全身放疗预处理方案改善了异基因外周血造血干细胞移植后成人 T 细胞淋巴母细胞淋巴瘤患者的生存。
Total Body Irradiation-Based Conditioning Regimen Improved the Survival of Adult Patients With T-Cell Lymphoblastic Lymphoma After Allogeneic Peripheral Blood Stem Cell Transplantation.
机构信息
Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Engineering Technology Research Center of Cell Therapy and Clinical Translation, Shanghai Science and Technology Committee, Shanghai, China.
出版信息
Cell Transplant. 2022 Jan-Dec;31:9636897221108890. doi: 10.1177/09636897221108890.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is one of the consolidation modalities for adult patients with T-cell lymphoblastic lymphoma (T-LBL). However, the optimal conditioning regimen needs to be explored. In the present study, 40 patients with T-LBL undergoing allo-HSCT were retrospectively analyzed, including 23/40 (57.5%) with total body irradiation (TBI)-based conditioning regimen and 17/40 (42.5%) with busulfan (BU)-based regimen. TBI-based regimen significantly increased the cumulative incidence (CI) of grade II to IV acute graft-versus-host disease (aGvHD) as compared with BU-based regimen (13.0% vs 0%, = 0.000). The relapse risk was significantly lowered in TBI-based group with a 2-year CI of relapse (CIR) of 9.1% as compared with that of 49.6% in BU-based group ( = 0.008). The 1-year and 2-year non-relapse mortalities (NRMs) for all patients were 5.0% and 10.3%, respectively. The 1-year and 2-year NRMs were 8.9% and 16.0% in TBI-based group, and 0.00% and 0.00% in BU-based group ( = 0.140). The 2-year probabilities of overall survival (OS) and relapse-free survival (RFS) were 83.0% [95% confidence interval, 63.4%-100%] and 74.0% (95% confidence interval, 54.4%-93.6%) in TBI-based group, which were higher than that of 35.0% (95% confidence interval, 0.0%-72.2%) and 50.0% (95% confidence interval, 24.5%-75.4%) in BU-based group, respectively ( = 0.020 for OS and = 0.081 for RFS). In multivariate analysis, TBI-based regimen significantly reduced the risk of relapse [subdistribution hazard ratio (SHR) = 0.030, 95% CI, 0.002-0.040, = 0.000] and improved the OS [hazard ratio (HR) 0.121, 95% CI, 0.021-0.683, = 0.017] as an independent prognostic factor. These results suggested that TBI-based regimen might be an optimal choice for adult patients with T-LBL undergoing allo-HSCT.
异基因造血干细胞移植（allo-HSCT）是 T 细胞淋巴母细胞淋巴瘤（T-LBL）成人患者的巩固治疗方式之一。然而，需要探索最佳的预处理方案。本研究回顾性分析了 40 例接受 allo-HSCT 的 T-LBL 患者，其中 23/40（57.5%）采用基于全身照射（TBI）的预处理方案，17/40（42.5%）采用基于白消安（BU）的方案。与 BU 为基础的方案相比，TBI 为基础的方案显著增加了 2 级至 4 级急性移植物抗宿主病（aGvHD）的累积发生率（CI）（13.0%对 0%， = 0.000）。TBI 为基础组的复发风险显著降低，2 年复发累积发生率（CIR）为 9.1%，而 BU 为基础组为 49.6%（ = 0.008）。所有患者的 1 年和 2 年非复发死亡率（NRM）分别为 5.0%和 10.3%。TBI 为基础组的 1 年和 2 年 NRM 分别为 8.9%和 16.0%，而 BU 为基础组分别为 0.00%和 0.00%（ = 0.140）。TBI 为基础组的 2 年总生存率（OS）和无复发生存率（RFS）分别为 83.0%（95%置信区间，63.4%-100%）和 74.0%（95%置信区间，54.4%-93.6%），高于 BU 为基础组的 35.0%（95%置信区间，0.0%-72.2%）和 50.0%（95%置信区间，24.5%-75.4%）（OS： = 0.020，RFS： = 0.081）。多变量分析表明，TBI 为基础的方案显著降低了复发风险[亚分布风险比（SHR）= 0.030，95%置信区间，0.002-0.040， = 0.000]，并改善了 OS[风险比（HR）0.121，95%置信区间，0.021-0.683， = 0.017]，是独立的预后因素。这些结果表明，TBI 为基础的方案可能是接受 allo-HSCT 的 T-LBL 成人患者的最佳选择。
Zotero 插件