一线自体造血干细胞移植治疗30例高危淋巴母细胞淋巴瘤患者临床分析  

Clinical outcome of autologous stem cell transplantation as first-line treatment in 30 patients withhigh risk lymphoblastic lymphoma

作　　者：黄文阳[1] 邹德慧[1] 隋伟薇 王婷玉 付明伟 李增军 徐燕 赵耀中 冯四洲 韩明哲 邱录贵 

机构地区：[1]中国医学科学院、北京协和医学院血液学研究所、血液病医院,实验血液学国家重点实验室,天津300020

出　　处：《中华血液学杂志》2014年第4期332-336,共5页Chinese Journal of Hematology

基　　金：科技部重大血液病新药临床评价研究技术平台体系建设（2011ZX09302.007-4）;天津市科技支撑计划重点项目（12ZCDZSYl7600）

摘　　要：目的研究自体造血干细胞移植（AscT）一线治疗高危淋巴母细胞淋巴瘤（LBL）患者的疗效及不同诱导治疗方案对其预后的影响。方法纳入1996年至2012年于完全缓解期接受ASCT治疗的30例ujL患者，对其进行回顾性分析。结果①30例患者中男23例，女7例，发病中位年龄19（7～53）岁。T-LBL25例，B—LBL5例，其中合并巨大纵隔肿物者14例（46．7％），合并骨髓受累者15例（50．0％）；临床分期Ⅱ期2例，Ⅲ期5例，Ⅳ期23例；年龄调整的国际预后指数（aalPI）积分1分5例，2分14例，3分11例。②中位随访32（10～171）个月，13例患者移植后出现复发和死亡。5年无病生存（DFS）率和5年总生存（OS）率分别为（50．4＋10．7）％和（53．9-4-10．2）％。③根据ASCT前诱导方案的不同分为急性淋巴细胞白血病（ALL）样治疗组和非霍奇金淋巴瘤（NHL）样治疗组。NHL样治疗组12例患者中复发死亡9例，中位DFS和OS时间分别为24和36个月，5年预期DFS和OS率分别为（22．2土12．8）％和（33．3~13．6）％；ALL样治疗组18例患者中复发死亡4例，中位DFS和OS时间未达到，5年预期DFS和OS率分别为（77．84-9．8）％和（77．84-9．8）％；两组间DFS和OS率差异有统计学意义（P值分别为0．022和0．049）。结论对于高危LBL患者，诱导治疗阶段采用较为强烈的ALL样治疗方案获得完全缓解，后续ASCT强化巩固治疗，可以明显提高患者的生存。Objective To investigate the treatment outcomes of autologous stem cell transplantation （ASCT） as first-line treatment in patients with high risk lymphoblastic lymphoma （LBL） and compare the effect of different induction regimen on prognosis. Methods Thirty LBL patients in complete remission received ASCT from 1996 to 2012 in our hospital were retrospectively analyzed. Results ①Of the 30 patients, 25 were T-LBL and 5 B-LBL with a median age of 19 （7 - 53） years old. Ratio of male to female is 23 ： 7. Fourteen （46.7%） patients presented with bulky mediastinal masses and 15 （50.0%） with bone marrow involvement. The distribution of stages was 2 （6.7%）, 5 （16.7%） and 23 （76.6%） patients with stages II, III, and IV, respectively. The distribution according to age-adjusted international prognostic index （aalPI） was 5 （16,7%） patients in 1 score, 14 （46.6%） in 2 scores and 11 （36.7%） in 3 scores. ②At a median follow-up of 32 （range, 10-171） months, 17 patients were alive and 13 relapsed and died from LBL after ASCT. The estimated 5-year probability of DFS and OS was （50.4 ± 10.7）% and （53.9 ± 10.2）% for all the patients. ③According to the treatment regimens before ASCT, the patients were divided into NHL-type group （n=12） and ALL-type group （n=18）. In NHL-type group, 9 patients relapsed and died, the estimated 5-year probability of DFS and OS was （22.2 ±12.8）% and （33.3 ±13.6）%, respectively. Median DFS and OS time were 24 months and 36 months. In ALL-type group, 4 patients relapsed and died from lymphoma, the estimated 5-year probability of DFS and OS was （77.8 ＋ 9.8）% and （77.8±9.8）%, respectively. Median DFS and OS time were not reached. For DFS and OS, ALL-type group were better than that of NHL-type group and the difference was significant （P=-0.022 and P=0.049）. Conelnsion The results showed that complete remission with intensive first-line ALL-type regimens and followed by ASCT consolidation may significantly im

关 键 词：前体细胞淋巴母细胞白血病淋巴瘤 造血干细胞移植 无病生存 总生存 

分 类 号：R733.1[医药卫生—肿瘤]