Yasuda Shunichiro, Najima Yuho, Konishi Tatsuya, Yamada Yuta, Nagata Akihito, Takezaki Toshiaki, Kaito Satoshi, Kurosawa Shuhei, Sakaguchi Masahiro, Harada Kaito, Shingai Naoki, Yoshioka Kosuke, Inamoto Kyoko, Mukae Junichi, Toya Takashi, Igarashi Aiko, Shimizu Hiroaki, Kobayashi Takeshi, Kakihana Kazuhiko, Sakamaki Hisashi, Kawamata Norihiko, Ohashi Kazuteru, Doki Noriko
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan; Department of Immunotherapy for Hematopoietic Disorders, Tokyo Medical and Dental University, Tokyo, Japan.
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Leuk Res. 2021 Sep;108:106627. doi: 10.1016/j.leukres.2021.106627. Epub 2021 May 18.
Although the indications for allogeneic hematopoietic stem cell transplantation (allo-HSCT) as a treatment for T-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL) and Philadelphia chromosome (Ph)-negative B-cell acute lymphoblastic leukemia (B-ALL) are similar, few studies have compared its outcomes for T-ALL/LBL and Ph-negative B-ALL. The clinical data of 28 patients with T-ALL, 16 with T-LBL, and 99 with Ph-negative B-ALL who underwent the first allo-HSCT from 2000 to 2019 were retrospectively analyzed. Complete remission (CR) rates at allo-HSCT were 79 %, 63 %, and 75 % for T-ALL, T-LBL, and B-ALL, respectively; the 3-year overall survival (OS) rates were 55.7 %, 56.2 %, and 58.6 %, respectively (p = 0.92). Univariate analysis revealed that disease subtypes were not significantly associated with OS (B-ALL vs. T-ALL: hazard ratio [HR]=0.89, p = 0.70; T-LBL vs. T-ALL: HR=0.87, p = 0.75), and CR at allo-HSCT was the only prognostic factor for OS (HR=0.25, p < 0.001). Multivariate analysis demonstrated that CR at allo-HSCT was the only predictor of OS (HR=0.24, p < 0.001). In all three disease subtypes, patients in CR at allo-HSCT tended to have a lower cumulative incidence of relapse than did those in non-CR (T-ALL: 13.6 % vs. 50.0 %, p = 0.10; T-LBL: 20.0 % vs. 50.0 %, p = 0.21; B-ALL: 10.0 % vs. 56.0 %, p < 0.01). Thus, the outcomes of allo-HSCT for T-ALL/LBL were comparable to those of Ph-negative B-ALL. Irrespective of the disease subtypes, achieving CR before allo-HSCT was associated with a favorable OS. Further advances in chemotherapy before allo-HSCT and defining the optimal timing of allo-HSCT would improve the prognosis of patients with T-ALL/LBL.
尽管异基因造血干细胞移植（allo-HSCT）作为治疗T细胞急性淋巴细胞白血病/淋巴瘤（T-ALL/LBL）和费城染色体（Ph）阴性B细胞急性淋巴细胞白血病（B-ALL）的适应证相似，但很少有研究比较其对T-ALL/LBL和Ph阴性B-ALL的治疗效果。回顾性分析了2000年至2019年接受首次allo-HSCT的28例T-ALL患者、16例T-LBL患者和99例Ph阴性B-ALL患者的临床资料。allo-HSCT时的完全缓解（CR）率在T-ALL、T-LBL和B-ALL中分别为79%、63%和75%；3年总生存率（OS）分别为55.7%、56.2%和58.6%（p = 0.92）。单因素分析显示，疾病亚型与OS无显著相关性（B-ALL与T-ALL：风险比[HR]=0.89，p = 0.70；T-LBL与T-ALL：HR=0.87，p = 0.75），allo-HSCT时的CR是OS的唯一预后因素（HR=0.25，p < 0.001）。多因素分析表明，allo-HSCT时的CR是OS的唯一预测因素（HR=0.24，p < 0.001）。在所有三种疾病亚型中，allo-HSCT时处于CR的患者复发累积发生率往往低于未达到CR的患者（T-ALL：13.6%对50.0%，p = 0.10；T-LBL：20.0%对50.0%，p = 0.21；B-ALL：10.0%对56.0%，p < 0.01）。因此，allo-HSCT治疗T-ALL/LBL的效果与Ph阴性B-ALL相当。无论疾病亚型如何，allo-HSCT前达到CR与良好的OS相关。allo-HSCT前化疗的进一步进展以及确定allo-HSCT的最佳时机将改善T-ALL/LBL患者的预后。
