不同治疗方式对T淋巴母细胞淋巴瘤的疗效影响

Comparing the efficacies of different treatments for T lymphoblastic lymphoma

目的探讨常规化学药物治疗、自体造血干细胞移植(auto-HSCT)及异基因造血干细胞移植(allo-HSCT)对T淋巴母细胞淋巴瘤(T-LBL)的疗效差异。方法回顾性分析2012年1月至2022年12月在华中科技大学同济医学院附属同济医院接受治疗的82例T-LBL患(受)者的临床资料,根据不同的治疗方法分为未移植组(49例)和移植组(33例),移植组又根据不同移植方式分为allo-HSCT组(22例)和auto-HSCT组(11例),未移植组绝大部分患者采用环磷酰胺+美司钠+阿霉素+地塞米松+长春新碱/甲氨蝶呤+阿糖胞苷(Hyper CAVD A/B)方案进行诱导缓解,6例使用环磷酰胺+阿糖胞苷+6-巯基嘌呤(CAT)、依托泊苷+长春新碱+多柔比星+环磷酰胺+泼尼松(EPOCH)、大剂量甲氨蝶呤+地塞米松,长春新碱+吡柔比星+环磷酰胺+培门冬酶+泼尼松(VDCLP)等方案为基础进行诱导缓解,移植组在接受多药联合强化诱导治疗后进行造血干细胞移植。通过观察患(受)者的总存活率和无进展存活(progression free survival,PFS)率等,对其进行疗效和生存分析。结果共纳入82例患(受)者,男64例,女18例,年龄为23岁(11~74)岁。62例(75.61%)临床分期为Ⅲ~Ⅳ期,43例(53.44%)起病时有发热、盗汗、体重减轻的全身症状(B症状),其中骨髓受累50例(61.00%),Ann Arbor分期Ⅲ期及以上33例(80.5%);东部肿瘤协作组(ECOG)评分≤2分的共65例(79.27%),>2分的共17例(20.73%);国际预后指数(IPI)≤3分的共63例(76.83%),>3分的共19例(23.17%)。全部82例患(受)者的随访时间为27.5个月(5~118)个月,3年总存活率、无进展存活(PFS)率分别为53.64%(95%CI:42.35%~64.62%)和47.56%(95%CI:36.53%~58.82%)。未移植组、移植组3年总存活率比较差异有统计学意义[42.86%(95%CI:29.12%~57.71%)比69.70%(95%CI:51.13%~83.79%),P=0.014],3年PFS率分别为38.76%(95%CI:25.54%~53.76%)和60.61%(95%CI:42.24%~76.57%),差异有统计学意义(P=0.032)。结论T-LBL患者接受造血干细胞移植巩固治疗相较于单纯化疗可改善长期预后,但auto-HSCT和allo-HSCT的疗效相似。

Objective To explore the differential efficacies of conventional chemotherapy,autologous hematopoietic stem cell transplantation(auto-HSCT)and allogeneic hematopoietic stem cell transplantation(allo-HSCT)for T lymphoblastic lymphoma(T-LBL).Method From January 2012 to December 2022,the relevant clinical data were retrospectively reviewed for 82 T-LBL patients hospitalized at Affiliated Tongji Hospital.According to different treatments,they were assigned into two groups of non-transplantation(49 cases)and transplantation(33 cases).The transplantation group was divided further into two groups of allo-HSCT(22 cases)and auto-HSCT(11 cases)according to different transplantation modes.In non-transplantation group,remission was induced mostly by cyclophosphamide+messosodium+doxorubicin+dexamethasone+vincrine/methotrexate+Hyper CAVD A/B.Six patients achieved remission based upon cyclophosphamide+cytarabine+6-mercaptopurine(CAT),etoposide+vincristine+doxorubicin+cyclophosphamide+cyclophosphamide+prednisone(EPOCH),high-dose methotrexate+dexamethasone and vincristine+pirubicin+cyclophosphamide+pemasase+prednisone(VDCLP).The transplantation group underwent HSCT after multi-drug combination intensive induction therapy.Efficacy and survival were analyzed by observing the rates of overall survival(OS)and progression-free survival(PFS).Result There were 64 males and 18 females with a median age of 23(11~74)year.Among them,62 cases(75.61%)had clinical stageⅢ~Ⅳ.And 43 cases(53.44%)had systemic symptoms(B symptom)of fever,night sweats and weight loss at an onset of disease.Fifty cases(61.00%)had an involvement of bone marrow and 33 cases(80.5%)belonged to Ann Arbor stageⅢand above.There were 65 cases(79.27%)with Eastern Cooperative Oncology Group(ECOG)score≤2 and 17 cases(20.73%)with ECOG score>2.International Prognostic Index(IPI)was≤3(63 cases,76.83%)and>3(19 cases,23.17%).Follow-up period was 27.5(5~118)month.And 3-year OS and PFS were 53.64%(95%CI:42.35%~64.62%)and 47.56%(95%CI:36.53%~58.82%).Significant inter-group difference existed in 3-year OS[42.86%(95%CI:29.12%~57.71%)vs 69.70%(95%CI:51.13%~83.79%),P=0.014]and 3-year PFS was 38.76%(95%CI:25.54%~53.76%)and 60.61%(95%CI:42.24%~76.57%).And the difference was statistically significant(P=0.032).Conclusion As a consolidation therapy,HSCT may improve the long-term outcomes of T-LBL patients as compared with chemotherapy alone.