自体造血干细胞移植治疗难治复发霍奇金淋巴瘤、灰区淋巴瘤的疗效及预后分析

Evaluation of effects of autologous peripheral blood stem cell transplantation on the response rates and survival rates in the patients with refractory or relapsed Hodgkin lymphoma and grey zone lymphoma

目的评价自体外周血干细胞移植（APBSCT）对霍奇金淋巴瘤（HL）及灰区淋巴瘤患者的缓解率和生存率的作用。方法回顾性分析30例接受APBSCT的HL及灰区淋巴瘤患者临床资料，中位移植年龄30岁（13。55岁），病理类型以结节硬化型HL为主，占19例；临床分期以Ⅲ～Ⅳ期为主；分析APBSCT治疗HL及灰区淋巴瘤患者的疗效及生存情况，并探讨了相关影响因素。结果30例患者均成功采集干细胞，采集单个核细胞中位数为6．8×10^8／kg（1．0×10^8／kg～13．8×10^8／kg），CDh细胞中位数为6．3×10^6／kg（0．6×10^6／kg～20．6×10^6／kg）。中性粒细胞中位植入时间9d（8～12d）。28例可评估患者，中位随访时间为18．5个月（2．5—95．0个月），18例（64．3％）获完全缓解（CR），7例（25．0％）部分缓解（PR），总反应率（RR）89．3％。预计5年总生存（OS）率、无进展生存（PFS）率分别为78％、58％。7例未缓解患者在移植前更换化疗方案为利妥昔单抗联合化疗后3例获得CR，2例PR。单因素分析提示移植前疾病状态及更换化疗种类数影响OS，移植前放疗史影响PFS。结论APBSCT可提高HL及灰区淋巴瘤患者CR率，改善患者的0s及PFS；移植前挽救化疗采用利妥昔单抗联合化疗有助于改善移植前疗效；移植前化疗敏感性影响生存，过多化疗种类更换不利生存，移植前放疗史有影响患者PFS的趋势。

Objective To evaluate the response rate and survival rates of refractory or relapsed Hodgkin lymphoma （HL） and grey zone lymphoma patients treated with autologous peripheral blood stem cell transplantation （APBSCT）. Methods From January 2004 to August 2012, 30 HL and grey zone lymphoma patients were retrospectively analyzed. Statistical analysis was done to explore the long term outcome and prognostic factors of patients treated with APBSCT. Among all patients, the median age at transplantion was 30 （13-55） years old. Patients were major with nodular sclerosis HL and in stage Ⅲ/Ⅳ. Results Every patient had a successful collection. The median MNC cell dose infused was 6.8×10^8/kg [range （1.0-13.8）×10^8 /kg] and median CD34＋ cell dose infused was 6.3×10^6/kg [range （0.6-20.6）×10^6/kg]. Median time to neutrophil engraftment was 9 days （range 8-12 days）. 28 patients were evaluable after transplantation with a median follow-up of 18.5 months （range 2.5-95.0 months）. The overall response rate was 89.3 % [CR 64.3 % （18/28）, PR 25.0 % （7/28）]. The overall survival （OS） rate and progression free survival （PFS） rate at 5 year would be 78 % and 58 % for all patients. 3 in 7 patients with no remission after salvage chemotherapy with rituximab plus chemotherapy before APBSCT got CR and 2 got PR. Univariate analysis showed that disease status and the number of replacement types of chemotherapy prior to transplantation affected OS, the history of radiotherapy prior to transplantation affected PFS. Conclusion APBSCT can increase CR rate, prolong survival time in patients with refractory or relapsed HL and grey zone lymphoma. Rituximab plus chemotherapy as a salvage therapy could raise CR rate before APBSCT. Chemosensitivity before transplantation affect outcome with APBSCT. Changing many types of chemotherapy is adverse for APBSCT. Salvage radiotherapy before APBSCT is not recommended.