| ObjectiveTo investigate the efficacy and prognostic factors of autologous and allogeneic hematopoietic stem cell transplantation in the treatment of T lymphoblastic lymphoma/leukemia(T-LBL/ALL).MethodsThe clinical data of 54 T-LBL/ALL patients who received hematopoietic stem cell transplantation(HSCT)in our hospital from March 2012 to December 2020 were analyzed retrospectively.According to the different consolidation therapy after induced remission,the patients were divided into autologous hematopoietic stem cell transplantation(auto-HSCT)and allogeneic hematopoietic stem cell transplantation(allo-HSCT)group(sibling identical hematopoietic stem cell transplantation(Sib-HSCT)and substitute donor hematopoietic stem cell transplantation(AD-HSCT)group).The relationship between clinical characteristics and prognosis of the three groups was analyzed,and the effects of the threetransplantation methods were compared after determining the balance among the three groups.After determining the balance among the three groups,the curative effects of the three transplantation methods were compared,and compared with the results of other center transplantation.The efficacy of HSCT in the treatment of T-LBL/ALL and the factors that may affect the prognosis were analyzed.Results1.A total of 54 patients received HSCT in this study,including 41 males(76%),24 patients with mediastinal involvement(44%),37 patients with bone marrow involvement(68.5%),III and 40 patients with IV stage(74.0%).Among them,19patients received auto-HSCT,of which 1 patient underwent secondary transplantation after recurrence and survived for 21 months after the second transplantation.Of the35 patients who received allo-HSCT,15(42.9%)were Sib-HSCT and 20(57.1%)were AD-HSCT.2.Hematopoietic reconstitution:hematopoietic reconstitution was achieved in 19patients with Auto-HSCT.The median implantation time of neutrophils and platelets was 11(7-14)days and 14(7-36)days respectively.Hematopoietic reconstitution was achieved in 35 patients with Auto-HSCT.The median transfusion of donor CD34+cells was 5.59×10~6 kg.The median implantation time of granulocytic and megakaryocytic series was 12(10-18)days and 14(8-25)days respectively.3.The OS rate and PFS rate of Auto-HSCT patients 3 years after transplantation were 65.4%and 62.3%,respectively,and the cumulative recurrent(Cl R)rate and non-recurrent death(NRM)rate were 40.8%and 7.1%,respectively.The OS rate and PFS rate of Allo-HSCT patients 3 years after transplantation were 34.4%and 35.1%,respectively.The Cl R rate and NRM rate are 45.9%and 37.5%,respectively.The OS rates of pre-transplant disease status CR1 and non-CR1 3 years after transplantation in Auto-HSCT patients were 91.7%and 28.6%(P=0.012),respectively,and the PFS rates were 83.3%and 14.3%(P=0.009)3 years after transplantation,respectively.The CIR rates of 3 years after transplantation were 16.7%and 82.1%(P=0.023),respectively,and the NRM rates of 3 years after transplantation were 0%and 20%(P=0.180),respectively.4.The results of multivariate analysis showed that pre-transplant disease status of non-CR1 was a poor prognostic factor for OS and PFS in auto-HSCT patients,and their HR values were 9.624(95%CI,1.112-83.26)and 6.501(95%CI,1.294-32.663),respectively.IPI score and pre-transplant disease status non-CR1 were independent poor prognostic factors for OS in Allo-HSCT patients,and their HR values were3.171(95%CI,1.033-9.736)and 3.492(95%CI,4.421-8.582),respectively.Pre-transplant disease status non-CR1 is an independent poor prognostic factor for PFS in allo-HSCT patients,and its HR value is 5.872(95%CI,2.022-17.058).5.The balance among Auto-HSCT group,Sib-HSCT group and AD-HSCT group was analyzed.The results showed that the distribution of clinical characteristics was balanced among the three groups.The OS rates of Auto-HSCT group,Sib-HSCT group and AD-HSCT group 3 years after transplantation were65.4%,45.7%and 24.6%,respectively,compared with those of AD-HSCT group,which was statistically significant.There was no statistical significance in the comparison of OS rates between the other two groups.Three years after transplantation,the NRM rates of Auto-HSCT group,Sib-HSCT group and AD-HSCT group were 7.1%,6.7%and 56.7%,respectively.There was a pairwise comparison of NRM rates among the three groups.The comparison of NRM rates between Auto-HSCT group and AD-HSCT group was statistically significant(P=0.001).The comparison of NRM rate between Sib-HSCT group and AD-HSCT group was statistically significant(P=0.008),while the comparison of NRM rate between auto-HSCT group and Sib-HSCT group was not statistically significant(P=0.793).6.Eleven patients with Allo-HSCT(31.4%)died of non-recurrence,including 6cases of severe infection(54.5%),1 case of hepatic encephalopathy(9.1%)and 4cases of transplantation-related death(36.4%),including 2 cases of thrombotic microvascular disease after transplantation and 2 patients of acute graft-versus-host disease(a GVHD).Conclusions1.Non-CR1 disease status before transplantation is an independent poor prognostic factor for OS and PFS in patients with auto-HSCT.2.IPI score≥3 and disease status before transplantation were independent poor prognostic factors of OS in patients with allo-HSCT.Non-CR1 disease status before transplantation is an independent poor prognostic factor for PFS in patients with allo-HSCT.3.The rates of OS,PFS and NRM in auto-HSCT group are better than those in AD-HSCT group. |
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