T淋巴母细胞淋巴瘤自体干细胞移植后的长期随访观察

目的评价自体造血干细胞移植（autologous hematopoietic stem cell transplantation,AHSCT）治疗复发难治T淋巴母细胞淋巴瘤（TLBL）的临床疗效及安全性。方法本文回顾性分析AHSCT治疗后长期随访的TLBL16例,预处理方案主要为BEAM和BEAC。结果 15例患者可评价疗效,1例失访。中位随访37个月（12~132个月）,中位无进展生存时间（PFS）34.5个月。预计中位总生存时间49月。1、3、5年总生存率分别为60%、53%、32%。初治患者一线治疗有效者,接受AHSCT者预计中位总生存时间为108个月,5年总生存率、无进展生存率分别为62%、63%;复发患者挽救治疗后接受AHSCT者,中位总生存时间为22.8个月,5年总生存率、无进展生存率分别为33%、22%。初始治疗未达CR/PR的难治患者,中位生存仅21个月,5年生存率和无进展生存率分别为20%和29%。结论 AHSCT常规化疗治疗TLBL安全、有效,可提高复发难治的T淋巴母细胞淋巴瘤的远期生存,延长初治TLBL患者的无进展生存期,但复发率仍偏高,值得开展大规模临床试验进一步深入研究。

Long-term observation on the patients with T-lymphoblastic lymphoma after autologous hematopoietic stem cell transplantation

Objective To evaluate the clinical efficacy and safety of autologous hematopoietic stem cell transplantation（AHSCT） on treating patients with relapsed or refractory T-lymphoblastic lymphoma（TLBL）.Methods 16 patients with TLBL were long-term followed-up and analyzed retrospectively.The major conditioning regimens were BEAM and BEAC.Results 15 patients were evaluable for efficacy and 1 patient lost in follow-up.The median progression-free survival（PFS） was 34.5 months.The expecting median overall survival time（OS） was 49 months.The rates of 1-,3-and 5-year OS were 60%,53% and 32% respectively.Among the newly diagnosed patients who were effectively first-line treated,the median OS was 108 months,the rates of 5-year OS and PFS were 62% and 63% respectively.Among the patients who had response after first line treatment,the median OS was 22.8 months,the rates of 5-year OS and PFS were 33% and 22% respectively.Median OS for the heavily-treated or refractory patients was 21 months,the rates of 5-year OS and PFS were 20% and 29% respectively.Conclusions AHSCT is effective and safe for TLBL after conventional chemotherapy.It can improve long-term survival and extend PFS on the initial treated patients,though the recurrent rate remains relatively high.Large-scale clinical trial is urgently warranted.