自体造血干细胞移植治疗复发、难治性经典型霍奇金淋巴瘤的疗效观察

向茜茜; 刘耀; 高力; 李佳丽; 孔佩艳; 刘红; 高蕾; 张诚; 文钦; 彭贤贵; 孙爱华; 张曦

doi:10.16016/j.1000-5404.201708193

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自体造血干细胞移植治疗复发、难治性经典型霍奇金淋巴瘤的疗效观察

临床医学 | 更新时间：2026-01-09

- 自体造血干细胞移植治疗复发、难治性经典型霍奇金淋巴瘤的疗效观察
- Efficacy of autologous hematopoietic stem cell transplantation in treatment of relapsed and/or refractory classical Hodgkin lymphoma
- 第三军医大学学报 2017年39卷第20期页码：2010-2016
- 作者机构：
  
  400037 重庆, 第三军医大学新桥医院全军血液病中心
- 作者简介：
  
  [张曦, 电话: (023)68755609, E-mail: zhangxxi@sina.com ZHANG Xi, Tel: 86-23-68755609, E-mail: zhangxxi@sina.com
- 基金信息：
  
  重庆市社会事业与民生保障科技创新专项(CSTC2016shms-ztzx10003);全军后勤科研“十二五”计划重大项目(AWS14C014)
- DOI：10.16016/j.1000-5404.201708193
  中图分类号： R181.32;R617;R733.1
- 收稿：2017-08-18，
  
  修回：2017-09-04，
  
  纸质出版：2017-10-30
- 稿件说明：
移动端阅览
向茜茜, 刘耀, 高力, 等. 自体造血干细胞移植治疗复发、难治性经典型霍奇金淋巴瘤的疗效观察[J]. 第三军医大学学报, 2017,39(20):2010-2016.

Xixi XIANG, Yao LIU, Li GAO, et al. Efficacy of autologous hematopoietic stem cell transplantation in treatment of relapsed and/or refractory classical Hodgkin lymphoma[J]. Journal of Third Military Medical University, 2017, 39(20): 2010-2016.
向茜茜, 刘耀, 高力, 等. 自体造血干细胞移植治疗复发、难治性经典型霍奇金淋巴瘤的疗效观察[J]. 第三军医大学学报, 2017,39(20):2010-2016. DOI： 10.16016/j.1000-5404.201708193.

Xixi XIANG, Yao LIU, Li GAO, et al. Efficacy of autologous hematopoietic stem cell transplantation in treatment of relapsed and/or refractory classical Hodgkin lymphoma[J]. Journal of Third Military Medical University, 2017, 39(20): 2010-2016. DOI： 10.16016/j.1000-5404.201708193.

摘要

目的

评价自体外周血造血干细胞移植对复发、难治性的经典型霍奇金淋巴瘤治疗疗效，并探讨临床预后因素。

方法

对本中心2000-2013年所有复发、难治性经典型霍奇金淋巴瘤97例患者进行回顾性分析，随访至少12个月。按治疗方法分为自体造血干细胞移植组(

=52) 和未移植继续放化疗组(

=45)。分析两组患者的临床特征及疗效，Kaplan-Meier法行生存分析，COX逐步回归进行多因素预后分析。

结果

移植组出现Ⅳ级骨髓抑制、消化道反应及粒细胞缺乏伴发热的发生率明显高于未移植组(

0.05)，其余并发症的发生率差异无统计学意义(

0.05)。中位随访56(12~158) 个月，移植组死亡6例，病死率11.5%，3年无进展生存率(progression-free survival

PFS)为(78.6±6.20)%

总生存率(overall survival

OS)为(85.9±5.5)%；未移植组死亡21例，病死率46.6%，3年PFS为(43.1±7.60)%

OS为(54.1±8.1)%。移植组3年OS及PFS均明显优于未移植组(

0.05)。移植前行正电子发射计算机断层显像(positron emission tomography

PET)检查，PET阴性评判为CR的患者，其PFS明显优于PET阳性的患者(

=0.021)，而对于OS差异无统计学意义(

=0.077)。COX多因素分析显示，未采用ASCT、LDH值高于正常、有骨髓侵犯是影响PFS的危险因素；而未采用ASCT、LDH值高于正常、国际预后评分≥3以及有骨髓侵犯是影响OS的危险因素。

结论

自体造血干细胞移植在治疗复发、难治性霍奇金淋巴瘤的疗效肯定，其安全性较好，在我国可作为复发、难治性经典型霍奇金淋巴瘤有效的治疗方案。

Abstract

Objective

To determine the therapeutic effect of autologous hematopoietic stem cell transplantation (ASCT) in treatment of relapsed and/or refractory classical Hodgkin lymphoma (RR-CHL)

and investigate the prognostic factors.

