单倍型造血干细胞移植治疗26例复发难治侵袭性非霍奇金淋巴瘤疗效和安全性研究

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.