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目的观察大剂量BEAC方案[卡莫司汀(BCNU)、依托泊甙(VP-16)、阿糖胞苷(Ara-C)、环磷酰胺(CTX)]联合自体干细胞移植(autologous stem cell transplantation,ASCT)治疗具有不良预后因素的弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的疗效。方法选择2000年1月-2011年12月新疆医科大学附属肿瘤医院收治按年龄调整的国际预后指数(Age-adjusted international prognostic index,aaIPI)评分为1～3分、行大剂量BEAC联合ASCT治疗的DLBCL患者35例,常规化疗疗效达完全缓解或部分缓解后行自体外周血干细胞动员,动员方案为VP-16联合粒细胞集落刺激因子(Granulocyte colony-stimulating factor,G-CSF)。大剂量化疗(high-dose chemotherapy,HDC)方案采用BEAC(BCNU 450mg/m2,第1～2d静注;VP-16 800mg/m2,第1～3d分2次静注;Ara-C 1.5g/m2,第1d静注;CTX 3.6g/m2第1～2d静注)方案。采用Kaplan-Meier法进行生存分析。结果 35例患者均移植成功,重建造血功能。移植前13例CR,22例PR,移植后23例CR,12例PR,无移植相关死亡,中位随访时间为39个月(7～135个月),随访期间6例因病情进展死亡,5年生存率为80%。结论采用大剂量BEAC方案联合ASCT治疗具有不良预后因素的DLBCL取得了较好疗效,值得进一步研究。
Objective To observe the effects of high dose BEAC regimen (BCNU, VP-16, Ara-C, CTX) combined with autologous stem cell transplantation , ASCT) in the treatment of diffuse large B-cell lymphoma (DLBCL) with adverse prognostic factors. Methods The age-adjusted international prognostic index (aaIPI) score of 1 to 3 was collected from January 2000 to December 2011 in Cancer Hospital Affiliated to Xinjiang Medical University. Large-dose BEAC combined with ASCT Thirty-five patients with DLBCL had complete or partial response to conventional chemotherapy and mobilized autologous peripheral blood stem cells. The mobilization protocol was Granulocyte colony-stimulating factor (G-CSF). High-dose chemotherapy (HDC) regimen was performed with BEAC (BCNU 450 mg / m2, intravenously 1 to 2 days; VP-16 800 mg / m2, 1d intravenous injection; CTX 3.6g / m2 1 ~ 2d intravenous) program. Survival analysis was performed using Kaplan-Meier method. Results All the 35 patients were successfully transplanted and the hematopoietic function was reconstructed. There were 13 cases of CR before transplantation, 22 cases of PR, 23 cases of CR after transplantation and 12 cases of PR without graft-related death. The median follow-up time was 39 months (range, 7-135 months). Six patients died during the follow- 5-year survival rate was 80%. Conclusion The high dose of BEAC combined with ASCT in the treatment of DLBCL with adverse prognostic factors has achieved good results and deserves further study.