非霍奇金淋巴瘤采用BEAM方案預(yù)處理行自體外周血干細(xì)胞移植治療的臨床分析

鄭志海　廖麗昇　曲雙　謝穎　陳碧云

[關(guān)鍵詞] 非霍奇金淋巴瘤;BEAM方案;造血干細(xì)胞移植;自體

[中圖分類號(hào)] R730.5? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）22-0086-04

Clinical analysis of BEAM regimen pretreatment for autologous peripheral blood stem cell transplantation in treatment of non-Hodgkin′s lymphoma

ZHENG Zhihai? ?LIAO Lisheng? ?QU Shuang? ?XIE Ying? ?CHEN Biyun

Department of Hematology， Fujian Provincial Hospital， Fuzhou? ?350001， China

[Abstract] Objective To explore the clinical efficacy and safety of BEAM regimen pretreatment for autologous peripheral blood stem cell transplantation in the treatment of non-Hodgkin′s lymphoma. Methods A retrospective analysis of 28 patients with non-Hodgkin′s lymphoma received autologous peripheral blood stem cell transplantation in the Department of Hematology of Fujian Provincial Hospital from January 2016 to June 2019 was conducted. The classic BEAM pretreatment regimen was used：Carmustine 300 mg/m2（-6 d）， etoposide 200 mg/m2[（-5 d）-（-2 d）]， cytarabine 400 mg/m2 [（-5 d）-（-2 d）]， and melphalan 140 mg/m2（-1 d）. Results The bone marrow hematopoiesis was reconstructed in all patients after transplantation. After transplantation， the median time to achieve absolute peripheral blood neutrophil count （ANC） ≥0.5×109/L and platelet≥20×109/L was 12.0（9-22）d and 15.5（10-28） d， respectively.The main adverse events were bone marrow suppression， infection， diarrhea， oral mucositis and implantation syndrome. The median follow-up time was 35.4 （6-92）months， and the median survival time was 28.5 （11-84） months. The estimated 2-year overall survival （OS） was 84.3%， and the 2-year disease-free survival （DFS） was 83.6%. Conclusion BEAM regimen pretreatment for autologous peripheral blood stem cell transplantation has positive effect in the treatment of non-Hodgkin's lymphoma， with rapid hematopoietic reconstitution， high safety and low toxicity.

[Key words] Non-Hodgkin′s lymphoma; BEAM regimen; Hematopoietic stem cell transplantation; Autologous

侵襲非霍奇金淋巴瘤（Non-hodgkin lymphoma，NHL）是常見(jiàn)的血液系統(tǒng)惡性腫瘤，使用聯(lián)合化療可很大程度地改善患者的預(yù)后，然而仍有相當(dāng)一部分患者緩解后復(fù)發(fā)或治療無(wú)效，療效相對(duì)較好的病理類型彌漫性大B細(xì)胞淋巴瘤，采用聯(lián)合治療也仍有約50%的患者病情復(fù)發(fā)。自體外周血造血干細(xì)胞移植（Autologous peripheral blood stem-cell transplantation，APBSCT）能最大程度上清除患者體內(nèi)腫瘤細(xì)胞，已成為治療侵襲性淋巴瘤的重要手段。為探索適宜的預(yù)處理方案，本研究對(duì)選用經(jīng)典BEAM方案作為預(yù)處理方案序貫自體外周血造血干細(xì)胞移植治療的28例NHL患者病歷資料進(jìn)行回顧性分析，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料

回顧性分析2016年1月至2019年6月住院的28例NHL患者，中位年齡39.5（17～61）歲，其中男18例，女10例。所有患者均經(jīng)病理組織學(xué)確診，其中彌漫大B細(xì)胞淋巴瘤14例，濾泡性淋巴瘤1例，Burkitt淋巴瘤1例，套細(xì)胞淋巴瘤1例，B細(xì)胞源性淋巴瘤1例，間變大細(xì)胞性淋巴瘤4例，外周T細(xì)胞淋巴瘤2例，血管免疫母細(xì)胞性T細(xì)胞淋巴瘤2例，T淋巴母細(xì)胞淋巴瘤2例。其中1例彌漫大B細(xì)胞淋巴瘤和1例間變大細(xì)胞性淋巴瘤初診時(shí)合并中樞神經(jīng)系統(tǒng)浸潤(rùn)。所有患者移植前多采用ECHOP、RCHOP、RCHOPE、Hyper-CVAD-A/B、REPOCH、GDP+P-ASP等方案化療;有3例患者移植前做過(guò)局部放療;移植前評(píng)價(jià)達(dá)CR或接近CR者14例，達(dá)PR者14例。