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目的评价自体外周血干细胞移植治疗高龄恶性血液病的疗效。方法将60例老年患者分为移植组与非移植组,其中移植组的34例高龄恶性血液病患者首次缓解并经3~4个周期强化治疗后,行自体外周血干细胞移植,预处理方案采用MAC、M及CY+TBI,造血重建后予以大剂量IL-2行生物治疗4个疗程,之后每3~4个月予以长间歇维持化疗1次,常用方案包括TA、MA、MP、CTOD等;非移植组的26例患者采用常规的化疗治疗。结果34例患者移植后均成功重建造血,无一例移植相关死亡。移植后维持化疗满2年的患者有20例,有10例复发(50%),其中6例死亡。34例患者中16例复发(47.1%),其中死亡8例。3年无病生存率为(43.0±7.1)%。26例常规化疗的患者中20例复发(76.9%),其中有12例死亡,3年无病生存率为(19.2±6.2)%。结论自体外周血干细胞移植、生物治疗、长间歇维持化疗序贯治疗高龄恶性血液病,治疗相关死亡率低,无病生存率较高,可作为改善高龄恶性血液病治疗效果的重要措施。
Objective To evaluate the efficacy of autologous peripheral blood stem cell transplantation in the treatment of advanced hematological malignancies. Methods 60 elderly patients were divided into transplantation group and non-transplantation group. 34 patients with advanced hematologic malignancies in the transplantation group were relieved for the first time and were treated with 3 to 4 cycles of intensive therapy. Autologous peripheral blood stem cell transplantation was performed. The pretreatment protocol MAC, M and CY + TBI. After hematopoietic reconstitution, high-dose IL-2 biotherapy is given for 4 cycles and every 3 to 4 months for long-term maintenance chemotherapy. Common protocols include TA, MA, MP, CTOD, etc. Twenty-six patients in the non-transplant group received conventional chemotherapy. Results All the 34 patients successfully reconstructed hematopoiesis after transplantation. None of the patients died of transplantation. Twenty patients remained on chemotherapy for 2 years after transplantation, with 10 recurrences (50%) and 6 deaths. Of the 34 patients, 16 were recurrent (47.1%), of which 8 died. Three-year disease-free survival rate was (43.0 ± 7.1)%. Of 26 patients with conventional chemotherapy, 20 patients relapsed (76.9%), of which 12 patients died and the 3-year disease-free survival rate was (19.2 ± 6.2)%. Conclusion Autologous peripheral blood stem cell transplantation, biological therapy, long-term intermittent maintenance chemotherapy sequential treatment of advanced hematologic malignancies, treatment-related mortality is low, high disease-free survival rate can be used as an important measure to improve the treatment of elderly patients with hematological malignancies.