| T-lymphoblastic lymphoma(T-LBL)is a typical highly invasive lymphoma with poor curative effect.It has a wide range of lesions and progresses rapidly,accounting for about 2% of non-Hodgkin's lymphoma.Early treatment of T-LBL is mainly traditional or enhanced NHL chemotherapy regimen.Modern treatment for T-LBL has gradually developed to adult ALL regimen and even pediatric ALL regimen.However,it is still controversial whether hematopoietic stem cell transplantation should be used for consolidation therapy on the basis of pediatric-like ALL treatment.At present,age,LDH value,central infiltration,bone marrow infiltration,IPI score,minimal residual disease(MRD),Ann Arbor stage,B symptoms are considered as major prognosis factors for T-Lymphoblastic Lymphoma.There are a few studies in foreign countries,while the reliable risk factors or prognostic factors have not yet been determined in adult patients with T-LBL.PART ONE: Objective:To discuss the effect of consolidation therapy with hematopoietic stem cell transplantation on prognosis of T-LBL patients who have achieved initial remission after pediatric-like ALL treatment.Methods:Retrospectively analyzed the clinical data of 48 patients with T-LBL who achieved CR/PR for the first time(after 2 courses of treatment)with pediatric-like ALL regimen,and the prognosis was followed up.According to whether hematopoietic stem cell transplantation was applied,the patients were divided into transplantation group(21 cases)and non-transplantation group(27 cases).Survival analysis was employed to compare the differences of OS and PFS between transplantation group and non-transplantation group after excluding the clinical data deviation.On this basis,transplanted patients were divided into auto-HSCT group(14 cases)and allo-HSCT group(7 cases),and the differences of OS and PFS between the two groups were compared.The migration analysis of basic clinical data was validated by Max 2 test(categorized variable)and t test(continuous variable);the survival analysis of PFS and OS were performed by Kaplan-Meier survival curve;the single factor analysis was performed by logarithmic rank test,and the difference was statistically considered as significant(P < 0.05).Results: 1.The 3-year OS rate in transplantation group was 84.7%(95% CI,76.5% ~92.9%)and that in non-transplantation group was 42.8%(95% CI,32.9%~52.7%)with a P value of 0.006.The 3-year PFS rate of transplantation group was 75.4%(95% CI,65.8% ~85.0%)and that of non-transplantation group was 38.9%(95% CI,29.1%~49.7%)with a P value of 0.004.2.In auto-HSCT group,the 3-year OS rate was 92.9%(95% CI,86.0% ~99.8%);fin allo-HSCT group,the 3-year OS rate was 71.4%(95% CI,54.5%~89.5%)and the P value was 0.496.In auto-HSCT group,the 3-year PFS rate was 77.9%(95% CI,66.6% ~89.2%);in allo-HSCT group,the 3-year expected PFS rate was 71.4%(95% CI,54.5% ~89.5%)and the P value was 0.811.Conclusion: 1.Consolidation therapy with hematopoietic stem cell transplantation can significantly improve prognosis and prolong OS and PFS in patients with T-LBL who achieve CR/PR under pediatric-like ALL chemotherapy regimen.2.Compared with allo-HSCT group,the OS rate and PFS of auto-HSCT group had no statistical difference.Therefore,the two transplantation methods were equivalent as consolidation therapy for T-LBL patients.Considering the complications of allo-HSCT,the need for long-term prevention of GVHD and higher treatment costs after transplantation,auto-HSCT is recommended as the first choice for consolidation therapy.PART TWO: Objective:To investigate the effects of gender,age,mediastinal mass,central invasion,bone marrow invasion,B symptoms,LDH value,initial physical strength score(ECOG score),Ann Arbor stage,IPI score,initial CR,and hematopoietic stem cell transplantation on the prognosis of T-LBL patients who achieved CR/PR under the new pediatric-like ALL chemotherapy regimen.Methods:According to the above factors,48 patients with T-LBL who achieved CR/PR under pediatric-like ALL chemotherapy regimen were divided into groups.The survival curves of PFS and OS were analyzed by Kaplan-Meier survival curve.The single factor analysis was applied by logarithmic rank test.The factors P<0.1 in the single factor analysis were included in COX multi-factor risk ratio model for multi-factor prognosis analysis,and the final P<0.05.The difference was statistically significant.Results: 1.Multivariate analysis of COX model showed that the independent risk factors for OS in T-LBL patients with early remission(including CR and PR)were bone marrow invasion,early induction therapy not reaching CR and no transplantation.The HR values were 5.804(95% CI,1.140~29.549),3.605(95% CI,1.157 11.232),5.871(95% CI,1.711~20.14).2.The independent risk factors of PFS in T-LBL patients with early remission(including CR and PR)were bone marrow invasion and non-transplantation,with HR values of 8.640(95% CI,1.730~43.147)and 4.554(95% CI,1.575~13.172)respectively.Conclusion: 1.Bone marrow invasion,early induction therapy not reaching CR and non-transplantation are independent risk factors for OS of T-LBL patients who achieve CR/PR in the early stage(two courses)of pediatric-like ALL regimen.The mortality risk of patients with bone marrow invasion is about 5.804 times that of patients without bone marrow invasion;the mortality risk of patients with initial induced PR is about 3.605 times that of patients with CR;the mortality risk of patients without transplantation is about 5.871 times that of patients without transplantation.2.Bone marrow invasion and non-transplantation were independent risk factors for PFS in T-LBL patients who achieved CR/PR after two courses of treatment with pediatric-like ALL regimen.The risk of disease progression in non-transplanted patients was 4.554 times higher than that in transplanted patients;the risk of disease progression in patients with bone marrow invasion was not. |
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