白血病·淋巴瘤
白血病·淋巴瘤
백혈병·림파류
JOURNAL OF LEUKEMIA & LYMPHOMA
2009年
3期
152-154
,共3页
刘辉%常乃柏%魏建平%赵声明%范芸%张野坪%李江涛%冯茹%程玮%田园
劉輝%常迺柏%魏建平%趙聲明%範蕓%張野坪%李江濤%馮茹%程瑋%田園
류휘%상내백%위건평%조성명%범예%장야평%리강도%풍여%정위%전완
淋巴瘤%大细胞%弥漫型%抗肿瘤联合化疗方案%利妥昔单抗
淋巴瘤%大細胞%瀰漫型%抗腫瘤聯閤化療方案%利妥昔單抗
림파류%대세포%미만형%항종류연합화료방안%리타석단항
Lymphoma,large-cell,diffuse%Antineoplastie combined chemotherapy protocols%Rituximab
目的 观察利妥昔单抗(商品名:美罗华)联合化疗治疗弥漫大B细胞淋巴瘤(DLBCL)的临床疗效及淋巴瘤国际预后指数(IPI)评分对预后的影响;探讨利妥昔单抗在DLBCL自体外周血干细胞移植(APBSCT)中的应用.方法 DLBCL患者21例,IPI评分低危和中低危(0～2分)14例,中高危和高危(3～5分)7例.采用利妥昔单抗联合CHOP(环磷酰胺、多柔比星、长春新碱、泼尼松)方案4～8个疗程,其中有5例接受APBSCT,动员方案为利妥昔单抗联合环磷酰胺加依托泊苷,预处理方案为CBV(环磷酰胺、卡莫司汀、依托泊苷)方案.结果 21例患者中CR 13例(61.9%),总有效率90.5%(19/21);2年疾病无进展生存率为(69.74±10.43)%,2年总生存率为(84.44 ±8.35)%.IPI评分0～2分患者CR率92.9%,总有效率100%,3～5分患者CR率0,总有效率71.4%,IP10～2分患者CR率高于3～5分患者(P＜0.01);5例接受APBSCT的患者采集的中位单个核细胞(MNC)为7.34×108/kg,中位CDh细胞为8.82×106/kg,造血恢复中性粒细胞＞0.5×109/L的中位时间+9天,血小板＞20×109/L的中位时间+12天;主要不良反应是输注相关的不良反应(14.3%)以及化疗相关的血液学不良反应.结论 利妥昔单抗联合化疗治疗DLBCL疗效满意,IP10～2分患者的完全缓解率明显高于3～5分患者;利妥昔单抗不影响外周造血干细胞的采集及造血重建;利妥昔单抗应用安全性较好.
目的 觀察利妥昔單抗(商品名:美囉華)聯閤化療治療瀰漫大B細胞淋巴瘤(DLBCL)的臨床療效及淋巴瘤國際預後指數(IPI)評分對預後的影響;探討利妥昔單抗在DLBCL自體外週血榦細胞移植(APBSCT)中的應用.方法 DLBCL患者21例,IPI評分低危和中低危(0～2分)14例,中高危和高危(3～5分)7例.採用利妥昔單抗聯閤CHOP(環燐酰胺、多柔比星、長春新堿、潑尼鬆)方案4～8箇療程,其中有5例接受APBSCT,動員方案為利妥昔單抗聯閤環燐酰胺加依託泊苷,預處理方案為CBV(環燐酰胺、卡莫司汀、依託泊苷)方案.結果 21例患者中CR 13例(61.9%),總有效率90.5%(19/21);2年疾病無進展生存率為(69.74±10.43)%,2年總生存率為(84.44 ±8.35)%.IPI評分0～2分患者CR率92.9%,總有效率100%,3～5分患者CR率0,總有效率71.4%,IP10～2分患者CR率高于3～5分患者(P＜0.01);5例接受APBSCT的患者採集的中位單箇覈細胞(MNC)為7.34×108/kg,中位CDh細胞為8.82×106/kg,造血恢複中性粒細胞＞0.5×109/L的中位時間+9天,血小闆＞20×109/L的中位時間+12天;主要不良反應是輸註相關的不良反應(14.3%)以及化療相關的血液學不良反應.結論 利妥昔單抗聯閤化療治療DLBCL療效滿意,IP10～2分患者的完全緩解率明顯高于3～5分患者;利妥昔單抗不影響外週造血榦細胞的採集及造血重建;利妥昔單抗應用安全性較好.
