异基因造血干细胞移植对化疗耐药的复发/难治外周T细胞淋巴瘤的疗效分析  

Evaluation of clinical outcomes of allogeneic hematopoietic stem cell transplantation for relapsed/refractory peripheral T-cell lymphoma with chemoresistance

作　　者：王璐[1] 李乃农 王昭[3] 吴晓雄[4] 董玉君[5] 付晓瑞[6] 刘耀 胡亮钉 李晓帆 王旖旎[3] 吴亚妹[4] 任汉云[5] 张明智[6] 王买红 李欲航 刘代红[1] 黄文荣[1] Wang Lu;Li Nainong;Wang Zhao;Wu Xiaoxiong;Dong Yujun;Fu Xiaorui;Liu Yao;Hu Liangding;Li Xiaofan;Wang Yini;Wu Yamei;Ren Hanyun;Zhang Mingzhi;Wang Maihong;Li Yuhang;Liu Daihong;Huang Wenrong(Department of Hematology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Hematology,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Hematology,Beijing Friendship Hospital,Hematology Department,Beijing 100050,China;Department of Hematology,the Forth Medical Center of Chinese PLA General hospital,Beijing 100048,China;Department of Hematology,Peking University First Hospital,Beijing 100034,China;Oncology Department,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Hematology,Xinqiao Hospital,Army Medical University,Chongqing 400037,China;Department of Hematological Stem Cell Transplant,the Fifith Medical Center of Chinese PLA General hospital,Beijing 100071,China)

机构地区：[1]解放军总医院第一医学中心血液科,北京100853 [2]福建医学大学附属协和医院血液科,福州350001 [3]首都医科大学附属北京友谊医院血液科,北京100050 [4]解放军总医院第四医学中心血液科,北京100048 [5]北京大学附属第一医院血液科,北京100034 [6]郑州大学第一附属医院肿瘤科,郑州450000 [7]陆军军医大学第二附属医院新桥医院血液科,重庆400037 [8]解放军总医院第五医学中心移植科,北京100071

出　　处：《中华医学杂志》2019年第48期3786-3791,共6页National Medical Journal of China

摘　　要：目的分析异基因造血干细胞移植对化疗耐药的复发/难治外周T细胞淋巴瘤(PTCL)的疗效。方法回顾性收集国内8所三甲教学医院2007至2017年行异基因造血干细胞移植治疗化疗耐药的复发/难治T细胞淋巴瘤患者临床资料,总结分析患者的临床特点及治疗转归。结果共有23例对化疗耐药的复发/难治PTCL患者纳入本研究,其中18例移植前处于疾病进展状态,5例处于疾病稳定状态。23例患者中17例为同胞全合异基因造血干细胞移植,2例为无关供者造血干细胞移植,4例为单倍体异基因造血干细胞移植。存活大于28 d可评估植入的患者21例,其中20例获得稳定的粒系及血小板植入,白细胞中位植入时间为+13 d(9~22 d),血小板中位植入时间为+16 d(10~38 d)。100 d移植相关死亡率为13.1%。11例(47.8%)患者发生急性移植物抗宿主病(aGVHD),中位发生时间为+22 d(+6~82 d),6例为Ⅱ-Ⅳ度aGVHD。移植后存活大于100 d患者15例,其中10例患者发生慢性移植物抗宿主病,中位发生时间为7.9个月(3.5~27个月)。所有纳入研究的复发难治患者移植后中位随访时间29个月(0.3~102个月),13例(56.5%)死亡,中位死亡时间为116 d(21~240 d),其中4例死于移植相关并发症,9例死于疾病复发进展。3年总生存率为43.03%(95%CI:29.79~69.16);3年无进展生存率39.13%(95%CI:23.50~65.14)。移植前疾病状态为疾病进展(PD)的患者与疾病稳定(SD)的患者移植后无进展生存率差异无统计学意义(P=0.113)。结论异基因造血干细胞移植是治疗化疗耐药复发/难治外周T细胞淋巴瘤的有效手段。Objective To evaluate the clinical outcomes in patients with relapsed or refractory peripheral T-cell lymphoma(PTCL)who had undergone allogeneic hematological stem cell transplantation(allo-HSCT).Methods From June 2007 to June 2017,the clinical data of PTCL patients who underwent HSCT from eight hospitals were assessed retrospectively.Results There were 23 patients diagnosed as relapsed or refractory PTCL with chemoresistance who underwent allo-HSCT.Among these patients,18 were identified as progressive disease(PD)status and 5 patients as stable disease(SD)status before allo-HSCT.Seventeen patients received allo-HSCT from matched sibling donor(MSD),2 patients from matched unrelated donor and 4 patients from related haplo-identical donor(HD).After a median follow-up of 29 months,21 patients survived longer than 28 days after allo-HSCT.Hematopoietic reconstitution was achieved in 20 of the 21 patients.The median time of myeloid and platelet engraftment were+13(9-22)d and+16(10-38)d,respectively.The 100-d treatment-related mortality rate was 13.1%.Acute GVHD occurred in 11(47.8%)patients at a median time of 22(6-82)d after transplantation.GradeⅡ~ⅣaGVHD occurred in 6 patients.Chronic GVHD occurred in 10 patients at a median of 7.9(3.5-27)months.After a median follow-up of 29 months,13 patients died after HSCT.Four of them died of complications associated with allo-HSCT,and other 9 patients died of the primary lymphoma.The 3-years cumulative overall survival(OS)and progress-free survival(PFS)were 43.03%(95%CI:29.79-69.16)and 39.13%(95%CI:23.50-65.14),respectively.No significant difference was found in the 3-year PFS between patients with PD status and SD status before allo-HSCT(P=0.133).Conclusion Allo-HSCT can be a promising treatment for relapsed or refractory PTCL with chemoresistance.

关 键 词：淋巴瘤 T细胞 复发 挽救疗法 造血干细胞移植 

分 类 号：R733[医药卫生—肿瘤]