自体外周血干细胞移植联合过继免疫治疗B细胞性非霍奇金淋巴瘤的临床分析

Clinical analysis of autologous peripheral blood stem cell transplantation combined adoptive immunotherapy in non-Hodgkin' s lymphoma of B lymphocyte

目的:探讨自体外周血干细胞移植联合过继免疫治疗B细胞性非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)的疗效。方法:以2000年1月-2009年12月经病理形态学及免疫组织化学检查确诊的78例B细胞性NHL患者为治疗组,交替应用CHOP、TAOP和MEOP方案各2个疗程化疗后,以化疗联合重组人粒细胞集落刺激因子方法动员自体外周血干细胞,TBI+VEMAC方案实施预处理,进行自体外周血干细胞移植。造血恢复后每月给予重组人白细胞介素-2 100WU/d×10天为1个疗程的过继免疫治疗,6个疗程后观察疗效。以1995年1月-1999年12月的52例B细胞性NHL患者为对照组,化疗及移植方法同上,未给予过继免疫治疗。随访时间5年。结果:治疗组及对照组中各有1例患者在3个月、2个月时分别因肝功衰竭和脑出血死亡,其他患者均获得造血重建。随访1年时,治疗组和观察组患者无病生存(disease free survival,DFS)率分别为96.2%、90.4%(P>0.05)。随访3、5年时,两组患者的DFS分别为93.6%、88.5%和73.1%、65.4%(P<0.01)。随访1年时,两组中III/IV期患者的DFS分别为95.2%和88.1%(P>0.05)。随访3、5年时,两组中III/IV期患者的DFS分别为92.1%、87.3%和69.0%、59.5%(P<0.01)。结论:自体外周血干细胞移植联合过继免疫治疗B细胞性NHL疗效显著,尤其III/VI期患者获益明显。

Objective：To investigate the efficacy treated with autologous peripheral blood stem cell transplantation （APBSCT） combined adoptive immunotherapy in non - Hodgking lymphoma（NHL） of B lymphocyte. Methods：A to- tal 78 patients diagnosed as NHL of B lymphocyte by pathology and immunohistochemistry from January 2000 to De- cember 2009, as treatment group, were treated sequentially with chemotherapy regimens （CHOP,TAOP, MEOP） for 2 courses respectively. After that, autologous peripheral blood stem cells were mobilized with chemotherapy combined rhG - CSF, and received APBSCT after conditioning regimen with TBI combined VEMAC. After hematopoietic recon- struction, they were given six courses of adoptive immunotherapy（ rhIL- 2 100WU/day for 10 days monthly for each course）. 52 cases of NHL patients of B lymphocyte from January 1995 to December 1999, as control group,received chemotherapy regimens and APBSCT only, but no rhIL - 2 adoptive immunotherapy. All patients were followed - up for more than 5 years. Results：There was one patient in each group,who died of liver failure and cerebral hemorrhage respectively within three and two months, and other patients achieved hematopoietic reconstruction. Follow - up 1 year, disease free survival（DFS） rates were 96.2% and 90.4% respectively （ P 〉 0.05 ）. Follow - up 3 and 5 years, DFS rates were 93.6% , 88.5% and 73.1% ,65.4% respectively（ P 〈 0.01 ）. Follow- up of 1 year, DFS rates in phase III/IV of two groups were 95.2% and 88.1% （ P 〉 0.05 ）. Follow - up of 3 and 5 year, DFS rates in phase III/ IV of two groups were 92.1%, 87.3 % and 69.0%, 59.5 % respectively （P 〈 0. 01 ）. Conclusion：There were obvious efficacy to patients of NHL of B lymphocyte treated with APBSCT combined adoptive immunotherapy, especially to pa- tients with phase III/IV.