异基因造血干细胞移植治疗髓系恶性血液病移植前临床特征与预后的相关性研究

目的 :回顾性分析髓系白血病接受异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)患者的预后相关因素。方法 :纳入175例接受allo-HSCT治疗患者,其中男性105例,女性70例,中位年龄37(28,46)岁,急性髓系白血病(acute myeloid leukemia,AML)145例,骨髓增生异常综合征(myelodysplasia syndrome,MDS)30例。根据移植前疾病状态将患者分为早期和进展期2组。早期患者包括AML第1次完全缓解(first complete remission,CR1)期和低中危MDS共116例;进展期患者包括AML非CR1期和高危MDS共59例。所有患者按照欧洲血液和骨髓移植组(European Group for Blood and Marrow Transplantation,EBMT)移植评分分为低危组(EBMT积分0~2分)86例和高危组(EBMT积分≥3分)89例。allo-HSCT干细胞供体来源为人类白细胞抗原(human leukocyte antigen,HLA)全相合同胞供体(Sib)85例,HLA相合非血缘供体(mismatched unrelated donor,MUD)64例和亲缘半相合(Haplo)26例。单因素分析患者年龄、性别、移植前疾病阶段、EBMT积分、供者来源对移植后整体生存(overall survival,OS)率、无事件生存(event free survival,EFS)率、非复发死亡率(non relapse mortality,NRM)和复发率(relapse rate,RR)的影响。结果 :所有患者中位随访12.7(3.9,45.1)个月,预期3年OS率、EFS率、NRM和RR分别为51.4%±4.0%、46.8%±4.0%、31.6%±3.7%和29.0%±4.4%。其中疾病早期移植与进展期移植2组,EBMT积分低危和高危2组OS率、EFS率、RR、NRM差异均有统计学意义(均P<0.05)。在所有移植患者或疾病早期移植组和进展期移植组中供体来源移植后OS率等指标差异均无统计学意义。结论:移植前状态及EBMT积分对髓系白血病接受allo-HSCT的整体疗效具有重要意义,不同移植供者移植后疗效相近。     

自体造血干细胞移植+BEAC方案治疗预后不良非霍奇金淋巴瘤疗效观察

用自体外周血造血干细胞移植（APBSCT）＋大剂量BEAC方案治疗预后不良非霍奇金淋巴瘤（NHL）患者10例,均获快速造血功能重建,其中7例高危初治者完全缓解（CR）,3例复发者中CR2例、PR1例;无移植相关死亡。提示APBSCT＋大剂量化疗对预后不良或复发NHL安全有效,能改善患者生存率。     

一线自体造血干细胞移植治疗老年人初治中高危或高危弥漫大B细胞淋巴瘤临床分析

目的探讨一线自体造血干细胞移植(auto-HSCT)巩固治疗老年人初治中高危/高危弥漫大B细胞淋巴瘤(DLBCL)的疗效及相关影响因素。方法回顾性分析2015年1月至2020年8月在宁波大学附属人民医院接受auto-HSCT的国际预后指数(IPI)≥3分的初治老年DLBCL患者的临床特征、治疗效果及预后因素。结果全部31例患者中男18例、女13例, 中位年龄65(60～75)岁;13例(41.9%)淋巴结外受累部位≥2处, 13例(41.9%)骨髓累及, IPI中高危(3分)21例(67.7%)、高危(≥4分)10例(32.2%);移植前疾病处于完全缓解(CR)21例(67.7%)、部分缓解(PR)10例(32.3%)。所有患者均获得造血重建, 中性粒细胞植入、血小板植入中位时间分别为10(9～16)d、12(8～58)d。移植后中位随访20.9(3.1～73.0)个月, 100 d内移植相关死亡率为3.2%(1/31), 2年总生存(OS)率、无进展生存(PFS)率分别为(77.2±8.4)%、(72.7±8.3)%。多因素Cox回归分析结果显示, 移植前部分缓解状态[OS(HR=3...     

