T淋巴母细胞淋巴瘤自体干细胞移植后的长期随访观察

目的评价自体造血干细胞移植（autologous hematopoietic stem cell transplantation,AHSCT）治疗复发难治T淋巴母细胞淋巴瘤（TLBL）的临床疗效及安全性。方法本文回顾性分析AHSCT治疗后长期随访的TLBL16例,预处理方案主要为BEAM和BEAC。结果 15例患者可评价疗效,1例失访。中位随访37个月（12~132个月）,中位无进展生存时间（PFS）34.5个月。预计中位总生存时间49月。1、3、5年总生存率分别为60%、53%、32%。初治患者一线治疗有效者,接受AHSCT者预计中位总生存时间为108个月,5年总生存率、无进展生存率分别为62%、63%;复发患者挽救治疗后接受AHSCT者,中位总生存时间为22.8个月,5年总生存率、无进展生存率分别为33%、22%。初始治疗未达CR/PR的难治患者,中位生存仅21个月,5年生存率和无进展生存率分别为20%和29%。结论 AHSCT常规化疗治疗TLBL安全、有效,可提高复发难治的T淋巴母细胞淋巴瘤的远期生存,延长初治TLBL患者的无进展生存期,但复发率仍偏高,值得开展大规模临床试验进一步深入研究。     

单纯Hyper-CVAD方案或联合自体造血干细胞移植一线治疗淋巴母细胞淋巴瘤的疗效分析*

目的：探讨单纯Hyper-CVAD 方案与Hyper-CVAD 方案联合自体造血干细胞移植一线巩固治疗淋巴母细胞淋巴瘤（lymphoblastic lymphoma ,LL）的疗效。方法：回顾性分析26例青少年和成人初治采用改良Hyper-CVAD 方案的LL患者资料。其中,22例不伴骨髓受侵的患者中,11例接受单纯改良Hyper-CVAD 方案治疗,另外11例接受改良Hyper-CVAD 方案联合HDT/AHSCT 巩固治疗。结果：全组61.5%（16/26）的患者初治达完全缓解（complete remission ,CR）或不确定的CR（unconfirmedCR,CRu ）,中位随访29.5 个月,5 年的总生存（overall survival,OS）率和无进展生存（progress-free survival ,PFS）率分别为66.8% 和50.2% 。22例无骨髓受侵的患者中,单纯Hyper-CVAD 组与联合HDT/AHSCT组的5 年OS率分别为60.0% 和70.7%（P=0.438）,5 年PFS 率分别为43.6% 和62.3%（P=0.209）,均无统计学差异。单因素预后分析结果显示,初治缓解后1 年内疾病进展或复发与预后不良相关（P=0.012）。 结论：改良Hyper-CVAD 方案是青少年和成人LL一线有效的治疗方案。对于无骨髓侵犯的患者,单纯改良HyperCVAD 已能取得较好疗效,联合HDT/AHSCT巩固治疗未能进一步改善预后。     

自体造血干细胞移植治疗恶性淋巴瘤效果观察

目的观察自体造血干细胞移植治疗恶性淋巴瘤的效果。方法回顾性分析2010年5月至2014年6月在山西医科大学附属肿瘤医院行自体造血干细胞移植治疗的26例恶性淋巴瘤患者的临床资料,其中霍奇金淋巴瘤3例,非霍奇金淋巴瘤23例。预处理方案均为BEAM方案（卡莫司汀＋阿糖胞苷＋依托泊苷＋美法仑）。结果所有患者均采集到足够的外周血造血干细胞且移植后均获得造血重建,无移植相关死亡发生。中性粒细胞植入中位时间为9d（8～15d）,血小板植入的中位时间为10d（9～19d）。中位随访10个月（1～48个月）,无病生存24例（92．3％）,复发2例（7．7％）,其中1例因疾病进展死亡,t例经治疗带瘤生存。结论自体造血干细胞移植治疗恶性淋巴瘤的移植相关死亡率低,无病生存率较高,是一种安全、有效的方法。     

自体造血干细胞移植治疗NK/T细胞淋巴瘤的临床研究

目的：观察自体造血干细胞移植治疗NK/T细胞瘤鼻型的疗效。方法：2001年3月-2010年4月行AHST治疗NK/T细胞淋巴瘤15例,所有患者均采用VAEMMC＋TBI预处理方案。结果：随访中位时间49月（15-120月）,14例患者（93.3%）存活,其中无病存活13例（86.7%）;2（13.3%）例复发：1例移植前为Ⅲ期PR,移植后7个月复发;1例Ⅳ期PR于移植后3个月复发并死亡。结论：自体造血干细胞移植治疗NK/T细胞淋巴瘤安全有效,但对于Ⅲ、Ⅳ期患者疗效差。     

