临床肿瘤学杂志

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自体外周血干细胞移植治疗T细胞淋巴瘤的临床研究

侯 军,章卫平,邱慧颖,郑晓丽,王利平,倪 雄,宋献民,王健民   

  1. 上海第二军医大学长海医院血液科
  • 收稿日期:2008-09-11 修回日期:1900-01-01 出版日期:2009-02-25 发布日期:2009-02-25
  • 通讯作者: 王健民

Autologousperipheralbloodstem celltransplantationforTcelllymphoma:aretrospectivestud

  • Received:2008-09-11 Revised:1900-01-01 Online:2009-02-25 Published:2009-02-25

摘要: 【摘 要】 目的:探讨自体外周血干细胞移植(APBSCT)治疗T细胞淋巴瘤的临床疗效和安全性。方法:2000年7月~2008年4月,行APBSCT的T细胞淋巴瘤患者共17例,包括T淋巴母细胞淋巴瘤10例,鼻型NK/T淋巴瘤4例,外周细胞T
淋巴瘤2例,间变大细胞淋巴瘤1例。按照AnnArbor标准和IPI分期评分。8例患者的采集物采用CD34+细胞纯化。所有患者均采用CTX+VP16+TBI预处理方案。结果:(1)所有患者移植后造血功能均顺利重建,中性粒细胞恢复至05×109/L为移植后(1218±263)天,血小板恢复至20×109/L为移植后(1450±402)天。(2)中位随访7个月(1~94个月),2年预期的无疾病生存率为6289%,总生存率为7187%。(3)随访2年以上未复发的6例患者,均无病存活,中位随访54个月(24~94个月)。(4)死亡均发生在移植后半年内,移植前未缓解的2例患者移植后均死亡,移植前处于复发状态的患者移植后3个月时再次出现复发,带病生存。(5)至随访截止时间,获完全缓解患者行或未行CD34+细胞分选移植的疗效无明显差别。结论:APBSCT对移植前完全缓解和部分缓解的T细胞淋巴瘤患者疗效较好,造血重建顺利,且安全性好,但复发和原发难治的患者疗效相对差,应考虑选择异基因造血干细胞移植治疗。

Abstract:  【Abstract】 Objective:Toanalyzeretrospectivelytheresultsoftreatmentwithautologousperipheralbloodstemcelltransplantation(APBSCT)forTcelllymphoma(TCL).Methods:ToconductareviewofpatientswhounderwentAPBSCTforTCLfromJuly2000toApril2008.Seventeencaseswereidentifiedconsistingof10caseslymphoblasticlymphoma,4casesnasaltypeextranodalNK/T,2casesperipheralTcelllymphomas,and1caseanaplasticlargecelllymphomas.ThepatientswereclassifiedbyAnnArborstagingsystemandinternationalprognosisindex(IP1).CD34+cellpurificationofPBSCwerecarriedoutin8patients.Allthepatientsreceivedthehighdosechemotherapywithcyclophosphamide,etoposideandtotalbodyirradiation(TBI)asconditioningregimen.Results:Plateletrecovery(>20×109/L)timewas(145±402)daysandleukocyterecovery(>05×109/L)timewas(1218±263)days,whichwaswithintheexpectedranges.Aftermedianfollowupof7(194)months,theprobabilitiesof2yearoverallsur
vivalanddiseasefreesurvivalaftertransplantationwere7187% and6289%,respectively.Sixpatientswerestillindiseasefreesur
vivalaftertwoyearsofAPBSCTwithfollowupof54(2494)months.FourcasesweredeadwithinhalfayearafterAPBSCTincluding2casesofnonremissionbeforereceivingautograft,andpatientsinrelapsebeforetransplantationrelapsedagainafter3monthsandwerestillalivewithdisease.TherewasnosignificantdifferenceontheoutcomeamongthepatientsofcompleteresponsewhetherornotreceivingautologousCD34+celltransplantationbythetimeofstoppingfollowup.Conclusion:APBSCTasconsolidationtherapyinfirstcompleteorpartialresponseTCLpatientsmayofferadurablesurvivalbenefit.However,therewasminimaldurablebenefitinpatientswithrelapsedorrefractoryTCLafterautotransplantionandallogeneicHCTshouldbemoreaggressivelyexploredforthem.

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