Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Department of Oncology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Sci Rep. 2024 Sep 27;14(1):22356. doi: 10.1038/s41598-024-72897-9.
The aim of this retrospective study was to evaluate the efficiency and safety of total body irradiation plus cyclophosphamide (TBI/Cy) followed by autogenetic hematopoietic stem cell transplantation (auto-HSCT) in T-LBL/ALL patients that cannot receive allogeneic hematopoietic stem cell transplant (allo-HSCT). Between 2013 and 2023, 24 patients received auto-HSCT following by TBI/Cy, 26 patients underwent allo-HSCT, all patients achieved completed hematopoietic reconstitution after HSCT. The progression free survival (PFS) and overall survival (OS) had no statistically significant differences between the two groups (P = 0.791, HR 1.127, 95%CI 0.456-2.785; P = 0.456, HR 0.685, 95%CI 0.256-1.828). Although the cumulative incidence of relapse was lower for patients who received allo-HSCT than auto-HSCT (P = 0.033, HR 3.707, 95%CI 1.188-11.570, 2-year relapse 11.5% vs. 33.3%), the incidence of non-relapse mortality (NRM) was higher than that in the auto-HSCT group (P = 0.014, HR 0.000, 95%CI -1.000 - -1.000, 2-year NRM, 23.1% vs. 0%). Trough Landmark analysis, the two groups showed a statistically significant difference in 3-year PFS and 4-year OS curves (Figure S2A&B, P = 0.039, HR 0.426, 95%CI 0.163-1.117; P = 0.014, HR 0.317, 95%CI 0.113-0.887). By COX analysis, poor baseline performance status (ECOG-PS ≥ 2) and CNS involvement were risk factors for PFS and OS. In conclusion, TBI/Cy followed by auto-HSCT is a good choice next to allo-HSCT for patients with T-LBL/ALL.
本回顾性研究的目的是评估全身照射加环磷酰胺（TBI/Cy）后自体造血干细胞移植（auto-HSCT）在不能接受异基因造血干细胞移植（allo-HSCT）的 T-LBL/ALL 患者中的疗效和安全性。2013 年至 2023 年，24 例患者接受 TBI/Cy 后行 auto-HSCT，26 例患者行 allo-HSCT，所有患者 HSCT 后均成功造血重建。两组患者无进展生存（PFS）和总生存（OS）无统计学差异（P=0.791，HR1.127，95%CI0.456-2.785；P=0.456，HR0.685，95%CI0.256-1.828）。虽然接受 allo-HSCT 的患者累积复发率低于 auto-HSCT（P=0.033，HR3.707，95%CI1.188-11.570，2 年复发率为 11.5% vs. 33.3%），但非复发死亡率（NRM）高于 auto-HSCT 组（P=0.014，HR0.000，95%CI-1.000-1.000，2 年 NRM，23.1% vs. 0%）。通过 Landmark 分析，两组 3 年 PFS 和 4 年 OS 曲线存在统计学差异（图 S2A&B，P=0.039，HR0.426，95%CI0.163-1.117；P=0.014，HR0.317，95%CI0.113-0.887）。通过 COX 分析，基线较差的体能状态（ECOG-PS≥2）和 CNS 受累是 PFS 和 OS 的危险因素。总之，TBI/Cy 后自体造血干细胞移植是 T-LBL/ALL 患者除 allo-HSCT 之外的另一种较好选择。
