Carlsten Mattias, Jädersten Martin, Hellström Anna, Littmann Karin, Melén Christopher M, Junlén Henna Riikka, Sonnevi Kristina, Ljungman Per, Björkstrand Bo, Wahlin Björn Engelbrekt
1Center for Hematology and Regenerative Medicine, Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
2PO Hematology, Karolinska University Hospital, Stockholm, Sweden.
Exp Hematol Oncol. 2019 Mar 18;8:7. doi: 10.1186/s40164-019-0131-3. eCollection 2019.
Autologous stem-cell transplantation (ASCT) is a common treatment for lymphoma but it has some mortality.
All 433 lymphoma patients who underwent ASCT for lymphoma at Karolinska Huddinge 1994-2016 were investigated, including CD34 cell amounts, medications, infectious and other complications, intensive care, longitudinal laboratory values, and secondary myeloid neoplasia.
The 100-day non-relapse and overall mortalities were 5.6% and 7.2%. Stem-cell harvests < 5 million CD34 cells/kg correlated with inferior 100-day and long-term survival. Prior to conditioning (93% BEAM), elevated (both 3-9 and ≥ 10 mg/L) C-reactive protein (CRP) and creatinine, and low albumin (but not higher age) predicted inferior higher 100-day survival. Intravenous antibiotics were given to 97% (22% positive blood cultures) and parenteral nutrition to 89%. After 1 year, 86% had normalized hemoglobin. The 5-year risk for secondary myeloid neoplasia was 4.1%, associated with smaller harvests.
Before starting conditioning, patients should have preferably harvested ≥ 5 million CD34 cells/kg and normal CRP, albumin, and creatinine. It appears safe to transplant patients ≥ 66 years.
自体干细胞移植（ASCT）是淋巴瘤的一种常见治疗方法，但存在一定死亡率。
对1994年至2016年在卡罗林斯卡胡丁厄接受淋巴瘤ASCT的433例淋巴瘤患者进行了调查，包括CD34细胞数量、用药情况、感染及其他并发症、重症监护、纵向实验室检查值以及继发性髓系肿瘤。
100天无复发生存率和总死亡率分别为5.6%和7.2%。干细胞采集量<500万个CD34细胞/kg与100天及长期生存率较低相关。在预处理前（93%为BEAM方案），C反应蛋白（CRP）和肌酐升高（3 - 9mg/L及≥10mg/L）以及白蛋白降低（而非年龄较大）预示着100天生存率较低。97%的患者接受了静脉抗生素治疗（22%血培养阳性），89%的患者接受了肠外营养。1年后，86%的患者血红蛋白恢复正常。继发性髓系肿瘤的5年风险为4.1%，与采集量较小有关。
在开始预处理前，患者最好采集≥500万个CD34细胞/kg，且CRP、白蛋白和肌酐正常。对66岁及以上患者进行移植似乎是安全的。
