and followed-up after receiving APBSCT conditioned with BEAM(51 cases)or CBV(3 cases).Result:One patient who failed to engraft received second transplant using haplo-identical donor;Two patients died from treatment related toxicity(TRM);The time of ANC≥0.5×10⁹/L and platelet count≥20×10⁹/L were at 10d(8-25 d)and 15 d(6-36 d)respectively.The median follow-up time was 42.5 months(6-102 months);The estimated 3-year overall survival(OS)is 66.6%;The estimated 3-year disease-free survival(DFS)is 66.4%;Cox multivariate analysis showed that the disease stage and the platelet engraftment time were correlated with survival of high risk aggressive NHL following APBSCT conditioned with BEAM.Conclusion:APBSCT using BEAM as conditioning regimens is a safe and effective therapy for aggressive non-Hodgkin lymphoma.It can be used either as salvage treatment or first-line consolidation for high risk aggressive non-Hodgkin lymphoma.
- lymphoma,non-Hodgkin /
- peripheral blood stem-cell transplantation,autologous /
- conditioning regimens

HTML全文

参考文献(19)

[1]	PASQUINI M.Part I-CIBMTR summary slides,2005[J].CIBMTR News,2006,12:5-8.
[2]	GRATWOHL A,BALDOMERO H,FRAUENDORFER K,et al.Results of the EBMT activity survey 2005 on haematopoietic stem cell transplantation:focus on increasing use of unrelated donors[J].Bone Marrow Transplant,2007,39:71-87.
[3]	ROSENBERG S A.Autologous bone marrow transplantation in non-Hodgkin's lymphoma[J].N Engl J Med,1987,316:1541-1542.
[4]	PHILIP T,ARMITAGE J O,SPITZER G,et al.High-dose therapy and autologous bone marrow transplantation after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin's lymphoma[J].N Engl J Med,1987,316:1493-1498.
[5]	PHILIP T,GUGLIELMI C,HAGENBEEK A,et al.Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma[J].N Engl J Med,1995,333:1540-1545.
[6]	ZHANG D H,ZHANG L,XIAO Y,et al.Clinical observation of patients with hematological malignancies treated with hematopoietic stem cell transplantation[J].J Huazhong Univ Sci Technol Med Sci,2004,24:345-349.
[7]	PRESS O W,LEONARD J P,COIFFIER B,et al.Immunotherapy of non-Hodgkin's lymphomas[J].Hematology Am Soc Hematol Educ Program,2001:221-237.
[8]	GISSELBRECHT C,GLASS B,MOUNIER N,et al.Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era[J].J Clin Oncol,2010,28:4184-490.
[9]	GREB A,BOHLIUS J,TRELLE S,et al.High-dose chemotherapy with autologous stem cell support in first-line treatment of aggressive non-Hodgkin lymphoma-results of a comprehensive meta-analysis[J].Cancer Treat Rev,2007,33:338-346.
[10]	HAIOUN C,LEPAGE E,GISSELBRECHT C,et al.Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin's lymphoma:final analysis of the prospective LNH87-2 protocol-a groupe d'Etude des lymphomes de l'Adulte study[J].J Clin Oncol,2000,18:3025-3030.
[11]	BETTICHER D C,MARTINELLI G,RADFORD J A,et al.Sequential high dose chemotherapy as initial treatment for aggressive sub-types of non Hodgkin lymphoma:results of the international randomized phase III trial(MISTRAL)[J].Ann Oncol,2006,17:1546-1552.
[12]	CORRADINI P,TARELLA C,ZALLIO F,et al.Long-term follow-up of patients with peripheral T-cell lymphomas treated up-front with high-dose chemotherapy followed by autologous stem cell transplantation[J].Leukemia,2006,20:1533-1538.
[13]	PUIG N,DE LA RUBIA J,REMIGIA M J,et al.Morbidity and transplant-related mortality of CBV and BEAM preparative regimens for patients with lymphoid malignancies undergoing autologous stem-cell transplantation[J].Leuk Lymphoma,2006,47:1488-1494.
[14]	JO J C,KANG B W,JANG G,et al.BEAC or BEAM high-dose chemotherapy followed by autologous stem cell transplantation in non-Hodgkin'S lymphoma patients:Comparative analysis of efficacy and toxicity[J].Ann Hematal,2008,87:43-48.
[15]	BIERMAN P J,PHILLIPS G L.Role of hematopoietic stem cell transplantation in the treatment of non-Hodgkin's lymphoma[J].Cancer Treat Res,2009,144:357-397.
[16]	BUTCHER B W,COLLINS R H.The graft-versus-lymphoma effect:clinical review and future opportunities[J].Bone Marrow Transplant,2005,36:1-17.
[17]	PALTIEL O,RUBINSTEIN C,OR R,et al.Factors associated with survival in patients with progressive disease following autologous transplant for lymphoma[J].Bone Marrow Transplant,2003,31:565-569.
[18]	DE LIMA M,VAN BESIEN K W,GIRALT S A,et al.Bone marrow transplantation after failure of autologous transplant for non-Hodgkin's lymphoma[J].Bone Marrow Transplant,1997,19:121-127.
[19]	TSAI T,GOODMAN S,SAEZ R,et al.Allogeneic bone marrow transplantation in patients who relapse after autologous transplantation[J].Bone Marrow Transplant,1997,20:859-863.