大剂量化疗联合自体造血干细胞移植治疗外周T细胞淋巴瘤的回顾性研究

High-dose therapy combined with autologous peripheral blood stem cell transplantation in patients with peripheral T-cell lymphoma:a retrospective study

目的 ：探讨大剂量化疗联合自体造血干细胞移植（high-dose therapy/autologous hematopoietic stem cell transplantation,HDT/AHSCT）在外周T细胞淋巴瘤（peripheral T-cell lymphoma,PTCL）治疗中的价值。方法：对50例接受HDT/AHSCT治疗的PTCL患者的病历资料进行回顾性分析,并进行随访。结果 ：50例患者均未发生HDT/AHSCT相关死亡。中位随访时间为13个月（1~136个月）,2年无进展生存率为59.0%,2年总生存率为65.0%。单因素分析结果显示,移植前达完全缓解（complete remission,CR）患者的2年无进展生存率和总生存率均明显优于非CR患者（2年无进展生存率：72.8%vs 41.9%,P=0.003;2年总生存率：88.2%vs41.9%,P=0.002）,一线治疗敏感患者接受HDT/AHSCT的预后优于二线治疗敏感患者（2年无进展生存率：76.8%vs 30.8%,P=0.001;2年总生存率：81.1%vs 46.2%,P=0.015）。此外,移植前的红细胞沉降率是2年无进展生存率和2年总生存率的影响因素（P=0.004,P=0.018）,移植前血清乳酸脱氢酶水平是2年无进展生存率的影响因素（P=0.044）。多因素分析结果显示,仅移植前达CR是2年总生存率的独立影响因素[相对风险=4.879（95%可信区间：1.583~15.034）,P=0.006];未发现与2年无进展生存率相关的独立影响因素。亚组分析显示,一线治疗达CR的血管免疫母细胞性T细胞淋巴瘤及晚期自然杀伤细胞/T细胞淋巴瘤患者接受HDT/AHSCT可有生存获益。结论 ：HDT/AHSCT作为PTCL患者一线巩固治疗或挽救治疗的安全性较高,并且可以部分改善PTCL患者的预后。今后有待开展前瞻性随机对照研究以验证HDT/AHSCT在不同病理亚型及移植前状态下的应用价值。

Objective：To explore the value of high-dose therapy/autologous hematopoietic stem cell transplantation（HDT/AHSCT） in the treatment of patients with peripheral T-cell lymphoma（PTCL）.Methods：The medical records of 50 patients with PTCL who received HDT/AHSCT were retrospectively analyzed.The followed-up was performed.Results：No HDT/AHSCT-related death occurred.The median follow-up time was 13 months（range：1-136）.The 2-year progression-free survival（PFS） and 2-year overall survival（OS） were 59.0% and 65.0%,respectively.Univariate analysis showed that the patients achieving complete remission（CR） before HDT/AHSCT had superior 2-year PFS and 2-year OS as compared with those of the patients not achieving CR（2-year PFS：72.8% vs 41.9%,P = 0.003; 2-year OS：88.2% vs 41.9%,P = 0.002）.The 2-year PFS was 76.8% for the patients who were sensitive to the fi rstline treatment（CR1/PR1） as compared with 30.8% for the patients who were sensitive to the secondline treatment（CR2/PR2）（P = 0.001）.The 2-year OS for patients achieving CR1/PR1 was also much better than that for patients achieving CR2/PR2（81.1% vs 46.2%,P = 0.015）.Furthermore,Erythrocyte sedimentation rate（ESR） before transplantation was an important factor for 2-year PFS and 2-year OS（P = 0.004,P = 0.018）.Serum lactate dehydrogenase（LDH） level before transplantation was another important factor for 2-year PFS（P = 0.044）.Multivariate analysis showed that the therapeutic response（achieving CR） before transplantation was an independent factor for 2-year OS [risk ratio：4.879（95% confi dence interval：1.583-15.034）,P = 0.006].No independent factors for 2-year PFS were observed.Subgroup analysis revealed that the patients with angioimmunoblastic T-cell lymphoma and advanced natural killer（NK）/T-cell lymphoma who received HDT/AHSCT during fi rst CR may have benefi t in survival from HDT/AHSCT.Conclusion：HDT/AHSCT can be used as safe and effective first-line consolidation therapy or salvage therapy in patints with PTCL and partially improve the prognosis.Prospective randomized controlled trials are necessary to confi rm the suitable pathologic subtype and the best pretransplantation status for HDT/AHSCT.