一项关于外周 T 细胞淋巴瘤自体造血干细胞移植的回顾性研究：移植前部分缓解的患者从移植后维持治疗中获益。
A retrospective study of autologous hematopoietic stem cell transplantation for peripheral T-cell lymphoma: pre-transplant patients with partial remission benefit from post-transplant maintenance therapy.
作者信息
Huang Zhenghua, Li Zhen, Wang Juan, Gui Ruirui, Zu Yingling, Yu Fengkuan, Lin Quande, Zhao Huifang, Zhang Yanli, Fang Baijun, Liu Yanyan, Zhou Keshu, Li Yufu, Fu Yuewen, Yao Zhihua, Song Yongping, Zhou Jian
机构信息
Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China.
Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Oncol. 2023 May 15;13:1162413. doi: 10.3389/fonc.2023.1162413. eCollection 2023.
BACKGROUND
Whether autologous hematopoietic stem cell transplantation (ASCT) improves the survival of patients with peripheral T-cell lymphoma (PTCL) remains controversial. Some studies have demonstrated that the efficacy of ASCT is superior in patients with complete remission (CR), whereas patients with partial remission (PR) remain vulnerable to relapse after ASCT, resulting in decreased survival rates. Maintenance therapy after chemotherapy may reduce the relapse rate of PTCL and improve survival; however, the role of maintenance therapy after ASCT in PTCL remains unclear. In this study, we aimed to analyze the efficacy of ASCT and post-transplant maintenance therapy in PTCL.
METHODS
We retrospectively analyzed the clinical data of 69 patients with PTCL who underwent ASCT at our center between November 2001 and November 2021. According to the patients' intention, thirty patients received post-transplant maintenance treatment, whereas 39 did not. The overall survival (OS) and progression-free survival (PFS) between the groups were compared using the log-rank test.
RESULTS
At a median follow-up of 36 months, the entire cohort's 3-year OS and PFS were 67.8% and 53.0%, respectively. The 3-year OS and PFS of patients with CR1, CR2, and PR were 85.3% and 65.4%, 80.0% and 60.0%, and 38.4% and 32.0%, respectively (OS: =0.001; PFS: =0.003). The relapse rates between the groups with or without maintenance therapy were 26.7% vs. 52.2%, the 3-year OS was 86.0% vs. 54.2% (=0.004), and the 3-year PFS was 73.3% vs. 37.5% (=0.004). Further analysis revealed that the efficacy of maintenance therapy was not significant in patients with CR1 and CR2, whereas patients with PR benefited from maintenance therapy. The relapse rate of patients with PR who received or did not receive maintenance therapy was 33.3% vs. 78.7%, 3-year OS was 66.7% vs. 21.9% (=0.007), and 3-year PFS was 66.7% vs. 12.5% (=0.004).
CONCLUSIONS
Patients with CR in PTCL benefit from ASCT, and post-transplant maintenance therapy reduces the relapse rate and significantly improves OS and PFS in patients with PR.
背景
自体造血干细胞移植（ASCT）是否能提高外周T细胞淋巴瘤（PTCL）患者的生存率仍存在争议。一些研究表明，ASCT对完全缓解（CR）患者的疗效更佳，而部分缓解（PR）患者在ASCT后仍易复发，导致生存率降低。化疗后的维持治疗可能会降低PTCL的复发率并提高生存率；然而，ASCT后维持治疗在PTCL中的作用仍不明确。在本研究中，我们旨在分析ASCT及移植后维持治疗在PTCL中的疗效。
方法
我们回顾性分析了2001年11月至2021年11月期间在本中心接受ASCT的69例PTCL患者的临床资料。根据患者意愿，30例患者接受了移植后维持治疗，而39例未接受。使用对数秩检验比较两组之间的总生存期（OS）和无进展生存期（PFS）。
结果
中位随访36个月时，整个队列的3年OS和PFS分别为67.8%和53.0%。CR1、CR2和PR患者的3年OS和PFS分别为85.3%和65.4%、80.0%和60.0%、38.4%和32.0%（OS：=0.001；PFS：=0.003）。接受或未接受维持治疗组之间的复发率分别为26.7%和52.2%，3年OS分别为86.0%和54.2%（=0.004），3年PFS分别为73.3%和37.5%（=0.004）。进一步分析显示，维持治疗对CR1和CR2患者的疗效不显著，而PR患者从维持治疗中获益。接受或未接受维持治疗的PR患者的复发率分别为33.3%和78.7%，3年OS分别为66.7%和21.9%（=0.007），3年PFS分别为66.7%和12.5%（=0.004）。
结论
PTCL中的CR患者从ASCT中获益，移植后维持治疗可降低复发率，并显著提高PR患者的OS和PFS。
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