| Objective: To explore the effect and prognostic factors of autologous hematopoietic stem cell transplantation in the treatment of hematological malignancies.Methods: A retrospective analysis was performed on 215 cases of autologous hematopoietic stem cell transplantation due to malignant hematological diseases in the 940 th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army from January 1983 to December 2019.Peripheral blood stem cells were mobilized using cyclophosphamide(Cy)combined with etoposide(VP-16)chemotherapy and G-CSF.Conditioning regimen: TBI and VEM/IAC as conditioning regimen for malignant lymphoma,acute leukemia,and extramedullary plasmacytoma patients.And 10 cases of multiple myeloma received busulfan and VP-16 and Cy(BVC)regimen,5 cases of multiple myeloma received bortezomib(P)and BVC regimen,5 cases of multiple myeloma received bortezomib(P)and melphalan,7 case of multiple myeloma received melphalan;1 case of solitary plasmacytoma received BVC regimen.The overall survival(OS),progression free survival(PFS),and the relapse rate(RR)were analyzed.SPSS 25.0 statistical software was used for statistical processing,nonparametric test was used for the multi classification data.The OS and DFS of patients were calculated by Kaplan-Meier method,and the comparison between groups was tested by Log rank test.The multivariate analysis affecting OS and DFS was analyzed by Cox proportional risk regression model.P <0.05 was considered statistically significant.Results: Of the 215 patients with auto-HSCT in this study,33 patients underwent autologous bone marrow transplantation(ABMT)and 182 patients underwent autologous peripheral blood stem cell transplantation(APBSCT).There were 169 cases of malignant lymphoma(ML)[119 cases of non-Hodgkin lymphoma(NHL),47 cases of Hodgkin lymphoma(HL),3 cases of gray zone lymphoma(GZL)],27 cases of multiple myeloma(MM),2 cases of plasmacytoma(1 case of extramedullary plasmacytoma,1 case of solitary plasmacytoma),1 case of NHL with extramedullary plasmacytoma,10 cases of acute lymphoblastic leukemia(ALL)(Ph + 1 case),5 cases of acute myeloid leukemia [1 case of M2,1 case of M3(PML / RAR? negative),2 cases of M5,1 case of granulosa sarcoma],1 case of Langerhans cell histiocytosis(LCH).The median age was 34 years(11 to 61 years),including 148 males and 67 females.The median follow-up time was 36 months(0 to 426 months).Except for one patient who died of acute pulmonary edema after reinfusion of autologous peripheral blood stem cells,and one patient who died of fungal sepsis on the 9th day after transplantation,the remaining 213 patients received hematopoietic reconstruction.The median time for neutrophil reconstruction was +12(+8 to +33)days,and the median time for platelet reconstruction was +13(0 to +73)days.The hematopoietic reconstruction of ABMT was slower than that of APBSCT(P < 0.05).The 3-year and 5-year OS rates were 79.9% and 74.9%,and 3-year and 5-year PFS rates were 66.9% and 63.2% respectively.The rate of recurrence was 26.98%(58/215),and transplant-related mortality(TRM)was 3.72%(8/215).Among the 76 patients with PR,NR,progression or recurrence before transplantation,51 patients achieved CR after transplantation,and the effective remission rate was 67.11%.Univariate analysis showed that the gender,age of transplantation,and course of pre-transplantation had no significant effect on the long-term survival of transplant patients(P> 0.05).The source of stem cells had effect on the 3-year OS and PFS of the patient.The 3 years OS and PFS of autologous peripheral blood stem cell transplantation are better than those of autologous bone marrow transplantation.Diagnosis had effect on the 3 years OS,the 3 years OS in patients with ML and MM after transplantation was better than patients with AL,and the 3 years OS was 81.0%,73.2%,50.8%,respectively.The pre-transplant disease status affected 3 years PFS,the 3 years PFS of CR and PR before transplantation was better than that of NR,PD and relapse patients.Multivariate analysis showed that acute leukemia was an independent risk factor for OS of patients,and the relative risk(RRs)was 4.397(95% CI,1.716-11.268)(P <0.05).And the no remission,recurrence,and progression before transplantation was an independent risk factor for PFS of patients,the relative risk(RRs)was 2.718(95% CI,1.283-5.754)(P <0.05).Conclusions: Autologous hematopoietic stem cell transplantation is safe and effective in the treatment of hematological malignancies.It can be used as a consolidation treatment for patients with hematological malignancies after induction of remission.And some patients can achieve long-term survival after transplantation.For patients with relapsed or refractory hematological malignancies or patients without remission before transplantation,autologous hematopoietic stem cell transplantation can be used as a salvage treatment to improve the remission rate,prolong the survival period and improve the quality of life. |
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