自体造血干细胞移植治疗恶性淋巴瘤的疗效及影响因素

Efficacy and influencing factors of autologous hematopoietic stem cell transplantation in the treatment of malignant lymphoma

背景:针对淋巴瘤的治疗方案包括化学治疗、局部放射治疗、自体外周血造血干细胞移植及细胞免疫治疗等。大剂量化疗联合自体造血干细胞移植能明显延长患者的生存时间,改善预后,被推荐为复发难治性和(或)高侵袭性淋巴瘤的一线治疗方案。目的:分析大剂量化疗联合自体造血干细胞移植治疗恶性淋巴瘤患者的临床特征及生存预后因素等,以期提高临床医师对自体造血干细胞移植治疗淋巴瘤的认识。方法:回顾性分析2015年10月至2020年3月就诊于中国科学技术大学附属第一医院西区血液科移植病房,行大剂量化疗联合自体造血干细胞移植治疗的74例淋巴瘤患者的临床资料,评价自体造血干细胞移植治疗淋巴瘤的疗效和影响预后的相关因素。结果与结论:①随访截至于2020-05-15,确诊至移植中位时间为8(3-83)个月,中位随访时间为17(2-59)个月;②所有患者移植后均获得造血重建,粒细胞植入中位时间为+10(+8至+17)d,血小板植入中位时间为+12(+9至+22)d;③移植后无进展生存60例,复发13例,复发患者中死亡11例,1例于移植后11个月因肺部感染死亡;④4例移植前为进展期患者均于移植后7个月内因原发病进展死亡;⑤74例患者接受造血干细胞移植后2年总生存率为78.5%,2年无进展生存率为75.8%;移植前国际预后指数≤2分及>2分患者移植后2年总生存分别为93.9%,66.4%(P=0.003),2年无进展生存分别为85.6%,65.5%(P=0.017);⑥移植前有骨髓侵犯及无骨髓侵犯患者移植后2年总生存率分别为55.5%,91.9%(P=0.001);2年无进展生存率分别为53.1%,88.7%(P<0.001);⑦临床分期Ⅰ、Ⅱ期患者2年总生存率优于临床分期Ⅲ、Ⅳ期患者(100%vs.82.5%,P=0.026);一线巩固治疗患者2年无进展生存率优于挽救治疗组(84%vs.48.9%,P=0.01);患者年龄、移植前缓解程度对无进展生存和总生存影响的差异均无显著性意义;⑧结果表明,大剂量化疗联合自体造血干细胞移植可明显改善淋巴瘤患者生存及预后,且安全性高,可作为淋巴瘤的一种安全有效的治疗方式。国际预后指数分值、有无骨髓侵犯、移植时机选择及原发病分期为影响患者预后的因素。

BACKGROUND:Chemotherapy,local radiotherapy,autologous peripheral blood stem cell transplantation and cellular immunotherapy are the treatment options for lymphoma.High-dose chemotherapy combined with autologous hematopoietic stem cell transplantation can significantly prolong the survival time and improve the prognosis of patients.It is recommended as the first-line treatment for relapsed refractory and(or)highly invasive lymphoma.OBJECTIVE:To explore the influencing factors of high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation in lymphoma.METHODS:The clinical records of 74 lymphoma patients after high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation in Transplantation Ward,Department of Hematology,West District of The First Affiliated Hospital of University of Science and Technology of China from October 2015 to March 2020 were collected and analyzed retrospectively to evaluate efficacy and prognostic factors of autologous hematopoietic stem cell transplantation for lymphoma.RESULTS AND CONCLUSION:(1)The follow-up period was up to May 15,2020.The median time from diagnosis to transplantation was 8(3-83)months,and the median follow-up time was 17(2-59)months.(2)All patients obtained hematopoietic reconstruction after transplantation.The median time for granulocyte implantation was+10(+8-+17)days,and the median time for platelet implantation was+12(+9-+22)days.(3)There were 60 cases of progressionfree survival after transplantation,13 cases of recurrence,11 of the relapsed patients died,and 1 died of lung infection 11 months after transplantation.(4)All four patients with progression disease before transplantation died within 7 months after transplantation due to the progression of the primary disease.(5)The 2-year overall survival rate after receiving autologous hematopoietic stem cell transplantation was 78.5%;the 2-year progression-free survival rate was 75.8%.Patients with international prognostic index≤2 points before transplantation and international prognostic index>2 points had 93.9%and 66.4%overall survival at 2 years after transplantation(P=0.003);progression-free survival rates at 2 years were 85.6%and 65.5%(P=0.017),respectively.(6)The two-year overall survival rates of patients with bone marrow invasion and no bone marrow invasion before transplantation were 55.5%and 91.9%(P=0.001)respectively.The 2-year progression-free survival rates were 53.1%and 88.7%(P<0.001),respectively.(7)The 2-year overall survival rate of patients in clinical staging(stages I and II)was better than that in clinical staging(stages III and IV)(100%vs.82.5%,P=0.026).The 2-year progression-free survival rate of first-line consolidation patients was better than that of rescue group(84%vs.48.9%,P=0.01).There was no statistically significant difference in the effects of patient age and degree of remission before transplantation on progression-free survival and overall survival.(8)Results found that high-dose chemotherapy combined with autologous hematopoietic stem cell transplantation could significantly improve the survival and prognosis of patients with lymphoma,and had high safety.It can be used as a safe and effective treatment for lymphoma.International prognostic index score,the presence or absence of bone marrow invasion,the timing of transplantation,and the stage of primary disease are relative to the prognosis of involved patients.