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序贯放化疗后自体外周血干细胞移植治疗鼻型结外NK/T细胞淋巴瘤的疗效

[Curative efficacy for nasal type extranodal NK/T-cell lymphoma by autologous peripheral blood stem cell transplantation after sequencing chemotherapy and radiotherapy].

作者信息

Wang Cun-Bang, Bai Hai, Xi Rui, Pan Yao-Zhu, Xu Shu-Fen, Zhang Qian, Chen Yan, Zhou Jin-Mao

机构信息

Department of Hematology, Lanzhou General Hospital of Lanzhou Military Command, Hematological Center of Chinese PLA, Lanzhou 730050, Gansu Province, China.

Department of Hematology, Lanzhou General Hospital of Lanzhou Military Command, Hematological Center of Chinese PLA, Lanzhou 730050, Gansu Province, China. E-mail:

出版信息

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2013 Dec;21(6):1477-81. doi: 10.7534/j.issn.1009-2137.2013.06.020.

Abstract

The purpose of this study was to explore the curative efficacy for nasal type extranodal NK/T-cell lymphoma by autologous peripheral blood stem cell transplantation (APBSCT) after sequencing chemotherapy and radiotherapy. A total 65 cases diagnosed as nasal type extranodal NK/T-cell lymphoma by pathology and immuno-histochemistry were treated with chemotherapy and radiotherapy in our hospital from January of 2000 to December of 2009. They were divided into observation group (34 cases) and transplantation group (31 cases). The 34 cases of observation group were ceased from treatment, the 31 cases in transplantation group received APBSCT after conditioning regimen with TBI combined VEMAC. Autologous peripheral blood stem cells were mobilized with chemotherapy combined rhG-CSF. The patients were followed up for 3-5 years. The results showed that some side-effects such as bone marrow suppression and injure of oral cavity mucosa were found in patients after sequencing chemotherapy and radiotherapy. All patients in transplantation group obtained hematopoietic reconstruction, and there were no any special side effect such as VOD. In transplantation group, the median time of ANC ≥ 0.5×10(9)/L was 14 (11-17) days, median time of WBC count ≥ 4.0×10(9)/L was 17 (16-20) days, median time of Plt count ≥ 50×10(8)/L were 25 (23-28) days. After chemotherapy and radiotherapy, effective rate of treatment was 91.2% in observation group, whereas was 90.3% in transplantation group, there were no obvious difference between two groups (P > 0.05). After following up about 1 year, effective rate of treatment was 76.5% in observation group, whereas was 96.8% in transplantation group, there were obvious difference between two groups (P < 0.05). After following up about 3 years and 5 years the disease-free survival (DFS) was 61.3%, 43.5% and 87.1%, 81.5% in observation group and transplantation group, there was significant difference between two groups (P < 0.05). It is concluded that treatment with APBSCT after sequencing chemotherapy and radiotherapy for nasal type extranodal NK/T-cell lymphoma may increase DFS efficiently.

摘要

本研究旨在探讨序贯化疗和放疗后行自体外周血干细胞移植(APBSCT)治疗鼻型结外NK/T细胞淋巴瘤的疗效。2000年1月至2009年12月,我院共收治65例经病理及免疫组化确诊为鼻型结外NK/T细胞淋巴瘤的患者,将其分为观察组(34例)和移植组(31例)。观察组34例停止治疗,移植组31例在采用TBI联合VEMAC预处理方案后接受APBSCT。采用化疗联合重组人粒细胞集落刺激因子(rhG-CSF)动员自体外周血干细胞。对患者进行3至5年的随访。结果显示,序贯化疗和放疗后患者出现了骨髓抑制和口腔黏膜损伤等不良反应。移植组所有患者均获得造血重建,且未出现诸如肝静脉闭塞病(VOD)等特殊不良反应。移植组中性粒细胞绝对值(ANC)≥0.5×10⁹/L的中位时间为14(11 - 17)天,白细胞计数(WBC)≥4.0×10⁹/L的中位时间为17(16 - 20)天,血小板计数(Plt)≥5×10⁸/L的中位时间为25(23 - 28)天。化疗和放疗后,观察组治疗有效率为91.2%,移植组为90.3%,两组间差异无统计学意义(P > 0.05)。随访约1年后,观察组治疗有效率为76.5%,移植组为96.8%,两组间差异有统计学意义(P < 0.05)。随访约3年和5年后,观察组无病生存率(DFS)分别为61.3%、43.5%,移植组分别为87.1%、81.5%,两组间差异有统计学意义(P < 0.05)。结论是,序贯化疗和放疗后行APBSCT治疗鼻型结外NK/T细胞淋巴瘤可有效提高无病生存率。

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