自体外周血造血干细胞移植治疗非霍奇金淋巴瘤182例临床分析

目的　评价自体外周血造血干细胞移植 (APBSCT)治疗非霍奇金淋巴瘤 (NHL)患者的疗效。方法　全国 34家单位采用APBSCT治疗NHL 182例。其中第一次完全缓解 (CR1)移植 112例 ,部分缓解 (PR)或复发期移植 70例。外周血造血干细胞 (APBSC)动员方案分为四组 :1组为大剂量环磷酰胺 (HD CY)联合粒细胞 集落刺激因子 (G CSF) 5 5例 ;2组为大剂量阿糖胞苷 (HD Ara C)联合G CSF7例 ;3组为增大环磷酰胺剂量的针对性化疗方案联合G CSF 10 2例 ;4组为单独应用G CSF 18例。预处理方案 :移植前处于CR1状态的 112例中 ,含有全身照射 (TBI)的预处理方案 39例 ,不含TBI的 73例 ;PR或复发的 70例中 ,含有TBI的预处理方案 2 9例 ,不含TBI的 4 1例。结果　四组所采集到的APBSC均可达到临床所需数量。四组间采集的单个核细胞数与采集次数之间无统计学差别。移植后WBC≥ 1 0× 10 9/L的中位数时间为 12 (10～ 30 )d ;血小板≥ 2 0× 10 9/L的中位数时间为 12 (0～ 181)d。患者移植后平均随访时间为 2 4个月。预期 3年无病生存率 (DFS)移植前达CR1期者 6 9 7% ;PR和复发期为 4 4 9%。在移植前达CR1期患者中 ,含有TBI和不含TBI的预处理方案的 3年DFS无统计学差别 (70 1%、6 8 0 % )。而对于PR或复发期患者 ,前者优于后者 (5 7     

33例结外NK/T细胞淋巴瘤临床分析

目的:分析结外NK/T细胞淋巴瘤的临床特征、生存时间及影响预后的因素。方法:回顾性分析我院收治的结外NK/T细胞淋巴瘤33例患者的临床资料,分析临床特征、生存时间及影响预后的因素。结果:共收集结外NK/T细胞淋巴瘤患者,男女比例为2∶1,发病年龄30～50岁。Ann Arbor分期:Ⅰ期10例(30.3%),Ⅱ期5例(15.2%),Ⅲ期2例(6.06%),Ⅳ期16例(48.5%)。B组患者21例(63.6%),乳酸脱氢酶升高23例(69.7%),血β2-微球蛋白升高26例(78.8%),病变组织中EBER阳性21例(63.6%)。33例患者中死亡22例,生存11例,中位生存时间12个月,2年总生存(OS)率39.4%。单因素分析结果显示,存在B组症状、体能状况差(ZPS≥2)、LDH/血β2-微球蛋白升高、EBER阳性、临床分期≥Ⅲ期者预后差。结论:NK/T细胞淋巴瘤患者预后差,影响预后的因素包括B组症状、ZPS评分、LDH/血β2-微球蛋白水平、EBV感染、临床分期等因素。     

老年霍奇金淋巴瘤初诊患者的临床特征及生存状况

目的探讨霍奇金淋巴瘤初诊老年患者的临床特征及生存状况。方法选取2002年5月至2009年4月来该院接受治疗的初诊为霍奇金淋巴瘤的老年患者100例,回顾性分析患者的临床特征和生存状况。结果多数霍奇金淋巴瘤初诊老年患者为男性且居住在城镇;患者病理分型以结节硬化型、混合细胞型为主,病理分期Ⅲ、Ⅳ期人数多于Ⅰ、Ⅲ期,首发症状以淋巴结肿大为主;患者2、3、5年的总生存(OS)率以及无事件生存(EFS)率分别为88%、84%、73%以及82%、71%、58%;经单因素分析可得,病理分期、有B症状、骨髓受累、肝肿大以及血清白蛋白(ALB)降低对老年患者生存的影响差异显著(P0.05);经多因素分析可得,有B症状(RR=3.452)、骨髓受累(RR=4.125)以及肝肿大(RR=4.361)是影响患者生存预后的独立危险因素(P0.05)。结论对于老年患者,霍奇金淋巴瘤是一种可治愈的恶性肿瘤,初诊多处于疾病的中晚期,5年OS率为73.0%;有B症状、骨髓受累以及肝肿大是影响患者生存预后的独立危险因素。     

