Zhao F, Shi Y Y, Zhang G X, Zhai W H, Pang A M, Ma Q L, Zhang R L, Wei J L, Huang Y, Yang D L, He Y, Jiang E L, Feng S Z, Han M Z
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 Aug 14;41(8):630-636. doi: 10.3760/cma.j.issn.0253-2727.2020.08.003.
To explore the clinical characteristics, related factors, and prognostic effect of patients with T cell large granular lymphocytosis following allo-HSCT. Consecutive patients with T-LGL following allo-HSCT who visited our center from June 2013 to February 2020 were studied retrospectively. We compared patients undergoing allo-HSCT during this period. The clinical characteristics, related factors, cumulative incidence of patients with T-LGL and rates of overall survival (OS) , disease free survival (DFS) , relapse, and non-relapse mortality (NRM) were analyzed. Total 359 patients were enrolled, including 17 with T-LGL and 342 without T-LGL following allo-HSCT. The median follow-up duration was 38 (3-92) month. The cumulative incidence at 1-, 2- and 3-years of T-LGL was 3.64% (95% 1.09%-6.19%) , 4.50% (95% 1.36%-7.64%) , and 4.84% (95% 1.10%-8.76%) , respectively. CMV reactivation (=0.013) , EB viremia (=0.034) , and aGVHD (=0.027) were associated with the development of T-LGL following allo-HSCT. Multivariate analysis showed that benign hematologic diseases[=0.027, =3.36 (95% 1.15-9.89) ] and haploidentical hematopoietic stem cell transplantation[=0.030, =4.67 (95% 1.16-18.75) ], unrelated donor transplantation[=0.041, =5.49 (95% 1.10-28.16) ] were independent predictive factors of T-LGL following allo-HSCT. There was a significant difference in the 3-year OS (100.0% . 78.6%, =0.04) , DFS (100.0% . 70.0%, =0.01) , and NRM (0 . 12.6%, =0.02) between the 2 cohorts. Subgroup analysis showed that malignant diseases recipients who developed T-LGL had better outcomes after allo-HSCT, and there was a significant difference in the NRM (=0.042) , DFS (=0.013) , and cumulative relapse rate (=0.028) between the 2 cohorts. In contrast, the appearance of T-LGL after allo-HSCT in patients with benign diseases had no significant effect on the prognosis. T-LGL was a durable and clinically benign phenomenon occurring in allo-HSCT recipients with malignant diseases. Factors associated with immune reconstitution and T-cell regulatory mechanisms might be major predictors of T-LGL following allo-HSCT.
探讨异基因造血干细胞移植（allo-HSCT）后T细胞大颗粒淋巴细胞增多症（T-LGL）患者的临床特征、相关因素及预后影响。对2013年6月至2020年2月期间在本中心就诊的allo-HSCT后发生T-LGL的连续患者进行回顾性研究。我们比较了在此期间接受allo-HSCT的患者。分析了临床特征、相关因素、T-LGL患者的累积发病率以及总生存（OS）率、无病生存（DFS）率、复发率和非复发死亡率（NRM）。共纳入359例患者，其中allo-HSCT后17例发生T-LGL，342例未发生T-LGL。中位随访时间为38（3 - 92）个月。T-LGL在1年、2年和3年的累积发病率分别为3.64%（95%可信区间1.09% - 6.19%）、4.50%（95%可信区间1.36% - 7.64%）和4.84%（95%可信区间1.10% - 8.76%）。巨细胞病毒再激活（P = 0.013）、EB病毒血症（P = 0.034）和急性移植物抗宿主病（aGVHD，P = 0.027）与allo-HSCT后T-LGL的发生相关。多因素分析显示，良性血液病（P = 0.027，风险比 = 3.36，95%可信区间1.15 - 9.89）、单倍体造血干细胞移植（P = 0.030，风险比 = 4.67，95%可信区间1.16 - 18.75）、无关供者移植（P = 0.041，风险比 = 5.49，95%可信区间1.10 - 28.16）是allo-HSCT后T-LGL的独立预测因素。两组患者的3年OS（100.0%对78.6%，P = 0.04）、DFS（100.0%对70.0%，P = 0.01）和NRM（0对12.6%，P = 0.02）存在显著差异。亚组分析显示，发生T-LGL的恶性疾病受者allo-HSCT后的预后较好，两组患者的NRM（P = 0.042）、DFS（P = 0.013）和累积复发率（P = 0.028）存在显著差异。相比之下，良性疾病患者allo-HSCT后T-LGL的出现对预后无显著影响。T-LGL是发生在恶性疾病allo-HSCT受者中的一种持久且临床良性的现象。与免疫重建和T细胞调节机制相关的因素可能是allo-HSCT后T-LGL的主要预测因素。
