激活骨髓自体移植治疗白血病和淋巴瘤的疗效分析

Autologous transplantation with recombinant interleukin-2 activated bone marrow for leukemia and lymphoma: an analysis of factors influencing the effect

目的 探讨激活骨髓自体移植治疗恶性血液病的疗效及影响因素。方法 44例为白血病和非霍奇金淋巴瘤 (NHL)患者进行激活骨髓自体移植 ,观察移植后造血与免疫功能重建 ,移植后完全缓解 (CR) ,移植后相关死亡、肿瘤复发率和长期无病生存率及移植物抗宿主病 (GVHD)样表现及毒副作用。选用Kaplan Meier生存曲线评估移植后 3、5年无病生存率 ,COX回归模型分析性别、年龄、疾病种类、移植前状态 (CR与未CR) ,预处理方案 ,移植前CR时间对无病生存时间的影响。结果 所有病人均获得造血重建 ,细胞与体液免疫重建恢复快。移植前 16例未CR病人 ,除 2例死于移植相关并发症外、其余均获CR ;44例移植相关死亡为 4 5 5 % (2 /4 4) ,肿瘤复发为 2 1 43(9/4 2 ) ,移植后 5年无病生存率为 (6 5 31± 9 0 0 ) % ,其中移植前CR(2 8例 )与未CR(16例 )患者 5年无病生存率分别为(80 6 1± 11 0 2 ) %与 (37 5 0± 14 32 ) % ,二者差异有显著性 (P <0 0 1)。急性淋巴细胞白血病 (ALL)、急性非淋巴细胞白血病和NHL 3、5年无病生存率高于ALL和慢性粒细胞白血病。COX模型多因素分析生存与移植前状态和疾病种类有关 ,而与性别、年龄、预处理方案、移植前CR时间无关。 4例病人出现类似异基因造血干细胞移植中的皮肤GVHD样反应。?

Objective To investigate the effect of autologous transplantation with recombinant interleukin 2 (rIL 2) activated bone marrow (ABM) in treating hematological malignancies and to find the factors influencing the effect Methods 44 patients with leukemia or non Hodgkn′s lymphoma(NHL) had autologous transplantion with rIL 2 ABM The reconstitution of hematopoiesis and immunity was observed post transplantation The complete remission(CR) rate in 16 patients with Non CR pre transplantation and the transplantation related death, the relapse rate and long term survival of all the patients post transplantation were investigated SPSS sofeware kits were used Kaplan Meier survival analysis model was used to estimate the disease free survival(DFS) at 3 or 5 years post transplantation and COX regression model to analyze the factors influencing the DFS, which included sex, age, kinds of disease, pre transplantation state (CR or Non CR),conditioning regimen and the time of CR pre transplantation Results All the patients reconstituted hematopiesis ANC>0 5×10 9/L was+(14 02±5 48) and PBC>20×10 9/L was +(18 31±8 88) days Cellular and humoral immunity resumed rapidly All the patients with Non CR pre transplantation ,except 2 patients who died of transplantation related complications, obtained CR post transplantation The transplantation related death rate was 4 55% and the relapse rate was 21 43% The DFS at 5 years post transplantation was (65 31±9 00)% in all patients and( 80 61±11 02)% in CR and (37 50±14 32)% in Non CR The DFS at 5 years was different between the patients in CR and Non CR pre transplantation ( P <0 01) The DFS at 5 years was (41 67±30 43)% for ALL, (81 98±6 95)% for AML, (69 84±12 76)% for NHL The DFS at 3 years was (30 00±23 87)% for CML The long term survival correlated with the state pre transplantation and the kinds of disease and did not correlated with sex, age, conditioning regimen and the time of CR pre transplantation 4 patients had signs similar to graft versus host disease in the skin Conclusions Autologous trarsplantation with ABM could accelerate the reconstitution of hematopoiesis and immunity funtions , induce graft versus tumor effect similar to that in allogeneic hematopoietic stem cell transplantation, reduce the relapse and increase the long term survival It is effective for the patients with minimal residual tumor cells, but not satisfactory for the patients with larger quantity of contaminating tumor cells