自体外周血造血于细胞移植治疗T细胞淋巴瘤疗效分析

Outcome of autologous peripheral blood stem cell transplantation for T cell lymphoma

目的评价自体外周血造血干细胞移植（APBSCT）治疗T细胞淋巴瘤的临床疗效。方法回顾性分析2006年9月至2011年12月于上海瑞金医院行APBSCT的T细胞淋巴瘤患者22例，包括T淋巴母细胞淋巴瘤6例，外周T细胞淋巴瘤（PTCL）16例（间变大细胞淋巴瘤8例，非特异性FTCIA例，皮下脂膜炎样T细胞淋巴瘤1例，鼻型NK／T细胞淋巴瘤2例，皮肤T细胞淋巴瘤1例）。所有病例均按WHO2001年和WHO2008年分类进行病理分型。预处理方案包括BEAM方案13例，ICE方案4例，CBV方案5例。采用1998年国际工作小组制定的非霍奇金淋巴瘤疗效评价标准评价疗效，根据患者移植前疾病状态和对化疗敏感性分为完全缓解（CR，）组和未达CR1组、敏感组和耐药组，并对临床治疗疗效以及移植前疾病状态与预后关系进行分析。结果22例患者移植后中位随访13．1个月（1-60个月），2年预期的无进展生存率为（67．6±11．0）％，总生存率为（71．1±11．1）％。移植后共6例出现疾病进展或复发，其中5例死亡。CR1和化疗敏感组无进展生存率分别为100％和91．7％，高于未达CR，组（42．6％）和耐药组（19．0％），而且两组病例总生存也显著优于未达CR组和耐药组。结论T细胞淋巴瘤患者移植时疾病缓解状态和对化疗敏感性对移植疗效有显著影响，提示在化疗敏感阶段和（或）获得CR，后应早期行APBSCT治疗。

Objective A retrospective analysis of patients with T-cell lymphoma （TCL） received autologous peripheral blood stem cell transplantation （APBSCT） was performed to evaluate the outcome of APBSCT. Methods A total of 22 patients who underwent APBSCT from September 2006 to December 2011 in Ruijin hospital were enrolled in the study,including 6 cases of lymphoblastie lymphoma and 16 of periphe：-al T- cell lymphoma （8 anaplastie large cell lymphoma, 4 PTCL-u, 1 subcutaneous panniculitis-like T-cell lymphoma, 2 nasal type extranodal NK/T and 1 primary cutaneous T-cell lymphoma）. All patients were diagnosed based on the WHO Classification of Tetmors of Hematopoietie and Lymphoid Tissues. Conditioning regimens were high-dose chemotherapies alone which include 13 cases with BEAM, 4 with ICE and 5 with CBV. The outcomes of the treatment were evaluated according to the revised International Working Groupcriteria. Results With a median follow-up of 13.1（1-60） months, the predicted 2-year overall survival （OS） and progression-free survival （PFS） after transplantation were （67.6±11.0） % and （71.1±11.1） %, respectively. A total of 6 patients experienced disease progression and 5 patients eventually died of disease. When all these patients based on the remission status before APBSCT （CR~ vs non-CRy） and chemosensitivity （sensitive vs refractory） were further classified, the PFS rates and OS rates Were 100 % and 91.7 % respectively in CR1 or chemosensitive patients which were significantly higher than patients not in CR1 （42.6 % ） or with chemoresistant disease （19.0 % ）. Conclusion Remission status and chemosensitivity at the time of transplantation significantly affect the outcome of APBSCT for TCL patients, thus it can be recommend to perform APBSCT for patients either in CR1 or early stage when the disease remain sensitive to chemotherapy.