自体外周血造血干细胞移植治疗高危难治恶性淋巴瘤96例疗效分析

Curative effect analysis of autologous peripheral blood hematopoietic stem cell transplantation in 96 patients with lymphoma

目的探讨恶性淋巴瘤患者接受自体外周血造血干细胞移植的疗效及预后因素。方法收集96例恶性淋巴瘤患者病理资料,常规化疗后均接受自体外周血造血干细胞移植。统计患者的基本临床资料、移植前相关指标及预后情况,采用SPSS19.0统计软件对预后情况进行Kaplan-Meier生存分析,应用Cox比例风险模型进行预后因素分析,回顾性的分析总体疗效及预后因素。结果 96例患者中94例顺利完成造血重建,中性粒细胞重建时间为7~19d,平均9d;血小板重建时间10~37d,平均16d;随访时间0~74个月,平均26个月。3年总体生存(OS)率为86.4%,3年无进展生存(PFS)率为70.3%。单因素分析显示IPI评分大于2分、移植前未能达到完全缓解(CR)、乳酸脱氢酶(LDH)高于正常水平、骨髓浸润等为不良预后因素,多因素分析显示移植前状态及LDH水平为独立影响因素。结论大剂量化学治疗联合自体外周血造血干细胞移植是高危难治恶性淋巴瘤安全、有效的治疗方法。移植前能否达到CR、LDH水平为移植疗效的影响因素。

Objective To discuss the efficacy of autologous hematopoietic stem cell transplantation（AHSCT） in patients with malignant lymphoma.Methods A total of 96 patients with malignant lymphoma were enrolled in this study;and all of them were treated with courses of chemotherapy before AHSCT.All the basic clinical characteristics;status before AHSCT and the prognosis situations were collected together.SPSS19.0 was used in the Kaplan-Meier survival analysis and the prognostic factors were analyzed by Cox model for retrospectively analyzing the overall efficacy and related prognostic factors.Results Totally 94 of the 96 patients achieved hematopoietic reconstitution;and the average reconstitution time of granulocyte and platelets were 9 days （7-19 days） and 16 days （10-37 days）.With a median follow-up time of 26 months （0-74 months）;the 3-year overall survival （OS） rate was 86.4% and the 3-year progression-free survival （PFS） rate was 70.3%.The higher IPI score （higher than 2 points）;not getting complete remission （CR） before AHSCT;high lactate dehydrogenase （LDH） level and bone marrow infiltration suggested poor prognosis;in which the disease status before transplantation and LDH level were revealed as two prognostic factors independently.Conclusion High-dose chemotherapy combined with AHSCT is a safe and effective therapy for patients with malignant lymphoma.Disease status before transplantation and LDH level are two independently prognostic factors in this study.