목적 관찰리타석단항(상품명:미라화)연합화료치료미만대B세포림파류(DLBCL)적림상료효급림파류국제예후지수(IPI)평분대예후적영향;탐토리타석단항재DLBCL자체외주혈간세포이식(APBSCT)중적응용.방법 DLBCL환자21례,IPI평분저위화중저위(0～2분)14례,중고위화고위(3～5분)7례.채용리타석단항연합CHOP(배린선알、다유비성、장춘신감、발니송)방안4～8개료정,기중유5례접수APBSCT,동원방안위리타석단항연합배린선알가의탁박감,예처리방안위CBV(배린선알、잡막사정、의탁박감)방안.결과 21례환자중CR 13례(61.9%),총유효솔90.5%(19/21);2년질병무진전생존솔위(69.74±10.43)%,2년총생존솔위(84.44 ±8.35)%.IPI평분0～2분환자CR솔92.9%,총유효솔100%,3～5분환자CR솔0,총유효솔71.4%,IP10～2분환자CR솔고우3～5분환자(P＜0.01);5례접수APBSCT적환자채집적중위단개핵세포(MNC)위7.34×108/kg,중위CDh세포위8.82×106/kg,조혈회복중성립세포＞0.5×109/L적중위시간+9천,혈소판＞20×109/L적중위시간+12천;주요불량반응시수주상관적불량반응(14.3%)이급화료상관적혈액학불량반응.결론 리타석단항연합화료치료DLBCL료효만의,IP10～2분환자적완전완해솔명현고우3～5분환자;리타석단항불영향외주조혈간세포적채집급조혈중건;리타석단항응용안전성교호.
Objectives To evaluate the efficacy of rituximab combined with chemotherapy in the treatment of diffuse large B-cell lymphoma (DLBCL) and the relationship of clinical prognosis with the International Prognostic Index (IPI) by the using rituximab in autologous peripheral stem cell transplantation (APBSCT) for the patients of DLBCL. Methods 21 patients with DLBCL, 11 patients of them were at IPI low risk, and 3 patients were IPI at low intermediate risk, 3 patients were at IPI high intermediate risk, 4patients IPI high risk. Rituximab combined with CHOP regimen (cyclophosphamide, adriamycin, vincfistine and prednisone) was given for 4～8 courses. 5 patients received APBSCT. The mobilizing regimen was rituximab combined with cyclophosphamide(CTX) and etoposide(VP16). The conditioning regimen were CBV(CTX combined with VP16 and carmustine). Results In 21 patients, the complete response rate was 61.9 %,with overall response rate 90.5 %. 2-year progression free survival was (69.74±10.43)%. 2-year overall survival was (84.44:1:8.35) %. The complete response rate was 92.9 % and overall response rate was 100 % in the patients IPI≤2. The overall response rate was 71.4 % in the patients with IPI≥3. The complete response rate was higher in the patients with IPI≤ 2 (P＜0.01). The amount of mononuclear cells (M NC) in harvest were 7.34 (4.6～8.53)×108/kg. The CD+34 cells in harvest were 8.82 (2.1～10.34)×1O6/kg. The mean time of neutrephil recovering to 0.5×109/L after APBSCT was +9 day. The mean time of platelet recovering to 20×109/L after APBSCT was +12 day. The major adverse reaction were infusion related response (14.3 %) and hematological toxieities. Conclusion The efficacy of rituximab combined with chemotherapy in the treatment of DLBCL is effective, The complete response rate was higher in the patients with IPI≤2 than in the patients with IPI≥3.Using rituximab in mobilizing regimen, all patients had harvested enough CD+34 cells. Rituximab given at +1day did not affect the hematopoiesis reconstruction.
