自体造血干细胞移植对淋巴瘤患者缓解率和生存率的影响

Effect of autologous peripheral hematopoietic stem cell transplantation on remission and survival rates in patients with lymphoma

目的:评价自体外周血造血干细胞移植(APBSCT)对提高淋巴瘤患者的缓解率和生存率的作用。方法:回顾性分析53例接受APBSCT淋巴瘤患者临床资料,病理类型以弥漫大B细胞淋巴瘤(DLBCL)为主,占50.94%,中位移植年龄34(12～57)岁,临床分期Ⅲ、Ⅳ期患者占78.8%,年龄矫正的国际预后指数(aaIPI)低危、低中危、中高危、高危患者分别占21.2%、46.7%、15.1%、17.0%。采用统计学分析APBSCT治疗淋巴瘤的疗效及其对生存情况的影响及相关预后影响因素。结果:52例患者成功接受了APBSCT治疗,移植后完全缓解(CR)率65.4%;部分缓解(PR)率19.2%,总反应率(RR)84.6%(CR加PR);其中移植前达CR患者移植后100%CR,PR患者61.2%获CR;1例疾病稳定(SD)患者移植后获CR;17例疾病进展(PD)患者移植后35.3%获CR,17.6%获PR,总反应率为52.9%。中位随访14个月,3年预期总生存(OS)率、无事件生存(EFS)率分别为56%、50%。APBSCT能克服初诊时乳酸脱氢酶(LDH)升高、进展期病变、结外病灶>1、巨块病变、B症状、骨髓浸润所引起的对患者生存期的影响;无法克服体能状态下降、移植前LDH水平升高、进展期病变对生存的影响。结论:APBSCT可提高淋巴瘤患者CR率,改善移植前未达CR患者的OS及EFS,移植前临床特征重新评估对判断预后具有重要意义。

Objective To evaluate the effect of autologous peripheral hematopoietic stem cell transplantation （APBSCT） on remission and survival rates in lymphoma patients. Methods Fifty-three patients with lymphoma undergone APBSCT were retrospectively analyzed. Results Pathologically, most of the patients （50.94%） were diffuse large B-cell lymphoma（DLBCL）. Median age at transplantation was 34 （12-57） years. Clinical staging showed that most of the patients（78.6%） were at stage Ⅲ/Ⅳ. The age adjusted International Prognosis Index showed the low risk, low/median risk, median/high risk and high risk accounted for 21.2%, 46.7%, 15.1%, and 17.0%, respectively. APBSCT was successively performed in 52 patients. Sixty-five point four percent of the patients attained a complete remission （CR） and 19.2% a partial remission （PR）. Overall response rate was 84.6%. The CR rates after transplantation for patients who had achieved CR, PR before transplantation were 100% and 61.2%, respectively. One patient with stable disease got CR after transplantation. Patients with progressive disease （PD） before transplantation had a CR rate of 35.3% and a PR rate of 17.6% after transplantation, the overall response rate was 52.9%. With a median follow-up of 14 months, the overall survival （OS） and event free survival（EFS） rate at 3 year were 56% and 50%, respectively. Poor prognosis caused by high lactate dehydrogenase （LDH） level at initial visit, PD, extra nodal lesion, bulky lesion, B symptom and bone marrow involvement could be ameliorated by APBSCT. However, the demerit effect on survival by decrease in performance status, increase of LDH level and PD before transplantation could not be ameliorated by APBSCT. Conclusions APBSCT could increase CR rate and improve OS and EFS rate for patients who had not achieved CR before transplantation. Re-evaluation of clinical characteristics before transplantation has important significance on predicting prognosis.