造血干细胞移植治疗T细胞性淋巴瘤高危患者的临床研究

Hematopoietic stem cell transplantation in high-risk T cell lymphoma patients: a retrospective study

目的探讨自体和异基因造血干细胞移植治疗高危T细胞性淋巴瘤的临床疗效和安全性。方法2002年1月至2009年7月,我院住院行造血干细胞移植的T细胞性非霍奇金淋巴瘤的患者23例,其中行自体造血干细胞移植的15例,异基因造血干细胞移植的8例。评估移植疗效及安全性。按照Ann Arbor标准和国际预后指数(international prognostic index,IPI)分期评分,结合病理类型,高中危患者18例,高危患者5例,自体造血干细胞移植患者的预处理多采用司莫斯丁、足叶乙甙、阿糖胞苷及马法兰(BEAM)方案,异基因造血干细胞移植患者的预处理多采用改良的马利兰、环磷酰胺(BuCY);全身放疗、环磷酰胺(TBI-CY)方案。观察造血恢复情况,并以Kaplan-Meier方法分析两组患者3年生存率和安全性。结果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的时间为移植后(10.4±2.0)天,血小板恢复至20×109/L的时间为移植后(11.1±3.4)天。自体造血干细胞移植安全性高,而异基因造血干细胞移植患者有更好的长期生存,并发症相对较多。结论高危组T细胞淋巴瘤侵袭性强,预后差,在缓解后优先选择造血干细胞移植治疗;IPI评分为中高危及复发难治的患者,应行异基因造血干细胞移植,发挥移植物抗淋巴瘤效应,争取获得长期生存。

Objective To assess retrospectively the efficacy and security of hematopoietic stem cell transplantation（HSCT） in treating high risk T cell lymphoma（TCL）. Methods From January 2002 to July 2009,23 cases undergoing HSCT were included. A risk-adapted layering method according to Ann Arbor staging system guided the classification. Combined IPI score with pathological subtype, most of eases belonged to high-risk group. Cases in APBSCT group mainly received a preconditioning regimen composed of BEAM （semustine,etoposide,cytarabine and melphalan） ,while those cases undergoing Allo HSCT received a regimen of cyclophosphamide combined with busulfan or total body irradiation （TBI）. Hematopoietic recovery was observed and 3-years overall survival and security were analyzed in two groups according to Kaplan Meier analysis. Results Hematopoietic reconstruction was fine in all the transplantation patients. The mean leukocyte recovery〉0.5×10^9/L duration was （10.4±2.0） days and platelet recovery （〉20 × 10^9/L） duration was （11.1 ±3.4） days,as expected. APBSCT group showed high security while Allo- HSCT group had a better long-term survival rate despite more complications. Conclusion High-risk T cell lymphoma is more aggressive with poor prognosis. Hematopoietic stem cell transplantation provides an excellent efficiency against this disorder. Allogeneic HSCT should be preferred after the patients had acquired remission. The acquired graft versus tumor effect may obtain long survival.