CAJ | 학술논문

目的评价自体外周血干细胞移植(APBSCT)对霍奇金淋巴瘤(HL)及灰区淋巴瘤患者的缓解率和生存率的作用.方法回顾性分析30例接受APBSCT的HL及灰区淋巴瘤患者临床资料,中位移植年龄30岁(13 ～ 55岁),病理类型以结节硬化型HL为主,占19例；临床分期以Ⅲ～Ⅳ期为主；分析APBSCT治疗HL及灰区淋巴瘤患者的疗效及生存情况,并探讨了相关影响因素.结果 30例患者均成功采集干细胞,采集单个核细胞中位数为6.8×108/kg(1.0× 108/kg～ 13.8×108/kg),CD34+细胞中位数为6.3×106/kg(0.6 × 106/kg ～ 20.6×106/kg).中性粒细胞中位植入时间9d(8～12d).28例可评估患者,中位随访时间为18.5个月(2.5～ 95.0个月),18例(643％)获完全缓解(CR),7例(25.0％)部分缓解(PR),总反应率(RR) 89.3％.预计5年总生存(OS)率、无进展生存(PFS)率分别为78％、58％.7例未缓解患者在移植前更换化疗方案为利妥昔单抗联合化疗后3例获得CR,2例PR.单因素分析提示移植前疾病状态及更换化疗种类数影响OS,移植前放疗史影响PFS.结论 APBSCT可提高HL及灰区淋巴瘤患者CR率,改善患者的OS及PFS;移植前挽救化疗采用利妥昔单抗联合化疗有助于改善移植前疗效；移植前化疗敏感性影响生存,过多化疗种类更换不利生存,移植前放疗史有影响患者PFS的趋势.
목적 평개자체외주혈간세포이식(APBSCT)대곽기금림파류(HL)급회구림파류환자적완해솔화생존솔적작용.방법 회고성분석30례접수APBSCT적HL급회구림파류환자림상자료,중위이식년령30세(13 ～ 55세),병리류형이결절경화형HL위주,점19례；림상분기이Ⅲ～Ⅳ기위주；분석APBSCT치료HL급회구림파류환자적료효급생존정황,병탐토료상관영향인소.결과 30례환자균성공채집간세포,채집단개핵세포중위수위6.8×108/kg(1.0× 108/kg～ 13.8×108/kg),CD34+세포중위수위6.3×106/kg(0.6 × 106/kg ～ 20.6×106/kg).중성립세포중위식입시간9d(8～12d).28례가평고환자,중위수방시간위18.5개월(2.5～ 95.0개월),18례(643％)획완전완해(CR),7례(25.0％)부분완해(PR),총반응솔(RR) 89.3％.예계5년총생존(OS)솔、무진전생존(PFS)솔분별위78％、58％.7례미완해환자재이식전경환화료방안위리타석단항연합화료후3례획득CR,2례PR.단인소분석제시이식전질병상태급경환화료충류수영향OS,이식전방료사영향PFS.결론 APBSCT가제고HL급회구림파류환자CR솔,개선환자적OS급PFS;이식전만구화료채용리타석단항연합화료유조우개선이식전료효；이식전화료민감성영향생존,과다화료충류경환불리생존,이식전방료사유영향환자PFS적추세.
Objective To evaluate the response rate and survival rates of refractory or relapsed Hodgkin lymphoma (HL) and grey zone lymphoma patients treated with autologous peripheral blood stem cell transplantation (APBSCT).Methods From January 2004 to August 2012,30 HL and grey zone lymphoma patients were retrospectively analyzed.Statistical analysis was done to explore the long term outcome and prognostic factors of patients treated with APBSCT.Among all patients,the median age at transplantion was 30 (13-55) years old.Patients were major with nodular sclerosis HL and in stage Ⅲ/Ⅳ.Results Every patient had a successful collection.The median MNC cell dose infused was 6.8×108/kg [range (1.0-13.8)×108/kg] and median CD34+ cell dose infused was 6.3×106/kg [range (0.6-20.6)×106/kg].Median time to neutrophil engraftment was 9 days (range 8-12 days).28 patients were evaluable after transplantation with a median follow-up of 18.5 months (range 2.5-95.0 months).The overall response rate was 89.3 ％ [CR 64.3 ％ (18/28),PR 25.0 ％ (7/28)].The overall survival (OS) rate and progression free survival (PFS) rate at 5 year would be 78 ％ and 58 ％ for all patients.3 in 7 patients with no remission after salvage chemotherapy with rituximab plus chemotherapy before APBSCT got CR and 2 got PR.Univariate analysis showed that disease status and the number of replacement types of chemotherapy prior to transplantation affected OS,the history of radiotherapy prior to transplantation affected PFS.Conclusion APBSCT can increase CR rate,prolong survival time in patients with refractory or relapsed HL and grey zone lymphoma.Rituximab plus chemotherapy as a salvage therapy could raise CR rate before APBSCT.Chemosensitivity before transplantation affect outcome with APBSCT.Changing many types of chemotherapy is adverse for APBSCT.Salvage radiotherapy before APBSCT is not recommended.