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Treatment of a Case of Non-Hodgkin Lymphoma with Pathologic Fracture of Multiple Thoracic Vertebra and Paralysis of Legs with Autologous Transplantation of Combination of Bone Marrow Cells and Peripheral Blood Progenitor Cells



Treatment of a Case of Non-Hodgkin Lymphoma with Pathologic Fracture of Multiple Thoracic Vertebra and Paralysis of Legs with Autologous Transplantation of Combination of Bone Marrow Cells and Peripheral Blood Progenitor Cells



Blood 100(11): Abstract No 5144, November 16



The patient is a Chinese boy, 16 years. He had severe pain on his back, high fever, paralysis of legs for 2 months and hospitalized on Oct. 22, 1996. CT-scanner showed that he had cut down fracture of his thoracic vertebra 3,4,10, resulting paralysis of two legs, pathologic destroy of thoracic vertebra 2 to 10 and vertebra lumber 2 to 4. After the operation for reducing pressure of vertebral tube, he was diagnosed as high-malignant, B-large cell Non-Hodgkin lymphoma, IV phase, B group. His blood test showed HBsAg (+).He received one course of CHOP regimen immediately. Then he had received 4 courses of CHOP+E (VP-16 1.8mg/kg, d1, d3, d5). After the two courses of higher dose of CAOPE regimens (CY 1400mg/m2, Ara-C 1400mg /m2, VCR, Pred, VP-16), his 2.09x108/kg of bone marrow mononuclear cells was harvested and cryopreserved with dimethyl sulfoxide(DMSO) in fluid nitrogen (-196degreeC)after moving red cell. After mobilization of G-CSF (Kirin, CO, Japan)300mug/d, d1-d3, his 5.14x108/kg of peripheral blood mononuclear cells which included CD34+ cells of 2.01x106/kg were collected by COBE Spectra blood separator (COBE, CO, Lakewood) and cryopreserved. The conditional regimen was Cy 120mg/kg and total body irradiation (60CO TBI) 800 cGY(lung 700 cGY, local pathologic thoracic and lumber vertebra 1050 cGY). He was treated with acyclovir and high-dose intravenous immunoglobulin for prophylactic virus infection. He had severe head pain and severe hemoglubinuria when he received transfusion of bone marrow cryopreserved cells on Jun.16, 1997. His hemoglubinuria was completely controlled by high-dose DXM (1.3mg/kg). His WBC decreased to 0 at +5d and recovered to 0.7x108/L at +12d. He can walk by himself from the isolation room at +17d. After discharged from hospital he received two courses of 60CO irradiation on local pathologic vertebra. The total dose was 6500 cGY. He has been disease-free survival for 6 years. We have some experiences (1) Some Lymphoma patients with thoracic vertebra with reversible paralysis can also be selected to transplant. We pay more attention to moving the body in case of severe vertebra fracture when carrying the patient out to TBI. It has key role for reversible paralysis that to give intensive consolidation therapy such as transplantation. (2) Autologous transplantation of combination of bone marrow cells and peripheral blood progenitor cells has some advantages such as rapid hematopoietic recovery. The reasons are closely related to double dosage of infusion cells number, also maybe to different characteristics of two kinds of progenitor cells such as bone marrow stromal cells. (3) HD-irradiation therapy after transplantation is also very important for cure of patient with pathologic bone fracture of vertebra. The patient has received total dose of 6500 cGy in local pathologic vertebra. (4) Could a hepatitis B virus carrier patient receive hematopoietic cells transplant? Some hematologists and oncologists thought chemotherapy results in active of hepatitis B virus. Why this patient did not acute hepatitis appearing during transplantation? Perhaps it is related to give treatment of acyclovir and high-dose intravenous immunoglobulin.

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