移植物CD34^+细胞数对自体外周血造血干细胞移植后非霍奇金淋巴瘤患者造血重建及预后的影响

Effects of infused CD34^+cell count on hematopoietic recovery and prognosis of non-Hodgkin lymphoma patients after autologous peripheral blood hematopoietic stem cell transplantation

目的探讨移植物CD34^+细胞数对自体外周血造血干细胞移植(APBSCT)后非霍奇金淋巴瘤(NHL)患者造血重建及预后的影响。方法回顾性分析2010年5月至2016年5月于山西省肿瘤医院行APBSCT的60例NHL患者相关资料,其中B-NHL 32例,T-NHL 28例。患者依据受试者工作特征曲线(ROC)所得CD34+细胞数阈值分组,分析移植后造血重建情况;分析移植物CD34+细胞数与预后的关系;采用单因素及多因素分析法分析预后影响因素。结果根据ROC确定CD34+细胞数阈值为4.35×10^6/kg。CD34+细胞数≥4.35×10^6/kg组(20例)和CD34+细胞数<4.35×10^6/kg组(40例)粒细胞植活时间分别为(9.9±1.2)d、(12.5±3.7)d(P=0.031),血小板植活时间分别为(9.4±1.7)d、(13.8±2.9)d(P=0.012),3年总生存(OS)率分别为85.0%、55.0%(P=0.024),3年无进展生存(PFS)率分别为85.0%、57.5%(P=0.016)。B-NHL患者中CD34^+细胞数≥4.35×10^6/kg组(11例)和CD34^+细胞数<4.35×106/kg组(21例)3年PFS率分别为81.8%和42.9%(P=0.037)。T-NHL患者中CD34+细胞数≥4.35×10^6/kg组(9例)与CD34+细胞数<4.35×10^6/kg组(19例)3年OS率分别为77.8%和36.8%(P=0.049)。单因素生存分析结果显示,年龄>60岁、Ann Arbor分期Ⅲ~Ⅳ期、国际预后指数(IPI)评分>2分、移植物CD34+细胞数<4.35×10^6/kg均为影响患者PFS和OS的危险因素(均P<0.05)。多因素分析结果显示,IPI评分和移植物CD34+细胞数为影响PFS的独立因素(RR=0.333,95%CI 0.112~0.994,P=0.049;RR=0.190,95%CI 0.047~0.773,P=0.020);IPI评分是影响OS的独立因素(RR=0.095,95%CI 0.011~0.837,P=0.034)。结论移植物中CD34+细胞数影响NHL患者APBSCT后的造血重建时间及成分血输注,对患者预后具有一定预测价值。

Objective To investigate the effect of infused CD34^+cell count on hematopoietic recovery and prognosis of non-Hodgkin lymphoma(NHL)patients after autologous peripheral blood hematopoietic stem cell transplantation(APBSCT).Methods The data of 60 NHL patients who underwent APBSCT from May 2010 to May 2016 in the Affiliated Cancer Hospital of Shanxi Medical University was retrospectively analyzed,including 32 B-NHL patients and 28 T-NHL patients.The patients were grouped according to the receiver operating characteristic curve(ROC)threshold,and the hematopoietic reconstruction after transplantation was analyzed.The relationship between the infused CD34^+cell count and prognosis was analyzed.The prognostic factors were analyzed using univariate and multivariate analyses.Results The CD34+cell count threshold was determined to be 4.35×10^6/kg based on ROC.In CD34+cell count≥4.35×10^6/kg group(20 cases)and CD34^+cell count<4.35×10^6/kg group(40 cases),the granulocyte recovery time was(9.9±1.2)d and(12.5±3.7)d(P=0.031),and the platelet recovery time was(9.4±1.7)d and(13.8±2.9)d(P=0.012).The 3-year overall survival(OS)rates in CD34^+cell count≥4.35×10^6/kg group and CD34+cell count<4.35×10^6/kg group were 85.0%and 55.0%(P=0.024),and the 3-year PFS rates were 85.0%and 57.5%(P=0.016).In B-NHL patients,the 3-year PFS rates in CD34+cell count≥4.35×10^6/kg group(11 cases)and CD34^+cell count<4.35×10^6/kg group(21 cases)were 81.8%and 42.9%(P=0.037),respectively.In T-NHL patients,the 3-year OS rates in CD34+cell count≥4.35×10^6/kg group(9 cases)and CD34^+cell count<4.35×10^6/kg group(19 cases)were 77.8%and 36.8%(P=0.049),respectively.Univariate survival analysis showed that the predictive factors of both OS and PFS included age>60 years old,Ann Arbor stageⅢ-Ⅳ,international prognostic index(IPI)score>2 and infused CD34+cell count<4.35×10^6/kg(all P<0.05).Multivariate analysis showed that IPI score and infused CD34+cell count were both independent predictive factors of PFS(RR=0.333,95%CI 0.112-0.994,P=0.049;RR=0.190,95%CI 0.047-0.773,P=0.020),and IPI score was an independent predictive factor of OS(RR=0.095,95%CI 0.011-0.837,P=0.034).Conclusion The infused CD34^+cell count affects the hematopoietic reconstruction time and component blood transfusion after APBSCT,and has certain predictive value for the prognosis of NHL patients.