目的:探讨单倍体相合供者造血干细胞移植(HID-HSCT)与配对同胞供者造血干细胞移植(MSD-HSCT)治疗T细胞淋巴母细胞淋巴瘤(T-LBL)的疗效和安全性差异。
方法:在本回顾性分析中,我们纳入了在2013年至2021年间在我们机构接受过同种异体HSCT的38例患者.研究参与者包括28例接受HID-HSCT的患者和10例接受MSD-HSCT的患者。我们比较了两组患者的特征以及治疗效果和安全性,并评估了T-LBL患者的潜在预后变量。
结果:HID-HSCT和MSD-HSCT组的中位随访时间分别为23.5(范围:4-111)和28.5(范围:13-56)个月,分别。所有患者在造血干细胞移植(HSCT)后均表现为完全供体嵌合状态。除了HID-HSCT队列中的两名患者出现了不良的移植物功能,所有患者在HSCT后均出现中性粒细胞和血小板植入.在HID-HSCT和MSD-HSCT组中,III-IV级急性移植物抗宿主病的累积发生率分别为37.5%和28.57%,分别(p=0.84)。有限的累积发病率(34.13%与28.57%,p=0.82)和广泛(31.22%与37.50%,p=0.53)慢性移植物抗宿主病在两个队列之间没有差异。在HID-HSCT和MSD-HSCT队列中,估计的2年总生存率为70.3%(95%置信区间[CI]:54.9%-90.0%)和56.2%(95%CI:31.6%-100%),分别(p=1.00),估计的2年无进展生存率(PFS)分别为48.5%(95%CI:32.8%-71.6%)和48.0%(95%CI:24.6%-93.8%),分别(p=0.94)。此外,Cox比例风险模型显示,在多变量分析中,完成化疗的患者在HSCT前的正电子发射断层扫描/计算机断层扫描(PET/CT)状态为PFS的独立危险因素(p=0.0367).
结论:这项研究表明,HID-HSCT在治疗T-LBL方面具有与MSD-HSCT相当的有效性和安全性。HID-HSCT可以作为T-LBL患者的替代治疗选择,而没有合格的相同供体。在HSCT之前达到PET/CT阴性状态可能有助于更好的生存。
To investigate the differences in efficacy and safety between haploidentical donor hematopoietic stem cell transplantation (HID-HSCT) and matched sibling donor HSCT (MSD-HSCT) in patients with T-cell lymphoblastic lymphoma (T-LBL).
In this retrospective analysis, we enrolled 38 patients who had undergone allogeneic HSCT at our institution between 2013 and 2021. The study participants included 28 patients who underwent HID-HSCT and 10 patients who underwent MSD-HSCT. We compared the patient characteristics and treatment effectiveness and safety between the two groups and evaluated potential prognostic variables for patients with T-LBL.
The median follow-up durations in the HID-HSCT and MSD-HSCT groups were 23.5 (range: 4-111) and 28.5 (range: 13-56) months, respectively. All patients showed full-donor chimerism after hematopoietic stem cell transplantation (HSCT). Except for two patients in the HID-HSCT cohort who developed poor graft function, all patients showed neutrophil and platelet engraftments after HSCT. The cumulative incidences of grades III-IV acute graft-versus-host disease were 37.5% and 28.57% in the HID-HSCT and MSD-HSCT groups, respectively (p = 0.84). The cumulative incidences of limited (34.13% vs. 28.57%, p = 0.82) and extensive (31.22% vs. 37.50%, p = 0.53) chronic graft-versus-host disease did not differ between the two cohorts. In the HID-HSCT and MSD-HSCT cohorts, the estimated 2-year overall survival rates were 70.3% (95% confidence interval [CI]: 54.9%-90.0%) and 56.2% (95% CI: 31.6%-100%), respectively (p = 1.00), and the estimated 2-year progression-free survival (PFS) rates were 48.5% (95% CI: 32.8%-71.6%) and 48.0% (95% CI: 24.6%-93.8%), respectively (p = 0.94). Furthermore, the Cox proportional-hazards model showed that a positive positron emission tomography/computed tomography (PET/CT) status before HSCT in patients who had completed chemotherapy was an independent risk factor for PFS in the multivariate analysis (p = 0.0367).
This study showed that HID-HSCT had comparable effectiveness and safety to MSD-HSCT in treating T-LBL. HID-HSCT could serve as an alternate treatment option for T-LBL in patients without an eligible identical donor. Achievement of the PET/CT-negative status before HSCT may contribute to better survival.