自体造血干细胞移植治疗恶性淋巴瘤的研究进展

大剂量化疗联合自体造血干细胞移植（ＨＤＴ-ＡＳＣＴ）是目前治疗复发难治的弥漫大Ｂ细胞淋巴瘤的标准方案,但其在滤泡性淋巴瘤、套细胞淋巴瘤及外周Ｔ细胞淋巴瘤治疗上的作用及地位存在争议。根据２０１０年ＮＣＣＮ非霍奇金淋巴瘤治疗指南建议,ＨＤＴ-ＡＳＣＴ仍是治疗复发滤泡性淋巴瘤、初治套细胞淋巴瘤及外周Ｔ细胞淋巴瘤的重要方法,但需大规模的前瞻性临床试验证实其作用及验证不同类型淋巴瘤最佳的诱导、动员及维持治疗方案。对于ＨＤＴ-ＡＳＣＴ在霍奇金淋巴瘤中的应用有很多问题需要解决,如预处理方案的选择、自体造血干细胞移植前的最佳化疗周期数、放疗在ＨＤＴ-ＡＳＣＴ中的应用及二重癌发生的风险等。现就ＡＳＣＴ近年来的研究进展作一综述。     

自体造血干细胞移植治疗复发难治恶性淋巴瘤十例效果观察

目的 探讨自体造血干细胞移植(AHSCT)治疗复发难治恶性淋巴瘤的疗效和安全性.方法 回顾性分析济南军区总医院2011年8月至2015年6月收治的10例接受AHSCT治疗的复发难治恶性淋巴瘤患者的临床资料,其中男性6例,女性4例;中位年龄34岁(20~50岁);复发4例,难治6例;霍奇金淋巴瘤(HL)5例,非霍奇金淋巴瘤(NHL)5例.移植前经过多个疗程的放化疗,予大剂量甲氨蝶呤(CTX)+粒细胞集落刺激因子(G-CSF)动员外周血造血干细胞,采用BEAM(卡莫司汀+依托泊苷+阿糖胞苷+美法仑)、CBV(环磷酰胺+卡莫司汀+依托泊苷)或全身照射(TBI)方案进行预处理.结果 10例AHSCT患者单个核细胞(MNC)中位计数为7.385×108/kg,移植后8例完全缓解,2例复发.中位随访时间为18个月(20~50个月),患者总生存率及无病生存率均为80%(8/10).患者均出现不同程度的恶心、呕吐、腹泻、口腔黏膜炎等不良反应,均可耐受.结论 AHSCT是治疗复发难治恶性淋巴瘤的有效方法,安全性较高.     

单纯CHOP样方案与CHOP样方案联合造血干细胞移植巩固治疗淋巴母细胞淋巴瘤的疗效分析

目的 探讨单纯CHOP样方案与CHOP样方案+高剂量治疗联合造血干细胞移植(HDT-HSCT)一线巩固治疗淋巴母细胞淋巴瘤(LBL)的疗效.方法 63例有完整治疗及随访记录的LBL患者,初治均采用标准CHOP样方案,42例获得完全缓解(CR)或不确定CR(CRu).其中26例接受HDT-HSCT巩固治疗,16例单纯进行6～8个周期CHOP样方案治疗.结果 63例患者中,初治总缓解率为82.5%.中位随访24个月时,5年生存率为31.2%,5年无病生存率为29.3%.接受HDT-HSCT巩固治疗的26例患者,5年生存率为59.8%;单纯CHOP样方案治疗的16例患者,5年生存率为14.6%,差异有统计学意义(P=0.004).单因素预后分析结果显示,年龄、骨髓侵犯、初治缓解情况与预后有关(均P<0.05).18例骨髓受侵的患者中,3例接受异基因造血干细胞移植(allo-HSCT)的患者在随访22、32和37个月时仍生存,而4例接受自体造血干细胞移植(auto-HSCT)的患者,均在14个月内死亡.结论 单纯应用CHOP样方案治疗LBL疗效欠佳.HDT-HSCT作为一线巩固治疗有可能提高LBL患者的总生存率和无病生存率.骨髓受侵的LBL患者,allo-HSCT的效果优于auto-HSCT.     

