利妥昔单抗联合自体外周血造血干细胞移植治疗高危侵袭及难治复发性B-NHL的疗效分析  

Clinical Efficiency of Rituximab Combined with Autologous Hematopoietic Blood Stem Cell Transplantation for Treatment of CD20^+B non-Hodgkin Lymphoma

作　　者：于前进 陈永升 曾东风[1] 李佳丽 朱丽丹 高蕾 高力 刘耀 尹晓林 张曦[1] 孔佩艳 YU Qian-Jin;CHEN Yong-Sheng;ZENG Dong-Feng;Ll Jia-Li;ZHU Li-Dan;GAO Lei;GAO Li;LIU Yao;YIN Xiao-Lin;ZHANG Xi;KONG Pei-Yan(Medical Center for Hematology,Second Affiliated Hospital of Army Medical University,Chongqing 400037;Department of Hematology,Linyi People's Hospital,Dezhou 251500,Shandong Province,China;Department of Hematology,the 923th Hospital of the People's Liberation Army Joint Service Support Force,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]陆军军医大学第二附属医院血液病医学中心,重庆400037 [2]山东省德州市临邑人民医院血液肿瘤科,山东德州251500 [3]中国人民解放军联勤保障部队第923医院血液科,广西南宁530021

出　　处：《中国实验血液学杂志》2021年第1期77-85,共9页Journal of Experimental Hematology

摘　　要：目的:探讨利妥昔单抗(R)联合自体外周血造血干细胞移植(auto-HSCT)治疗高危侵袭性及难治复发CD20^+B细胞非霍奇金淋巴瘤(B-NHL)的疗效。方法:选取本中心2005年1月-2013年12月确诊为高危侵袭性及难治复发CD20^+B-NHL、并行auto-HSCT治疗的患者资料83例。联合R治疗的患者为观察组,共57例,未用R的患者为对照组,共26例。观察组患者在移植前联合R 375 mg/m^2进行免疫化疗及采集前体内净化,部分患者移植后也采用R进行了维持治疗;对照组除未应用R外,诱导、强化及移植方案与观察组相同。依据观察组患者应用R的时机及频次不同进行疗效的亚组分析,并与对照组进行对比。随访截止时间为2014年4月30日。结果:移植成功后所有患者均达完全缓解(CR),中位随访时间39(2-113)个月。观察组和对照组患者均成功采集了自体外周血干细胞,造血重建时间两组无差异。观察组3年总生存(OS)率明显高于对照组(93.0%vs73.1%,P=0.037),无事件生存(EFS)率显著高于对照组(89.5%vs 65.4%,P=0.034);观察组患者死亡4例,复发3例(其中1例复发死亡,2例经巩固化疗后达CR2);对照组患者死亡7例,复发6例(其中4例复发死亡,2例经巩固化疗后达CR2)。亚组分析:移植前、采集前及移植后全程均使用R的32例患者与仅移植前化疗使用R的22例患者相比,OS、EFS率分别为97.0%vs 87.5%(P>0.05)和97.0%vs 76.2%(P=0.05);全程均使用R者与对照组比较,OS和EFS均有显著性差异(P=0.031,P=0.008);按R使用频次不同,其OS率依次为:1-2次(9例)88.9%,3-4次(29例)93.1%,≥5次(19例)94.7%,EFS率分别为77.8%、89.7%、94.7%。结论:在治疗高危侵袭及难治复发性CD20^+B-NHL患者的过程中,联合R的诱导化疗、干细胞采集前的R体内净化,以及移植后联合R维持治疗能明显改善行自体移植患者的OS及EFS,其中移植前、后均使用者,其EFS优于仅移植前使用的患者。Objective;To investigate the effeciency of autologous hematopoietic stem cell transplantation(auto-HSCT)combined with rituximab(R)to treat CD20^+B non-Hodgkin lymphoma(B-NHL).Methods:From January 2005 to December 2013,83 patients with refractory/recurrent CD20^+B-NHL who were treated with auto-HSCT in our department were enrolled.The patients were divided into 2 groups:57 patients in Rituximab group,and 26 patients in control group(without Rituximab).All the patients received chemotherapy and auto-HSCT.For the patients in treatment group,Tituximab was used before transplantation of the stem cells,and for some patients Rituximab was used after transplantation.For the patients in control group,the induction,enhancement and transplantation were the same as those in treatment group.The clinical efficiency of the patients in treatment group according to the time and frequency of R was analyzed in subgroups and compared with the control group.The deadline of follow-up was April 302014.Results:All the patient achieved complete response.The median follow-up time was 39 months.Both the two groups collected peripheral blood stem cells successfully,and had no difference in hematopoietic reconstitution time.Three patients in treatment group and six patients in control group relapsed and the three year overall survival and EFS in treatment group was significantly higher than that in control group,that is(93.0%vs 73.1%,P=0.037)and(89.5%vs 65.4%,P=0.034),respectively.Subgroup analysis showed that;compared with the treatment group in which using R in the whole courses(before and after transplantation,and collection of stem cells)was superior to the control group in both OS and EFS,with the OS 97%vs 87.5%(P>0.05)and EFS 97%vs76.2%(P=0.05)respectively.While stratified by the different courses ofrituximab,the OS was 88.9%(1-2 courses,9 cases),93.1%(3-4 courses,29 cases),94.7%(more than 5 courses,19 cases),and EFS was 77.8%,89.7%and 94.7%,respectively.Conclusion:For the patients with refractory/recurrent CD20^+B-NHL,the combination

关 键 词：CD20^+B细胞非霍奇金淋巴瘤 自体造血干细胞移植 利妥昔单抗 

分 类 号：R457.7[医药卫生—治疗学] R733[医药卫生—临床医学]