ASH 2017:CR后一线造血干细胞移植巩固在外周T细胞淋巴瘤中的价值:一项前瞻性多中心临床研究

2017-11-20 佚名 肿瘤资讯

已有研究表明外周T细胞淋巴瘤(PTCL)能否从一线治疗取得完全缓解(CR)对预后至关重要。在临床实践中,第一次CR后是否推荐行造血干细胞移植(HSCT)是每一位PTCL患者需要面临的问题。

研究背景:

已有研究表明外周T细胞淋巴瘤(PTCL)能否从一线治疗取得完全缓解(CR)对预后至关重要。在临床实践中,第一次CR后是否推荐行造血干细胞移植(HSCT)是每一位PTCL患者需要面临的问题。然而,有关指南性数据相对较少,因此导致临床实践循证依据不足。此前已有2期临床研究报道HSCT一线巩固治疗结果令人鼓舞,然而,将这些前瞻性研究与历史研究进行对照,其结果受多种合格标准、潜在的选择性偏倚以及HSCT前不同CR率的影响。此外,多数2期临床研究生存数据不包括对化疗耐药(即诱导化疗后未获得部分或完全缓解)患者,因此本质上偏向于选择了具有较好预后的这组患者。本项研究致力于探讨PTCL患者第一次CR后行HSCT能否改善生存结局这一问题。本研究为大型、前瞻性、多中心临床研究,入组患者为初诊PTCL患者,该研究称为美国综合肿瘤管理—外周T细胞淋巴瘤治疗(COMPLETE)。

研究方法:

将初诊病理学确诊为PTCL的侵袭性亚型患者纳入COMPLETE。将诱导治疗后获得CR患者纳入最终分析。用Kaplan-Meier法进行生存分析。用多因素Cox回归来评估预先指定变量与生存之间的关联性。

研究结果:

4年间COMPLETE总计纳入499例PTCL患者,中位随访2.9年(范围:1.9-4.0年),213例患者一线治疗后获得CR并有可用于分析的医疗记录。其中149例(70%)患者诱导治疗后未接受HSCT巩固治疗,另外64例(30%)患者接受HSCT巩固治疗,49例行自体HSCT,15例行异基因HSCT。125例(59%)患者通过PET/CT进行疗效评估,其余(41%)患者通过CT、MRI和/单纯PET或三者结合进行疗效评估。与non-HSCT组相比,HSCT组中进展期(III/IV期)患者和IPI≥2分患者明显较多,两组在人口统计学特征(年龄、性别和体能状态)方面无统计学差异。

所有患者中,血管免疫母细胞T细胞淋巴瘤(AITL)患者35例,外周T细胞淋巴瘤,非特指型(PTCL-NOS)58例。AITL和PTCL-NOS患者亚组分析中,HSCT患者中位无进展生存期(PFS)57.6个月,而non-HSCT患者中位PFS仅25.5个月,较HSCT组显著缩短(P=0.05)。对总生存(OS)进行亚组分析,AITL和PTCL-NOS患者HSCT组中位OS均未达到,较non-HSCT组显著延长(图1,P=0.02)。对51例间变大细胞淋巴瘤(ALCL)进行亚组分析,HSCT组与non-HSCT组中位PFS和OS均未达到,HSCT组未显示出生存优势(P分别为0.17和0.06)。值得注意的是,上述分析中包括21例ALK+ALCL患者和30例ALK-ALCL患者。对包括AITL、ALCL和PTCL-NOS在内的结内PTCL患者进行多因素分析,结果显示当控制分期和IPI评分时,HSCT可以明显提高OS,风险比为0.26(0.10-0.68;P<0.01)。



结论:

这是截止目前美国在探讨第一次CR后HSCT对PTCL患者价值的首次最大样本量前瞻性研究报道。研究显示结内PTCL患者CR后行一线HSCT巩固治疗可以提高生存。然而,由于随访时间相对较短以及研究设计的非随机性,需谨慎解读研究结果。有待进行随机对照临床研究探讨第一次CR后HSCT在不同类型PTCL患者中的价值。

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  4. 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  5. 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target=_blank style='color:#2F92EE;'>#造血干细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95001, encryptionId=a0ff950018f, topicName=造血干细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e729101, createdName=huanbaofeng, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301193, encodeId=9cca1301193a1, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494580, encodeId=53f51494580d0, content=<a href='/topic/show?id=084d9499599' target=_blank style='color:#2F92EE;'>#造血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94995, encryptionId=084d9499599, topicName=造血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caed9138962, createdName=俅侠, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
    2017-11-23 lofter

    学习了感谢分享

    0

  6. 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target=_blank style='color:#2F92EE;'>#造血干细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95001, encryptionId=a0ff950018f, topicName=造血干细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e729101, createdName=huanbaofeng, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301193, encodeId=9cca1301193a1, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494580, encodeId=53f51494580d0, content=<a href='/topic/show?id=084d9499599' target=_blank style='color:#2F92EE;'>#造血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94995, encryptionId=084d9499599, topicName=造血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caed9138962, createdName=俅侠, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
    2017-11-23 陈方郑

