造血干细胞移植治疗T细胞淋巴瘤/白血病的疗效观察

Clinical effect observation of hematopoietic stem cell transplantation in patients with T-cell lymphoma/leukemia

目的 探讨造血干细胞移植（HSCT）治疗T细胞淋巴瘤/白血病（TCL）的疗效.方法 选择2005年1月至2013年12月于广州医科大学附属第一医院血液肿瘤科行HSCT的TCL患者17例为研究对象,纳入移植组,回顾性分析其临床病历资料.其中,男性患者为13例,女性为4例;发病中位年龄为35.0岁（19～67岁）;接受自体HSCT（auto-HSCT）治疗为14例,异基因HSCT（allo-HSCT）治疗为3例.选择同期于本院接受常规化疗而未行HSCT的18例TCL患者,纳入常规化疗组.分析移植组造血干细胞（HSC）采集、移植后造血功能重建、移植物抗宿主病（GVHD）发生等情况及移植相关不良反应.统计学比较两组患者的总生存（OS）率与无病生存（DFS）率.结果 ①两组患者年龄、性别构成比、疾病类型、Ann Arbor分期、国际预后指数（IPI）评分及骨髓受累率比较,差异均无统计学意义（P＞0.05）.②移植组患者造血功能重建均成功,恢复中性粒细胞计数＞0.5×109/L的中位时间为11.0 d（8～15 d）,恢复血小板计数＞20×109/L的中位时间为13.0 d（8～18 d）.移植组患者CD34＋细胞数与血小板植活时间呈负相关关系（r=-0.557,P=0.020）,单个核细胞（MNC）计数与粒细胞植入时间、CD34＋细胞数与粒细胞植入时间、MNC计数与血小板植活时间差异无相关性（r=0.321,-0.312,0.256;P=0.210,0.224,0.321）.③移植组3例接受allo-HSCT治疗的患者均发生Ⅰ度急性GVHD,经治疗后均好转.④移植组和常规化疗组患者的中位随访时间、总有效率、OS率及DFS率分别为36个月（12～96个月）与17个月（2～61个月）,70.6％（12/17）与38.9％（7/18）,（69.4±9.9）％与（26.1±6.4）％,（61.9±9.1）％与（22.0±6.7）％.两组患者OS率、DFS率比较,差异均有统计学意义（x2=7.308,6.157;P=0.007,0.013）.结论 对于TCL患者,HSCT作为强化巩固治疗方案,可明显提高患者OS率.但对于化疗耐药或复发性、难治性TCL患者,需综合评估HSCT治疗的利弊.由于本研究纳入样本量较小,HSCT治疗TCL的确切疗效,尚需大样本、多中心的前瞻性随机对照研究进一步证实.

Objective To evaluate the treatment outcomes of hematopoietic stem cell transplantation （HSCT） in patients with T-cell lymphoma/leukemia （TCL）.Methods Seventeen TCL patients who received HSCT from January 2005 to December 2013 in Department of Oncology and Hematogy,the First Affiliated Hospital of Guangzhou Medical University were included into transplantation group and retrospectively analyzed.Among them,13 cases were male patients,and 4 cases were female;the media age was 35.0 years （19 to 67 years）;14 cases received autologous HSCT （auto-HSCT） and 3 cases received allogeneic HSCT （allo-HSCT）.Eighteen cases of TCL patients who received conventional chemotherapy without HSCT were chose as conventional chemotherapy group during the same period in the same hospital.The collection of hematopoietic stem cell （HSC）,reconstruction of hematopoietic function after transplantation,graft-versus-host disease （GVHD） and transplant-related cases of adverse reactions in transplantation group were analyzed.Overall survival （OS） rate and disease-free survival （DFS） rate between two groups were compared statistically.Results ①There were no significant differences of patients＇ general clinical features between two groups,such as age,gender ratio,types of diseases,Ann Arbor stage,International Prognostic Index （IPI） scores and rate of bone marrow involvement （P 〉 0.05）.② All the 17 patients in transplantation group were successfully engrafted,the median time of absolute neutrophil count 〉0.5× 109/L was 11.0 days （8 to 15 days）,the median time of platelet count 〉20× 109/L was 13.0 days （8 to 18 days）.CD34＋ cell count and platelet-sik live time of transplantation group was negatively correlated （r=-0.557,P=0.020）,while as MNC count and neutropenia engraftment time,CD34＋ cells and neutrophils engraftment time,MNC count and platelet-sik live time,there were no correlations between them （r=0.321,-0.312,0.256;P=0.210,0.224,0.321）.③A total of 3 cases of auto-HSCT patients in transplantation group developed Ⅰ degree GVHD,and all of them were improved after corresponding treatments.④The median follow-up time,total effective rate,OS rate and DFS rate of transplantation group and conventional chemotherapy group were 36 months （12 to 96 months） and 17 months （2 to 61 months）,70.6% （12/17） and 38.9% （7/18）,（69.4±9.9）% and （26.1±6.4）%,（61.9±9.1）% and （22.0±6.7）%,respectively.The OS rate and DFS rate of transplantation group were both significantly higher than those of conventional chemotherapy group,and both the differences were statistically significant （x2 =7.308,6.157;P =0.007,0.013）.Conclusions HSCT may significantly improve the OS rate of patients with TCL.But for chemotherapy resistant or relapsed,refractory TCL patients,it needs a comprehensive assessment of the advantages and disadvantages of HSCT treatment.Since the small sample size of this study,the exact effect of HSCT treatment in TCL patients still needs large sample,multi-center,prospective and randomized controlled trials to confirm.