Oji Y, Oka Y, Tatekawa T, Soma T, Matsunashi T, Yamagami T, Tsuboi A, Tamaki H, Kim E H, Sugiyama H, Ogawa H
Department of Clinical Laboratory Science, Osaka University Medical School, Japan.
Int J Hematol. 1999 Jun;69(4):263-7.
We report a patient with T-cell non-Hodgkin's lymphoma (NHL) who relapsed after treatment with relatively intensive third-generation chemotherapy, VACOP-B, and who was safely and effectively treated with allogeneic peripheral blood stem cell transplantation (allo PBSCT) with double conditioning. The first conditioning consisted of carboplatin and etoposide. Twenty-one days later, the second conditioning was performed with cytosine arabinoside, cyclophosphamide, and total body irradiation (AraC/Cy/TBI). Between the periods of the first and second conditioning, autologous (auto) PBSCT (4.4 x 10(5) colony-forming units granulocyte/macrophage (CFU-GM)/kg, 3.8 x 10(6) CD34+ cells/kg) was performed to rescue marrow aplasia after the first conditioning. After the second conditioning, allo PBSCT (2.1 x 10(5) CFU-GM/kg, 8.2 x 10(6) CD34+ cells/kg) was performed from a human leukocyte antigen-identical sibling. Marrow reconstitution after allo PBSCT was rapid. Grade I acute graft-vs.-host disease (GVHD) involving skin and chronic GVHD on the eye was observed. No severe transplantation-related complications occurred. With a follow-up of 22 months after allogeneic PBSCT, the patient is alive without evidence of the disease. This case shows that allo PBSCT with intensive double conditioning may become a new treatment strategy to achieve long-term disease-free survival for young NHL patients of resistant relapse with a great deal of tumor burden and invasion of lymphoma cells in bone marrow.
我们报告了1例T细胞非霍奇金淋巴瘤（NHL）患者，该患者在接受相对强化的第三代化疗方案VACOP - B治疗后复发，并接受了双程预处理的异基因外周血干细胞移植（allo PBSCT），且治疗安全有效。首次预处理方案为卡铂和依托泊苷。21天后，进行第二次预处理，采用阿糖胞苷、环磷酰胺和全身照射（AraC/Cy/TBI）。在首次和第二次预处理期间，进行了自体（auto）PBSCT（4.4×10⁵集落形成单位粒细胞/巨噬细胞（CFU - GM）/kg，3.8×10⁶ CD34⁺细胞/kg），以挽救首次预处理后的骨髓抑制。第二次预处理后，从人类白细胞抗原相合的同胞处进行了allo PBSCT（2.1×10⁵ CFU - GM/kg，8.2×10⁶ CD34⁺细胞/kg）。allo PBSCT后的骨髓重建迅速。观察到I度急性移植物抗宿主病（GVHD）累及皮肤，眼部出现慢性GVHD。未发生严重的移植相关并发症。异基因PBSCT后随访22个月，患者存活，无疾病证据。该病例表明，强化双程预处理的allo PBSCT可能成为一种新的治疗策略，可为有大量肿瘤负荷且淋巴瘤细胞侵犯骨髓的难治性复发年轻NHL患者实现长期无病生存。
