异基因造血干细胞移植治疗急性T淋巴细胞白血病和淋巴瘤:附50例临床报告

Allogeneic hematopoietic stem cell transplantation for T cell acute lymphoblastic leukemia and lymphoma:a clinical report of 50 cases

目的探讨异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)治疗急性T淋巴细胞白血病(T cell acute lymphoblastic leukemia,T-ALL)和急性T淋巴母细胞淋巴瘤(T cell acute lymphoblastic lymphoma,T-LBL)的疗效及预后。方法回顾性分析2014—2019年于航天中心医院接受allo-HSCT的50例T-ALL/LBL患者的临床资料,分析其临床疗效、并发症及预后。结果50例患者中男性41例,女性9例,中位年龄20.5岁(范围:9.0~63.0岁);单倍体移植44例,脐血移植2例,同胞全合移植4例;T-ALL 40例,T-LBL 10例;移植前处于完全缓解(CR)状态16例,处于未完全缓解(非CR)状态34例。移植后,中位随访20个月(范围:1~84个月),存活23例,死亡27例;移植后24个月的总生存率和无复发生存率分别为50.0%和44.0%,36个月的总生存率和无复发生存率分别为45.5%和40.0%。随访期间,共有20例患者复发,复发率为40.0%(20/50)。移植前获CR、无髓外病变、无中枢神经系统受累的患者预后较好,而移植前有无基因突变、不同预处理方案、有无急性/慢性GVHD患者的总生存期及无复发生存期组间比较差异无统计学意义(均P>0.05)。结论在这项小样本、无对照的临床研究中,T-ALL/LBL患者在缓解期行allo-HSCT可能较挽救性移植的生存预后有所改善,其中复发为移植失败的主要原因。

Objective To investigate the efficacy and prognosis of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in the treatment of T cell acute lymphoblastic leukemia(T-ALL)and T cell acute lymphoblastic lymphoma(T-LBL).Methods The clinical data of 50 patients with T-ALL/LBL received allo-HSCT at the Aerospace Center Hospital from 2014 to 2019 were retrospectively analyzed,with regard to efficacy,related complications and prognosis.Results A total of 50 patients were enrolled,41 males and 9 females,with a median age of 20.5 years(range:9.0-63.0 years);including 44 cases of haploid transplantation,2 cases of umbilical cord blood transplantation and 4 cases of matched sibling donor stem cell transplantation.Among them,40 cases were T-ALL and 10 cases were T-LBL;16 patients in complete remission(CR)status and 34 patients in non-CR status before transplantation.After transplantation,the median follow-up time was 20 months(range:1-84 months),23 patients survived and 27 died.The overall and relapse-free survival rates were 50.0%and 44.0%at 24 months after transplantation,45.5%and 40.0%at 36 months,respectively.During the follow-up period,a total of 20 patients relapsed,with a relapse rate of 40%(20/50).Those patients who achieved CR before transplantation,without extramedullary lesions and no central nervous system involvement had a better prognosis,where there was no significant difference in the overall survival and relapse-free survival between the groups with and without gene mutation,different conditioning regimen,and acute/chronic GVHD before transplantation(P>0.05).Conclusions In this small sample and uncontrolled clinical study,allo-HSCT in patients with T-ALL/LBL in remission may improve the survival prognosis compared with salvage transplantation,and relapse is the main reason for transplantation failure.