造血干细胞移植治疗间变大细胞淋巴瘤的临床分析

目的探讨造血干细胞移植治疗间变大细胞淋巴瘤(ALCL)的疗效及预后。方法回顾性分析全国八家三甲医院2005年1月至2017年12月收治的33例接受造血干细胞移植(HSCT)的ALCL患者临床资料,评价自体造血干细胞移植(auto-HSCT)和异基因造血干细胞移植(allo-HSCT)治疗ALCL的生存率、复发率和影响预后的相关因素。结果33例接受HSCT的ALCL患者的中位发病年龄为31(12~57)岁,男23例,女10例,间变性淋巴瘤激酶阳性(ALK+)和阴性(ALK-)分别为24例(72.7%)和9例(27.3%)。25例患者接受auto-HSCT(ALK+患者19例,ALK-患者6例),8例患者接受allo-HSCT(ALK+患者5例,ALK-患者3例)。移植后中位随访时间18.7(4.0~150.0)个月。移植前疾病缓解状态:完全缓解6例(均行auto-HSCT),部分缓解16例(auto-HSCT组14例,allo-HSCT组2例),复发难治11例(auto-HSCT组5例,allo-HSCT组6例)。疾病进展死亡7例,其中auto-HSCT组5例(20.0%),allo-HSCT组2例(25.0%)。移植相关死亡(TRM)5例,其中auto-HSCT组2例(8.0%),allo-HSCT组3例(37.5%)。auto-HSCT后中位无进展生存(PFS)和总生存(OS)时间均为15个月,allo-HSCT后中位PFS时间为3.7(1.0~90.0)个月,中位OS时间为4.6(1.0~90.0)个月,两组生存曲线差异无统计学意义(OS及PFS P值分别为0.247和0.317)。auto-HSCT和allo-HSCT组的2年OS率分别为72%和50%,5年OS率分别为36%和25%。结论ALCL化疗反应率高,有不良预后因素的情况下化疗后序贯auto-HSCT为重要治疗措施,高危患者或可从allo-HSCT中获益。

Outcomes of 33 patients with anaplastic large cell lymphoma treated after hematopoietic stem cell transplantation

Objective To explore the efficacy and prognostic factors of hematopoietic stem cell transplantation(HSCT)for the treatment of patients with anaplastic large cell lymphoma(ALCL).Methods The clinical records of 33 ALCL patients after HSCT were collected and analyzed retrospectively to evaluate the rates of overall survival(OS)and recurrence after autologous(auto-HSCT)and allogeneic HSCT(allo-HSCT)and the factors influencing prognosis.Results The median-age of this cohort of 33 ALCL cases at diagnosis was 31(12-57)years old with a male/female ratio of 23/10,24 cases(72.7%)were ALK+and 9 ones(27.3%)ALK-.Of them,25 patients(19 ALK+and 6 ALK-)underwent auto-HSCT and 8 cases(5 ALK+and 3ALK-)allo-HSCT with a median follow-up of 18.7(4.0-150.0)months.Disease states before HSCT were as follows:only 6 patients achieved CR status and received auto-HSCT,16 patients achieved PR(14 cases by auto-HSCT and 2 ones allo-HSCT),the rest 11 cases were refractory/relapse(5 cases by auto-HSCT and 6 ones allo-HSCT).There were 7 cases died of disease progression(5 after auto-HSCT and 2 allo-HSCT)and 5 cases treatment-related mortality(TRM)(2 after auto-HSCT and 3 allo-HSCT),TRM of two groups were 8.0%and 37.5%,respectively.Both the median progression-free survival(PFS)and OS were 15 months after auto-HSCT,the median PFS and OS after allo-HSCT were 3.7(1.0-90.0)and 4.6(1.0-90.0)months,respectively.There was no statistically significant difference in terms of survival curves between the two groups(OS and PFS,P=0.247 and P=0.317).The 2-year OS rates in auto-HSCT and allo-HSCT groups were 72%and 50%,respectively.The 5-year OS rates in auto-HSCT and allo-HSCT groups were 36%and 25%,respectively.Conclusion ALCL treated by chemotherapy produced high rates of overall and complete responses.Chemotherapy followed by auto-HSCT remained to be good choice for patients with poor prognostic factors.High-risk patients should be considered more beneficial from allo-HSCT.