CAJ | 학술논문

目的：探讨自体造血干细胞移植（autologous hematopoietic stem cell transplantation，ASCT）治疗原发中枢神经系统淋巴瘤（primary central nervous system lymphoma，PCNSL）疗效和预后。方法回顾性分析我中心2例PCNSL临床资料，病理类型均为弥漫大B细胞淋巴瘤。经含甲氨蝶呤（methotrexate，MTX）的方案或大剂量 MTX（3 g/m2）化疗4～5周期，每周期化疗期间给予2次腰椎穿刺＋鞘内注射，疾病状态达到完全缓解，后进行大剂量化疗联合自体造血干细胞移植（high-dose chemotherapy with autologous stem cell transplantation，HDC/ASCT）巩固治疗。患者1预处理方案为美罗华联合卡氮芥＋依托泊苷＋阿糖胞苷＋注射用美法仑（马法兰）（BEAM），患者2预处理方案为马利兰＋噻替哌（TB）。患者1移植后给予腰椎穿刺＋鞘注维持治疗，患者2未接受维持治疗。结果患者1移植后无事件生存4年；患者2移植后2年出现疾病复发，再次给予大剂量 MTX等治疗，疗效不佳，半年后死亡。结论 PCNSL 患者经大剂量MTX 化疗达到完全缓解后，行自体造血干细胞移植巩固治疗，有机会获得长期无病生存；但PCNSL 预后差，最好进行移植后维持治疗。
목적：탐토자체조혈간세포이식（autologous hematopoietic stem cell transplantation，ASCT）치료원발중추신경계통림파류（primary central nervous system lymphoma，PCNSL）료효화예후。방법회고성분석아중심2례PCNSL림상자료，병리류형균위미만대B세포림파류。경함갑안접령（methotrexate，MTX）적방안혹대제량 MTX（3 g/m2）화료4～5주기，매주기화료기간급여2차요추천자＋초내주사，질병상태체도완전완해，후진행대제양화료연합자체조혈간세포이식（high-dose chemotherapy with autologous stem cell transplantation，HDC/ASCT）공고치료。환자1예처리방안위미라화연합잡담개＋의탁박감＋아당포감＋주사용미법륜（마법란）（BEAM），환자2예처리방안위마리란＋새체고（TB）。환자1이식후급여요추천자＋초주유지치료，환자2미접수유지치료。결과환자1이식후무사건생존4년；환자2이식후2년출현질병복발，재차급여대제량 MTX등치료，료효불가，반년후사망。결론 PCNSL 환자경대제량MTX 화료체도완전완해후，행자체조혈간세포이식공고치료，유궤회획득장기무병생존；단PCNSL 예후차，최호진행이식후유지치료。
Objective To analyze autologous hematopoietic stem cell transplantation(ASCT)for patients with primary central nervous system lymphoma (PCNSL).Methods Two patients with PCNSL receiving ASCT were retrospectively analyzed,both cases were diffused large B-cell lymphoma (DLBCL ).Four to five courses of methotrexate-containing chemotherapy or high dose-methotrexate(3 g/m2 )chemotherapy were performed.During each course,patients received two times intrathecal chemotherapy,and disease status was complete remission (CR ). Sequentially,patients received high-dose chemotherapy with autologous stem cell transplantation (HDC/ASCT)as consolidation treatment.Patient 1 received rituximab combined with BEAM (carmustine,etoposide,cytarabine and melphalan)conditioning regimen,and patient 2 received TB (busulfan and thiotepa)conditioning regimen.Patient 1 received intrathecal chemotherapy post-transplantation,and patient 2 did not.Results Patient 1 was event-free survival in four years,and patient 2 was relapse at two years post-transplantation,and he received high dose-MTX chemotherapy again,but could not get remission,finally died from PCNSL relapse half a year later.Conclusion After high dose-MTX chemotherapy and reaching CR,patients with PCNSL receiving consolidated HDC/ASCT can get long time disease-free survival.Since PCNSL has poor prognosis,it is better to receive maintenance therapy post-transplantation for patients with PCNSL.