Methods

Clinical data of 97 RR-CHL patients treated in our center from January 2000 to December 2013 who were followed up for at least 12 months

were collected and retrospectively in this study. According to their treatment methods

they were divided into ASCT group (

=52) and non-transplantation group (

=45

undergoing chemotherapy). The clinical characteristics and efficacies of the treatments were analyzed between the 2 groups. Kaplan-Meier survival analysis and COX regression model were used respectively for their survive and prognostic factors.

Results

The incidences of fever

neutropenia

severe bone marrow suppression

and gastrointestinal adverse reactions were obviously higher in the ASCT group than the non-transplantation group (

0.05)

but no such difference was seen in those of other complications (

0.05). In the median follow-up period of 56 (12~158) months

6 cases from the ASCT group died

with

mortality of 11.5%

and the 3-year progression-free survival (PFS) was (78.6±6.20)%

and over survival (OS) was (85.9±5.5)%. And in the non-t

ransplantation group

21 patients (46.6%) died

the 3-year PFS was (43.1±7.60)%

and the OS was (54.1±8.1)%. The 3-year OS and PFS in the ASCT group were obviously better than those in the non-transplantation group (

0.05). For the patients with negative results of pre-transplantation Positron emission tomography (PET) and evaluated as complete remission (CR)

they had better PFS than those with positive results of PET (

=0.021)

but had no significant OS difference (

=0.077). Multivariate regression analysis showed that the main risk factors of PFS were non-adopt ASCT

LDH value higher than normal

and bone marrow involvement. The main risk factors of OS were non-adopt ASCT

LDH value higher than normal

international prognostic score (IPS) ≥3 and bone marrow involvement.

Conclusion

ASCT is safe and effective in the treatment of RR-CHL. It should be recommended as one of effective treatment of RR-CHL in clinical practice.

关键词

Keywords

references

ARMITAGE J O. Early-stage hodgkin's iymphoma[J]. N Engl J Med, 2010, 363(7): 653-662. DOI: 10.1056/NEJMra1003733.

LAZARUS H M, ROWLINGS P A, ZHANG M J, et al. Autotransplants for hodgkin's disease in patients never achieving remission: a report from the autologous blood and marrow transplant registry[J]. J Clin Oncol, 1999, 17(2): 534-545. DOI: 10.1200/JCO.1999.17.2.534.

KURUVILLA J, KEATING A, CRUMP M. How I treat relapsed and refractory Hodgkin lymphoma[J]. Blood, 2011, 117(16): 4208-4217. DOI: 10.1182/blood-2010-09-288373.

SUREDA A, PEREIRA M I, DREGER P, et al. The role of hematopoietic stem cell transplantation in the treatment of relapsed/refractory Hodgkin's lymphoma[J]. Curr Opin Oncol, 2012, 24(6): 727-732. DOI: 10.1097/CCO.0b013e32835955 7e.

MEIGNAN M, GALLAMINI A, HAIOUN C, et al. Report on the second International workshop on interim positron emission tomography in lymphoma held in menton, france, 8-9 april 2010[J]. Leuk Lymphoma, 2010, 51(12): 2171-2180. DOI: 10. 3109/10428194.2010.529208.

MEIGNAN M, GALLAMINI A, ITTI E, et al. Report on the third international workshop on interim positron emission tomography in lymphoma held in menton, france, 26-27 september 2011 and menton 2011 consensus[J]. Leuk Lymphoma, 2012, 53(10): 1876-1881. DOI: 10.3109/ 10428194.2012.677535.

李佳丽, 刘耀, 文钦, 等.双次自体造血干细胞移植治疗T淋巴母细胞淋巴瘤21例的临床疗效观察[J].第三军医大学学报, 2016, 38(12): 1350-1355. DOI: 10.16016/j.1000-5404. 201601148.

LI J L, LIU Y, WEN Q, et al. Double autologous peripheral blood stem cells transplant for 21 patients with lymphoblastic lymphoma[J]. J Third Mil Med Univ, 2016, 38(12): 1350-1355. DOI: 10.16016/j.1000-5404.201601148.

