Kameda Kazuaki, Kako Shinichi, Kim Sung-Won, Usui Yoshiaki, Kato Koji, Fukuda Takahiro, Uchida Naoyuki, Kobayashi Hikaru, Wakayama Toshio, Sakaida Emiko, Yano Shingo, Imada Kazunori, Nara Miho, Ikeda Takashi, Fuchida Shin-Ichi, Ishikawa Jun, Sugahara Hiroyuki, Kanda Junya, Kimura Takafumi, Ichinohe Tatsuo, Atsuta Yoshiko, Kondo Eisei
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Leukemia. 2022 May;36(5):1361-1370. doi: 10.1038/s41375-022-01545-w. Epub 2022 Mar 28.
Fit patients with peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL) in relapsed or refractory (R/R) disease status often receive salvage chemotherapy followed by autologous hematopoietic stem cell transplantation (autoHCT) or allogeneic HCT (alloHCT). However, there is no consensus on the type of HCT that should be applied for such patients. Herein, we retrospectively evaluated the survival outcome of 760 adult R/R PTCL-NOS or AITL patients who underwent the first HCT. Among them, 318 relapsed after first remission (REL) and 442 were refractory to the primary therapy (PIF). The 4-year overall survival (OS) of autoHCT and alloHCT was 50 and 50% for REL patients, and 52 and 49% for PIF patients, respectively. In the multivariable analysis, alloHCT tended to be associated with better progression-free survival (PFS) in REL (hazard ratio [HR] 0.74; 95% confidence interval [CI]: 0.53-1.03), and significantly better PFS in PIF (HR 0.64; 95% CI: 0.46-0.88) compared with autoHCT. The subgroup analysis with propensity-score matching showed that alloHCT was associated with better OS for REL-sensitive and PIF-nonremission disease. This study suggested that the advantage of alloHCT for R/R PTCL-NOS or AITL is different, depending on the disease status at HCT.
适合接受治疗的外周T细胞淋巴瘤患者,未另行特指(PTCL-NOS)和血管免疫母细胞性T细胞淋巴瘤(AITL)处于复发或难治(R/R)疾病状态时,通常先接受挽救性化疗,然后进行自体造血干细胞移植(autoHCT)或异基因造血干细胞移植(alloHCT)。然而,对于这类患者应采用何种类型的造血干细胞移植尚无共识。在此,我们回顾性评估了760例接受首次造血干细胞移植的成年R/R PTCL-NOS或AITL患者的生存结果。其中,318例在首次缓解后复发(REL),442例对初始治疗难治(PIF)。对于REL患者,autoHCT和alloHCT的4年总生存率(OS)分别为50%和50%,对于PIF患者,分别为52%和49%。在多变量分析中,与autoHCT相比,alloHCT在REL患者中倾向于与更好的无进展生存期(PFS)相关(风险比[HR]0.74;95%置信区间[CI]:0.53 - 1.03),在PIF患者中PFS显著更好(HR 0.64;95% CI:0.46 - 0.88)。倾向评分匹配的亚组分析表明,alloHCT与REL敏感和PIF未缓解疾病的更好OS相关。这项研究表明,alloHCT对R/R PTCL-NOS或AITL的优势因造血干细胞移植时的疾病状态而异。