自体外周血造血干细胞移植治疗淋巴瘤效果分析

Efficacy analysis of autologous peripheral blood hematopoietic stem cell transplantation in treatment of lymphoma

目的探讨自体外周血造血干细胞移植治疗淋巴瘤的临床效果。方法回顾性分析2014年1月至2020年12月济宁医学院附属医院行自体外周血造血干细胞移植治疗的41例淋巴瘤患者临床资料,包括霍奇金淋巴瘤6例,非霍奇金淋巴瘤35例。采用化疗药物+粒细胞集落刺激因子(G-CSF)+血小板生成素(TPO)或化疗药物+G-CSF的动员方案。移植前预处理方案:26例患者采用BEAM方案+地西他滨,12例采用BEAM方案,3例采用BEAM方案+西达苯胺。观察患者无进展生存(PFS)及总生存(OS)、相关并发症、移植后转归,以及临床分期、B症状、国际预后指数(IPI)评分、结外累及部位、血红蛋白、乳酸脱氢酶(LDH)、β_(2)-微球蛋白(β_(2)-MG)、移植方案、移植前状态对移植后OS及PFS的影响。结果41例患者中自体外周血造血干细胞移植前疾病获得完全缓解37例(90.24%),部分缓解2例(4.88%),未评估2例(4.88%)。24例干细胞采集资料完整的患者采集的中位有核细胞计数12.74×10^(8)/kg[(3.91~22.68)×10^(8)/kg],中位CD34阳性细胞数为6.74×10^(6)/kg[(0.91~50.47)×10^(6)/kg]。全部41例患者均获得造血重建,中位血小板植入时间为11 d(7~32 d),中位粒细胞植入时间为9 d(8~16 d)。41例患者移植后疾病均获得完全缓解,无一例发生移植相关死亡。至随访结束,无疾病进展33例,死亡8例。患者移植后12、24、72个月OS率分别为93.4%、85.3%和60.9%,PFS率分别为93.3%、84.0%、84.0%。中位PFS及OS时间均为未达到。不同性别、临床分期、B症状、IPI评分、结外累及部位、血红蛋白、LDH、β_(2)-MG、移植前状态患者OS及PFS差异均无统计学意义(均P>0.05),移植前预处理方案为BEAM方案+地西他滨患者PFS及OS均优于单用BEAM方案患者(均P<0.05)。结论自体外周血造血干细胞移植治疗淋巴瘤具有较好的效果。BEAM方案+地西他滨预处理方案较单用BEAM方案可获得更长的生存时间。

Objective To investigate the clinical efficacy of autologous peripheral blood hematopoietic stem cell transplantation(HSCT)in treatment of lymphoma.Methods The clinical data of 41 lymphoma patients undergoing autologous peripheral blood HSCT at the Affiliated Hospital of Jining Medical University between January 2014 to December 2020 were retrospectively analyzed.There were 6 cases of Hodgkin lymphoma and 35 cases of non-Hodgkin lymphoma.The mobilization regimens included chemotherapy drugs+granulocyte colony-stimulating factor(G-CSF)+thrombopoietin(TPO)or chemotherapy drugs+G-CSF.The pre-conditioning schemes before transplantation were listed as follows:BEAM(mustine+cytarabine+etoposide+melphalan)regimen+decitabine in 26 patients,BEAM regimen in 12 patients,BEAM regimen+chidamide in 3 patients.The progression-free survival(PFS),overall survival(OS),related complications,prognoses after transplantation were observed.The effects of clinical staging,B symptom,International Prognostic Score Index(IPI),extranodal involved sites,hemoglobin(Hb),lactic dehydrogenase(LDH),β_(2)-microglobulin(β_(2)-MG),transplantation regimen and the status before transplantation on PFS and OS after transplantation were evaluated.Results Among 41 patients,37 patients(90.24%)achieved complete remission(CR),2 patients(4.88%)achieved partial remission(PR)and 2 patients loss assessment data(4.88%)before autologous peripheral blood HSCT.The median karyocyte count was 12.74×10^(8)/kg[(3.91-22.68)×10^(8)/kg]in 24 patients with the complete data of stem cell collection,the median CD34 positive cell count was 6.74×10^(6)/kg[(0.91-50.47)×106/kg].All 41 patients had hematologic reconstruction.The median time of platelet implantation was 11 d(7-32 d)and the median time of granulocyte implantation was 9 d(8-16 d).All patients achieved CR after transplantation and no one case had transplantation-related death.By the end of follow-up,33 cases(80.49%)had no progression of disease,8 cases(19.51%)died.The OS rates of 12-month,24-month and 72-month were 93.4%,85.3% and 60.9%,respectively after transplantation.The PFS rates of 12-month,24-month and 72 month were 93.3%,84.0% and 84.0%,respectively.Median PFS and OS had not been reached.There were no statistically significant differences in the PFS and OS of patients with different gender,clinical staging,B symptom,IPI score,extranodal involved sites,Hb,LDH,β_(2)-MG and the status before transplantation(all P>0.05).The PFS and OS of patients receiving BEAM regimen+decitabine were better than those of patients receiving BEAM regimen alone(all P<0.05).Conclusions Autologous peripheral blood HSCT is effective in treatment of lymphoma.Moreover,BEAM regimen+dicitabine preconditioning regimen can achieve longer survival time compared with BEAM regimen alone.