改良移植预处理方案治疗B细胞非霍奇金淋巴瘤临床分析

Clinical Analysis of B-Cell Non-Hodgkin Lymphoma Treated with Modified Conditioning Regimen

目的:探讨经典预处理方案与改良预处理方案对B细胞非霍奇金淋巴瘤患者自体造血干细胞移植的疗效、安全性及预后的影响。方法:回顾性分析2015年1月-2018年6月于天津市肿瘤医院血液科接受自体造血干细胞移植治疗的B细胞非霍奇金淋巴瘤患者36例,根据其预处理方案不同,分为加伊达比星组和无伊达比星组,对2组患者的总生存(OS)、无进展生存(PFS)、相关不良反应和造血重建时间进行分析。分析方法应用Kaplan-Meier法进行单因素生存分析,组间比较用Log-rank检验,多因素分析采用Cox回归。结果:截止2019年6月,中位随访时间29个月。36例患者移植前疗效为:达到CR 21例,PR 15例。对2组患者造血重建时间进行分析,中性粒细胞(P=0.795)及血小板重建时间(P=0.551)无统计学差异。2组患者的不良反应并无差异,加入伊达比星并未使患者的不良反应加重,伊达比星组患者的OS及PFS较未使用伊达比星组的患者更长,疗效较好。多因素分析结果显示,改良预处理方案及移植前疗效与预后密切相关。结论:预处理方案加入伊达比星可以明显延长患者的OS及PFS,并未加重患者的骨髓抑制,其造血重建时间没有明显延长,也并未加重患者的相关不良反应,这说明,加入伊达比星的改良预处理方案可作为B细胞非霍奇金淋巴瘤患者的选择之一。

Objective:To investigate the efficacy,sarety and prognosis of auto-HSCT between classical and modified conditioning regimen in patients with B-cell non-Hodgkin lymphoma.Methods:36 patients diagnosed as B-cell nonHodgkin lymphoma treated with autologous hematopoietic stem cell transplantation from January 2015 to June 2018 in Tianjin Cancer Hospital were retrospectively analyzed.The patients were divided into two groups:Idarubicin group and non-Idarubicin group.The overall survival(OS),progression-free survival(PFS),adverse reactions and hematopoietic reconstitution time between the two groups were compared.Survival analysis was performed by using the Kaplan-Meier method.Log-rank test was used for comparison between groups,and Cox regression was used for multivariate analysis.Results:The median follow-up time was 29 months.Among these 36 patients with B-cell non-Hodgkin lymphoma before transplantation,21 patients achieved CR and 15 patients achieved PR.The reconstitution time of neutrophil(P>0.05)and platelet(P>0.05)was not significantly different between Idarubicin and non-Idarubicin group.Also,the adverse reactions were not significantly different between two groups.The addition of idarubicin showed not aggravate the adverse reactions of patients.The OS and PFS of patients with idarubicin was longer than that of patients without idarubicin.The multivariate analysis showed that,the modified conditioning regimen and the remission state before transplantation were closely associated with prognosis.Conclusion:The above-mentioned results indicated that the combination of modified conditioning regimen with idarubicin can lengthen the OS and PFS of the patients significantly,and show not aggravate of bone marrow inhibition,moreover,the hematopoietic reconsititution time show not lengthen,which means that it can be a safe and effective choice for autologous HSCT in the patients with B cell non-Hodgkin lymphoma.