自体外周血干细胞移植联合受累野放疗治疗纵隔巨块型淋巴瘤16例临床分析

目的：分析自体外周血干细胞移植联合受累野放疗治疗纵隔巨块型淋巴瘤的临床特征及治疗策略。方法：初治患者经4～7个疗程CHOP方案等常规化疗后，CR10例、PR3例、SD2例、PD1例。之后进行1疗程单次自体造血干细胞移植5例、2疗程双次自体造血干细胞移植11例，16例均联合受累野20-45Gy放疗。结果：中位随访26个月（7-72月）。生存11例，死亡5例，5年OS 68．7％。移植前CR＋PR组5年OS 84％，而SD＋PD组3例全部死亡；霍奇金淋巴瘤组5年OS 100％，非霍奇金淋巴瘤组5年OS 58％；B细胞组5年OS80％，T细胞组5年OS 50％；双次移植组5年OS 81％，单次移植组5年OS 60％；LDH正常组5年OS 71％，LDH增高组5年OS 66％；邻近器官无侵犯组5年OS 81％，邻近器官有侵犯组5年OS 60％；由于例数相对较少，统计学分析除临床分期和病理类型有显著差异外，余均无统计学意义。结论：自体外周血干细胞移植联合受累野放疗是治疗原发纵隔巨块型淋巴瘤的较好选择。     

209例慢性B淋巴细胞增殖性疾病临床特征及预后分析

目的:探讨慢性B淋巴细胞增殖性疾病(B-CLPD)的临床特征、鉴别诊断、治疗方式与预后转归的相关性。方法:回顾性研究209例B-CLPD患者的临床特征、实验室及影像学检查资料,分析患者初诊时疾病状态、诊断方式、治疗方案与生存预后的关系。结果:209例患者男女比例约2.67∶1.00,中位年龄59(17~86)岁,中位随访时间33(2~331)个月,慢性淋巴细胞白血病/小淋巴细胞淋巴瘤化疗患者完全缓解率(CR)、部分缓解率(PR)、总体有效率(ORR)分别为59.7%、14.5%、74.2%,滤泡性淋巴瘤化疗患者CR、PR、ORR分别为54.5%、18.2%、72.7%,套细胞淋巴瘤化疗患者CR、PR、ORR分别为46.7%、26.7%、73.3%,边缘区淋巴瘤化疗患者CR、PR、ORR分别为57.1%、21.4%、78.6%,淋巴浆细胞淋巴瘤/华氏巨球蛋白血症化疗患者CR、PR、ORR分别为75.0%、8.3%、83.3%,以骨髓检查或淋巴结/原发病灶检查确诊的患者生存期无显著差异。多因素生存分析显示,血清乳酸脱氢酶、红细胞沉降率水平升高为预后不良的独立影响因素。淋巴瘤联合利妥昔单抗化疗组(67例)较未联合化疗组(16例)5年累积生存率明显改善(53.9%∶33.3%,P0.05)。结论:流式细胞检测显示单克隆性B淋巴细胞增生通常提示B-CLPD。血乳酸脱氢酶、红细胞沉降率升高为预后不良因素。骨髓检查或淋巴结/原发病灶检查确诊不影响患者预后。联合应用利妥昔单抗能显著改善患者生存。     

难治性急性髓系白血病异基因造血干细胞移植治疗疗效分析

目的 :评价异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗复发难治性急性髓系白血病(refractory acute myeloid leukemia,r AML)的疗效。方法:收集2000年1月至2015年6月在上海交通大学医学院附属瑞金医院和海军医科大学附属长海医院接受allo-HSCT治疗的r AML患者73例,按移植前疾病状态分为完全缓解(complete remission,CR)组(44例)和未缓解(non-remission,NR)组(29例),随访截止时间2015年12月31日,分析allo-HSCT后非复发死亡率(non-relapsing mortality,NRM)、粒细胞及血小板植入时间、移植物抗宿主病(graft versus host disease,GVHD)发生率、2年总生存(overall survival,OS)率、2年无病生存(disease-free survival,DFS)率等数据。结果 :所有患者移植后获得造血功能重建,中位随访时间470(230.5,1 011.5)d。所有患者2年OS率为56.5%,2年DFS率为41.8%。移植前CR组和NR组2年OS率分别为64.0%和45.6%(P=0.345),2年DFS率分别为45.6%和35.6%(P=0.393);移植前CR组和NR组NRM、粒细胞及血小板植入时间、GVHD发生率差异均无统计学意义。结论:allo-HSCT是治疗r AML的有效治疗手段,长期DFS为41.8%,移植前疾病状态是否达到CR对移植后的预后无显著影响。     

