自体造血干细胞移植治疗外周T细胞淋巴瘤

Autologous hematopoietic stem cell transplantation for peripheral T cell lymphoma

背景:外周T细胞淋巴瘤亚洲地区发病率高,具有侵袭性,预后普遍较差,目前尚无标准治疗策略。目的:评价自体造血干细胞移植治疗外周T细胞淋巴瘤的疗效及毒副反应。方法:回顾性分析2003年3月至2014年4月行自体造血干细胞移植治疗外周T细胞淋巴瘤35例,包括结外NK/T细胞淋巴瘤鼻型22例,血管免疫母细胞T细胞淋巴瘤1例,外周T细胞淋巴瘤(非特殊型)8例,间变性大T细胞淋巴瘤ALK(+)3例,ALK(-)1例;所有病例均按WHO 2001年和WHO 2008年分类进行病理分型,均采用VAEMMC+全射照射预处理方案。结果与结论:随访中位时间54个月(9-120个月),28例患者(80%)存活,其中无病存活25例(71%),8例(23%)复发,其中7例死亡,1例尚在治疗中。近期毒性主要为骨髓造血受抑,无明显远期并发症。结果表明自体造血干细胞移植治疗外周T细胞淋巴瘤安全有效,早期(第1次完全缓解)行移植疗效佳。

BACKGROUND： The incidence rate of peripheral T cell lymphoma is high in Asia, and peripheral T cell lymphoma is aggressive with generally poor prognosis. However, there is no standard treatment strategy.OBJECTIVE： To retrospectively analyze the therapeutic effect of autologous hematopoietic stem cell transplantation on peripheral T cell lymphoma as well as relevant toxic and side effects.METHODS： A retrospective review was conducted in 35 patients with peripheral T cell lymphoma who underwent autologous hematopoietic stem cell transplantation from March 2003 to April 2014, including 22 cases of extranodal NK/T-cell lymphoma（nasal type）, 1 case of angioimmunoblastic T-cell lymphoma, 8 cases of peripheral T cell lymphoma（non-specific）, 3 cases of ALK-positive anaplastic large cell lymphoma, and 1 case of ALK-negative anaplastic large cell lymphoma. All of 35 patients were classified pathologically according to WHO pathological type in 2001 and 2008, and received the high-dose chemotherapy with vincristine, cytarabine,etoposide, mitoxantrone, semustine, cyclophosphamide, and total body irradiation.RESULTS AND CONCLUSION： After a median follow-up of 54（9-120） months, the probabilities of overall survival and disease-free survival after transplantation were 80%（n=28） and 71%（n=25）, respectively. Eight cases（23%） relapsed after transplantation, seven of which died. It was safe with mild and moderate transplantation related side-effects on opportunistic infections, oral cavity mucosa and bladder responses and so on, and there were no severe, life-threatening late complications. Autologous hematopoietic stem cell transplantation may be an effective and safe treatment for peripheral T cell lymphoma, and there is a better benefit in peripheral T cell lymphoma patients with first complete remission.