一项关于中国自体与异体造血干细胞移植治疗外周 T 细胞淋巴瘤的真实世界结局的多中心回顾性研究。
A multicenter retrospective study on the real-world outcomes of autologous vs. allogeneic hematopoietic stem cell transplantation for peripheral T-cell lymphoma in China.
机构信息
Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China.
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
出版信息
Chin Med J (Engl). 2021 Jun 16;134(13):1584-1592. doi: 10.1097/CM9.0000000000001575.
BACKGROUND
There were few studies on real-world data about autologous hematopoietic stem cell transplantation (auto-HSCT) or allogeneic HSCT (allo-HSCT) in peripheral T-cell lymphoma (PTCL). This study aimed to investigate the clinical outcomes of patients who received auto-HSCT or allo-HSCT in China.
METHODS
From July 2007 to June 2017, a total of 128 patients who received auto-HSCT (n = 72) or allo-HSCT (n = 56) at eight medical centers across China were included in this study. We retrospectively collected their demographic and clinical data and compared the clinical outcomes between groups.
RESULTS
Patients receiving allo-HSCT were more likely to be diagnosed with stage III or IV disease (95% vs. 82%, P = 0.027), bone marrow involvement (42% vs. 15%, P = 0.001), chemotherapy-resistant disease (41% vs. 8%, P = 0.001), and progression disease (32% vs. 4%, P < 0.001) at transplantation than those receiving auto-HSCT. With a median follow-up of 30 (2-143) months, 3-year overall survival (OS) and progression-free survival (PFS) in the auto-HSCT group were 70%(48/63) and 59%(42/63), respectively. Three-year OS and PFS for allo-HSCT recipients were 46%(27/54) and 44%(29/54), respectively. There was no difference in relapse rate (34%[17/63] in auto-HSCT vs. 29%[15/54] in allo-HSCT, P = 0.840). Three-year non-relapse mortality rate in auto-HSCT recipients was 6%(4/63) compared with 27%(14/54) for allo-HSCT recipients (P = 0.004). Subanalyses showed that patients with lower prognostic index scores for PTCL (PIT) who received auto-HSCT in an upfront setting had a better outcome than patients with higher PIT scores (3-year OS: 85% vs. 40%, P = 0.003). Patients with complete remission (CR) undergoing auto-HSCT had better survival (3-year OS: 88% vs. 48% in allo-HSCT, P = 0.008). For patients beyond CR, the outcome of patients who received allo-HSCT was similar to that in the atuo-HSCT group (3-year OS: 51% vs. 46%, P = 0.300).
CONCLUSIONS
Our study provided real-world data about auto-HSCT and allo-HSCT in China. Auto-HSCT seemed to be associated with better survival for patients in good condition (lower PIT score and/or better disease control). For patients possessing unfavorable characteristics, the survival of patients receiving allo-HSCT group was similar to that in the auto-HSCT group.
背景
外周 T 细胞淋巴瘤（PTCL）的自体造血干细胞移植（auto-HSCT）或异基因 HSCT（allo-HSCT）的真实世界数据研究较少。本研究旨在探讨在中国接受 auto-HSCT 或 allo-HSCT 的患者的临床结局。
方法
本研究纳入了 2007 年 7 月至 2017 年 6 月期间在中国 8 家医疗中心接受 auto-HSCT（n = 72）或 allo-HSCT（n = 56）的 128 例患者。我们回顾性收集了他们的人口统计学和临床数据，并比较了两组之间的临床结局。
结果
接受 allo-HSCT 的患者在移植时更有可能患有 III 或 IV 期疾病（95% vs. 82%，P = 0.027）、骨髓受累（42% vs. 15%，P = 0.001）、化疗耐药疾病（41% vs. 8%，P = 0.001）和进展性疾病（32% vs. 4%，P < 0.001）。中位随访 30（2-143）个月后，auto-HSCT 组的 3 年总生存率（OS）和无进展生存率（PFS）分别为 70%（48/63）和 59%（42/63）。allo-HSCT 组的 3 年 OS 和 PFS 分别为 46%（27/54）和 44%（29/54）。两组的复发率无差异（auto-HSCT 为 34%[17/63]，allo-HSCT 为 29%[15/54]，P = 0.840）。auto-HSCT 组的 3 年非复发死亡率为 6%（4/63），allo-HSCT 组为 27%（14/54）（P = 0.004）。亚分析显示，在初始治疗中接受 auto-HSCT 的 PTCL 预后指数（PIT）评分较低的患者比 PIT 评分较高的患者具有更好的结局（3 年 OS：85% vs. 40%，P = 0.003）。接受 auto-HSCT 并达到完全缓解（CR）的患者生存更好（3 年 OS：allo-HSCT 为 88%，auto-HSCT 为 48%，P = 0.008）。对于未达到 CR 的患者，allo-HSCT 组的患者结局与 auto-HSCT 组相似（3 年 OS：51% vs. 46%，P = 0.300）。
结论
本研究提供了中国关于 auto-HSCT 和 allo-HSCT 的真实世界数据。对于身体状况良好的患者（较低的 PIT 评分和/或更好的疾病控制），auto-HSCT 似乎与更好的生存相关。对于具有不利特征的患者，allo-HSCT 组患者的生存与 auto-HSCT 组相似。
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