Objective: To explore the efficacy and safety of haploidentical hematopoietic stem cell transplantation (Haplo- HSCT) for refractory, relapsed or highly aggressive non- Hodgkin lymphoma (NHL) patients.
Methods: A total of 26 patients with refractory, relapsed or highly aggressive NHL who received Haplo- HSCT from Jan. 2004 to Mar. 2015 were analyzed retrospectively.
Results: Of them, 4 patients had diffuse large B-cell lymphoma (DLBCL), 1 had follicular lymphoma, 5 had B-lymphoblastic lymphoma/leukemia, 9 had T- lymphoblastic lymphoma/leukemia, 1 patient anaplastic large cell lymphoma (ALK-negative), 5 had peripheral T-cell lymphoma (NOS), and 1 had NK/T-cell lymphoma. At the time of initial diagnosis, 6 patients had Ann Arbor stage Ⅲ disease, 20 patients showed stage Ⅳ. At the time of Haplo- HSCT, 7 patients were in the first complete remission (CR1), 4 in the second complete remission (CR2), 7 in partial remission, 1 in stable disease, 7 in progressive disease, and 19 of 26 patients were refractory or relapsed. The neutrophil and platelet counts recovered at 12 (11-17) d and 14 (11-31) d after Haplo- HSCT, respectively. All patients achieved full donor chimerism at 30d after Haplo- HSCT. With a median follow- up of 14 (4- 136) months, 20 cases (76.92%) survived, 15 (57.69%) survived without lymphoma, and 7 (26.92%) relapsed. Conditioning regimen related adverse reactions were all disappeared after treatment. The estimated 2-year recurrence rate after Haplo-HSCT was 42.20%. The estimated 2-year overall survival (OS) and disease-free survival (DFS) rate was 71.60% and 48.90%, respectively. Patients in CR before Haplo- HSCT experienced better 2- year OS (100.0% vs 52.4%, P=0.023) and 2- year DFS (88.9% vs 27.0%, P=0.013).
Conclusion: Haplo- HSCT may effective and safe for those relapsed, refractory or highly aggressive NHL patients who did not have matched donor nor suitable for autologous HSCT.
目的: 探讨单倍型造血干细胞移植（Haplo-HSCT）治疗复发难治侵袭性非霍奇金淋巴瘤（NHL）患者的疗效和安全性。
方法: 回顾性分析2004年1月至2015年3月采用亲缘Haplo-HSCT治疗的26例复发难治侵袭性NHL患者临床资料。
结果: 26例患者中弥漫大B细胞淋巴瘤（DLBCL）4例，滤泡性淋巴瘤1例，B淋巴母细胞淋巴瘤／白血病5例，T淋巴母细胞淋巴瘤／白血病9例，间变性大细胞淋巴瘤（ALK阴性）1例，外周T细胞淋巴瘤（非特指型）5例，NK/T细胞淋巴瘤1例。Ann Arbor分期：Ⅲ期6例，Ⅳ期20例。26例患者移植前状态：第1次完全缓解（CR1) 7例，第2次完全缓解（CR2）4例，部分缓解（PR）7例，疾病稳定（SD）1例，疾病进展（PD）7例。其中复发难治性病例19例。移植后26例患者均获粒系造血重建，粒细胞中位植入时间为12(11~17) d。25例患者获巨核系造血重建，血小板中位植入时间为14(11~31) d。所有患者在+30 d经植入鉴定证实为完全供者嵌合体。中位随访时间14(4~136）个月，26例患者中20例（76.92%）存活，15例（57.69%）无病存活，7例（26.92%）复发（其中2例死亡，5例存活）。预处理相关不良反应经对症处理后症状均消失。Haplo-HSCT后2年累积复发率为42.20%；2年总生存（OS）率为71.60%；2年无病生存（DFS）率为48.90%。移植前CR患者移植后2年OS与DFS率均明显高于移植前未达CR的患者（OS：100.0％对52.4%，P=0.023；DFS：88.9％对27.0%，P=0.013）。
结论: 对于不适合行自体造血干细胞移植且无完全相合供者的复发难治侵袭性NHL患者，尝试进行Haplo-HSCT有效、安全。