自体外周血造血干细胞移植治疗恶性淋巴瘤的临床研究

Clinical Study of Autologous Peripheral Blood Stem-cell Transplantation for Treatment of Malignant Lymphoma

目的观察恶性淋巴瘤患者在常规化疗后用自体外周血造血干细胞移植作为巩固治疗方法的初期疗效。方法 52例恶性淋巴瘤患者,按完全随机设计的原则,按入院单号为对照组,双号为移植组。对照组26例采用CHOP、COMP、VDLP、ABVD等常规化疗方案化疗6个疗程。移植组26例在常规化疗基础上行自体外周血造血干细胞移植。动员方案采用大剂量环磷酰胺(HD-CTX)联合粒细胞集落刺激因子(G-CSF);预处理方案采用CBV(环磷酰胺、环己亚硝脲、足叶乙甙)。结果 26例患者移植后造血功能快速重建。移植后ANC>0.5×109/L、Plt>20×109/L的中位时间分别为10 d、13 d,移植组与对照组的完全缓解率分别为80.77%和34.62%;总有效率分别为92.31%和61.54%,移植组疗效好于对照组(P<0.05)。随访时间6～76个月。移植组和对照组的3年无事件生存率(EFS)分别为83.33%(15/18)和37.50%(6/16),5年EFS分别为58.33%(7/12)和23.08%(3/13),移植组3年、5年EFS均高于对照组(P<0.05)。复发率分别为19.23%和46.15%,移植组复发率低于对照组(P<0.05)。结论自体外周血造血干细胞移植作为恶性淋巴瘤患者缓解后的巩固治疗比单纯化疗有更好的疗效,复发率较单纯化疗低。

Objective To evaluate the initial therapeutic effect of autologous peripheral blood stem-cell transplantation （APBSCT） after the routine chemotherapy on malignant lymphoma. Methods Fifty two cases of malignant lymphoma were randomly divided into two groups, control group and transplantation group. The control group（26 cases） was treated with six courses of CHOP or COMP or VDLP or ABVD plan, the transplantation group （26 cases） was treated with APBSCT after six-course routine chemotherapy. Hematopoietic stem cells were mobilized and collected by granulocyte colony stimulating factor（G-CSF） combined with high-dose cyclophosphamide （HD-CTX）. The conditioning regimen was CBV. Results Twenty six cases were engrafted and hematopoietic reconstitution was rapid：The mean days of ANC recovery up to 〉0.5 ×10^9/L and Pit up to 〉20×10^9/L were 10 days and 13 days,respectively. Complete remission （CR） rate of transplantation group was 80.77% and that of control group was 34.62% ;Overall response rate： 92.31% vs 61.54%, the eiticacy of transplantation group was better than that of control group（P 〈0. 05）. The follow-up lasted for 6 -76 months. The 3-year event free survival（EFS） rates of transplantation group and control group were 83.33% （15/18） and 37.50% （6/16）,respectively;The 5-year EFS rates were 58.33% （7/12） and 23.08% （3/13）,respectively. The 3-year ,5-year EFS rate of transplantation group were higher than those of control group（P 〈0.05）. Recurrence rate of transplantation group was lower than that of control group（ 19.23% vs 46. 15% ,P 〈0.05）. Conclusion APBSCT has better effect than chemotherapy alone for the pest-remission treatment of malignant lymphoma,and its recurrence rate is lower than that of chemotherapy alone.