自体造血干细胞移植治疗复发、难治性经典型霍奇金淋巴瘤的疗效观察

Efficacy of autologous hematopoietic stem cell transplantation in treatment of relapsed and/or refractory classical Hodgkin lymphoma

目的评价自体外周血造血干细胞移植对复发、难治性的经典型霍奇金淋巴瘤治疗疗效,并探讨临床预后因素。方法对本中心2000-2013年所有复发、难治性经典型霍奇金淋巴瘤97例患者进行回顾性分析,随访至少12个月。按治疗方法分为自体造血干细胞移植组(n=52)和未移植继续放化疗组(n=45)。分析两组患者的临床特征及疗效,Kaplan-Meier法行生存分析,COX逐步回归进行多因素预后分析。结果移植组出现Ⅳ级骨髓抑制、消化道反应及粒细胞缺乏伴发热的发生率明显高于未移植组(P<0.05),其余并发症的发生率差异无统计学意义(P>0.05)。中位随访56(12~158)个月,移植组死亡6例,病死率11.5%,3年无进展生存率(progression-free survival,PFS)为(78.6±6.20)%,总生存率(overall survival,OS)为(85.9±5.5)%;未移植组死亡21例,病死率46.6%,3年PFS为(43.1±7.60)%,OS为(54.1±8.1)%。移植组3年OS及PFS均明显优于未移植组(P<0.05)。移植前行正电子发射计算机断层显像(positron emission tomography,PET)检查,PET阴性评判为CR的患者,其PFS明显优于PET阳性的患者(P=0.021),而对于OS差异无统计学意义(P=0.077)。COX多因素分析显示,未采用ASCT、LDH值高于正常、有骨髓侵犯是影响PFS的危险因素;而未采用ASCT、LDH值高于正常、国际预后评分≥3以及有骨髓侵犯是影响OS的危险因素。结论自体造血干细胞移植在治疗复发、难治性霍奇金淋巴瘤的疗效肯定,其安全性较好,在我国可作为复发、难治性经典型霍奇金淋巴瘤有效的治疗方案。

Objective To determine the therapeutic effect of autologous hematopoietic stem cell transplantation （ASCT） in treatment of relapsed and/or refractory classical Hodgkin lymphoma （RR-CHL）, and investigate the prognostic factors. Methods Clinical data of 97 RR-CHL patients treated in our center from January 2000 to December 2013 who were followed up for at least 12 months, were collected and retrospectively in this study. According to their treatment methods, they were divided into ASCT group （n=52） and non-transplantation group （n=45, undergoing chemotherapy）. The clinical characteristics and efficacies of the treatments were analyzed between the 2 groups. Kaplan-Meier survival analysis and COX regression model were used respectively for their survive and prognostic factors. Results The incidences of fever, neutropenia, severe bone marrow suppression, and gastrointestinal adverse reactions were obviously higher in the ASCT group than the non-transplantation group （P〈0.05）, but no such difference was seen in those of other complications （P〉0.05）. In the median follow-up period of 56 （12～158） months, 6 cases from the ASCT group died, with a mortality of 11.5%, and the 3-year progression-free survival （PFS） was （78.6±6.20）%, and over survival （OS） was （85.9±5.5）%. And in the non-transplantation group, 21 patients （46.6%） died, the 3-year PFS was （43.1±7.60）%, and the OS was （54.1±8.1）%. The 3-year OS and PFS in the ASCT group were obviously better than those in the non-transplantation group （P〈0.05）. For the patients with negative results of pre-transplantation Positron emission tomography （PET） and evaluated as complete remission （CR）, they had better PFS than those with positive results of PET （P=0.021）, but had no significant OS difference （P=0.077）. Multivariate regression analysis showed that the main risk factors of PFS were non-adopt ASCT, LDH value higher than normal, and bone marrow involvement. The main risk factors of OS were non-adopt ASCT, LDH value higher than normal, international prognostic score （IPS） ≥3 and bone marrow involvement. Conclusion ASCT is safe and effective in the treatment of RR-CHL. It should be recommended as one of effective treatment of RR-CHL in clinical practice.