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目的:探讨以BEAM方案为主的预处理后行自体外周血干细胞移植(APBSCT)对侵袭性非霍奇金淋巴瘤(NHL)的疗效。方法:诊断为侵袭性NHL患者54例,其中难治、复发NHL的挽救治疗41例,作为高危侵袭性NHL的一线缓解后治疗13例;经环磷酰胺加VP-16动员后行BEAM方案(51例)或CBV方案(3例)预处理的APBSCT。结果:1例未植活,3个月后行半相合异基因干细胞移植;2例患者死于移植相关的并发症,其余患者均获得造血功能重建;移植后外周血中性粒细胞绝对计数(ANC)≥0.5×109/L的中位时间为10d(平均8～25d);血小板≥20×109/L的中位时间为15d(平均6～36d)。随访时间为6～102个月,中位随访时间为42.5个月。中位生存时间为35个月(2～100个月),3年总生存率为66.6%,3年无病生存率为66.4%;Cox多因素分析显示,疾病的分期和血小板植活的时间与NHL患者APBSCT后的生存相关。结论:BEAM为主的预处理方案的APBSCT无论作为侵袭型NHL的挽救治疗或高危侵袭型NHL的一线缓解后治疗安全,疗效肯定。
Objective: To investigate the efficacy of BEAM-based pretreatment on invasive non-Hodgkin’s lymphoma (NHL) using autologous peripheral blood stem cell transplantation (APBSCT). Methods: Forty-five patients with aggressive NHL were diagnosed as refractory or relapsed NHL. Thirty-one patients were treated with salvage NHL as first-line remission after high-risk invasive NHL. Thirteen patients were treated with cyclophosphamide plus VP-16 and BEAM regimen 51 cases) or CBV regimen (3 cases) pretreated with APBSCT. Results: One case was not alive, and three months later, hematopoietic stem cell transplantation was performed. Two patients died of graft-related complications, and the remaining patients received hematopoietic reconstitution. The absolute count of peripheral blood neutrophils The median time for ANC≥0.5 × 109 / L was10d (mean, 8 ~ 25d). The median time for platelet≥20 × 109 / L was15d (average6 ~ 36d). The follow-up time ranged from 6 to 102 months, and the median follow-up time was 42.5 months. The median survival time was 35 months (range, 2 to 100 months). The 3-year overall survival rate was 66.6% and the 3-year disease-free survival rate was 66.4%. Cox multivariate analysis showed that the disease stage and platelet activation time Associated with survival after APBSCT in NHL patients. Conclusions: The BEAM-based pretreatment program of APBSCT affirmed the efficacy of salvage therapy as a salvage-type NHL or first-line remission therapy for high-risk invasive NHL.