自体造血干细胞移植治疗81例恶性淋巴瘤患者临床分析

Clinical analysis of 81 cases of malignant lymphoma treated with autologous hematopoietic stem celltransplantation

目的观察白体造血干细胞移植（ASCT）治疗恶性淋巴瘤的疗效。方法回顾性分析1999年4月至2013年10月接受ASCT的81例恶性淋巴瘤患者的临床资料。其中非霍奇金淋巴瘤（NHL）70例，霍奇金淋巴瘤（HL）11例。外周血造血干细胞动员均采用大剂量依托泊苷联合G．CSF，预处理方案均为BEAM方案（卡莫司汀邯可糖胞苷＋依托泊苷＋马法兰）。结果所有患者均采集到足够的外周血造血干细胞。所有患者移植后均获得造血重建，中性粒细胞绝对值恢复至〉0．5×10。／L的中位时间为10（7～16）d，血小板计数恢复至〉20×10。／L的中位时间为10（6～17）d。中位随访23（2-139）个月，无进展生存（PFS）率为72．7％，总生存（OS）率为88．6％，中位PFS、OS时间均未达到。移植前患者是否达完全缓解为影响PFS的独立预后因素。无一例患者发生移植相关死亡。结论ASCT是治疗恶性淋巴瘤安全、有效的方法。

Objective To investigated the curative effect of autologous hematopoietic stem cell transplantation （ASCT） for malignant lymphoma. Methods The clinical data of 81 patients with malignant lymphoma received ASCT from April 1999 to October 2013 were retrospectively analyzed. Of 81 patients, 70 were non-Hodgkin＇ s lymphoma （NHL） and 11 Hodgkin＇ s lymphoma （HL）. High dose of etoposide combined with G-CSF was used to mobilize peripheral hematopoietic stem cell. Preconditioning regimen was BEAM （carmustine ＋ cytarabine ＋ etoposide ＋ melphalan）. Results Enough peripheral blood stem cells were collected from all patients. All of the patients after transplantation achieved hematopoietic reconstitution, the median time of the absolute neutrophil count （ANC） recovery to 〉0.5 x 109/L time was 10 （7-16） d, and the median time ofplatelet count recovery to 〉20x 109/L was l0 （6-17） d. With the follow-up of 23 （2-139） months, progression free survival （PFS） was 72.7%, and overall survival （OS） was 88.6%. The median PFS and OS were not reached. Complete remission （CR） before ASCT was an independent prognostic factor of PFS. No transplant related death happened. Conclusion ASCT was a safe and effective method for treatment of malignant lymphoma.