自体外周血造血干细胞移植治疗恶性淋巴瘤99例临床分析

Autologous peripheral blood stem cell transplantation in the treatment of malignant lymphoma in 99 cases

目的:探讨自体外周血造血干细胞移植(autologous peripheral blood stem cell transplantation,APBSCT)治疗恶性淋巴瘤的疗效。方法:回顾性分析2005至2015年于我院血液科接受APBSCT治疗的99例恶性淋巴瘤患者的临床资料。结果:(1)99例患者中,男性68例,女性31例,中位发病年龄44(16~69)岁。其中,非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)88例(BNHL 60例,T-NHL 28例),霍奇金淋巴瘤11例;国际预后指数(international prognostic index,IPI)评分≤2和IPI评分>2分别为78例和21例;移植前处于完全缓解(complete remission,CR)状态的患者65例;临床分期Ⅲ~Ⅳ期者84例;移植前化疗中,31例B-NHL应用利妥昔单抗联合化疗,29例未使用。(2)全部患者动员后均采集到足够的造血干细胞,其中2例未获得全面造血重建,后因脓毒血症死亡,其余患者均造血重建成功。全组中位随访时间25(0~109)个月,3年总生存(overall survival,OS)率和无进展生存(progression-free survival,PFS)率分别为74.70%和61.60%。移植前达CR状态患者的3年OS率和PFS率分别为86.20%和76.90%;未达CR状态的3年OS率和PFS率分别为52.90%和32.40%;两组相比OS率和PFS率差异均有统计学意义(P=0.000,P=0.000)。移植前IPI评分处于低中危组(IPI≤2)患者的3年PFS率为69.20%,中高危组(IPI>2)3年PFS率为33.30%,2组间PFS率差异有统计学意义(P=0.000)。B-NHL患者的3年PFS率与T-NHL相比差异有统计学意义(3年PFS率70.00%vs.42.90%,P=0.019)。B-NHL中应用1~2疗程利妥昔单抗联合化疗组、3~4疗程组与未使用组相比OS率和PFS率差异均无统计学意义(P=0.152,P=0.368)。结论:APBSCT是治疗恶性淋巴瘤安全、有效的方法;移植前未达CR状态、移植前IPI评分>2以及T-NHL为影响恶性淋巴瘤的预后不良因素。

ObjectiVe：To investigate the curative effect of autologous peripheral blood stem cell transplantation （APBSCT） in the treat- ment of malignant lymphoma. Methods ： Ninety-nine cases of malignant lymphoma patients were admitted and treated with APBSCT in the hematology department of our hospital from 2005 to 2015. Results：（Of the 99 cases, 11 were Hodgkin＇s lymphoma, 88 with non-Hodgkin＇s lymphoma（60 cases of B-cell and 28 cases of T/NK-cell）,with a median age of 44（16 to 69） years old. Ratio of male to female was 68：31. The patients with international prognostic index（IPI） scores≤2 were 78 cases while 21 cases with IPI scores〉2. According to the stages of lymphoma, 84 cases were stage Ill/IV. Before APBSCT,65 patients were in complete remission （CR）. Among all the 60 patients with B-cell non-Hodgkin＇s lymphoma, 31 cases were treated in combination of Rituximab, while another 29 patients without the addition of Rituximab. （2）Enough peripheral blood hemopoietic stem cell were collected from the patients who accepted APBSCT after the mobilization. All the patients achieved hematopoiefic reconstitution after transplantation,excepted two patients,who died because of septicopyemia. The overall survival rate（OS） of 3-years and progression-free sur- vival rate（PFS） were 74.70% and 61.60%. The 3-year OS and PFS rate in the patients,who achieved CR before transplanta- tion were 86.20% and 76.90% ,while 52.90% and 32.40% in the patiehts with non CR status. The OS and PFS rate of the two groups had significant statistical differences （P=0.000,P= 0.000）. The 3-year PFS rate in the group with IPI scores≤2 were 69.20% and in the group with IPI scores〉2 were 33.30% and had statistically significant differences（P=O.O00）. The 3-year PFS of the patients with B-cell non-Hodgkin＇s lymphoma and T-cell non-Hodgkin＇s lymphoma had significant statistical differences （3-year PFS were 70.00% vs. 42.90%,P=0.019）. The 3-year OS and PFS of the patients who treated in combination of Rituximab and chemotherapy had no statistical difference with the patients who treated without Rituximab（P=0.152,P=0.368）. Conclusion ：APBSCT is a safe and effective method for the treatment of malignant lymphoma. T-cell non-Hodgkin＇s lymphoma,non CR status and IPI scores〉2 before APBSCT are the independent adverse prognostic factors for lymphoma.