CARELLA A M, BELLEI M, BRICE P, et al. High-dose therapy and autologous stem cell transplantation versus conventional therapy for patients with advanced Hodgkin's lymphoma responding to front-line therapy: long-term results[J]. Haematologica, 2009, 94(1): 146-148. DOI: 10.3324/haematol.13484.

LINCH D C, WINFIELD D, GOLDSTONE A H, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial[J]. Lancet, 1993, 341(8852): 1051-1054. DOI: 10.1016/0140-6736(93)92411-l.

SCHMITZ N, PFISTNER B, SEXTRO M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive hodgkin's disease: a randomised trial[J]. Lancet 2002, 359: 2065-2071. DOI: 10.1016/S0140-6736(02)08938-9.

RANCEA M, MONSEF I, VON TRESCKOW B, et al. High-dose chemotherapy followed by autologous stem cell transplantation for patients with relapsed/refractory Hodgkin lymphoma[J]. Cochrane Database Syst Rev, 2013, 6: D9411. DOI: 10.1002/14651858.CD009411.pub2.

万文丽, 田磊, 克晓燕, 等. 62例霍奇金淋巴瘤患者临床特征与预后分析[J].中华血液学杂志, 2013, 34(7): 618-621. DOI: 10.3760/cma.j.issn.0253-2727.2013.07.013.

WAN W L, TIAN L, KE X Y, et al. Clinical characteristics and prognostic factors of 62 cases with Hodgkin lymphoma[J]. Chin J Hema, 2013, 34(7): 618-621. DOI: 10.3760/cma.j.issn.0253-2727.2013.07.013.

DI IANNI M, BALLANTI S, IODICE G, et al. High-dose thiotepa, etoposide and carboplatin as conditioning regimen for autologous stem cell transplantation in patients with high-risk hodgkin's lymphoma[J]. Hematology, 2012, 17(1): 23-27. DOI: 10.1179/102453312X13221316477534.

REECE D E, NEVILL T J, SAYEGH A, et al. Regimen-related toxicity and non-relapse mortality with high-dose cyclophosphamide, carmustine (BCNU) and etoposide (VP16-213) (CBV) and CBV plus cisplatin (CBVP) followed by autologous stem cell transplantation in patients with hodgkin's disease[J]. Bone Marrow Transplant, 1999, 23(11): 1131-1138. DOI: 10.1038/sj.bmt.1701790.

WILLIAM B M, LOBERIZA F R Jr, WHALEN V, et al. Impact of conditioning regimen on outcome of 2-year disease-free survivors of autologous stem cell transplantation for Hodgkin lymphoma[J]. Clin Lymphoma Myeloma Leuk, 2013, 13(4): 417-423. DOI: 10.1016/j.clml.2013.03.009.

CERCI J J, PRACCHIA L F, LINARDI C C, et al. 18F-FDG PET after 2 cycles of ABVD predicts event-free survival in early and advanced Hodgkin lymphoma[J]. J Nucl Med, 2010, 51(9): 1337-1343. DOI: 10.2967/jnumed.109.073197.

MOSKOWITZ A J, YAHALOM J, KEWALRAMANI T, et al. Pretransplantation functional imaging predicts outcome following autologous stem cell transplantation for relapsed and refractory Hodgkin lymphoma[J]. Blood, 2010, 116(23): 4934-4937. DOI:10.1182/blood-2010-05-282756.

MOSKOWITZ C H, MATASAR M J, ZELENETZ A D, et al.Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma[J]. Blood, 2011, 119(7): 1665-1670. DOI: 10.1182/blood-2011-10-388058.

YOUNES A, BARTLETT N L, LEONARD J P, et al. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas[J]. N Engl J Med, 2010, 363(19): 1812-1821. DOI: 10.1056/NEJMoa1002965.

YOUNES A, GOPAL A K, Smith S E, et al. Results of a pivotal phase Ⅱ study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma[J]. J Clin Oncol, 2012, 30(18): 2183-2189. DOI: 10.1200/JCO.2011.38.0410.

[National Comprehensive Cancer Network v1.2017 guideline on Hodgkin lymphoma[G/OL ] [2017-3-1 ] . http://www.nccn.org/professionals/physician_gls/f_guidelines.asp http://www.nccn.org/professionals/physician_gls/f_guidelines.asp . Accessed March 1, 2017.

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