    多活动活动好的好的

    0

  7. 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attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83erHmiaPStHsBjHGm3Y4ZHHanFXRDgAiaEiabOGdC4Q6KfAYrmmuicVyBk7YMJOMXTuQnIpZqReTiceibjdg/132, createdBy=2ab92087896, createdName=陈方郑, createdTime=Thu Nov 23 07:59:13 CST 2017, time=2017-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372625, encodeId=b2f313e26254d, content=<a href='/topic/show?id=7d2d1802820' target=_blank style='color:#2F92EE;'>#T细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18028, encryptionId=7d2d1802820, topicName=T细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1271425, encodeId=0cc912e1425cd, content=<a href='/topic/show?id=a0ff950018f' 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GetPortalCommentsPageByObjectIdResponse(id=1494580, encodeId=53f51494580d0, content=<a href='/topic/show?id=084d9499599' target=_blank style='color:#2F92EE;'>#造血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94995, encryptionId=084d9499599, topicName=造血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caed9138962, createdName=俅侠, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1658834, encodeId=27b81658834e7, content=<a href='/topic/show?id=c40ce798412' target=_blank style='color:#2F92EE;'>#细胞移植#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77984, encryptionId=c40ce798412, topicName=细胞移植)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4724938298, createdName=limedical1982, createdTime=Mon Mar 12 18:39:00 CST 2018, time=2018-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903942, encodeId=3d7f19039428f, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=02f5179, createdName=luoxiaog, createdTime=Tue Aug 07 19:39:00 CST 2018, time=2018-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1702447, encodeId=4b3b1e0244723, content=<a href='/topic/show?id=ddc9e795159' target=_blank style='color:#2F92EE;'>#细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77951, encryptionId=ddc9e795159, topicName=细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=201630414353, createdName=marlenexl, createdTime=Fri Jul 27 19:39:00 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2006416, encodeId=d150200641670, content=<a href='/topic/show?id=924a3264381' target=_blank style='color:#2F92EE;'>#前瞻性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, 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attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83erHmiaPStHsBjHGm3Y4ZHHanFXRDgAiaEiabOGdC4Q6KfAYrmmuicVyBk7YMJOMXTuQnIpZqReTiceibjdg/132, createdBy=2ab92087896, createdName=陈方郑, createdTime=Thu Nov 23 07:59:13 CST 2017, time=2017-11-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372625, encodeId=b2f313e26254d, content=<a href='/topic/show?id=7d2d1802820' target=_blank style='color:#2F92EE;'>#T细胞淋巴瘤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=18028, encryptionId=7d2d1802820, topicName=T细胞淋巴瘤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1271425, encodeId=0cc912e1425cd, content=<a href='/topic/show?id=a0ff950018f' target=_blank style='color:#2F92EE;'>#造血干细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95001, encryptionId=a0ff950018f, topicName=造血干细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e729101, createdName=huanbaofeng, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301193, encodeId=9cca1301193a1, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494580, encodeId=53f51494580d0, content=<a href='/topic/show?id=084d9499599' target=_blank style='color:#2F92EE;'>#造血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94995, encryptionId=084d9499599, topicName=造血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caed9138962, createdName=俅侠, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1658834, encodeId=27b81658834e7, content=<a href='/topic/show?id=c40ce798412' target=_blank style='color:#2F92EE;'>#细胞移植#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77984, encryptionId=c40ce798412, topicName=细胞移植)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4724938298, createdName=limedical1982, createdTime=Mon Mar 12 18:39:00 CST 2018, time=2018-03-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1903942, encodeId=3d7f19039428f, content=<a href='/topic/show?id=7d454302945' target=_blank style='color:#2F92EE;'>#多中心#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43029, encryptionId=7d454302945, topicName=多中心)], attachment=null, authenticateStatus=null, createdAvatar=, 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target=_blank style='color:#2F92EE;'>#造血干细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95001, encryptionId=a0ff950018f, topicName=造血干细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e729101, createdName=huanbaofeng, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301193, encodeId=9cca1301193a1, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1494580, encodeId=53f51494580d0, content=<a href='/topic/show?id=084d9499599' target=_blank style='color:#2F92EE;'>#造血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94995, encryptionId=084d9499599, topicName=造血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caed9138962, createdName=俅侠, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
    2017-11-22 kksonne
  10. 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GetPortalCommentsPageByObjectIdResponse(id=1494580, encodeId=53f51494580d0, content=<a href='/topic/show?id=084d9499599' target=_blank style='color:#2F92EE;'>#造血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94995, encryptionId=084d9499599, topicName=造血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caed9138962, createdName=俅侠, createdTime=Wed Nov 22 14:39:00 CST 2017, time=2017-11-22, status=1, ipAttribution=)]
    2017-11-22 俅侠