化疗序贯自体造血干细胞移植治疗淋巴瘤的疗效评价及影响因素分析  

Efficacy evaluation and influencing factors of autologous hematopoietic stem cell transplantation following chemotherapy in the treatment of lymphoma

作　　者：平措卓嘎 左旭盈 王剑利[1] 何爱丽[1] 张鹏宇[1] PINGCUO Zhuoga;ZUO Xuying;WANG Jianli;HE Aili;ZHANG Pengyu(Department of Hematology,the Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710004,China;Department of Blood Transfusion,the Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院血液科,陕西西安710004 [2]西安交通大学第二附属医院输血科,陕西西安710004

出　　处：《现代肿瘤医学》2022年第3期509-513,共5页Journal of Modern Oncology

基　　金：陕西省西安市科技计划项目[编号:2017114SF/YX008(10)]。

摘　　要：目的:探讨化疗序贯自体造血干细胞移植(auto-HSCT)对淋巴瘤患者的疗效及影响因素。方法:回顾性分析2015年09月至2020年12月于我科接受大剂量化疗(HDC)序贯自体外周血造血干细胞移植治疗的患者,并进行疗效及不良反应评价。结果:40例患者,其中非霍奇金淋巴瘤34例,霍奇金淋巴瘤6例;男性27例,女性13例,中位年龄44(15-65)岁。除2例早期死亡患者外,其余38例患者均获得造血重建,血小板中位植入时间10(6~15)d;中性粒细胞中位植入时间9(7~14)d。40例患者中移植前完全缓解(CR)25例(62.5%),部分缓解9例(22.5%),未缓解6例(15%)。移植相关死亡(transplantation related mortality,TRM)为2例(5%)。中位随访27(0.2~64)个月,移植后1年、3年的总生存(OS)率分别为92.3%、85.4%;移植后1年、3年无进展生存(PFS)率分别为81.6%、66.9%。移植前是否为完全缓解是影响化疗序贯自体造血干细胞移植治疗淋巴瘤患者疗效的预后危险因素(P<0.05),也是影响PFS的独立危险因素(P<0.05)。结论:大剂量化疗序贯自体造血干细胞移植是淋巴瘤安全、有效的治疗方式。移植前疾病达完全缓解状态有利于提高疗效。Objective:To explore the efficacy and influencing factors of autologous hematopoietic stem cell transplantation(auto-HSCT)following chemotherapy in the treatment of lymphoma.Methods:Retrospective analysis was made in lymphoma patients treated with high-dose chemotherapy(HDC)and sequential auto-HSCT in our department from Sep.2015 to Dec.2020,the efficacy and adverse reactions were evaluated.Results:40 patients,including 34 cases of non-Hodgkin lymphoma and 6 cases of Hodgkin lymphoma;There were 27 males and 13 females,with a median age of 44(15-65)years.Except for 2 patients who died early after auto-HSCT,the remaining 38 patients had hematopoietic reconstruction.The median platelet engraftment time was 10(6~15)days,median neutrophil engraftment time was 9(7~14)days.25 patients(62.5%)had complete remission before transplantation,9 cases(22.5%)had partial remission,6 cases(15%)had no remission.The early transplantation related mortality(TRM)occurred in 2 cases(5%).The median follow-up time was 27(0.2~64)months.1 year and 3 years overall survival(OS)rates were 92.3%and 85.4%.1 year and 3 years progression-free survival(PFS)rates were 81.6%and 66.9%.Whether achieving complete remission(CR)before transplantation was major risk factor affecting the prognosis of lymphoma patients with auto-HSCT(P<0.05),and an independent risk factor affecting PFS(P<0.05).Conclusion:HDC followed by auto-HSCT is a safe and effective treatment for lymphoma.Achieving CR before transplantation is beneficial for the therapeutic outcome.

关 键 词：淋巴瘤 大剂量化疗 自体造血干细胞移植 预后影响因素 

分 类 号：R733.4[医药卫生—肿瘤]