利妥昔单抗联合APBSCT治疗B细胞性非霍奇金淋巴瘤的临床研究

A clinical study of rituximab combined with autologous peripheral blood stem cell transplantation in treatment of B-cell non-Hodgkin′s lymphoma

目的探讨利妥昔单抗联合自体外周血造血干细胞移植（APBSCT）治疗B细胞性非霍奇金淋巴瘤的疗效。方法回顾分析该院2007年1月至2013年10月44例确诊为侵袭性或复发难治性B细胞淋巴瘤并接受APBSCT治疗的患者临床资料。分为两组,治疗组（n=22）：APBSCT前应用利妥昔单抗联合化疗或动员造血干细胞（2.9±1.1）次,移植后有条件患者采用利妥昔单抗加白细胞介素-2（IL-2）维持治疗;对照组（n=22）：除未使用利妥昔单抗,其余处理与治疗组相同。结果治疗组和对照组采集单核细胞数分别为（13.01±4.22）×10^8/kg和（11.63±2.95）×10^8/kg（P=0.214）。两组均顺利完成造血重建。两组中性粒细胞恢复时间和血小板恢复时间差异无统计学意义（P〉0.05）。移植后两组病例均达到完全缓解（CR）,中位随访时间20（2-73）个月,治疗组2例复发,对照组5例复发。治疗组和对照组2年总生存率分别为95.0%和75.1%,差异无统计学意义（P=0.179）,2年疾病无进展生存率分别为82.4%和74.5%,差异无统计学意义（P=0.393）。结论利妥昔单抗联合APBSCT治疗侵袭性和（或）复发难治性B细胞非霍奇金淋巴瘤是可行的,但是否能使患者长期获益仍需要进一步研究。利妥昔单抗的加入不影响造血干细胞采集和造血重建。

Objective To evaluate the therapeutic effect of rituximab combined with autologous peripheral blood stem cell transplantation（APBSCT）in treatment of aggressive or refractory and recrrent B-cell non-Hodgkin′s lymphoma.Methods Forty-four patients with aggressive or refractory and recrrent B-cell non-Hodgkin′s lymphoma and treated with APBSCT in this department from Janauary 2007 to October 2013 were admitted.All the subjects were divided into 2groups according to their own choice：22patients received rituximab treatment（treatment group）and 22 patients were treated without rituximab treatment（control group）.For patients in treatment group,rituximab was used with chemotherapy or mobilization of stem cells before APBSCT for（2.9±1.1）times.After transplantation,IL-2was used in both groups as maintenance treatment.And rituximab was used in the treatment group if the budget allows.Results The mononuclear cell count in treatment and control group was（13.01±4.22）×10^8/kg and（11.63±2.95）×10^8/kg（P=0.214）.Hematopoietic reconstruction was successfully achieved in the both groups.No significant difference was found between 2groups on the recovery time of neutrophilic granulocytes and platelets（P〉0.05）.All patients achieved complete remission（CR）,at a median follow-up of 20months（2-73months）,the disease relapsed in 2patients in treatment group and 5in control group.The 2-year overall survival rate in treatment group and control group were 95.0%and 75.1%,2-year progression-free survival rates were 82.4% and 74.5%,there were no significant difference between two groups（P=0.179,0.393）.Conclusion Rituximab combined with APBSCT in treatment of aggressive or refractory and recurrent B-cell lymphoma is feasible,however whether patients can benefit from long-term studies still need further research.Adding rituximab does not affect the hematopoietic stem cell collection and hematopoietic reconstitution.