自体干细胞移植治疗T细胞淋巴瘤31例临床分析

目的 探讨自体干细胞移植治疗T细胞淋巴瘤的疗效和其预后因素.方法 回顾性分析31例给予自体干细胞移植治疗的T细胞淋巴瘤的临床资料,观察3年总生存率和无进展生存率,分析一般状况(PS)、乳酸脱氢酶(LDH)、移植前状况、分期、外周T细胞淋巴瘤预后指数(PIT)评分对生存的影响.结果 全组中位随访时间为28(5～68)个月...     

血管免疫母细胞性T细胞淋巴瘤研究进展

血管免疫母细胞性T细胞淋巴瘤是一种少见的侵袭性淋巴瘤,临床上以周身淋巴结肿大、肝脾肿大、自身免疫现象、溶血性贫血和多克隆高球蛋白血症为特征性表现。AITL有明确的病理学特点,其免疫标志CD10、CXCLB有助于诊断。肿瘤细胞是成熟αβCD4＋CD8-细胞,起源于生发中心滤泡辅助性T细胞。传统化疗效果较差,大剂量化疗联合自体干细胞移植显示较好疗效。     

自体造血干细胞移植治疗恶性淋巴瘤的初步临床观察

目的:探讨自体追血干细胞移植(AHSCT)治疗恶性淋巴瘤的疗效.方法:造血干细胞动员采集方案采用移植前化疗敏感方案,如CHOP、DICE和ESHAP,大剂量阿糖胞苷(HD-Ara-C)等联合粒细胞集落刺激因子(G-CSF).预处理则采用BEAC(BCNU、VP-16、Ara-C和CTX)方案.结果:所有患者均采集到足够造血干细胞数,CD34+平均为2.7×108kg-1.移植后所有患者均恢复造血并出现Ⅳ度骨髓抑制,移植相关死亡率为0.移植后8例CR,3例PR.先后有2例进展(复发),其中1例死亡.中位随访时问为24.6个月,2年总生存率为84.6%.结论:AHSCT是一种有效治疗恶性淋巴瘤的方法,安全性好,但对于高危患者仍需探讨新的方法.     

Interstitial pneumonia after autologous hematopoietic stem cell transplantation in B-cell non-hodgkin lymphoma

IntroductionDuring the past decade, interstitial pneumonia (IP) is one of the newly recognized adverse events regarding rituximab therapy. However, disease characteristics of IP after autologous hematopoietic stem cell transplantation (ASCT) have not been well-described since the introduction of rituximab.Patients and MethodsWe retrospectively analyzed 103 patients with B-cell non-Hodgkin lymphoma undergoing ASCT. A propensity scoring system was applied in our analysis to eliminate potential confounding factors of covariates.ResultsThe total number of patients who developed IP was nine. Five patients developed IP among 57 patients previously treated with rituximab, and four patients developed IP among 46 who were rituximab-naïve. Cumulative incidence of IP was 7.8% at 1 year. Among the patients using rituximab, one patient had IP during the peri-engraftment period (cytomegalovirus infection), three patients had IP between 3 and 12 months (Pneumocystis pneumonia [PCP, n = 1] and unknown cause [n = 2]), and the other one patient had IP 3.3 years after ASCT (unknown cause). Four patients in the rituximab-naïve group developed IP between 3 and 12 months (PCP [n = 1] and unknown cause [n = 3]). All nine patients had symptomatic episodes before IP, three of which died of IP or secondary infections. Patients receiving a total body irradiation conditioning regimen had a higher risk of IP (odds ratio = 3.6, P < .001), whereas the incidence was not affected by rituximab usage (P = .85, Log-rank test).ConclusionThis study shows that the rituximab usage was not identified as a risk factor of IP and that total body irradiation was the only independent risk factor for IP. Close monitoring is encouraged when symptomatic unexplained episodes are identified during follow-up examinations after ASCT.     

