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目的：观察大剂量放、化疗加自身外周血造血干细胞移植（ＡＰＢＳＣＴ）治疗难治性恶性淋巴瘤的疗效。方法：２１例病人接受此治疗。分别用葡聚糖硫酸酯（ＤＳ，９例）、粒细胞集落刺激因子（Ｇ－ＣＳＦ，４例）和环磷酰胺＋粒细胞集落刺激因子（ＣＴＸ＋Ｇ－ＣＳＦ，８例）动员干细胞。１７例行大剂量化疗（ＣＶＡＰ方案），其中２例加全身照射（ＴＢＩ），３例为超大剂量化疗（ＣＶＢ方案）。均于给药结束后４８ｈ回输分离细胞。１例单行全淋巴区照射（ＴＬＩ）１次。结果：移植组２１例中可评价的病人１９例，其中完全缓解（ＣＲ）１０例（５３％），部分缓解（ＰＲ）７例（３７％），稳定（ＳＤ）２例（１０％）。１、２、３年实际生存率分别为４４％（８／１８）、２７％（４／１５）和２５％（２／８）。无病生存者５例（７～４９个月，中位生存３２个月），１例ＣＲ者出院后２个月死于肺部感染，余均死于本病。疗效高于常规化疗组。骨髓抑制是主要的毒副作用，２例在化疗极期死于感染。超大剂量化疗组并发症较严重，骨髓恢复较慢。但全组绝大多数病人均安全度过骨髓抑制极期。结论：对于难治性恶性淋巴瘤，大剂量放、化疗结合ＡＰＢＳＣＴ的疗效优于常规化疗。大剂量化疗的疗效似不低于超大剂量?
Objective: To observe the efficacy of high-dose radiotherapy combined with chemotherapy and autologous hematopoietic stem cell transplantation (APBSCT) in the treatment of refractory lymphoma. Methods: Twenty-one patients received this treatment. The stem cells were mobilized with dextran sulfate (DS, 9 cases), granulocyte colony-stimulating factor (G-CSF, 4 cases) and cyclophosphamide + granulocyte colony-stimulating factor (CTX+G-CSF, 8 cases), respectively. Seventeen patients underwent high-dose chemotherapy (CVAP regimen), of whom 2 were given total body irradiation (TBI) and 3 were large-dose chemotherapy (CVB regimen). Both cells were transfused at 48 h after the end of the administration. One case had single-line lymph node irradiation (TLI) once. RESULTS: Of the 21 patients in the transplantation group, 19 were evaluable, of which 10 were complete remission (CR) (53%), 7 were partial remission (PR) (37%), and 2 were stable (SD) (10%). The actual survival rates for 1, 2, and 3 years were 44% (8/18), 27% (4/15), and 25% (2/8). Disease-free survival in 5 cases (7 to 49 months, median survival 32 months), 1 case of CR died of lung infection 2 months after discharge, and the rest died of this disease. The curative effect is higher than the conventional chemotherapy group. Myelosuppression was the main toxic side effect, and 2 cases died of infection in the very period of chemotherapy. The complications of the large-dose chemotherapy group are more serious and the bone marrow recovery is slower. However, the vast majority of patients in the entire group survived the phase of myelosuppression. Conclusion: For refractory lymphomas, the combination of high-dose radiotherapy and chemotherapy combined with APBSCT is superior to conventional chemotherapy. The efficacy of high-dose chemotherapy does not seem to be lower than the super-dose?