异基因造血干细胞移植治疗T淋巴母细胞白血病/淋巴瘤的疗效及预后因素  

Efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation treatment for T lymphoblastic leukemia/lymphoma

作　　者：罗澜 焦阳 杨萍[1] 李艳 黄文阳 克晓燕[1] 邹德慧 景红梅[1] Luo Lan;Jiao Yang;Yang Ping;Li Yan;Huang Wenyang;Ke Xiaoyan;Zou Dehui;Jing Hongmei(Department of Hematology,Peking University Third Hospital,Beijing 100191,China;Institute of Hematology and Blood Diseases Hospital,Chinese Academy of Medical Sciences,National Clinical Research Center for Blood Diseases,State Key Laboratory of Experimental Hematology,Tianjin 300020,China)

机构地区：[1]北京大学第三医院血液科,北京100191 [2]中国医学科学院血液病医院(中国医学科学院血液学研究所),天津300020

出　　处：《中华血液学杂志》2023年第5期388-394,共7页Chinese Journal of Hematology

摘　　要：目的探讨T淋巴母细胞白血病/淋巴瘤(T-ALL/LBL)采用异基因造血干细胞移植(allo-HSCT)作为巩固治疗的疗效及预后因素。方法收集2006年1月至2020年1月北京大学第三医院血液科和中国医学科学院血液病医院收治的119例T-ALL/LBL患者的临床资料。根据巩固治疗方案将患者分为单纯化疗组、化疗序贯异基因造血干细胞移植(allo-HSCT)组、化疗序贯自体造血干细胞移植(auto-HSCT)组,比较各组的5年总生存(OS)率、无进展生存(PFS)率。结果有效随访的113例患者中,79例(69.9%)诱导治疗后达完全缓解(CR),17例(15.0%)达部分缓解(PR),治疗总反应率(ORR)达84.9%。诱导治疗获得CR或PR的患者中,化疗序贯allo-HSCT组较单纯化疗组具有更高的5年OS率(55.6%对11.4%,P=0.001)和5年PFS率(54.2%对8.9%,P<0.001),而化疗序贯allo-HSCT组与化疗序贯auto-HSCT组比较5年OS率及5年PFS率差异均无统计学意义(P=0.271,P=0.197)。对获得CR的患者进行分析得出同样结论。在仅获得PR患者中,化疗序贯allo-HSCT组仍然较单纯化疗组显示出生存优势(5年OS率分别为37.5%和0,P=0.064)。不同供者来源的allo-HSCT患者5年OS率差异无统计学意义(同胞全相合移植、单倍体移植、无关供者移植分别为61.1%、63.6%和50.0%,P>0.05)。早期前体T淋巴细胞白血病(ETP-ALL)患者的诱导化疗缓解率和非ETP-ALL患者比较差异无统计学意义,单纯化疗组中ETP-ALL患者较非ETP-ALL患者5年OS率更低(0对12.6%,P=0.045),而在进行allo-HSCT的患者中,ETP-ALL患者与非ETP-ALL患者5年OS率差异无统计学意义(75.0%对62.9%,P=0.852)。诱导治疗未达CR、巩固治疗未采用移植、LDH≥2倍正常值上限为独立预后不良因素(P值均<0.05)。结论allo-HSCT可改善T-ALL/LBL患者预后,无论是对诱导治疗达CR还是PR患者,均可作为有效的巩固治疗方法。供者来源不影响allo-HSCT患者长期生存率,allo-HSCT作为巩固治疗手段可以克服ETP-ALL/LBL的不良预�Objective To analyze the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation(allo-HSCT)for treating T lymphoblastic leukemia/lymphoma(T-ALL/LBL).Methods This study retrospectively evaluated 119 adolescent and adult patients with T-ALL/LBL from January 2006 to January 2020 at Peking University Third Hospital and Institute of Hematology and Blood Diseases Hospital,Chinese Academy of Medical Sciences.Patients were divided into chemotherapy-only,chemotherapy followed by allo-HSCT,and chemotherapy followed by autologous hematopoietic stem cell transplantation(auto-HSCT)groups according to the consolidation regimen,and the 5-year overall survival(OS)and progression-free survival(PFS)rates of each group were compared.Results Among 113 patients with effective follow-up,96(84.9%)patients achieved overall response(ORR),with 79(69.9%)having complete response(CR)and 17(15.0%)having partial response(PR),until July 2022.The analysis of the 96 ORR population revealed that patients without transplantation demonstrated poorer outcomes compared with the allo-HSCT group(5-year OS:11.4%vs 55.6%,P=0.001;5-year PFS:8.9%vs 54.2%,P<0.001).No difference was found in 5-year OS and 5-year PFS between the allo-HSCT and auto-HSCT groups(P=0.271,P=0.197).The same results were achieved in the CR population.Allo-HSCT got better 5-year OS(37.5%vs 0)for the 17 PR cases(P=0.064).Different donor sources did not affect 5-year OS,with sibling of 61.1%vs hap-haploidentical of 63.6%vs unrelated donor of 50.0%(P>0.05).No significant difference was found in the treatment response in the early T-cell precursor acute lymphoblastic leukemia/lymphoma(ETP)and non-ETP populations.The ETP group demonstrated lower 5-year OS compared with the non-ETP group in the chemotherapy alone group(0 vs 12.6%,P=0.045),whereas no significant difference was found between the ETP and non-ETP groups in the allo-HSCT group(75.0%vs 62.9%,P=0.852).Multivariate analysis revealed that high serum lactate dehydrogenase level,without transplantation,an

关 键 词：早期前体T细胞白血病/淋巴瘤 T淋巴母细胞白血病/淋巴瘤 造血干细胞移植 预后 

分 类 号：R733[医药卫生—肿瘤]