Maintenance rituximab after autologous stem cell transplantation in patients with mantle cell lymphoma

BackgroundHigh-dose therapy and autologous stem cell transplantation (ASCT) improves outcomes for patients with mantle cell lymphoma (MCL), but relapse ultimately occurs in most patients. Recently presented interim results from a phase III prospective trial suggest maintenance rituximab (MR) after ASCT for MCL improves progression-free survival (PFS). The maturation of these data and any benefit of MR on overall survival (OS) remain to be defined.Patients and methodsIn this retrospective study, we examined a cohort of consecutive patients with MCL that underwent ASCT for MCL at our center and evaluated their outcomes according to whether they received MR after ASCT (n = 50) or did not (n = 107). MR was treated as a time-dependent covariate to account for variation in timing of its initiation.ResultsMR was associated with an improved PFS [hazard ratio (HR) 0.44; confidence interval (CI) (0.24–0.80), P = 0.007] and overall survival (OS; HR 0.46; CI 0.23–0.93, P = 0.03) following a multivariate adjustment for confounding factors with a median follow-up of ∼5 years. Grade 4 neutropenia was increased (34% versus 18%, P = 0.04) in the MR group, but no effect on the rate of mortality unrelated to relapse was observed.ConclusionsThese data support that MR after ASCT for MCL confers a benefit in PFS and additionally suggest it may improve OS. General application of this strategy will require confirmation of benefit in prospective randomized trials.     

自体造血干细胞移植治疗恶性淋巴瘤15例临床分析

目的:评价自体造血干细胞移植(AHSCT)治疗恶性淋巴瘤患者的疗效。方法:采用AHSCT治疗恶性淋巴瘤患者15例,其中霍奇金淋巴瘤患者3例(均为复发病例),非霍奇金淋巴瘤患者12例(Ⅲ、Ⅳ期或复发病例,IPI评分2-4分)。采集外周血造血干细胞前均经化疗及动员剂动员(CHOP方案9例,CHOP+MTX 3例,CEP、大剂量MTX、单用G-CSF各1例)。预处理方案为联合化疗10例(BEAC、CBV方案为主),联合化疗加放射治疗5例(TBI、TLI各1例,提前局部照射3例)。结果:移植后白细胞≥1.0×109/L的中位时间为10(9-13)天,血小板≥50×109/L的中位时间为14(11-17)天。随访时间为1-110.5个月。中位生存时间为43(1-110.5个月)个月,3年总生存率(OS)为66.7%。结论:AHSCT是一种治疗复发难治恶性淋巴瘤的安全有效的方法。     

Long-term results favor allogeneic over autologous hematopoietic stem cell transplantation in patients with refractory or recurrent indolent non-Hodgkin's lymphoma.

BACKGROUND: The aim of this study was to compare the outcomes of high-dose therapy (HDT) and allogeneic versus autologous hematopoietic stem cell transplantation (SCT) in patients with refractory or recurrent indolent non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: From January 1991 to March 2000, 112 patients underwent HDT followed by either autologous (68 patients) or allogeneic (44 patients) SCT for refractory or recurrent indolent NHL. Prior conventional chemotherapy had failed in all patients. RESULTS: The two groups were similar with respect to age at transplantation, gender, histological subtypes, number of chemotherapy regimens received before transplantation and International Prognostic Index scores. The median time from diagnosis to transplantation was longer in the autologous than in the allogeneic SCT group (46 versus 27 months, P = 0.002). In the allogeneic SCT group the median follow-up time was 53 months (range 21-113), and the overall survival (OS) and disease-free survival (DFS) rates were 49% and 45%, respectively. After a median follow-up time of 71 months (range 22-109), in the autologous SCT group, the OS and DFS rates were 34% and 17%, respectively. Patients who underwent autologous SCT were more likely to have chemosensitive disease (P <0.001) and were more likely to be in complete remission at the time of transplantation (P = 0.001) than those who underwent allogeneic SCT. However, the probability of disease progression was significantly higher in the autologous SCT group than in the allogeneic SCT group (74% versus 19%, P = 0.003). CONCLUSIONS: Patients who undergo HDT with allogeneic SCT for refractory or recurrent indolent NHL have lower relapse rates but higher treatment-related mortality rates than patients who undergo autologous SCT. However, with the development of non-myeloablative preparative regimens, which can decrease treatment-related mortality, patients with recurrent indolent NHL should be considered for controlled trials of allogeneic transplantation if they have a human leukocyte antigen-identical donor.     

自体造血干细胞移植治疗恶性淋巴瘤的研究进展

自体造血干细胞移植(AHSCT)是治疗恶性淋巴瘤(ML)的重要方法,其治疗过程较为复杂,疗效也受诸多因素影响.近年来AHSCT在ML的治疗中应用更加广泛,寻找有效的预后因素以进一步区分可能从AHSCT中获益的患者以及制订合理的移植方案是临床医生关注的重要问题.文章就AHSCT治疗ML的研究进展作一综述.