伊马替尼一线治疗慢性髓系白血病的预后相关因素分析

目的：评价生物学因素和治疗相关因素在伊马替尼一线治疗慢性髓系白血病（CML）中的预后价值。方法：回顾性分析 72例CML慢性期（CML-CP）患者的临床资料,包括性别、年龄、外周血白细胞计数、血小板计数、嗜碱性粒细胞比例、血红蛋白、脾肋下长度、附加染色体（ACAs）、血清乳酸脱氢酶（LDH）水平、伊马替尼治疗第3个月和第6个月的分子学反应。采用Kaplan-Meier方法分析上述因素对长期生存（OS）率及无事件生存(EFS)率的影响,Cox比例风险模型评估独立预后因素。结果：中位随访期为61（4~96）个月,5年中位OS率 88.89%,5年中位EFS率41.67%。单因素分析显示,各组内OS率比较,外周血嗜碱性粒细胞比例＜3%的患者明显高于外周血嗜碱性粒细胞比例≥3%的患者(97.1% vs 84.2%,P<0.05);不存在ACAs患者明显高于存在ACAs患者（97.6% vs 28.3%,P<0.05）;LDH＜1000U/L患者明显高于LDH≥1000U/L患者（96.2% vs 84.8%,P<0.05）。各因素组内EFS率比较显示,脾肋下长度＜7cm患者明显高于脾肋下长度≥7cm患者（41.8% vs 27.0%,P<0.05）;不存在ACAs患者明显高于存在ACAs患者（38.4% vs 10.4%,P<0.01）;第3个月早期分子学反应（EMR）≤0.1患者明显高于EMR＞0.1患者（45.1% vs 16.8%,P<0.01）;第6个月EMR＜0.1、0.1~0.01、＞0.1的3组患者EFS率分别为57.0%、31.8%、15.4%（均P＜0.05）。多因素分析显示存在ACAs [OR=5.821,95%CI（2.015,16.819),P<0.01]及治疗第6个月的EMR[OR=4.850,95%CI（2.887,8.148）,P＜0.01]对EFS率具有独立的预后价值。结论：外周血嗜碱性粒细胞比例、ACAs、LDH可能影响伊马替尼一线治疗CML患者的OS率,脾大小、ACAs、第3、6个月的EMR均会影响患者的EFS率。ACAs和第6个月的EMR对患者EFS率有独立的预后价值。     

High-dose chemotherapy and autologous stem cell transplantation for peripheral T-cell lymphoma: complete response at transplant predicts survival

Although the role of high dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) in the treatment of aggressive lymphoma has been established in several large prospective studies, its effectiveness in patients with peripheral T cell lymphoma (PTCL) has not been defined. We aimed to evaluate the efficacy of HDT and ASCT and prognostic factors for survival in patients with PTCL. We retrospectively analyzed the results of 40 PTCL patients treated with HDT and ASCT at Asan Medical Center between January 1995 and December 2005. Twenty patients had PTCL-U (peripheral T cell lymphoma, unspecified), 10 had extranodal natural killer/T cell lymphoma, 5 had anaplastic large cell lymphoma, 3 had angioimmunoblastic T cell lymphoma, 1 had hepatosplenic γσ T cell lymphoma, and 1 had disseminated mycosis fungoides. Disease status at transplant was complete response (CR)1 in 3 patients, CR2 or greater in 8, partial remission in 25, and refractory in 4. At a median follow-up of 16 months (range, 5 to 135 months) for surviving patients, the median overall survival (OS) was 11.5 months and the 1-year probability of survival was 46.1%. The median event free survival (EFS) was 3.6 months (95% confidence interval, 2.5 to 4.8 months). Ten patients (25%) remain alive without evidence of disease. The median OS of 11 patients with CR at ASCT was not reached; of these, 7 patients (63.6%) were alive with CR. In multivariate analysis, CR at ASCT was a prognostic factor for EFS (P = 0.025) and OS (P = 0.027) and normal lactate dehydrogenase (LDH) at ASCT was a prognostic factor for improved OS (P = 0.025). Chemosensitive patients with PTCL who achieved CR before ASCT seem to benefit from HDT and ASCT. Pretransplant values of LDH had potential to predict the survival.     

