自体造血干细胞移植不同预处理方案治疗恶性淋巴瘤100例临床观察

Clinical Observation of 100 Patients with Malignant Lymphoma Treating with Different Preconditioning Regimens Followed by Autologous Hematopoietic Stem Cell Transplantation

本研究比较大剂量化疗联合或不联合大面积照射预处理方案对恶性淋巴瘤(ML)患者行自体造血干细胞移植(AHSCT)的疗效、预后及安全性的影响。回顾性分析1992年9月至2010年8月在解放军307医院行AHSCT的100例ML患者,根据AHSCT预处理方案不同,分为高剂量化疗组和高剂量放、化疗组,分析3、5、10年的总生存(OS)率、无进展生存(PFS)率和不良反应。结果表明,截止至2011年2月,中位随访时间33.5个月,所有患者造血功能均获重建。高剂量化疗组和高剂量放、化疗组患者白细胞计数恢复至>1.0×109/L的中位时间为(6.0±0.4)d、(8.2±0.4)d,血小板恢复至>20.0×109/L的中位时间为(7.1±0.8)d、(11.4±2.5)d,差异均具有统计学意义(P<0.05)。高剂量化疗组和高剂量放、化疗组OS率分别为3年67.3%、68.9%,5年62.8%、60.6%,10年57.6%、56.2%;PFS率分别为3年63.6%、63.2%,5年59.4%、58.3%,10年50.8%、55.3%,差异均无统计学意义(P>0.05);两组患者发热、感染、出血差异无统计学意义(P>0.05)。结论:自体移植预处理方案中的高剂量放、化疗组较高剂量化疗组造血重建晚,但两组疗效及预后无统计学差异。

This study was designed to compare the curative effect,prognosis and safety of different preconditioning regimens for patients who received autologous hematopoietic stem cell transplantation（AHSCT） for malignant lymphoma（ML）.The clinical data of 100 ML patients（Sep 1992 to Aug 2010 in 307 Hospital） were retrospectively analyzed,and were divided into two groups by different preconditioning regimens： the high-dose chemotherapy preconditioning group and high-dose chemotherapy/radiotherapy preconditioning group.The overall survival（OS） rate,progress free survival（PFS） rate and adverse effect were analyzed.The results showed that until Feb 2011,the median follow-up was 33.5 months.All patients were engrafted and their hematopoiesis was reconstituted.The median time of WBC recovery up to〉1.0×1.09/L in high-dose chemotherapy preconditioning group and high-dose chemotherapy/radiotherapy preconditioning group were（6.0±0.4） d and（8.2±0.4） d,platelet up to〉20.0×1.09/L in two groups were（7.1±0.8） d and（11.4±2.5） d（P0.05）.Meanwhile,the incidence of fever,infection,bleeding,secondary cancer between two groups was not significant different（P〉0.05）.It is concluded that the hematopoietic reconstitution of high-dose chemotherapy/radiotherapy preconditioning group is later than that of high-dose chemotherapy preconditioning group.However,there is no significant difference in curative effect and prognosis between the two groups.