临床荟萃 ›› 2021, Vol. 36 ›› Issue (10): 901-904.doi: 10.3969/j.issn.1004-583X.2021.10.007

• 专题:血液病诊疗关键技术转化与推广 • 上一篇    下一篇

自体造血干细胞移植治疗原发中枢神经系统淋巴瘤

程莉, 黄文荣()   

  1. 解放军总医院第五医学中心 血液病医学部淋巴瘤-浆细胞疾病专科,北京 100071
  • 收稿日期:2021-10-21 出版日期:2021-10-20 发布日期:2021-11-10
  • 通讯作者: 黄文荣 E-mail:huangwr301@163.com
  • 作者简介:黄文荣,医学博士、主任医师,硕士研究生导师。解放军总医院第五医学中心血液病医学部淋巴瘤-浆细胞疾病专科主任,该专科为国内最大的淋巴瘤-浆细胞疾病诊疗中心之一。曾分析了原301医院近20年收治的各类淋巴瘤、多发性骨髓瘤及近千例造血干细胞移植病例的诊疗资料;先后组织全国10余家大型教学医院协作分析了我国外周T细胞淋巴瘤和弥漫大B细胞淋巴瘤诊疗现状与问题。在淋巴瘤和多发性骨髓瘤的分子靶向治疗、免疫治疗、化疗、造血干细胞移植等方面有深厚造诣,擅长淋巴瘤和多发性骨髓瘤的精准诊疗。作为负责人承担国家自然科学基金课题、军队课题、首都卫生发展基金专项课题等多个研究项目。曾获军队科技进步二等奖。任中国老年学和老年医学学会血液病医学专委会副主任委员,北京市抗癌协会淋巴血液肿瘤专委会副主任委员,中国研究型医院学会血液病精准诊疗专委会常委。

Effects of autologous hematopoietic stem cell transplantation in primary central nervous system lymphoma

Cheng Li, Huang Wenrong()   

  1. Department of Hematology, lymphoma-plasma cell disease specialist, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China
  • Received:2021-10-21 Online:2021-10-20 Published:2021-11-10
  • Contact: Huang Wenrong E-mail:huangwr301@163.com

摘要:

原发中枢神经系统淋巴瘤(PCNSL)由于发生率较低,不少医生对整体治疗流程中自体造血干细胞移植(ASCT)的作用还不甚了解。大剂量甲氨蝶呤(HD-MTX)为基础的诱导治疗使得PCNSL的早期控制率明显提高,但不少患者缓解深度不够,国际上大型临床研究提示完全缓解(CR)率多低于50%;缓解维持时间短,多在1年内复发。ASCT作为巩固治疗措施应用于初治或复发难治PCNSL使得CR率明显提高,长期无病生存率(PFS)显著提高;初治PCNSL患者长期PFS可达70%,复发难治PCNSL患者长期PFS可达50%。目前的临床实践证实,PCNSL多见于老年人,器官功能状态良好的老年PCNSL患者仍然可以耐受ASCT,并明显获益于ASCT。PCNSL的ASCT预处理方案以含大剂量塞替派的方案为佳,年轻、身体转态较好、前期诱导治疗未获得CR的患者,以预处理强度更强的TBC方案为佳;年龄偏大的患者可以选择TT-BCNU或减量的TBC预处理方案。

关键词: 神经淋巴瘤病, 自体造血干细胞移植, 缓解, 生存

Abstract:

The effects of autologous hematopoietic stem cell transplantation(ASCT) in the whole treatment process remain to be unknown to abundant physicians due to low incidence of primary central nervous system lymphoma(PCNSL). Induction therapy based on high-dose methotrexate(HD-MTX) has significantly improved the early control rate of PCNSL, and many patients receive insufficiently thorough remission. Large-scale international clinical studies show that the rate of complete remission(CR) is less than 50% in most case; while the duration of remission remain short and recur within one year. ASCT, a consolidation therapeutic strategy, is applied to primary or relapsed and refractory PCNSL, significantly improved the rate of complete remission and long-term disease-free survival(PFS); the long-term PFS of newly treated PCNSL patients can hit 70%, and that of relapsed and refractory PCNSL patients can hit 50%. Current clinical practices confirmed that PCNSL is more common in older patients. Elderly PCNSL patients with great organ functions remained to tolerate ASCT, significant benefited from ASCT. High-dose thiotepa is preferred for ASCT conditioning regimen of PCNSL, and TBC regimen with stronger conditioning intensity is patients for young patients with better physical conditioning failing reciveing CR after early induction therapy; Older patients are supported to choose TT-BCNU or reduced TBC conditioning regimen.

Key words: neurolymphomatosis, autologous hematopoietic stem cell transplantation, response, survival

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