霍奇金淋巴瘤51例临床分析

目的 探讨霍奇金淋巴瘤（HL）的临床及病理特征、治疗效果及预后相关因素.方法 收集51例HL患者临床资料,对其临床特征及预后相关因素进行回顾性分析.结果 51例患者中男女比例为2∶1,年龄15～75岁,13例（25.4％）为未具体分类的经典型HL（cHL）,混合细胞型（MC）和结节硬化型（NS）分别占总病例数的35.3％和25.5％.治疗总有效率为96.1％,37例（72.5％）获得完全缓解（CR）,12例（23.5％）获得部分缓解（PR）,2、3年总生存率（0S）分别为83.0％和78.6％,2、3年无疾病进展生存率（PFS）分别为81.1％和69.5％.单因素预后分析结果显示,红细胞沉降率（ESR）、骨髓累及、Ann Arbor分期和国际预后评分（IPS）和结外器官累及为预后相关因素,对患者3年PFS和OS率的影响有统计学意义（P＜0.05）.结论 HL为一种可治愈的恶性肿瘤,复发后部分患者病程呈惰性,对于二线方案治疗和自体骨髓移植仍有较高的缓解率.     

Long-term event-free survivors after high-dose therapy and autologous stem-cell transplantation for low-grade follicular lymphoma

Although follicular lymphoma (FL) is generally responsive to conventional-dose chemotherapy, improved survival in patients with this disease has been difficult to demonstrate. High-dose chemo/radiotherapy followed by autologous stem-cell transplantation (ASCT) can improve response rates, although its effects on survival remain controversial. Between 1990 and 2003, we transplanted 49 patients with low-grade FL at our institution. Twenty-two patients (45%) had undergone histologic transformation at the time of ASCT. In all, 44 patients (90%) had relapsed disease and five patients (10%) were resistant to chemotherapy at the time of transplantation. After ASCT, 30 patients (61%) were in complete remission (CR). The median overall survival (OS) has not been reached, while the median event-free survival (EFS) is 2.4 years. At a median follow-up of 5.5 years (longest 12.4 years), a plateau has been reached with 56% of patients remaining alive, and 35% event-free. ASCT was well tolerated except for two (4%) treatment-related deaths. In multivariable analysis, CR after ASCT and age less than 60 years are the best predictors of EFS and OS. ASCT is thus a safe therapeutic approach in FL, resulting in long-term EFS and OS for some patients, even with transformed disease.     

High-dose therapy and autologous stem cell transplantation in patients with diffuse large B-cell lymphoma in first complete or partial remission

Improved survival has been observed in poor-risk diffuse large B-cell lymphoma (DLBCL) patients treated with high-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) in first complete remission. Retrospective studies have suggested that HDT with ASCT can improve survival also in partial responders but some doubts about the advantage of intensive therapy in such patients still remain. We evaluated retrospectively the results of HDT and ASCT in 55 patients with confirmed DLBCL treated between May 1999 and July 2006. Thirty-six patients (65%) showed partial remission (PR) and 19 patients (35%) reached complete remission (CR) after induction treatment with (44%) or without (56%) concomitant rituximab (R) immunotherapy. After HDT and ASCT, 69% of patients fulfilled the criteria of CR, 22% had unconfirmed CR (CRu), 7% remained in PR and 1 patient (2%) relapsed. Twenty patients in PR after the induction treatment reached CR after ASCT, 12 other PR patients achieved CRu. The 5-year event-free survival (EFS) of the 55 transplanted patients was 76% (95% confidence interval /CI/, 63% to 89%) and the 5-year overall survival (OS) was 85% (95% CI, 73% to 97%). The EFS and OS rates differed significantly only between patients younger than 40 years and older groups (p=0.022 and p=0.046, respectively). On univariate analysis of prognostic factors, EFS and OS were not affected by any of the following: age, sex, stage, subtype of DLBCL, initial lactate dehydrogenase, beta-2-microglobulin and serum thymidine kinase levels, International Prognostic Index (IPI) and age-adjusted IPI scores, induction treatment with or without rituximab and type of primary therapeutic response (CR vs PR). These results show that first-line HDT and ASCT for adults up to the age of 65 years with poor-risk DLBCL is a feasible and effective treatment option even in the era of R-chemotherapy in CR as well as for patients in PR.     

