自体造血干细胞移植治疗复发弥漫大B细胞淋巴瘤的疗效观察

目的探讨自体外周血造血干细胞移植支持下大剂量化疗治疗复发弥漫大B细胞淋巴瘤的疗效及安全性。方法选择2000年1月至2011年12月在我科住院治疗的复发弥漫性大B细胞淋巴瘤患者72例,根据治疗方式随机分为移植组和常规化疗组,每组各36例。移植组患者实施移植前予以ICE方案化疗4～6个周期,行自体外周血造血干细胞移植后,未达到完全缓解的给予放疗;而常规化疗组仅给予ICE方案化疗4～6个周期,未达到完全缓解的给予放疗。治疗后比较两组的临床疗效和不良反应的发生情况。结果移植组患者完全缓解33例(91.7%),部分缓解3例(8.3%),常规化疗组患者完全缓解23例(63.9%),部分缓解13例(36.1%),两组临床疗效的差异有统计学意义(P<0.05)。移植组Ⅳ度骨髓抑制的发生率显著高于常规化疗组(P<0.05),而两组胃肠道反应发生率的差异无统计学意义(P>0.05)。移植组和常规化疗组的5年总生存率(OS)分别为56%和38%,5年无病生存率(DFS)分别是43%和20%,差异均有统计学意义(P<0.05)。结论自体外周血干细胞移植支持下大剂量化疗治疗复发弥漫大B细胞淋巴瘤疗效较单纯化疗更好,且不良反应患者可耐受。

Therapeutic Effect of Autologous Stem Cell Transplantation in the Adjuvant Treatment of Recurrence Diffuse Large B-cell Lymphoma

Objective To approach the therapeutic effect and reliability of high dose therapy supported by autologous stem cell transplantation for recurrence diffuse large B-cell lymphoma. Methods 72 patients with recurrence diffuse large B-cell lymphoma who hospitalized in our department during January 21）00 and December 2011 were divided randomly into transplantation group and routine-chemotherapy group according to the ways of therapy and each group included 36 patients. Patients in transplantation group were administrated with ICE schedule for 4-6 periods before autologous peripheral blood stem cell transplantation, and received radiotherapy if they didn＇ t get complete remission after transplantation. Patients in routine-chemotherapy group were only administrated with ICE schedule for 4-6 periods, and were offered with radiotherapy if no complete remission. Therapeutic effect and adverse reaction was observed and compared after treatment. Results In transplantation group, there were 33 cases （91.7 %） of complete renfission, and 3 cases （8.3 %） of partial remission. While in the routine-chemotherapy group, there were 23 cases （63.9 %） of complete renfission, and 13 cases （36.1%） of partial renfission. There was significant statistical difference in curative effect between the two groups （P 〈 0.05）. The incidence of Ⅳ degree bone marrow depression in transplantation group was apparently higher than that of routine-chemotherapy group （P〈 0.05）, but no statistical difference was found in incidence of gastrointestinal tract reaction between two groups. 5-year OS was respectively 56 % and 38 % in transplantation group and routine-chemotherapy group, and 5-year DFS was respectively 43 % and 20 % , both with statistically significant difference （P 〈 0.05）.Conclusion The therapeutic effect of high dose therapy supported by autologous stem cell transplantation for rectnxence diffuse large B-cell lymphoma was nmch better than that ofroutine-cllemotherapy, and adverse reaction was toleram.