自身造血干细胞移植术联合小剂量白介素-2治疗16例恶性淋巴系统肿瘤

Autogenous peripheral stem cell transplantation combined with interleukin-2 for treatment of 16 patients with lymphoid malignancies

目的:评价自体外周血造血干细胞移植(Auto-PBSCT)联合小剂量白介素-2(IL-2)在恢复细胞免疫,从而减少淋巴系统恶性肿瘤(ALL和NHL)移植后的高复发率和提高无病生存率中的作用。方法:采用化疗联合短程小剂量G-CSF的动员方法,收集自体外周血造血干细胞,对16例成人淋巴源性恶性血液肿瘤(7例CR_1ALL、3例CR1NHL、5例难治性NHL和1例CR_2ALL)进行移植,使用IL-2对移植物进行温育,移植术造血恢复过程中使用IL-2和造血恢复后长期小剂量使用IL-2 5万U/d。结果:ALL 7例CR_1,现仍存活,平均生存时间达73个月,中位生存期为51.5个月,3例CR_1NHL2例仍存活,10例CR_1恶性淋巴系肿瘤的6年无病生存率达0.90±0.11,其95%CI为0.71～0.99。而难治性NHL和CR_2-ALL,1例至今仍无病生存达63月。1例淋巴母细胞Ⅳ期NHL生存达46个月后复发死亡。这组3年无病生存率只有0.33±0.18,95%CI 0.02～0.64,平均生存时间只有20.66个月,中位生存期为6个月。结论:通过小样本Auto-PBSCT联合长期小剂量IL-2可能有效地提高CR1淋巴系恶性肿瘤无病生存率。

Purpose:To evaluate the effect of Auto-PBSCT combined with long-time low-dose interleukin-2 (after transplant) for increasing the rate of 5-year disease-free survival of lymphoid malignancies (ALL and NHL).Methods:U- sing chemotherapy combined with low dose G-CSF to mobilize peripheral blood stem cells,we carried out auto-PBSCT in lymphoid malignancies (7 cases CR_1 ALL、1 case CR_2 ALL、3 cases CR_1 NHL、5 cases refractory NHL).After transplant, 15 cases used low dose interleukin-2 at 5.10~5U/d for one year or longer.Results:7 cases CR_1 ALL are still alive,the aver- age disease-free survival is 73 months.Median disease-free survival is 51.5 months.2 of 3 cases CR_1 NHL are still alive. The 6 years disease-free survival in 10 cases CR_1 lymphoid malignancies(CR_1 NHL and CR_1 ALL) is 0.90±0.11,the aver- age disease-free survival is 66.8 months.In another PR (refractory) group of NHL and ALL (CR_2),3 years disease-free survival was 0.33±0.18,and average survival time was 20.66 months,but a chemotherapy-sensitive NHL is still alive (63 months),a case of lymphoblast cell NHL also survived for 46 months and died after relapse.Conclusions:Auto-PBSCT combined with long-turm low dose IL-2(after transplant) could effectively increase the rate of 5-year disease-free survival in CR_1 lymphoid malignancies(ALL and NHL).