单纯Hyper-CVAD方案或联合自体造血干细胞移植一线治疗淋巴母细胞淋巴瘤的疗效分析

Efficiency of the Hyper CVAD regimen with or without high-dose therapy combined with autologous hematopoietic stem cell transplantation in lymphoblastic lymphoma

目的:探讨单纯Hyper-CVAD方案与Hyper-CVAD方案联合自体造血干细胞移植一线巩固治疗淋巴母细胞淋巴瘤(lymphoblastic lymphoma,LL)的疗效。方法:回顾性分析26例青少年和成人初治采用改良Hyper-CVAD方案的LL患者资料。其中,22例不伴骨髓受侵的患者中,11例接受单纯改良Hyper-CVAD方案治疗,另外11例接受改良Hyper-CVAD方案联合HDT/AH-SCT巩固治疗。结果:全组61.5%(16/26)的患者初治达完全缓解(complete remission,CR)或不确定的CR(unconfirmed CR,CRu),中位随访29.5个月,5年的总生存(overall survival,OS)率和无进展生存(progress-free survival,PFS)率分别为66.8%和50.2%。22例无骨髓受侵的患者中,单纯Hyper-CVAD组与联合HDT/AHSCT组的5年OS率分别为60.0%和70.7%(P=0.438),5年PFS率分别为43.6%和62.3%(P=0.209),均无统计学差异。单因素预后分析结果显示,初治缓解后1年内疾病进展或复发与预后不良相关(P=0.012)。结论:改良Hyper-CVAD方案是青少年和成人LL一线有效的治疗方案。对于无骨髓侵犯的患者,单纯改良Hyper-CVAD已能取得较好疗效,联合HDT/AHSCT巩固治疗未能进一步改善预后。

Objectives： This study evaluated the efficiency of HyperCVAD regimen with or without high-dose therapy （HDT） combined with autologous hematopoietic stem cell transplantation （AHSCT） in lymphoblastic lymphoma （LL）. Methods：Data of 26 adolescent and adult LL patients were retrospectively analyzed. These patients were initially treated with the modified HyperCVAD reg-imen in a basic institution. Except 4 of the total 26 patients who suffered bone-marrow involvements, 11 patients received consolidation treatment of HDT/AHSCT, and the other 11 did not. Results：Of the total patients, 61.5%achieved complete remission （CR） or uncon-firmed CR. With a median follow-up period of 29.5 months, the 5-year overall survival （OS） and progress-free survival （PFS） rates were 66.8% and 50.2%, respectively. Of the 22 patients without bone marrow involvement, the corresponding 5-year OS rates were 60.0%and 70.7%in the patients treated with the HyperCVAD regimen alone and in those who received HDT/AHSCT as consolidation therapy （P=0.438）, with 5-year PFS rates of 43.6% and 62.3%, respectively （P=0.209）. Disease progression or relapse within a year was identified as the only significant prognostic factor for OS in univariate analysis. Conclusion：The HyperCVAD regimen is an effec-tive initial therapy for adolescent and adult LL patients. For patients without bone marrow involvement, the HyperCVAD regimen com-bined with HDT/AHSCT is not superior over the HyperCVAD regimen alone.