影响高危难治淋巴瘤患者自体外周血造血干细胞移植治疗后生存和预后的相关因素分析

Analysis of Related Factors of Survival and Prognosis in Patients With High-risk Refractory Lymphoma Treated with Auto-PBHSCT

目的:分析影响高危难治淋巴瘤患者自体外周血造血干细胞移植(auto-PBHSCT)治疗后生存和预后的相关因素。方法:对在本院行auto-PBHSCT治疗的96例高危难治淋巴瘤患者的总生存率应用Kapan-Meier曲线和Long rank检验进行了分析,并对影响患者预后的相关因素进行了单因素分析和COX比例风险回归分析。结果:96例患者的中位生存时间为30.67个月,其治疗后3、5年总生存率分别为81.25%和71.88%。单因素分析结果显示,血清乳酸脱氢酶(LDH)水平升高(>245 U/L)、国际预后指数(IPI)为3-5分、乙型肝炎病毒(HBV)感染、Ki-67高表达(≥65%)及骨髓浸润的高危难治淋巴瘤患者,其生存率较低(P<0.05)。COX比例风险回归分析结果显示,auto-PBHSCT前未达完全缓解状态和auto-PBHSCT后未行巩固治疗是影响患者预后的危险因素(OR=0.46、0.12,95%CI:0.22-0.95、0.02-0.82,P<0.05)。结论:auto-PBHSCT治疗可明显改善高危难治淋巴瘤患者的生存状况及预后,但auto-PBHSCT治疗后应进行巩固治疗以进一步提高远期生存率、延长生存时间。

Objective： To analyze the factors affecting survival and prognosis of patients with high-risk refractory lymphoma treated with autologous peripheral blood hematopoietic stem cell transplantation（ auto-PBHSCT）.Methods：A total of 96 cases of high-risk refractory lymphoma received auto-PBHSCT were selected.The total survival rate after the treatment was analyzed by using Kaplan-Meier curve and long rank test,and the prognosis-related factors were analyzed by univariate analysis and COX regression analysis.Results： The median survival time of 96 patients was 30.67 months,and the overall survival rate of 3 and 5 years after treatment was 81.25% and 71.88% respectively.Univariate analysis showed that the patients with high lactate dehydrogenase（ LDH） level（ 〉245 U/L）,3-5 scores of international prognostic index（ IPI）,hepatitis B virus（ HBV） infection,high expression of Ki-67（ ≥65%） and bone marrow infiltration had lower survival rate（ P〈0.05）.COX regression analysis showed that the complete remission wasn＇t reached before auto-PBHSCT and the consolidation therapy was not carried out after auto-PBHSCT,both of them were the risk factors affecting the prognosis（ OR = 0.46,0.12,95% CI： 0.22 - 0.95,0.02 - 0.82,P〈0.05）.Conclusion： Auto-PBHSCT in the treatment of patients with high-risk refractory lymphoma can significantly improve the survival status and prognosis,and the consolidotion therapy should be performed after auto-PBHSCT so as to further improve the long-term survival rate and prolong the survival time.