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38例外周T细胞淋巴瘤患者外周血干细胞移植的长期疗效

Long-term outcomes of peripheral blood stem cell transplantation for 38 patients with peripheral T-cell lymphoma.

作者信息

Bo Jian, Zhao Yu, Zhang Songsong, Hua Wenrong, Wang Shuhong, Gao Chunji, Wang Quanshun, Li Honghua, Yu Li

机构信息

Department of Hematology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.

出版信息

J Cancer Res Ther. 2016 Jul-Sep;12(3):1189-1197. doi: 10.4103/0973-1482.189235.

Abstract

OBJECTIVE

In this study, to investigate clinical characteristics, response, outcome, and prognosis of peripheral blood stem cell transplantation (PBSCT) for patients with peripheral T-cell lymphoma (PTCL).

METHODS

This study retrospectively analyzed the efficacy of PBSCT in 38 patients with PTCL. Kaplan-Meier methods were used in survival analysis, and the Cox regression model was applied in multivariate analysis. There were ten clinical parameters were analyzed.

RESULTS

The 2-year overall survival (OS) was 46%, and the 5-year OS was 34% after a median follow-up of 40 months. The patients who received allogeneic PBSCT (allo-PBSCT) had a higher nonrelapse mortality than autologous PBSCT (auto-PBSCT), but they could achieve a longer-term disease-free survival in the former, which OS could achieve 40%. Survival analysis with Kaplan-Meier method showed the pretransplant disease status, B symptoms, serum lactate dehydrogenase (LDH) in early (>275 U/L), Eastern Cooperative Oncology Group (ECOG) score (>1), prognostic index for PTCL score (>2) were all prognostic factors for posttransplant OS. Pretransplant disease status is the only prognostic factor for allo-PBSCT.

CONCLUSION

The key was to reducing transplant-related mortality of allo-PBSCT by reduced-intensity conditioning. Factors such as level of early serum LDH, extranodal involvement, B symptoms, ECOG score, Ann Arbor stage, and pretransplant disease status were all related to the prognosis of patients treated with PBSCT. Allo-PBSCT maybe suggested as the first line therapy for late-stage PTCL patients who could reach treatment remission before transplantation.

摘要

目的

本研究旨在探讨外周血干细胞移植(PBSCT)治疗外周T细胞淋巴瘤(PTCL)患者的临床特征、反应、结局和预后。

方法

本研究回顾性分析了38例PTCL患者接受PBSCT的疗效。生存分析采用Kaplan-Meier方法,多因素分析应用Cox回归模型。分析了10个临床参数。

结果

中位随访40个月后,2年总生存率(OS)为46%,5年OS为34%。接受异基因PBSCT(allo-PBSCT)的患者非复发死亡率高于自体PBSCT(auto-PBSCT),但前者可实现更长时间的无病生存,其OS可达40%。Kaplan-Meier方法进行的生存分析显示,移植前疾病状态、B症状、早期血清乳酸脱氢酶(LDH)(>275 U/L)、东部肿瘤协作组(ECOG)评分(>1)、PTCL预后指数评分(>2)均为移植后OS的预后因素。移植前疾病状态是allo-PBSCT的唯一预后因素。

结论

关键在于通过减低预处理强度降低allo-PBSCT的移植相关死亡率。早期血清LDH水平、结外受累、B症状、ECOG评分、Ann Arbor分期和移植前疾病状态等因素均与接受PBSCT治疗患者的预后相关。对于移植前能达到治疗缓解的晚期PTCL患者,allo-PBSCT可能建议作为一线治疗。

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