双次自体造血干细胞移植治疗T淋巴母细胞淋巴瘤21例的临床疗效观察  

Double autologous peripheral blood stem cells transplant for 21 patients with lymphoblastic lymphoma

作　　者：李佳丽[1] 刘耀[1] 文钦[1] 朱丽丹[1] 向茜茜[1] 高蕾[1] 高力[1] 张诚[1] 孔佩艳[1] 刘红[1] 陈幸华[1] 张曦[1] 

机构地区：[1]第三军医大学新桥医院全军血液病中心,重庆400037

出　　处：《第三军医大学学报》2016年第12期1350-1355,共6页Journal of Third Military Medical University

基　　金：国家自然科学基金面上项目(81570097);全军后勤科研"十二五"重大子项目(AWS14C0143)~~

摘　　要：目的探讨双次自体造血干细胞移植（autologous peripheral blood stem cell transplant,APSCT）治疗T淋巴母细胞淋巴瘤的临床疗效和安全性。方法收集2008年2月至2013年11月在我院血液病中心接受双次APSCT的T淋巴母细胞淋巴瘤患者共21例,中位年龄29岁。按照Ann Arbor标准,Ⅲ期5例,Ⅳ期16例,第1次移植前处于完全缓解（complete remission,CR）16例,部分缓解（partial remission,PR）为5例。第1次移植采用以环己亚硝脲＋依托泊苷＋阿糖胞苷＋环磷酰胺联合方案进行预处理,以上患者在第1次移植后4~6个月进行第2次造血干细胞移植,预处理方案为伊达比星＋阿糖胞苷＋环磷酰胺。结果 1所有患者双次自体移植后造血功能均顺利重建。2中位随访24个月,复发3例,死亡4例（因复发死亡2例,疾病进展死亡1例,移植相关死亡1例）,无病存活12例,4例疾病稳定,1例研究截止时疾病复发进展。3年预期无进展生存为68.9%,总生存率为73.6%。3预后相关因素中,患者的年龄、第1次移植后疾病状态是否CR影响患者的总生存期（overall survival,OS）和无进展生存期（progression-free survival,PFS）,第1次移植前疾病状态是否CR影响患者的OS。结论双次APSCT治疗T淋巴母细胞淋巴瘤患者疗效确切,造血重建顺利,移植相关死亡率低,安全性好。Objective To evaluate the efficacy and safety of tandem autologous peripheral blood stem cell transplant（ APSCT） for lymphoblastic lymphoma. Methods Clinic data of 21 patients（ median age of29） with lymphoblastic lymphoma undergoing double APSCT in our hospital from February 2008 to November2013 were collected and analyzed in this study. By Ann Arbor staging system,they were classified into 5 cases at stage Ⅲ and 16 cases at stage Ⅳ. Before the first transplantation,16 cases achieved complete remission（ CR） and 5 cases achieved partial remission（ PR）. Mobilization regimen was Mit ＋ Vds ＋ VP16 ＋ Dex ＋MTX combined with G-CSF 5 μg /（ kg ·d）. The conditioning regimens for the tandem transplantation were CCNU ＋ VP-16 ＋ Ara-c ＋ CTX and IDA ＋ Ara-c ＋ CTX respectively. The interval of the tandem transplantation was 4 to 6 months. Results All patients obtained prompt and sustained hematopoietic reconstitution after the tandem transplants. But 3 cases relapsed,4 cases died（ 2 died of recurrence,1 of disease progression,and 1of transplantation related mortality）,1 case relapsed and progressed,12 cases were still in disease-free survival,and 4 remained stable after median follow-up of 24（ 2 ~ 81） months. The 3-year progression-free survival（ PFS） was 68. 9%,and overall survival（ OS） was 72. 6%. Multivariate analysis demonstrated that OS and PFS were significantly affected by the age and disease status after first transplantation. The factor influencing OS was CR status or not after first transplantation. Conclusion Tandem APSCT is safe and effective for lymphoblastic lymphoma, with well hematopoietic reconstitution and low transplant-related mortality.

关 键 词：双次自体造血干细胞移植 T淋巴母细胞淋巴瘤 预后 

分 类 号：R329.24[医药卫生—人体解剖和组织胚胎学] R617[医药卫生—基础医学]