自体外周血干细胞移植联合过继免疫治疗B细胞性非霍奇金淋巴瘤的临床分析

摘要

目的：探讨自体外周血干细胞移植联合过继免疫治疗 B 细胞性非霍奇金淋巴瘤（non －Hodgkin＇s lymphoma，NHL）的疗效。方法：以2000年1月－2009年12月经病理形态学及免疫组织化学检查确诊的78例 B 细胞性 NHL 患者为治疗组，交替应用 CHOP、TAOP 和 MEOP 方案各2个疗程化疗后，以化疗联合重组人粒细胞集落刺激因子方法动员自体外周血干细胞，TBI ＋VEMAC 方案实施预处理，进行自体外周血干细胞移植。造血恢复后每月给予重组人白细胞介素－2100WU ／d ×10天为1个疗程的过继免疫治疗，6个疗程后观察疗效。以1995年1月－1999年12月的52例 B 细胞性 NHL 患者为对照组，化疗及移植方法同上，未给予过继免疫治疗。随访时间5年。结果：治疗组及对照组中各有1例患者在3个月、2个月时分别因肝功衰竭和脑出血死亡，其他患者均获得造血重建。随访1年时，治疗组和观察组患者无病生存（disease free survival， DFS）率分别为96．2％、90．4％（P ＞0．05）。随访3、5年时，两组患者的 DFS 分别为93．6％、88．5％和73．1％、65．4％（P ＜0．01）。随访1年时，两组中 III ／IV 期患者的 DFS 分别为95．2％和88．1％（P ＞0．05）。随访3、5年时，两组中 III ／IV 期患者的 DFS 分别为92．1％、87．3％和69．0％、59．5％（P ＜0．01）。结论：自体外周血干细胞移植联合过继免疫治疗 B 细胞性 NHL 疗效显著，尤其 III ／VI 期患者获益明显。%Objective:To investigate the efficacy treated with autologous peripheral blood stem cell transplantation (APBSCT)combined adoptive immunotherapy in non -Hodgkin's lymphoma(NHL)of B lymphocyte.Methods:A to-tal 78 patients diagnosed as NHL of B lymphocyte by pathology and immunohistochemistry from January 2000 to De-cember 2009,as treatment group,were treated sequentially with chemotherapy regimens(CHOP,TAOP,MEOP)for 2 courses respectively.After that,autologous peripheral blood stem cells were mobilized with chemotherapy combined rhG -CSF,and received APBSCT after conditioning regimen with TBI combined VEMAC.After hematopoietic recon-struction,they were given six courses of adoptive immunotherapy(rhIL -2 100WU /day for 10 days monthly for each course).52 cases of NHL patients of B lymphocyte from January 1995 to December 1999,as control group,received chemotherapy regimens and APBSCT only,but no rhIL -2 adoptive immunotherapy.All patients were followed -up for more than 5 years.Results:There was one patient in each group,who died of liver failure and cerebral hemorrhage respectively within three and two months,and other patients achieved hematopoietic reconstruction.Follow -up 1 year,disease free survival(DFS)rates were 96.2% and 90.4% respectively(P >0.05).Follow -up 3 and 5 years, DFS rates were 93.6%,88.5% and 73.1%,65.4% respectively(P <0.01).Follow -up of 1 year,DFS rates in phase III /IV of two groups were 95.2% and 88.1%(P >0.05).Follow -up of 3 and 5 year,DFS rates in phase III /IV of two groups were 92.1%,87.3% and 69.0%,59.5% respectively(P <0.01).Conclusion:There were obvious efficacy to patients of NHL of B lymphocyte treated with APBSCT combined adoptive immunotherapy,especially to pa-tients with phase III /IV.