【摘要】 目的 探討對自體造血干細胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后復發的非霍奇金淋巴瘤患者再進行異基因造血干細胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治療的臨床療效。 方法 收集2000年1月-2010年12月難治性惡性淋巴瘤采用auto-HSCT后復發患者11例，病程27個月~6.5年。所有患者在auto-HSCT前均為復發難治性病例，auto-HSCT后，完全緩解8例，部分緩解3例，自體移植后中位復發時間15個月，患者復發后采用異基因親緣造血干細胞移植，人類白細胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性別相同6例，性別不同5例。預處理方案為FBC方案，即氟達拉濱30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，環磷酰胺120 mg/kg分2 d使用。移植物均為外周血造血干細胞加骨髓。移植物抗宿主病（graft-versus-host disease，GVHD）的預防：HLA全相合采用環孢素+短程甲氨蝶呤+嗎替麥考酚酯，不全相合采用抗胸腺細胞球蛋白+環孢素+短程甲氨蝶呤+嗎替麥考酚酯。 結果 11例患者全部獲得造血重建，急性GVHD發生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；發生慢性GVHD 7例（63.64%），其中有2例急性GVHD轉為慢性，4例局限型，3例廣泛型。隨訪8個月~9年，有4例分別于移植后8、15、21、34個月疾病復發，另外6例仍生存。 結論 allo-HSCT對于auto-HSCT后復發的非霍奇金淋巴瘤患者仍是一種有效的挽救性治療手段。【Abstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
Objective
To investigate ultrasonography features of primary thyroid non-Hodgkin lymphoma (PT-NHL).
Methods
Ultrasonographic data of patients with PT-NHL(PT-NHL group) and non-Hodgkin lymphoma (control group) who were treated in our hospital from May. 2002 to Jul. 2014 were collected and analyzed.
Results
Compared with control group, enhancement of posterior echoes was more common in PT-NHL group (P=0.000), and difference values of transverse diameters, anteroposterior diameters, and sagittal diameters of more involved lobe to another lobe were bigger(P < 0.05), but echo pattern of gland, ultrasonographic classification of lesions, classification of vascularity, and condition of cervical lymph nodes were found no statistical difference(P > 0.05). In patients with nodular-type lesions(37 patients in PT-NHL group and 12 patients in control group), length of nodule lesions was larger in PT-NHL group (P=0.000), but there was no statistical difference in shape, boundary, orientation, and echoes of nodules between 2 groups(P > 0.05). In Pulsed-Wave(PW) Doppler between 2 groups(17 patients in PT-NHL group and 4 patients in control group), vascular resistance index(RI) was higher in PT-NHL group than those of control group (P=0.024).
Conclusion
The enhancement of posterior echoes was a feature in ultrasonography images of PT-NHL. Asymmetrical volume, high value of RI, and big nodule might link to PT-NHL, but diffuse heterogeneous echo with hypoechoic lesions might result in wrong diagnosis as PT-NHL.
Objective To systematically evaluate the pharmacoeconomic vaule of chemotherapy combined with rituximab for patients with non-Hodgkin’s lymphomas (NHL). Methods A systematic literature search of cost-effectiveness studies on rituximab treating NHL published from 1998 to 2012 was carried out in following databases: PubMed, ScienceDirect, Health Technology Assessment (HTA) and Cochrane Database of Systematic Reviews (CDSR). And the references of included studies were also retrieved manually. The studies were screened according to the pre-designed inclusion and exclusion criteria, and the incremental cost- effectiveness ratio (ICER) in comparison between chemotherapy plus rituximab and chemotherapy alone was systematically evaluated according to the literature evaluation index system. Results The average ICER of Rituximab treating NHL was 16 318/QALY, 17 688/QALY, and 22 461/QALY in the UK, Mainland Europe, and US, respectively. All the reported ICERs in the included studies were below the implemented country-specific thresholds. Conclusion Based on present foreign literature, the integrated therapy of chemotherapy and rituximab for NHL is supposed to be a better cost-effective therapy with ICER below the implemented country-specific thresholds.
Objective To evaluate the effectiveness and safety of chemotherapy regimens represented by pirarubicin (THP) vs. adriamycin hydrochloride (ADM) for non-Hodgkin lymphoma (NHL) in mainland China. Methods The randomized controlled trials (RCTs) about THP vs. ADM for treating NHL were collected in the databases such as CNKI, CBM, VIP and WanFang Data, and the references of the included studies were also retrieved manually, with the retrieval time from January 1989 to September 2012. According to the inclusion and exclusion criteria, two reviewers independently screened articles, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 15 RCTs involving 1 659 patients were included. The results of meta-analysis showed that: a) As for the total effective rate, the CTOP (C: cyclophosphamide, T: pirarubicin, O: vincristine, P: prednison) regimen was superior to the CHOP (C: cyclophosphamide H: adriamycin hydrochloride, O: vincristine, P: prednison) regimen with a significant difference (OR=1.07, 95%CI 1.02 to 1.12, P=0.006); and b) As for the safety, there were significant differences between the two groups in the incidence of cardiac toxicity (OR=0.42, 95%CI 0.30 to 0.57, Plt;0.000 01), gastrointestinal tract response (OR=0.69, 95%CI 0.56 to 0.85, P=0.000 5) and liver damage (OR=0.69, 95%CI 0.48 to 1.00, P=0.05). But no significant differences were found between the two groups in the incidence of mye1osuppression: the decreased hemoglobin (OR=0.83, 95%CI 0.61 to 1.14, P=0.25), leucopenia (OR=0.85, 95%CI 0.68 to 1.07, P=0.17), and thrombocytopenia (OR=0.99, 95%CI 0.70 to 1.39, P=0.95). Conclusion Based on the domestic evidences at current and compared with CHOP regimen represented by ADM, CTOP regimen represented by THP for treating NHL shows a higher total effective rate and less side effects. However, more high quality, large sample and double blind RCTs are required to prove this conclusion for the quality and quantity limitation of the included studies.
