CAJ | 학술논문

目的探讨减低强度预处理异基因造血干细胞移植(allo-HSCT)治疗复发难治性淋巴瘤的疗效和安全性.方法北京军区总医院2012年1月至2013年12月应用减低强度预处理allo-HSCT治疗5例复发难治性淋巴瘤,其中男4例,女1例,平均年龄28.7岁(20～ 39岁).3例为HLA配型全相合,2例为HLA配型不全相合.供者接受粒细胞集落刺激因子动员,采用骨髓加外周血干细胞联合移植,预处理方案为减低强度的氟达拉滨、白消安及抗人淋巴细胞免疫球蛋白,采用联合免疫抑制剂预防移植物抗宿主病(GVHD),包括环孢素A、甲氨蝶呤、霉酚酸酯等,移植后观察患者不良反应、GVHD和无病生存等情况.结果 5例患者均获造血重建,中性粒细胞数≥0.5×109/L及血小板数≥20× 109/L的平均时间分别为18.8 d及24.5d,植入证据检测为100％完全供者造血.随访至2014年12月,中位随访时间19.2个月(6～35个月),2例患者死于复发,其余患者处于完全缓解状态,最长无病生存时间达35个月.结论减低强度预处理allo-HSCT治疗复发难治性淋巴瘤的方案安全、可行,疗效确切,可作为挽救性治疗的关键技术在临床广泛开展.
목적 탐토감저강도예처리이기인조혈간세포이식(allo-HSCT)치료복발난치성림파류적료효화안전성.방법 북경군구총의원2012년1월지2013년12월응용감저강도예처리allo-HSCT치료5례복발난치성림파류,기중남4례,녀1례,평균년령28.7세(20～ 39세).3례위HLA배형전상합,2례위HLA배형불전상합.공자접수립세포집락자격인자동원,채용골수가외주혈간세포연합이식,예처리방안위감저강도적불체랍빈、백소안급항인림파세포면역구단백,채용연합면역억제제예방이식물항숙주병(GVHD),포괄배포소A、갑안접령、매분산지등,이식후관찰환자불량반응、GVHD화무병생존등정황.결과 5례환자균획조혈중건,중성립세포수≥0.5×109/L급혈소판수≥20× 109/L적평균시간분별위18.8 d급24.5d,식입증거검측위100％완전공자조혈.수방지2014년12월,중위수방시간19.2개월(6～35개월),2례환자사우복발,기여환자처우완전완해상태,최장무병생존시간체35개월.결론 감저강도예처리allo-HSCT치료복발난치성림파류적방안안전、가행,료효학절,가작위만구성치료적관건기술재림상엄범개전.
Objective To explore the efficacy and safety of reduced intensity allogeneic stem cell transplantation (allo-HSCT) in the treatment of relapsed or refractory lymphoma.Methods 5 patients with relapsed or refractory lymphoma received reduced intensity allo-HSCT from January 2012 to December 2013 of Beijing Military General Hospital,including 4 males and 1 female,aged from 20 to 39 years old,with the mean age 28.7 years old.3 cases were HLA-identical matching and the other two cases were HLA-haploidentical.Donors received granulocyte colony-stimulating factor mobilization,and stem cells were collected from both peripheral blood and bone marrow.Pretreatment scheme reduced the strength of pretreatment for fludarabine combined with busulfex and ATG.Combined immunosuppressive agents were used for graft-versus-host disease (GVHD) prophylaxis,including cyclosporine A,methotrexate,mycophenolate mofetil and soon.The toxicity,GVHD and disease-free survival in patients were observed after transplantation.Results All of the patients acquired hematopoietic reconstitution.The average time of the neutrophils count ≥ 0.5×109/L and platelets ≥ 20×109/L were 18.8 d and 24.5 d,respectively.Implantation was confirmed by the evidence of 100 ％ of donor hematopoiesis.As of follow-up to December 2014 with the median 19.2 months (6-35 months),2 cases died of recurrence,the other 3 patients remained disease-free survival,and the longest disease-free survival time was up to 35 months.Conclusions Reduced intensity allogeneic hematopoietic stem cell transplantation is an effective and safe method for relapsed or refractory lymphoma,which could be chosen as a salvage treatment method for relapsed or refractory lymphoma.