自体外周血造血干细胞移植治疗70例恶性淋巴瘤的疗效、安全性及预后影响因素研究

目的探讨自体外周血造血干细胞移植治疗恶性淋巴瘤(ML)的疗效、安全性及其预后影响因素。方法连续收集2014年1月至2017年3月在四川大学华西医院血液科收治的恶性淋巴瘤患者70例,所有患者在进行化学治疗后均接受自体外周血造血干细胞移植,统计患者的临床资料,回顾性分析移植前后疗效、不良反应、预后情况,采用单因素和多因素分析影响预后的相关因素。结果70例患者均较快获得造血功能重建,中性粒细胞重建时间为7~19 d,平均(13.08±2.16)d,血小板重建时间为10~26 d,平均(16.13±2.43)d;移植后患者达完全缓解占比81.43%明显高于移植前的64.29%,差异有统计学意义(P<0.05);70例ML患者3年的总生存期(OS)率为75.71%;单因素分析显示国际预后指数(IPI)评分、移植前是否缓解、疾病类型、乳酸脱氢酶(LDH)表达、Ann Arbor临床分期为影响预后的因素(P<0.05),骨髓受累、美国东部肿瘤协作组(ECOG)评分对恶性淋巴瘤的预后影响不明显(P>0.05);对影响预后因素进行多因素分析,移植前是否缓解、疾病类型、LDH表达是影响患者OS的独立预后因素(P<0.05)。结论与单纯的化学治疗相比,自体外周血造血干细胞移植作为ML的巩固治疗,疗效更好,安全性高,长期随访患者生存率较高,移植前能否达到完全缓解、疾病类型、LDH水平为影响预后的独立因素。

Curative effect,safety and prognostic factors of autologous peripheral blood hematopoietic stem cell transplantation in the treatment of 70 cases with malignant lymphomas

Objective To explore the curative effect of autologous hematopoietic stem cell transplantation(AHSCT)in peripheral blood on malignant lymphomas(ML)and influencing factors of prognosis.Methods A total of 70 ML patients who were admitted to Department of Hematology West China Hospital,Sichuan University,from January 2014 to March 2017 were collected continuously.After chemotherapy,all underwent AHSCT in peripheral blood.The clinical data were statistically analyzed.The curative effect,toxicities and prognosis before and after transplantation were retrospectively analyzed.The relevant factors that affected prognosis were analyzed by univariate and multivariate analysis.Results The hematopoietic function was reconstructed quickly in all the 70 patients.The reconstruction time and mean time of neutrophil and platelet were7-19 d,(13.08±2.16)d]and10-26 d,(16.13±2.43)d],respectively.Before transplantation,there were 45 cases(64.29%)with complete remission.After transplantation 81.43%of patients with CR were significantly higher than 64.29%before transplantation,the difference was statistically significant(P<0.05).The 3-year overall survival(OS)rate of 70 ML patients was 75.71%.Univariate analysis showed that international prognostic index(IPI)score,remission before transplantation,disease types,LDH expression and clinical stages of Ann Arbor were influencing factors of prognosis(P<0.05),while the effects of bone marrow involvement,Eastern United States Oncology Group(ECOG)score were not significant on prognosis of malignant lymphomas(P>0.05).Multivariate analysis was performed on influencing factors of prognosis.Remission before transplantation,disease types and LDH expression were independent prognostic factors of OS(P<0.05).Conclusion Compared with simple chemotherapy,as the consolidation treatment method of ML,curative effect of peripheral blood AHSCT is better,with higher safety and higher survival rate by long-term follow-up.Complete remission before transplantation,disease types and LDH level were independent influencing factors of prognosis.