初治外周T细胞淋巴瘤临床治疗分析

Clinical treatment analysis of newly treated peripheral T-cell lymphoma

目的探讨外周T细胞淋巴瘤(PTCL)的治疗方式。方法回顾性分析吉林大学第一医院2011年8月至2021年10月251例初治PTCL患者的临床资料,从中截取2015年2月(PTCL首个靶向药西达本胺在我国上市)至2021年10月患者168例,其中接受化疗联合维布妥昔单抗(BV)治疗20例(BV组),接受化疗联合西达本胺治疗37例(西达本胺组),接受非靶向治疗111例(非靶向治疗组);患者均接受≥2个疗程治疗。10例患者接受自体外周血造血干细胞移植,以同期50例非移植患者作为对照。分析采用不同治疗方法患者的临床疗效及预后。采用Kaplan-Meier法进行生存分析,并进行log-rank检验。结果251例PTCL患者中,26.7%(67/251)接受靶向治疗联合化疗。西达本胺组中36例可评估疗效,总反应率(ORR)为91.7%(33/36);非靶向治疗组中88例可评估疗效,ORR为71.6%(63/88);BV组中20例可评估疗效,ORR为75.0%(15/20)。非靶向治疗组ORR与西达本胺组比较差异有统计学意义(χ^(2)=5.89,P=0.015),与BV组比较差异无统计学意义(χ^(2)=0.09,P=0.759)。西达本胺组、BV组、非靶向治疗组1年无进展生存(PFS)率分别为79.9%、88.2%、64.2%,1年总生存(OS)率分别为85.7%、89.7%、70.1%;西达本胺组及BV组PFS、OS均优于非靶向治疗组(均P<0.05),且不良反应大多可耐受。化疗联合BV治疗的患者中,CD30表达率<60%、≥60%患者的ORR分别为54.5%(6/11)、100.0%(9/9),差异有统计学意义(P=0.038)。10例行外周血自体造血干细胞移植患者与50例未移植患者的1年PFS率分别为87.5%、59.5%,1年OS率分别为90.0%、67.1%,差异均无统计学意义(均P>0.05)。结论以化疗为主的综合治疗是PTCL的主要治疗方式,化疗联合西达本胺或BV靶向治疗、造血干细胞移植能改善PTCL患者的长期生存。

Objective To investigate the treatment methods of peripheral T-cell lymphoma(PTCL).Methods The clinical data of 251 newly treated PTCL patients in the First Hospital of Jilin University from August 2011 to October 2021 were retrospectively analyzed,from which 168 patients were intercepted from February 2015(the first targeted drug of PTCL,chidamide,was launched in China)to October 2021,among which 20 patients received chemotherapy combined with brentuximab vedotin(BV,BV group),37 patients received chemotherapy combined with chidamide(chidamide group),and 111 patients received non-targeted therapy(non-targeted therapy group);all patients received≥2 courses of treatment.Ten patients received autologous peripheral blood hematopoietic stem cell transplantation,with non-transplanted patients in the same period as controls.The clinical efficacy and prognosis of patients with different treatment methods were analyzed.Kaplan-Meier method was used for survival analysis and log-rank test was performed.Results Of all 251 patients with PTCL,26.7%(67/251)received targeted therapy in combination with chemotherapy.In the chidamide group,the efficacy could be evaluated in 36 cases,with an overall response rate(ORR)of 91.7%(33/36);in the non-targeted therapy group,the efficacy could be evaluated in 88 cases,with an ORR of 71.6%(63/88);in the BV group,20 cases were evaluable,with an ORR of 75.0%(15/20).The difference in ORR between the non-targeted therapy group and the chidamide group was statistically significant(χ^(2)=5.89,P=0.015),and the difference in ORR between the non-targeted therapy group and the BV group was not statistically significant(χ^(2)=0.09,P=0.759).The 1-year progression-free survival(PFS)rates were 79.9%,88.2%and 64.2%,and the 1-year overall survival(OS)rates were 85.7%,89.7%and 70.1%in the chidamide,BV and non-targeted therapy groups,respectively;the PFS and OS in the chidamide and BV groups were better than those in the non-targeted therapy group(all P<0.05),and the adverse effects were mostly tolerable.Among patients treated with chemotherapy combined with BV,the ORR of patients with CD30 expression rate<60%and≥60%were 54.5%(6/11)and 100.0%(9/9),and the difference was statistically significant(P=0.038).In the 10 hematopoietic stem cell transplanted patients and 50 non-transplanted patients,1-year PFS rates were 87.5%and 59.5%,1-year OS rates were 90.0%and 67.1%,and the differences were not statistically significant(both P>0.05).Conclusions Chemotherapy-based combination therapy is the main treatment methods for PTCL,and chemotherapy combined with chidamide or BV targeted therapy and hematopoietic stem cell transplantation can improve the long-term survival of PTCL patients.