利妥昔单抗联合自体外周血干细胞移植治疗弥漫大B细胞淋巴瘤的疗效观察
리타석단항연합자체외주혈간세포이식치료미만대B세포림파류적료효관찰
Combination of rituximab with autologous peripheral blood stem cell transplantation for treatment of diffuse large B-cell lymphoma: a single-center experience
  • 万方数据
    中华血液学杂志 중화혈액학잡지
    Chinese Journal of Hematology
    2012年 12期 1033-1037 ,共5页

    梁赜隐%岑溪南%邱志祥%欧晋平%王文生%许蔚林%李渊%王茫桔%董玉君%王莉红%尹玥%孙玉华%刘微%王倩%任汉云

    량색은%잠계남%구지상%구진평%왕문생%허위림%리연%왕망길%동옥군%왕리홍%윤모%손옥화%류미%왕천%임한운

    造血干细胞移植%淋巴瘤,大细胞,弥漫型%利妥昔单抗 造血榦細胞移植%淋巴瘤,大細胞,瀰漫型%利妥昔單抗
    조혈간세포이식%림파류,대세포,미만형%리타석단항
    Hematopoietic stem cell transplantation%Lymphoma,large B-cell,diffuse%Rituximab
    目的 探讨利妥昔单克隆抗体(单抗)联合自体外周血干细胞移植治疗弥漫大B细胞淋巴瘤(DLBCL)的疗效及影响预后的因素.方法 回顾性分析25例接受利妥昔单抗体内净化联合自体外周血干细胞移植治疗的DLBCL患者临床资料.患者中位年龄39(17~61)岁,Ann ArborⅠ~Ⅱ期2例、Ⅲ期3例、Ⅳ期20例,60%患者有B组症状,国际预后指数(IPI)评分低危组、低中危组、高中危组及高危组患者分别为2、11、10及2例.预处理方案采用BEAM方案(21例)及全身照射为主的方案(4例).造血干细胞动员化疗前1 d及化疗后第7天、自体造血干细胞回输前1 d及回输后第8天各输注利妥昔单抗1次,每次剂量为375 mg/m2.结果 自体造血干细胞移植前疾病获得完全缓解(CR)者20例、部分缓解者5例.92%患者于移植后达到CR.中位随访时间45 (2~121)个月,19例无病存活,4例死亡.全组患者3年总生存率及无进展生存(PFS)率分别为78.9%及75.9%,累积复发及进展率为19.1%.20例移植前CR的患者3年总生存率及PFS率分别为87.4%及82.4%,复发率为11.8%.多因素分析显示,移植前是否CR是影响总生存的独立危险因素,而IPI是影响PFS的独立危险因素.结论 利妥昔单抗体内净化联合自体外周血干细胞移植治疗DLBCL的疗效良好.
    목적 탐토리타석단극륭항체(단항)연합자체외주혈간세포이식치료미만대B세포림파류(DLBCL)적료효급영향예후적인소.방법 회고성분석25례접수리타석단항체내정화연합자체외주혈간세포이식치료적DLBCL환자림상자료.환자중위년령39(17~61)세,Ann ArborⅠ~Ⅱ기2례、Ⅲ기3례、Ⅳ기20례,60%환자유B조증상,국제예후지수(IPI)평분저위조、저중위조、고중위조급고위조환자분별위2、11、10급2례.예처리방안채용BEAM방안(21례)급전신조사위주적방안(4례).조혈간세포동원화료전1 d급화료후제7천、자체조혈간세포회수전1 d급회수후제8천각수주리타석단항1차,매차제량위375 mg/m2.결과 자체조혈간세포이식전질병획득완전완해(CR)자20례、부분완해자5례.92%환자우이식후체도CR.중위수방시간45 (2~121)개월,19례무병존활,4례사망.전조환자3년총생존솔급무진전생존(PFS)솔분별위78.9%급75.9%,루적복발급진전솔위19.1%.20례이식전CR적환자3년총생존솔급PFS솔분별위87.4%급82.4%,복발솔위11.8%.다인소분석현시,이식전시부CR시영향총생존적독립위험인소,이IPI시영향PFS적독립위험인소.결론 리타석단항체내정화연합자체외주혈간세포이식치료DLBCL적료효량호.
    Objective This study was aimed to investigate whether incorporation of rituximab into high-dose chemotherapy with autologous peripheral blood stem cell transplantation （auto-PBSCT）could improve the survival of patients with diffuse large B-cell lymphoma (DLBCL), and evaluate the safety of this regimen. MethodsTwenty-five patients (age, 17-61 yrs) with DLBCL were treated with a sequential chemotherapy for remission induction，intensive chemotherapy for mobilization of stem cells, and high-dose chemotherapy followed by auto-PBSCT. Among 25 patients, 22 cases were at Ⅳ Ann Arbor stage, 60% cases with B symptom, and 10 cases with intermediate-high risk and 2 cases with high risk when evaluated by International Prognostic Index (IPI). The high-dose chemotherapy included BEAM regimen for 21 patients, and TBI conditioning regimen for 4 patients. Each patient received infusion of rituximab at a dose of 375 mg/m2 for 2 times, each at peripheral blood stem cell mobilization and peripheral stem cell infusion．Results20 patients achieved complete remission (CR) before transplantation. After high-dose chemotherapy and auto-PBSCT, 92% patients achieved CR．At a median follow-up of 45 months, the estimated 3-year overall survival (OS) and progression-free survival (PFS) were 78.9% and 75.9%, respectively, for all patients; while those were 87.4% and 82.4% for patients achieved CR before auto-PBSCT．Multivariate analysis by Cox regression revealed that failure to achieving CR before auto-PBSCT was an independent prognostic factor affecting OS, while factor affecting PFS was IPI scores. Rituximab was generally well tolerated with few side- effects．ConclusionOur results suggested that the addition of rituximab to high-dose chemotherapy followed by auto-PBSCT was effective and safe for patients with DLBCL.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문