Hu Meiwei, Wang Huafeng, Wang Lei, Yang Min, Lou Yinjun, Jin Jie
Department of Hematology, the Second Affiliated Hospital of Zhejiang Chinese Medical University Department of Hematology, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2018 Jul;97(28):e11374. doi: 10.1097/MD.0000000000011374.
To study the prognostic factors of adult patients with T-lymphoblastic lymphoma (T-LBL) and to evaluate therapeutic effects of acute lymphoblastic leukemia (ALL)-type chemotherapy in combination with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients who achieved overall response (OR) with first line ALL-type chemotherapy.This was a retrospective study of 59 adult patients with T-LBL treated with hyper-fractionated administration of cyclophosphamide, vincristine, doxorubicin and dexamethasone/methotrexate (hyper-CVAD/MA) chemotherapy alone or in combination with allo-HSCT between June 2008 and October 2015. Complete response (CR) and OR rates were evaluated after the initial chemotherapy. Clinical characteristics and the risk factors associated with prognosis and overall survival (OS) were analyzed in all patients and the effects of allo-HSCT on OS were evaluated in patients who had achieved OR after initial chemotherapy.Forty-eight patients (81.4%) achieved OR by hyper-CVAD chemotherapy, among which, 22 patients (45.8%) further received allo-HSCT. The median follow-up was 31.5 months, ranging from 11 to 97 months. The 3-year OS and progression-free survival (PFS) were 45.7% and 45.0% for patients who achieved OR after chemotherapy and both 0 for patients who did not achieve OR (both P < .001). Three year OS and PFS were higher in patients who received chemotherapy + allo-HSCT than in patients who received chemotherapy alone (3-year OS: 72.8% vs 17.5%, P = .008; PFS: 65.1% vs 27.8%, P = 0.007). Shorter survival was independently associated with elevated lactic dehydrogenase (LDH), Ki-67≥75%, pleural effusion and no OR (all P < .05) in all patients. But shorter survival was only associated with elevated LDH level, leukocytosis (>10 G/L), and chemotherapy alone in patients who achieved OR (all P < .05).The mid-term outcomes of adult patients with T-LBL are associated with response to chemotherapy (in all patients) and performance of allo-HSCT (in patients who achieved OR). Allo-HSCT could be a feasible and effective consolidation therapy for adult T-LBL.
研究成人T淋巴细胞母细胞淋巴瘤（T-LBL）的预后因素，并评估急性淋巴细胞白血病（ALL）型化疗联合异基因造血干细胞移植（allo-HSCT）对一线ALL型化疗获得完全缓解（OR）的患者的治疗效果。这是一项回顾性研究，纳入了2008年6月至2015年10月期间59例接受环磷酰胺、长春新碱、阿霉素和地塞米松/甲氨蝶呤超分割给药（hyper-CVAD/MA）化疗单独治疗或联合allo-HSCT治疗的成人T-LBL患者。初始化疗后评估完全缓解（CR）率和OR率。分析所有患者的临床特征以及与预后和总生存期（OS）相关的危险因素，并评估allo-HSCT对初始化疗后达到OR的患者OS的影响。48例患者（81.4%）通过hyper-CVAD化疗达到OR，其中22例患者（45.8%）进一步接受了allo-HSCT。中位随访时间为31.5个月，范围为11至97个月。化疗后达到OR的患者3年OS率和无进展生存期（PFS）分别为45.7%和45.0%，未达到OR的患者均为0（P均<0.001）。接受化疗+allo-HSCT的患者3年OS率和PFS高于单纯接受化疗的患者（3年OS率：72.8%对17.5%，P = 0.008；PFS：65.1%对27.8%，P = 0.007）。所有患者中，生存期较短与乳酸脱氢酶（LDH）升高、Ki-67≥75%、胸腔积液和未达到OR独立相关（均P<0.05）。但在达到OR的患者中，生存期较短仅与LDH水平升高白细胞增多（>10 G/L）和单纯化疗相关（均P<0.05）。成人T-LBL患者的中期结局与化疗反应（所有患者）和allo-HSCT的实施情况（达到OR的患者）相关。allo-HSCT可能是成人T-LBL一种可行且有效的巩固治疗方法。
