异基因造血干细胞移植治疗急性T 淋巴细胞白血病和淋巴瘤：附50例临床报告

目的 探讨异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治疗急性T淋巴细胞白血病（T cell acute lymphoblastic leukemia，T-ALL）和急性T淋巴母细胞淋巴瘤（T cell acute lymphoblastic lymphoma， T-LBL）的疗效及预后。方法 回顾性分析2014—2019年于航天中心医院接受allo-HSCT的50例T-ALL/LBL患者的临床资料，分析其临床疗效、并发症及预后。结果 50例患者中男性41例，女性9例，中位年龄20.5岁（范围：9.0~63.0岁）；单倍体移植44例，脐血移植 2例，同胞全合移植 4例；T-ALL 40例，T-LBL 10例；移植前处于完全缓解（CR）状态16例，处于未完全缓解（非CR）状态34例。移植后，中位随访20个月（范围：1~84个月），存活23例，死亡27例；移植后24个月的总生存率和无复发生存率分别为50.0%和44.0%，36个月的总生存率和无复发生存率分别为45.5%和40.0%。随访期间，共有20例患者复发，复发率为40.0%（20/50）。移植前获CR、无髓外病变、无中枢神经系统受累的患者预后较好，而移植前有无基因突变、不同预处理方案、有无急性/慢性GVHD患者的总生存期及无复发生存期组间比较差异无统计学意义（均P>0.05）。结论 在这项小样本、无对照的临床研究中，T-ALL/LBL患者在缓解期行allo-HSCT可能较挽救性移植的生存预后有所改善，其中复发为移植失败的主要原因。

Allogeneic hematopoietic stem cell transplantation for T cell acute lymphoblastic leukemia and lymphoma: a clinical report of 50 cases

Objective To investigate the efficacy and prognosis of allogeneic hematopoietic stem cell transplantation(allo-HSCT) in the treatment of T cell acute lymphoblastic leukemia (T-ALL) and T cell acute lymphoblastic lymphoma (T-LBL). Methods The clinical data of 50 patients with T-ALL/LBL received allo-HSCT at the Aerospace Center Hospital from 2014 to 2019 were retrospectively analyzed, with regard to efficacy, related complications and prognosis. Results A total of 50 patients were enrolled, 41 males and 9 females, with a median age of 20.5 years (range: 9.0-63.0 years); including 44 cases of haploid transplantation, 2 cases of umbilical cord blood transplantation and 4 cases of matched sibling donor stem cell transplantation. Among them, 40 cases were T-ALL and 10 cases were T-LBL; 16 patients in complete remission (CR) status and 34 patients in non-CR status before transplantation. After transplantation, the median follow-up time was 20 months (range: 1-84 months), 23 patients survived and 27 died. The overall and relapse-free survival rates were 50.0% and 44.0% at 24 months after transplantation, 45.5% and 40.0% at 36 months, respectively. During the follow-up period, a total of 20 patients relapsed, with a relapse rate of 40% (20/50). Those patients who achieved CR before transplantation, without extramedullary lesions and no central nervous system involvement had a better prognosis, where there was no significant difference in the overall survival and relapse-free survival between the groups with and without gene mutation, different conditioning regimen, and acute/chronic GVHD before transplantation (P>0.05). Conclusions In this small sample and uncontrolled clinical study, allo-HSCT in patients with T-ALL/LBL in remission may improve the survival prognosis compared with salvage transplantation, and relapse is the main reason for transplantation failure.