【摘要】 目的:观察大剂量化疗联合应用粒细胞集落刺激因子在没有干细胞支持情况下,治疗难治或复发性非霍奇金淋巴瘤(NHL)的疗效和不良反应。方法:采用大剂量化疗方案,DIAEM方案:异环磷酰胺1 500 mg/m2,静脉滴入,d1～d5;美斯纳800 mg/次,于异环磷酰胺后0、4和8 h静脉滴入,并同时水化;依托泊苷200 mg/m2,静脉滴入,d1～d5;表柔比星60 mg/m2,静脉滴入,d1。地塞米松20 mg,静脉滴入,d1～d5。ESHAP方案:顺铂25 mg/m2,静脉滴入,d1～d4;替尼泊苷(Vm-26)100 mg,静脉滴入,d1～d4;甲基泼尼松龙500 mg,静脉滴入,d1～d4;阿糖胞苷1 500 mg/m2,d5。两方案交替进行,粒细胞集落刺激因子5～10μg/(kg.d)于每周期化疗结束后24 h开始应用,至白细胞达2.0×109L-1且持续3 d停用。结果:大剂量化疗总有效率61.1%(22/36),其中CR12例(33.3%),PR10例(27.8%),SD 4例,PD 10例,1例于大剂量化疗后第7天死于颅内出血。主要不良反应为骨髓抑制,白细胞和血小板降到最低的中位时间分别为6和5 d,其恢复时间分别为10和12 d;27例(76.5%)出现发热性粒细胞减少,中位时间为6 d。结论:在无干细胞支持的情况下,采用大剂量化疗辅以粒细胞集落刺激因子支持是治疗难治或复发性NHL的有效措施。更多还原

【Abstract】 OBJECTIVE: To observe the effect and toxicity of high dose chemotherapy(HDC) combined with G-CSF on refractory and relapsed non-Hodgkin lymphoma’s(NHL).METHODS:DIAEM regimen:IFO 1 500 mg/m2,iv,d1-d5;mesna 800 mg/time,0,4,8 hours after IFO given,iv,with enough fluid supplement;Vp-16 200 mg/m2,iv,d1-d5;EPI 60 mg/m2,iv,d1.DXM 20 mg,iv,d1-d5.ESHAP regimen: DDP 25 mg/m2 iv,d1-d4,Vm-26 100 mg iv,d1-d4,solumedrol 500 mg iv,d1-d4,Arc-a 1 500 mg/m2 iv d5.G-CSF 5-10 μg(kg·d) was given 24 hours after the end of the chemotherapy and was discontinued when WBC count reached 2×109 L-1 and persisted for 3 days.RESULTS:The total response rate was 61.1%(22/36) of HDC,including CR 12 cases(33.3%) and PR 10 cases(27.8%).Four cases remained stabe,PD 10 cases,and 1 case died of intracerebral hemorrahage after 7 days with HDC application.The main toxic effect of HDC was bone marrow suppression.The median time of leukopenia and platelet reduction was 6 days and 5 days respectively.The recovery time was 10 and 12 days respectively.Twenty-seven cases(76.5%) had leukopenia induced fever,and the median time was 6 days.CONCLUSION:HDC combined with G-CSF is an effective regimen treating refractory and relapsed NHL without stem cell support.更多还原