CAJ | 학술논문

背景与目的：目前，大剂量化疗+自体造血干细胞移植(autologous stem cell transplantation，auto-HSCT)是部分复发/难治淋巴瘤的首选治疗方案，但其再次复发率仍较高。因此我院血液科骨髓移植病区尝试对自体干细胞移植治疗后高危复发的难治性患者进行巩固化疗，并对其临床疗效进行比较分析。方法：回顾性分析38例接受auto-HSCT治疗的复发/难治性淋巴瘤患者的临床资料。将auto-HSCT治疗后给予巩固化疗的19例患者作为治疗组，与仅接受auto-HSCT治疗的19例进行对照(对照组)。巩固化疗方案为Mini-BEAM或减低剂量CBV，每次化疗间隔2～3个月，共2个疗程。以auto-HSCT为随访起点，比较2组患者无进展生存期(progression-free survival，PFS)和总体生存期(overall survival，OS)的差异。结果：治疗组及对照组中位随访时间分别为17.2和7.5个月。意向性分析显示2组中位PFS分别为24.7和7.8个月，治疗组明显优于对照组(P=0.029)。OS呈现一定差异的趋势(P=0.055)。完成治疗分析显示2组中位PFS分别为24.7和5.2个月，治疗组亦优于对照组(P=0.01)。结论：针对高危恶性淋巴瘤患者，在自体移植基础上进一步予以巩固化疗，可延迟疾病复发、降低复发率，延长患者生存时间。
배경여목적：목전，대제양화료+자체조혈간세포이식(autologous stem cell transplantation，auto-HSCT)시부분복발/난치림파류적수선치료방안，단기재차복발솔잉교고。인차아원혈액과골수이식병구상시대자체간세포이식치료후고위복발적난치성환자진행공고화료，병대기림상료효진행비교분석。방법：회고성분석38례접수auto-HSCT치료적복발/난치성림파류환자적림상자료。장auto-HSCT치료후급여공고화료적19례환자작위치료조，여부접수auto-HSCT치료적19례진행대조(대조조)。공고화료방안위Mini-BEAM혹감저제량CBV，매차화료간격2～3개월，공2개료정。이auto-HSCT위수방기점，비교2조환자무진전생존기(progression-free survival，PFS)화총체생존기(overall survival，OS)적차이。결과：치료조급대조조중위수방시간분별위17.2화7.5개월。의향성분석현시2조중위PFS분별위24.7화7.8개월，치료조명현우우대조조(P=0.029)。OS정현일정차이적추세(P=0.055)。완성치료분석현시2조중위PFS분별위24.7화5.2개월，치료조역우우대조조(P=0.01)。결론：침대고위악성림파류환자，재자체이식기출상진일보여이공고화료，가연지질병복발、강저복발솔，연장환자생존시간。
Background and purpose: High-dose chemotherapy followed by autologous stem cell transplantation (auto-HSCT) is considered as the ifrst line treatment for patients with relapse/refractory lymphoma after conventional chemotherapy. However, most of these patients still relapse the second time. The purpose of this study was to analyze the efifcacy of the consolidation chemotherapy after autologous stem cell transplantation (HSCT) refractory/relapse lymphoma in high risk. Methods:A total of 38 patients with relapsed/refractory lymphoma including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) were included, who were underwent auto-HSCT in our transplan-tation department from Jan. 2010 to Dec. 2013. In treatment group, 19 patients received 2 courses of consolidation che-motherapy after auto-HSCT every 2 to 3 months, with the regimen of mini-BEAM or modiifed mini-CBV. Another 19 patients had no chemotherapy after auto-HSCT as control group. Results:The median follow-up duration was 17.2 and 7.5 months in the treatment and control group respectively. The follow-up data demonstrated prolonged progression-free survival (PFS) in the treatment group than the control group [24.7 months vs 7.8 months, P=0.029 under intend-to-treat analysis ITT;24.7 months vs 5.2 months, P=0.01 under per protocol analysis(pp)]. There is also a trend of improved overall survival (OS) in the treatment group (P=0.055, ITT). Conclusion:Consolidation chemotherapy after auto-HSCT for refractory/relapsed lymphoma patients delay the relapse and tend to improve the overall relapse rate.