异质性外周 T 细胞淋巴瘤和血管免疫母细胞性 T 细胞淋巴瘤患者干细胞移植的疗效。
Effects of stem cell transplantation in patients with peripheral T-cell lymphoma not otherwise specified and angioimmunoblastic T-cell lymphoma.
机构信息
Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-Ku, Fukuoka, 810-8563, Japan.
Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
出版信息
Int J Hematol. 2020 Jul;112(1):74-83. doi: 10.1007/s12185-020-02879-w. Epub 2020 Apr 15.
The effects of stem cell transplantation (SCT) in patients with peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL) remain controversial. We analyzed the feasibility of SCT and risk factors associated with outcomes of PTCL-NOS and AITL patients to identify the potential clinical efficacy of SCT. We retrospectively analyzed the data of PTCL-NOS (n = 83) and AITL (n = 112) patients who received autologous (n = 10 and 16, respectively) or allogeneic (n = 12 and 4, respectively) SCT, or no SCT (n = 61 and 92, respectively) between 2008 and 2018. All PTCL-NOS and AITL diagnoses were reconfirmed by an experienced hematopathologist. Median age at PTCL-NOS and AITL diagnoses in the SCT group was younger than that in the no SCT group. Significant risk factors for lower overall survival were intermediate-high and high-risk international prognostic indexes in PTCL-NOS patients (P = 0.0052), and a > 2 modified prognostic index for T-cell lymphoma (P = 0.0079) and no SCT (P = 0.028) in AITL patients. Autologous or allogeneic SCT compared with no SCT in AITL patients resulted in 3-year overall survival of 68.6% and 100% vs. 57.2% (P = 0.018). Strategies should be developed to improve selection of PTCL-NOS and AITL patients suitable for SCT and/or additional novel therapies.
异基因造血干细胞移植治疗外周 T 细胞淋巴瘤非特指型和血管免疫母细胞性 T 细胞淋巴瘤的疗效仍存在争议。本研究旨在分析异基因造血干细胞移植治疗外周 T 细胞淋巴瘤非特指型和血管免疫母细胞性 T 细胞淋巴瘤的可行性，并探讨影响其预后的相关因素，以明确异基因造血干细胞移植治疗的潜在临床疗效。
本研究回顾性分析了 2008 年至 2018 年间收治的 83 例外周 T 细胞淋巴瘤非特指型和 112 例血管免疫母细胞性 T 细胞淋巴瘤患者的临床资料，其中接受自体造血干细胞移植（n=10 和 16）、异基因造血干细胞移植（n=12 和 4）和未接受造血干细胞移植（n=61 和 92）患者的临床资料。所有患者的诊断均经经验丰富的血液病理学家重新确认。
结果显示，接受异基因造血干细胞移植的外周 T 细胞淋巴瘤非特指型和血管免疫母细胞性 T 细胞淋巴瘤患者的中位年龄均小于未接受造血干细胞移植的患者。多因素分析显示，国际预后指数中危-高危及高危、改良 T 细胞淋巴瘤预后指数（mPIT）评分>2 分及未接受造血干细胞移植是影响外周 T 细胞淋巴瘤非特指型患者总生存的独立预后因素（P 值分别为 0.0052、0.0079 和 0.028）；而改良 T 细胞淋巴瘤预后指数评分>2 分和未接受造血干细胞移植是影响血管免疫母细胞性 T 细胞淋巴瘤患者总生存的独立预后因素（P 值分别为 0.0079 和 0.028）。
与未接受造血干细胞移植相比，异基因造血干细胞移植可改善血管免疫母细胞性 T 细胞淋巴瘤患者的总生存，其 3 年总生存率分别为 68.6%、100%和 57.2%（P=0.018）。
综上，对于外周 T 细胞淋巴瘤非特指型和血管免疫母细胞性 T 细胞淋巴瘤患者，应制定相应策略，以改善适合接受造血干细胞移植及（或）其他新型治疗的患者的选择。
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