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Objective:To assess the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging and relevant factors in the prognosis of patients with classic Hodgkin lymphoma (cHL) before or after autologous stem cell transplantation (ASCT). Methods:From January 2008 to June 2017, 55 cHL patients (28 males, 27 females; age: (28.8±9.6) years) confirmed by pathology in Shanghai General Hospital were retrospectively included. 18F-FDG PET/CT imaging was performed before ASCT in 43 cases and after ASCT in 34 cases (22 patients underwent the imaging both before and after ASCT). Patients were divided into positive group (≥4) and negative group (<4) according to 18F-FDG PET/CT imaging results using Deauville 5-point scale. The predictive value of relevant factors in the prognosis was evaluated with progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis and log-rank test. Hazard ratio ( HR) was calculated by Cox regression model. Results:Of 55 cHL patients, 29 (53%) had a progression of disease after a median follow-up of 8 months, and 11 (20%) patients died after a median follow-up of 29.5 months, with the 3-year PFS rate of 46.4% and OS rate of 84.5%. Significant differences of PFS rate were found between patients with or without B symptoms, between patients with or without large mediastinal mass, between patients with international prognostic score (IPS) of 0-2 and those with IPS of 3-7, among patients with different effect of salvage chemotherapy (complete remission (CR), partial remission (PR) + stable disease (SD), progressive disease (PD)), and between patients with negative or positive PET/CT imaging results before or after ASCT ( χ2 values: 5.52-20.01, HR: 2.21(95% CI: 1.56-3.12)-5.51(95% CI: 1.86-16.33), all P<0.05). B symptoms and large mediastinal mass were also prognostic factors for OS rate ( HR: 5.28(95% CI: 1.14-24.51) and 4.27(95% CI: 1.24-14.79), both P<0.05). The combination of 18F-FDG PET/CT imaging before and after ASCT was statistically significant for predicting PFS ( χ2=11.28, P<0.01). Multivariate survival analysis showed that the risk of progression in patients with positive PET/CT results after ASCT was significantly higher than those with negative results ( HR=6.20, P<0.01), and the risk of death in patients with B symptoms was significantly higher than those without B symptoms ( HR=5.28, P<0.05). Conclusion:18F-FDG PET/CT imaging results after ASCT have important values for predicting PFS in cHL patients after ASCT, and B symptoms can be used as an important prognostic indicator of OS after ASCT.
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Objective To evaluate the efficacy of haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HSCT) combined with third-party umbilical cord blood (UCB) infusion in treatment of high-risk lymphoblastic malignancies. Methods The clinical data of 20 patients with high-risk lymphoblastic malignancies who received Haplo-HSCT from April 2012 to April 2015 in Shanghai General Hospital were retrospectively analyzed, which were compared with the data from 15 patients who underwent matched unrelated donor HSCT (MUD-HSCT) or 14 matched sibling donor HSCT (MSD-HSCT) during the same period. The efficacy of Haplo-HSCT combined with UCB infusion in treatment of high-risk lymphoblastic malignancies was evaluated. The preparative regimen mainly consisted of teniposide, cyclophosphamide and total body irradiation (TBI). Graft versus host disease (GVHD) preparative regimen included cyclosporine and a short term of methotrexate. The patients who received Haplo-HSCT combined with UCB infusion and MUD-HSCT were treated with antithymocyte globulin (ATG). Results After the transplantation, one patient in MUD-HSCT group and one in MSD-HSCT group died within 21 days, and other patients were engrafted successfully. The median time of neutrophil engraftment was 13 days (10-18 d), 12 days (9-16 d) and 12 days (9-14 d) in Haplo-HSCT + UCB group, MUD-HSCT group and MSD-HSCT group, respectively; the median time of platelets engraftment was 11 days (9-18 d), 12 days (10-23 d) and 12 days (9-14 d), respectively. There were 10, 3, 3 cases of grade Ⅱ-Ⅳacute GVHD at day 100 in the three groups, respectively, and there were 6, 4, 3 cases of chronic GVHD in the three groups, respectively. The 2-year cumulative incidence of relapse was 40.6%, 66.2% and 26.7%, respectively. The predicted 2-year overall survival rate was 37.9%, 42.9% and 55.4%, respectively. All these data had no significant difference (all P＞ 0.05). Conclusion The efficacy of Haplo-HSCT combined with UCB infusion is similar to that of MUD-HSCT or MSD-HSCT in treatment of high-risk lymphoblastic malignancies, which should be recommended to the patients with high-risk lymphoblastic malignancies and without matched donors.
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Objective To evaluate the response rate and survival rates of refractory or relapsed Hodgkin lymphoma (HL) and grey zone lymphoma patients treated with autologous peripheral blood stem cell transplantation (APBSCT).Methods From January 2004 to August 2012,30 HL and grey zone lymphoma patients were retrospectively analyzed.Statistical analysis was done to explore the long term outcome and prognostic factors of patients treated with APBSCT.Among all patients,the median age at transplantion was 30 (13-55) years old.Patients were major with nodular sclerosis HL and in stage Ⅲ/Ⅳ.Results Every patient had a successful collection.The median MNC cell dose infused was 6.8×108/kg [range (1.0-13.8)×108/kg] and median CD34+ cell dose infused was 6.3×106/kg [range (0.6-20.6)×106/kg].Median time to neutrophil engraftment was 9 days (range 8-12 days).28 patients were evaluable after transplantation with a median follow-up of 18.5 months (range 2.5-95.0 months).The overall response rate was 89.3 ％ [CR 64.3 ％ (18/28),PR 25.0 ％ (7/28)].The overall survival (OS) rate and progression free survival (PFS) rate at 5 year would be 78 ％ and 58 ％ for all patients.3 in 7 patients with no remission after salvage chemotherapy with rituximab plus chemotherapy before APBSCT got CR and 2 got PR.Univariate analysis showed that disease status and the number of replacement types of chemotherapy prior to transplantation affected OS,the history of radiotherapy prior to transplantation affected PFS.Conclusion APBSCT can increase CR rate,prolong survival time in patients with refractory or relapsed HL and grey zone lymphoma.Rituximab plus chemotherapy as a salvage therapy could raise CR rate before APBSCT.Chemosensitivity before transplantation affect outcome with APBSCT.Changing many types of chemotherapy is adverse for APBSCT.Salvage radiotherapy before APBSCT is not recommended.