Remission status defined by immunofixation vs. electrophoresis after autologous transplantation has a major impact on the outcome of multiple myeloma patients

We have retrospectively analysed 344 multiple myeloma (MM) patients (202 de novo patients) treated in a non-uniform way in whom high-dose therapy and autologous stem cell transplantation (ASCT) response was simultaneously measured by both electrophoresis (EP) and immunofixation (IF). Patients in complete remission (CR) by EP were further subclassified as CR1 when IF was negative and CR2 when it remained positive. Partial responders (PR) were also subclassified as PR1 (very good PR, > 90% reduction in M-component) or PR2 (50-90% reduction). CR1 patients showed a significantly better event-free survival (EFS) [35% at 5 years, 95% confidence interval (CI) 17-53, median 46 months] and overall survival (OS) (72% at 5 years, CI 57-86, median not reached) compared with any other response group (univariate comparison P < 0.00000 to P = 0. 004). In contrast, comparison of CR2 with PR1 and with PR2 did not define different prognostic subgroups (median EFS 30, 30 and 26 months respectively, P = 0.6; median survival 56, 44 and 42 months respectively, P = 0.5). The non-responding patients had the worst outcome (5-year OS 8%, median 7 months). Multivariate analysis confirmed both the absence of differences among CR2, PR1 and PR2 and the highly discriminatory prognostic capacity of a three-category classification: (i) CR1 (ii) CR2 + PR1 + PR2, and (iii) non-response (EFS P < 0.00000; OS P < 0.00000; both Cox models P < 0.00000). In the logistic regression analysis, the factors significantly associated with failure to achieve CR1 were the use of two or more up-front chemotherapy lines, status of non-response pre-ASCT and inclusion of total body irradiation (TBI) in the preparative regimen. Tandem transplants or the use of multiple agents (busulphan and melphalan) in the preparative regimen resulted in a higher CR1 level; none of the biological factors explored influenced the possibility of achieving CR1. These results confirm that, in MM patients undergoing ASCT, achieving a negative IF identifies the patient subset with the best prognosis; accordingly, therapeutic strategies should be specifically designed to achieve negative IF.     

培美曲塞联合顺铂治疗晚期三阴性乳腺癌的疗效观察

目的探讨培美曲塞联合顺铂治疗蒽环类和紫杉类化疗失败的晚期三阴性乳腺癌的疗效和不良反应。方法选取已接受过蒽环类和紫杉类化疗的晚期三阴性乳腺癌患者23例,给予培美曲塞联合顺铂治疗:培美曲塞500 mg/m2d1,顺铂25 mg/m2d1~3,每21天为1周期,接受化疗至少2周期后评价疗效和不良反应。结果 23例患者均可评价疗效和不良反应;其中完全缓解2例(8.7%),部分缓解7例(30.4%),稳定9例(39.1%),进展5例(21.8%);有效率为39.1%;临床获益率为78.2%;中位疾病进展时间为6.5个月(3.9,9.1);中位生存期为13.5个月(8.7,18.3);主要不良反应为骨髓抑制和胃肠道反应,经对症处理后可缓解。结论培美曲塞联合顺铂的治疗方案对紫杉类和蒽环类化疗失败的晚期三阴性乳腺癌具有较好的疗效和耐受性。     

Primary refractory Hodgkin's lymphoma: outcome after high-dose chemotherapy and autologous SCT and impact of various prognostic factors on overall and event-free survival. A single institution result of 66 patients

