造血干细胞移植治疗外周T细胞淋巴瘤疗效及预后分析

Long Term Curative Effects and Prognostic Analysis of Stem Cell Transplantation for Treating Patients with Peripheral T Cell Lymphoma

目的:分析造血干细胞移植(HSCT)治疗外周T细胞淋巴瘤的疗效及预后因素。方法:回顾性分析53例我院确诊并接受HSCT治疗的外周T细胞淋巴瘤患者的临床资料,评估外周T细胞淋巴瘤预后指数(PIT)的预后价值。结果:HSCT的患者中auto-HSCT 31例,allo-HSCT 22例,移植后中位随访时间62个月(1-174个月),auto-和allo-HSCT组各有1例植入失败,allo-HSCT组有4例在移植后1月内死亡。两组生存曲线无显著性差异,3年总生存分别为42.3%(95%CI 24.1%-60.5%)和42.9%(95%CI 21.7%-64.1%)。两组分别有11例和3例死于疾病进展,治疗相关死亡率分别为22.6%(95%CI 6.1%-39.0%)和48.7%(95%CI 26.8%-70.7%)。初诊时骨髓受累是预后不良因素,根据PIT评分allo-HSCT患者中无或仅有1个危险因素的总体生存率和无进展生存率均显著优于伴有3-4个危险因素的患者。结论:复发难治患者自体移植后复发风险仍较高,allo-HSCT早期移植相关死亡率高但有望获得长期生存,PIT评分系统有助于判断外周T细胞淋巴瘤患者行HSCT的预后。

Objective：To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation in the treatment of patients with peripheral T cell lymphoma （PTCL）. Methods ：The clinical records of 53 patients with PTCL were collected and analyzed retrospectively. The prognostic value of prognostic index PIT were evaluated. Results： Among 53 cases of PTCL, 31 patients underwent hematopoietic autologous stem cell transplantation （ auto-HSCT）, 22 patients received allogeneic hematopoietic stem cell transplantation （ allo-HSCT）, their median follow-up time was 62 （ 1 - 174） months, from them 1 patients was not engrafted in each group, 4 patients underwent allo-HSCT died within 1 month after transplantation. The 3 -year overall survival rates in auto- and allo-HSCT groups were 42.3% （95% CI 24. 1 - 60.5 % ） and 42.9% （95 % CI 21.7 - 64. 1% ） respectively, 11 and 3 patients died of relapse after auto-HSCT and allo-HSCT, respectively, the treatment-related mortality （TRM） was 22.6% （95% CI 6.1% - 39.0% ） and 48. 7% （95% CI 26.8% -70.7% ）, respectively. Univariate analysis showed that bone marrow involvement at diagnosis was associated with poor prognosis. In allo-HSCT group, PIT showed statistically significant difference in both OS and PFS between the patients without or with one risk factor and the patients with 3 -4 risk factors. Conclusion：The relapse rate of relapse/refractory patients is high after auto-HSCT. The TRM is high after allo-HSCT, but long term survival is promising. The prognostic index for PTCL can reliably assess the prognosis of PTCL.