异基因造血干细胞移植治疗T淋巴母细胞白血病/淋巴瘤的疗效及预后因素

OBJECTIVE: To analyze the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation（allo-HSCT）for treating T lymphoblastic leukemia/lymphoma（T-ALL/LBL）. METHODS: This study retrospectively evaluated 119 adolescent and adult patients with T-ALL/LBL from January 2006 to January 2020 at Peking University Third Hospital and Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences. Patients were divided into chemotherapy-only, chemotherapy followed by allo-HSCT, and chemotherapy followed by autologous hematopoietic stem cell transplantation（auto-HSCT）groups according to the consolidation regimen, and the 5-year overall survival（OS）and progression-free survival（PFS）rates of each group were compared. RESULTS: Among 113 patients with effective follow-up, 96（84.9％）patients achieved overall response（ORR）, with 79（69.9％）having complete response（CR）and 17（15.0％）having partial response（PR）, until July 2022. The analysis of the 96 ORR population revealed that patients without transplantation demonstrated poorer outcomes compared with the allo-HSCT group（5-year OS: 11.4％ vs 55.6％, P＝0.001; 5-year PFS: 8.9％ vs 54.2％, P<0.001）. No difference was found in 5-year OS and 5-year PFS between the allo-HSCT and auto-HSCT groups（P＝0.271, P＝0.197）. The same results were achieved in the CR population. Allo-HSCT got better 5-year OS（37.5％ vs 0）for the 17 PR cases（P＝0.064）. Different donor sources did not affect 5-year OS, with sibling of 61.1％ vs hap-haploidentical of 63.6％ vs unrelated donor of 50.0％（P>0.05）. No significant difference was found in the treatment response in the early T-cell precursor acute lymphoblastic leukemia/lymphoma（ETP）and non-ETP populations. The ETP group demonstrated lower 5-year OS compared with the non-ETP group in the chemotherapy alone group（0 vs 12.6％, P＝0.045）, whereas no significant difference was found between the ETP and non-ETP groups in the allo-HSCT group（75.0％ vs 62.9％, P＝0.852）. Multivariate analysis revealed that high serum lactate dehydrogenase level, without transplantation, and no CR after chemotherapy induction were independently associated with inferior outcomes（P<0.05）. CONCLUSION: Allo-HSCT could be an effective consolidation therapy for adult and adolescent patients with T-ALL/LBL. Different donor sources did not affect survival. Allo-HSCT may overcome the adverse influence of ETP-ALL/LBL on OS.