造血干细胞移植治疗血管免疫母细胞性T细胞淋巴瘤临床分析

Clinical outcomes of hematopoietic stem cell transplantation for angioimmunoblastic T-cell lymphoma

目的分析造血干细胞移植(HSCT)治疗血管免疫母细胞性T细胞淋巴瘤(AITL)的临床疗效.方法回顾性分析2007年6月至2017年6月期间在国内八所医院接受HSCT的AITL患者.结果共有19例患者纳入本研究,其中男13例,女6例,中位年龄50(32~60)岁;自体造血干细胞移植(auto-HSCT)12例,异基因造血干细胞移植(allo-HSCT)7例(均为同胞全相合供者,其中2例为auto-HSCT后复发患者).auto-HSCT组移植前疾病处于完全缓解(CR)、部分缓解(PR)状态者分别为5例、7例;allo-HSCT组患者移植前疾病处于PR、疾病进展(PD)状态者分别为2例、3例.失访2例(均为auto-HSCT组),中位随访时间46.5(1~100)个月.allo-HSCT组3例患者发生急性移植物抗宿主病(GVHD)(Ⅰ度2例,Ⅱ度1例),5例发生慢性GVHD(局限型2例,广泛型3例).auto-HSCT组死亡4例(原发病复发死亡3例),allo-HSCT组死亡3例(移植相关死亡2例,原发病复发死亡1例).auto-HSCT组(10例)、allo-HSCT组(7例)的3年总生存率分别为56%(95%CI 32%~100%)、57%(95%CI 30%~100%)(P=0.979);3年累积无进展生存率分别为34%(95%CI 14%~85%)、57%(95%CI 30%~100%)(P=0.451).结论 auto-HSCT和allo-HSCT均是AITL的有效治疗方法.

Objective To evaluate clinical outcomes of autologous (auto-HSCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) for angioimmunoblastic T-cell lymphoma (AITL). Methods From June 2007 to June 2017, clinical data of AITL patients who underwent HSCT in eight hospitals were assessed retrospectively. Results Of 19 patients, 13 male and 6 female with a median age of 50 (32-60) years old, 12 auto-HSCT and 7 allo-HSCT recipients were enrolled in this study, all donors were HLA-identical siblings. Two of allo-HSCT recipients were relapsed auto-HSCT ones. There were 5 patients (5/12) in complete response (CR) status and 7 (7/12) in partial remission (PR) status before transplantation in auto-HSCT group, and 2 (2/7) in PR status and 3 (3/7) in progression disease (PD) status before transplantation in allo-HSCT group. The median follow-up for the surviving patients was 46.5 months (range, 1-100 months) for the whole series, two patients lost in auto-HSCT group. Three patients developed acute graft-versus-host disease (aGVHD) and 5 chronic graft-versus-host disease (cGVHD) after allo-HSCT. Three patients died of primary disease and 1bleeding in auto-HSCT group. One patient died of primary disease and 2 transplantation-related mortality in allo-HSCT group. The 3-year cumulative overall survival (OS) were 56%(95%CI 32%-100%) and 57%(95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.979). The 3-year cumulative progression-free survival (PFS) were 34%(95%CI 14%-85%) and 57%(95%CI 30%-100%) for auto-HSCT and allo-HSCT, respectively (P=0.451). Conclusion Both auto-HSCT and allo-HSCT were optimal choices for AITL. In clinical practice, which HSCT was better for AITL patients should be based on comprehensive factors including sensitivity to chemotherapy, risk stratification and disease status at transplantation.