自体移植一线巩固治疗非局限期鼻型结外NK/T细胞淋巴瘤

Safety and efficacy of upfront autologous transplantation as a consolidation therapy for progressive nasal type extranodal NK/T-cell lymphoma

目的评估一线自体造血干细胞移植(autologous hematopoietic stem cell transplantation,auto-HSCT)巩固治疗非局限期鼻型结外NK/T细胞淋巴瘤(extranodal natural killer/T-cell lymphoma nasal type,ENKL)的疗效及安全性。方法回顾性分析2012年1月至2021年6月在河南省肿瘤医院接受含门冬酰胺酶方案化疗序贯一线auto-HSCT巩固治疗的28例ENKL受者的临床资料。其中,男19例,女9例;移植时中位年龄34.5(14~61)岁;鼻型22例,非鼻型6例;Ann Arbor分期Ⅲ期15例,Ⅳ期13例;NK/T细胞淋巴瘤预后指数(Prognostic Index for Natural-Killer cell lymphoma-Epstein-Barr virus,PINK-E)中危8例,高危20例。结果28例受者均获得造血重建,粒细胞植入的中位时间为10 d,范围在8~17 d;血小板植入的中位时间为13 d,范围在10~22 d。中位随访时间为59.5个月,5年总生存率及无进展生存率分别为70.00%(95%CI:50.60%~89.40%)和59.10%(95%CI:39.11%~79.10%);5年的累积复发率及非复发死亡率分别为35.42%(95%CI:19.11%~59.39%)和4.20%(95%CI:2.16%~29.87%)。结论含门冬酰胺酶方案化疗序贯自体造血干细胞移植一线巩固治疗非局限期ENKL具有较好的疗效和安全性。

Objective To evaluate the efficacy and safety of upfront autologous hematopoietic stem cell transplantation(auto-HSCT)as a consolidation therapy of progressive nasal type extranodal NK/T-cell lymphoma,(ENKL).Methods From January 2012 to June 2021,clinical data were retrospectively reviewed for 28 patients with advanced-stage ENKL on chemotherapy of asparaginase-containing regimen followed by upfront auto-HSCT as a consolidation therapy.The median age at transplantation was 34.5(14-61)years.There were 19 males and 9 females.Clinical types were nasal(n=22)and non-nasal(n=6).Clinical stages were Ann Arbor III(n=15)and IV(n=13).Clinical risks were intermediate(n=8)and high(n=20)according to the Prognostic Index for Natural-Killer cell lymphoma-Epstein-Barr virus(PINK-E).Results Hematopoietic reconstruction was performed.Median time of neutrophil engraftment was 10(8-17)days and 13(10-22)days for platelet.Median follow-up time was 59.5 months and 5-year OS/PFS 70.0%(95%CI:50.60%-89.40%)and 59.1%(95%CI:39.11%-79.10%).And 5-year cumulative recurrence and non-recurrence mortality rates were 35.42%(95%CI:19.11%-59.39%)and 4.2%(95%CI:2.16%-29.87%).Conclusions Asparaginase-based chemotherapy followed by auto-HSCT is both safe and efficacious for progressive ENKTL.