自体外周血干细胞移植治疗T细胞淋巴瘤的临床研究

Autologous peripheral blood stem cell transplantation for T cell lymphoma:a retrospective study

目的:探讨自体外周血干细胞移植(APBSCT)治疗T细胞淋巴瘤的临床疗效和安全性。方法:2000年7月～2008年4月,行APBSCT的T细胞淋巴瘤患者共17例,包括T淋巴母细胞淋巴瘤10例,鼻型NK/T淋巴瘤4例,外周细胞T淋巴瘤2例,间变大细胞淋巴瘤1例。按照AnnArbor标准和IPI分期评分。8例患者的采集物采用CD34+细胞纯化。所有患者均采用CTX+VP-16+TBI预处理方案。结果:(1)所有患者移植后造血功能均顺利重建,中性粒细胞恢复至0.5×109/L为移植后(12.18±2.63)天,血小板恢复至20×109/L为移植后(14.50±4.02)天。(2)中位随访7个月(1～94个月),2年预期的无疾病生存率为62.89%,总生存率为71.87%。(3)随访2年以上未复发的6例患者,均无病存活,中位随访54个月(24～94个月)。(4)死亡均发生在移植后半年内,移植前未缓解的2例患者移植后均死亡,移植前处于复发状态的患者移植后3个月时再次出现复发,带病生存。(5)至随访截止时间,获完全缓解患者行或未行CD34+细胞分选移植的疗效无明显差别。结论:APBSCT对移植前完全缓解和部分缓解的T细胞淋巴瘤患者疗效较好,造血重建顺利,且安全性好,但复发和原发难治的患者疗效相对差,应考虑选择异基因造血干细胞移植治疗。

Objective：To analyze retrospectively the results of treatment with autologous peripheral blood stem cell transplantation （APBSCT） for T cell lymphoma（TCL）. Methods：To conduct a review of patients who underwent APBSCT for TCL from July 2000 to April 2008. Seventeen cases were identified consisting of 10 cases lymphoblastic lymphoma, 4 cases nasal type extranodal NK/ T, 2 cases peripheral T cell lymphomas, and 1 case anaplastic large cell lymphomas. The patients were classified by Ann Arbor staging system and international prognosis index （IP1）. CD34 ＋ cell purification of PBSC were carried out in 8 patients. All the patients received the high-dose chemotherapy with eyclophosphamide, etoposide and total body irradiation（TBI） as conditioning regimen. Results：Platelet recovery （ 〉 20 × 10^9/L）time was （14. 5 ± 4.02） days and leukocyte recovery （ 〉 0. 5 × 10^9/L） time was （12. 18 ± 2. 63 ） days, which was within the expected ranges. After median follow-up of 7 （1-94） months, the probabilities of 2-year overall survival and disease-free survival after transplantation were 71.87% and 62. 89%, respectively. Six patients were still in disease-free survival after two years of APBSCT with follow-up of 54 （24-94）months. Four cases were dead within half a year after APBSCT including 2 cases of non-remission before receiving autograft, and patients in relapse before transplantation relapsed again after 3 months and were still alive with disease. There was no significant difference on the outcome among the patients of complete response whether or not receiving autologous CD34 ＋ cell transplantation by the time of stopping follow-up. Conclusion：APBSCT as consolidation therapy in first complete or partial response TCL patients may offer a durable survival benefit. However, there was minimal durable benefit in patients with relapsed or refractory. TCL after autotransplantion and allogeneic HCT should be more aggressively explored for them.