We report our experience with high-dose chemotherapy (HDC) and autologous SCT (ASCT) in 66 patients with primary refractory Hodgkin's lymphoma (PR-HL) who received salvage chemotherapy followed by BEAM as HDC. Median age at ASCT was 23 years. Before salvage chemotherapy, stages I:II:III:IV were 2:21:14:29, bulky disease 27%, involvement of mediastinum 79%, spleen 26% and extranodal site 47%, 92% had ESHAP as salvage. Post-ASCT evaluation showed response in 50 patients (76%); complete response (CR) 37 (56%), partial response 14 (21%), no response or stable disease 3 (5%) and progressive disease in 10 (15%). Another five patients achieved CR after radiation therapy and one after surgery, making total CR 43 (65%). From diagnosis and HDC, median follow-up is 38.5 and 22.8 months and median overall survival (OS) 78 and 57 months, respectively. Event-free survival (EFS) and OS are 36 and 64%, respectively. In all, 47% patients are in CR. Twenty-two patients (33%) died due to disease. Multivariate analysis showed elevated lactate dehydrogenase (LDH) for EFS (P=0.041) and mediastinal involvement for OS (P=0.038) as negative prognostic factors. In conclusion, EFS and OS are only 36 and 64%, respectively. Elevated LDH and mediastinal involvement are poor prognostic factors.     

微波消融序贯化疗治疗晚期非小细胞肺癌的免疫学效应观察

目的探讨冷循环微波消融序贯化疗治疗晚期非小细胞肺癌（NSCLC）的近期疗效和免疫学效应。方法对58例晚期NSCLC行微波凝固治疗,1周后序贯化疗（方案为多烯紫杉醇75mg／m2＋顺铂30mg／m2,1～3d,21天为一周期,4周期为一疗程）,治疗前后采血检测免疫指标,胸部增强CT动态观察前后变化。结果58例NSCLC微波凝固治疗7d后细胞毒性T淋巴细胞（CTL）活性升高30例,升高率51．7％。1周后增强CT显示90％的肿块有10％-50％不同程度的缩小,完全坏死率达100％者36例、达80％以上者5例。化疗1疗程后行CT评价,完全缓解（CR）5．2％（3／58）、部分缓解（PR）34．5％（20／58）、病变稳定（SD）51．7％（30／58）、病变进展（PD）8．6％（5／58）;微波凝固序贯化疗患者临床获益率达91．4％。随访最短6月,最长24月,中位生存时间为13．2月,1年生存率为49．3％。结论CT引导下冷循环微波消融系统治疗肺癌是一种安全、有效的肿瘤局部治疗手段。微波凝固治疗即可降低肿瘤负荷,还可提高机体免疫,提高综合治疗的疗效。     

重组人血管内皮抑制素联合替莫唑胺治疗复发高级别胶质瘤的临床研究

目的观察重组人血管内皮抑制素(恩度)联合替莫唑胺(TMZ)与单纯应用TMZ治疗复发高级别胶质瘤患者的安全性与疗效。方法将74例复发高级别胶质瘤患者随机均分为两组,一组单纯应用TMZ化疗(37例),另一组应用恩度联合TMZ联合化疗(37例)。TMZ化疗方案的选择基于患者O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)蛋白表达状况和既往TMZ化疗效果,采用个体化的治疗。恩度剂量为15 mg静脉滴注,连续应用14 d,间歇2周重复。结果 37例单纯TMZ化疗患者共接受129周期化疗,中位3次(1~10次)。完全缓解(CR)1例(2.7%),部分缓解(PR)9例(24.3%),微效(MR)3例(8.1%),疾病控制率(CR+PR+MR)为35.1%。中位无进展生存期(PFS)为4个月(95%CI 1.9~6.1个月),6个月的PFS率为27.0%。37例恩度联合TMZ化疗患者共接受200周期化疗,中位6次(2~10次)。CR 3例(8.1%),PR 14例(37.8%),MR 6例(16.2%),疾病控制率(CR+PR+MR)为62.1%。中位PFS为6个月(95%CI 4.9~7.1个月),6个月的PFS率为43.0%。不良反应中,同单纯TMZ组相比,恩度联合TMZ组具有更高的高血压发生率。结论恩度联合TMZ化疗较TMZ单药化疗在复发高级别胶质瘤的治疗有更好的客观疗效,相对延长PFS,且具有较好的安全性。