自体外周血造血干细胞移植术治疗弥漫大B细胞淋巴瘤的临床研究  

Clinical research on autologous peripheral blood hematopoietic stem cell transplantation in the treatment of patients with diffuse large B cell lymphoma

作　　者：刘瑜[1] 王劲[1] 曾艳[1] 彭翠翠[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所血液科,重庆400042

出　　处：《实用临床医药杂志》2015年第11期12-14,22,共4页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11520398)

摘　　要：目的观察自体外周血造血干细胞移植术(Auto-PBSCT)治疗弥漫大B细胞淋巴瘤(DLBCL)的疗效及毒副反应,并探讨术后维持治疗、国际预后指数(IPI)积分等对疗效的影响。方法 21例Ann Arbor分期Ⅲ、Ⅳ期的DLBCL患者在大剂量化疗后行Auto-PBSCT,术后予干扰素或利妥昔单抗维持治疗,观察术后临床疗效、毒副反应及随访结果。结果移植术后总有效率为81.0%。随访至2014年12月,1年总存活率为81.0%、无事件存活率为66.7%;3年总存活率为47.6%、无事件存活率为33.3%。IPI评分高中危及高危患者术后均复发或进展,5例行二次Auto-PBSCT强化治疗,术后均达CR。结论大剂量化疗+Auto-PBSCT是Ⅲ、Ⅳ期DLBCL患者的有效治疗方案,术后是否维持治疗、IPI积分的高低可能对术后疗效产生影响,复发、难治或具有高复发危险因素的患者,可考虑行二次Auto-PBSCT。Objective To observe the clinical efficacy and toxic responses of autologous peripheral blood hematopoietic stem cell transplantation（ Auto-PBSCT） in the treatment of patients with diffuse large B cell lymphoma（ DLBCL） and to explore the influence of postoperative maintenance therapy and international prognostic index（ IPI） on the clinical efficacy. Methods A total of 21 DLBCL patients with Ann Arbor stages of Ⅲ and Ⅳ were given Auto-PBSCT after large-dose chemotherapy. Interferon and rituximab maintenance therapies were performed after operation. Postoperative clinical efficacy,toxic responses and follow-up results were observed. Results After Auto-PBSCT,the total effective rate was 81. 0%. The follow up was ended in December 2014,and the results showed that 1-year survival rate and event-free survival rate were 81. 0% and 66. 7%,while the 3-year survival rate and event-free survival rate were 47. 6%and 33. 3%,respectively. IPI scores suggested that high-moderate-risk and high-risk patients had recurrence or disease progression after operation,and 5 patients achieved complete response（ CR） after operation by the secondary Auto-PBSCT intensive treatment. Conclusion Larger-dose chemotherapy plus AutoPBSCT are effective in the treatment of DLBCL patients with Ann Arbor stages of Ⅲ and Ⅳ,and the postoperative application of maintenance therapy and the IPI scores have certain influence on the postoperative clinical efficacy. In addition,secondary Auto-PBSCT should be considered to DLBCL patients with postoperative recurrence,difficulty in treatment or high-recurrent risk factors.

关 键 词：大剂量化疗 自体外周血造血干细胞移植术 弥漫大B细胞淋巴瘤 国际预后指数 维持治疗 利妥昔单抗 

分 类 号：R733[医药卫生—肿瘤]