异基因造血干细胞输注支持下化疗治疗老年淋巴瘤3例报告

摘要

目的：观察异基因造血干细胞分次输注（微移植）支持下联合化疗治疗老年非霍奇金淋巴瘤（ NHL ）的临床疗效。方法 NHL老年患者3例，年龄70～78岁，其中病例1为反复治疗后复发患者，病例2和病例3均为初治患者，分别予CHOP（环磷酰胺＋阿霉素＋长春新碱＋强的松）方案或GeMoD（吉西他滨＋奥沙利铂＋地塞米松）方案化疗。供者为人类白细胞抗原半相合的患者子女，采集重组人粒细胞集落刺激因子动员后的供者外周血干细胞，于化疗结束后约36 h分次输注。观察患者的疾病状态、生存时间、骨髓抑制情况及不良反应等。结果病例1、病例2、病例3治疗后分别达病情稳定、完全缓解和部分缓解，生存期分别为4个月、26个月、10个月。病例1在化疗第3、第4疗程出现粒细胞缺乏，在第4疗程出现严重血小板减少，其余患者未出现严重的骨髓抑制，所有患者均未输注血小板。所有患者未出现移植物抗宿主病。结论化疗联合微移植治疗老年淋巴瘤骨髓抑制轻，使用安全，值得更大规模的临床研究进行探索。%Objective To investigate the clinic efficacy of combined chemotherapy supported by allogeneic hematopoietic stem cell transfusion(microtransplantation) for elderly patients with non-Hodgkins lymphoma(NHL).Methods Three elderly patients with NHL aged from 70 to 78 years were enrolled in the study .The patient in Case 1 relapsed after multiple chemotherapy .The patents in Case 2 and Case 3 were newly diagnosed as NHL ,and were treated with chemotherapy regimen of CHOP ( cyclophosphamide +doxorubicin+vincristine+prednisone ) or GeMod( gemcitabine+oxaliplatin+dexamethasone ) .The donors were children of patients with human leukocyte antigen semi-matched.Peripheral blood stem cells ( PBSC) from the donors were mobilized with granulocyte colony-stimulating factor and then were collected.Patients were transfused with PBSC 36 hours after the chemotherapy finished .The disease status,survival time,myelosuppression and side effects were observed .Results The disease statuses after treatment of Case 1,Case 2 and Case 3 were stable disease,complete response and partial response ,respectively.The survival time of Case 1,Case 2 and Case 3 was 4 months,26 months and 10 months, respectively .Granulocytopenia was observed in Case 1 during the third and forth period of chemotherapy ,and severe thrombocytopenia only occurred in Case 1 during the forth period.Severe myelosuppression did not occurred in other cases .None of three cases received transfusion of platelet .Graft versus host disease was not found in any patients .Conclusion Chemotherapy combined with microtransplantation has mild myelosuppression ,and was safe for elderly patients with NHL .Large-scale clinic study for further research is deserved .