【摘要】 目的 探讨对自体造血干细胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后复发的非霍奇金淋巴瘤患者再进行异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治疗的临床疗效。 方法 收集2000年1月-2010年12月难治性恶性淋巴瘤采用auto-HSCT后复发患者11例，病程27个月~6.5年。所有患者在auto-HSCT前均为复发难治性病例，auto-HSCT后，完全缓解8例，部分缓解3例，自体移植后中位复发时间15个月，患者复发后采用异基因亲缘造血干细胞移植，人类白细胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性别相同6例，性别不同5例。预处理方案为FBC方案，即氟达拉滨30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，环磷酰胺120 mg/kg分2 d使用。移植物均为外周血造血干细胞加骨髓。移植物抗宿主病（graft-versus-host disease，GVHD）的预防：HLA全相合采用环孢素+短程甲氨蝶呤+吗替麦考酚酯，不全相合采用抗胸腺细胞球蛋白+环孢素+短程甲氨蝶呤+吗替麦考酚酯。 结果 11例患者全部获得造血重建，急性GVHD发生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；发生慢性GVHD 7例（63.64%），其中有2例急性GVHD转为慢性，4例局限型，3例广泛型。随访8个月~9年，有4例分别于移植后8、15、21、34个月疾病复发，另外6例仍生存。 结论 allo-HSCT对于auto-HSCT后复发的非霍奇金淋巴瘤患者仍是一种有效的挽救性治疗手段。
【Abstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
Citation： SU Yi,YI Hai,FU Li,FAN Fangyi,SUN Haoping,LIU Yangyang,DENG Tao,WANG Yi,HE Guangcui,LAI Sihan,WANG Lin,LIU Yilan. Therapeutic Effect of Allogeneic Hematopoietic Stem Cell Transplantation on Relapsing Non-Hodgkin′s Lymphoma after Autologous Stem Cell Transplantation. West China Medical Journal, 2011, 26(12): 1780-1782. doi: Copy