ALL儿童方案序贯造血干细胞移植治疗T淋巴母细胞淋巴瘤疗效及预后因素分析

OBJECTIVE: To discuss the effect and prognostic factors of hematopoietic stem cell transplantation（HSCT）in patients with T-lymphoblastic lymphoma（T-LBL）who have achieved complete remission（CR）and partial response（PR）after pediatric-like acute lymphoblastic leukemia（ALL）therapy. METHODS: Basic information and clinical data of patients with T-LBL treated in the hematologic center of Tangdu Hospital from January 2013 to January 2017 were collected, and the patients who achieved CR/PR were included in this study and retrospectively analyzed. RESULTS: ①A total of 48 patients received pediatric-like ALL chemotherapy, among which 39 patients achieved CR and 9 patients achieved PR after 2 courses of induction chemotherapy. Auto-HSCT was performed in 14 cases and allo-HSCT in 7 cases, and the hematopoietic function of all 21 patients was successfully reconstructed after transplantation. ②The follow-up period was 9–61 months, with a median of 31 months. The 3-year overall survival（OS）rate was 61.0%（95% CI 53.7%–68.3%）, and the 3-year progression-free survival（PFS）rate was 54.8%（95% CI 47.1%–62.2%）. ③The 3-year OS rate of transplantation group was 84.7%, and that of non-transplantation group was 42.8%. Significant difference of OS rate was observed between the 2 groups（P＝0.006）. The 3-year PFS rate was 75.4%in transplantation group and 38.9%in non-transplantation group. Significant difference of the PFS rate between the two groups was observed（P＝0.004）. ④No difference of OS rate between auto-HSCT and allo-HSCT groups was observed（P＝0.320）, same as the PFS rate（P＝0.597）. ⑤Among the prognostic factors, bone marrow invasion and no HSCT are independent risk factors affecting the long-term prognosis of patients. The mortality rate of patients with bone marrow invasion is about 5.804 times higher than that of patients without bone marrow invasion, and the mortality rate of patients with HSCT is about 5.871 times higher than that of patients without HSCT. CONCLUSION: T-LBL received pediatric-like ALL chemotherapy and HSCT has definite curative effect with lower transplant-related mortality and more safety. In the transplantation group, there is no significant difference of OS and PFS rates between patients receiving auto-HSCT and patients receiving allo-HSCT. Moreover, bone marrow invasion and no HSCT are both independent risk factors for long-term prognosis of patients.