目的 增加對慢性淋巴細(xì)胞白血病合并非霍奇金淋巴瘤臨床病例的認(rèn)識。 方法 通過報道2011年11月和2012年7月入住的2例確診為慢性淋巴細(xì)胞白血病合并非霍奇金淋巴瘤患者的診治過程，復(fù)習(xí)文獻(xiàn)，討論其發(fā)病機(jī)制、治療及預(yù)后。 結(jié)果 該2例患者均予以化療，其中1例淺表淋巴結(jié)明顯縮小，骨髓涂片基本恢復(fù)正常，病情控制較好；另1例合并癥多、病情惡化快、腫瘤化療效果欠佳，最后因呼吸衰竭死亡。 結(jié)論 慢性淋巴細(xì)胞白血病合并非霍奇金淋巴瘤，治療上應(yīng)綜合考慮患者年齡、ECOG評分、臨床分期、預(yù)后指數(shù)等因素，原則上以治療惡性程度更高的非霍奇金淋巴瘤為主，可根據(jù)慢性淋巴細(xì)胞白血病分期進(jìn)行觀察、隨訪或積極治療。
【摘要】 目的 探討對自體造血干細(xì)胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后復(fù)發(fā)的非霍奇金淋巴瘤患者再進(jìn)行異基因造血干細(xì)胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治療的臨床療效。 方法 收集2000年1月-2010年12月難治性惡性淋巴瘤采用auto-HSCT后復(fù)發(fā)患者11例，病程27個月~6.5年。所有患者在auto-HSCT前均為復(fù)發(fā)難治性病例，auto-HSCT后，完全緩解8例，部分緩解3例，自體移植后中位復(fù)發(fā)時間15個月，患者復(fù)發(fā)后采用異基因親緣造血干細(xì)胞移植，人類白細(xì)胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性別相同6例，性別不同5例。預(yù)處理方案為FBC方案，即氟達(dá)拉濱30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，環(huán)磷酰胺120 mg/kg分2 d使用。移植物均為外周血造血干細(xì)胞加骨髓。移植物抗宿主?。╣raft-versus-host disease，GVHD）的預(yù)防：HLA全相合采用環(huán)孢素+短程甲氨蝶呤+嗎替麥考酚酯，不全相合采用抗胸腺細(xì)胞球蛋白+環(huán)孢素+短程甲氨蝶呤+嗎替麥考酚酯?！〗Y(jié)果 11例患者全部獲得造血重建，急性GVHD發(fā)生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；發(fā)生慢性GVHD 7例（63.64%），其中有2例急性GVHD轉(zhuǎn)為慢性，4例局限型，3例廣泛型。隨訪8個月~9年，有4例分別于移植后8、15、21、34個月疾病復(fù)發(fā)，另外6例仍生存。 結(jié)論 allo-HSCT對于auto-HSCT后復(fù)發(fā)的非霍奇金淋巴瘤患者仍是一種有效的挽救性治療手段?！続bstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
【摘要】 目的 了解人工肝支持系統(tǒng)搶救造血干細(xì)胞移植合并重癥肝靜脈閉塞病的臨床療效?！》椒ā?002年1月-2010年12月因造血干細(xì)胞移植并發(fā)重癥肝靜脈閉塞病的6例患者，利用人工肝支持系統(tǒng)，選用血漿置換程序進(jìn)行血漿置換?！〗Y(jié)果 6例患者經(jīng)血漿置換治療后，膽紅素均明顯下降，3例最終恢復(fù)，2例因肝功能再次惡化死亡，1例死于嚴(yán)重混合性感染?！〗Y(jié)論 人工肝支持系統(tǒng)搶救造血干細(xì)胞移植合并重癥肝靜脈閉塞病是一種新的嘗試，是有效和可靠的?！続bstract】 Objective To explore the therapeutic efficacy of artificial liver support system on severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation. Methods Between January 2002 and December 2010, six patients with severe hepatic veno-occlusive disease accompanied with hematopoietic stem cell transplantation underwent plasma exchange with plasma exchange procedures using artificial liver support system. Results After plasma exchange treatment, the bilirubins of six patients significantly decreased; three patients eventually recovered, two died because of liver function deteriorated again, and one died of severe mixed infections. Conclusion Artificial liver support system is effective and reliable for hematopoietic stem cell transplantation accompanied with severe hepatic veno-occlusive disease.