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Abstracts / Biol Blood Marrow Transplant 22 (2016) S19eS481
T-Cell Acute Lymphoblastic Lymphoma (T-LBL) and Stem Cell Transplantation (SCT): A Comparison of Outcomes with T-Cell Acute Lymphoblastic Leukemia (T-ALL) T细胞急性淋巴母细胞淋巴瘤（T-LBL）与干细胞移植（SCT）：与T细胞急性淋巴母细胞白血病对比
Jonathan E. Brammer 1, Issa F. Khouri 2, Celina Ledesma 3, Gabriela Rondon 1, Stefan O. Ciurea 1, Yago Nieto 1,Richard E. Champlin 4, Chitra Hosing 1, Partow Kebriaei 1. 1 Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX; 2 The University of Texas MD Anderson Cancer Center, Houston, TX; 3 Department of Stem Cell Transplantation and Cellular Therapy, University of Texas, MD Anderson Cancer Center, Houston, TX; 4 Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX
Introduction: T-LBL represents less than 2% of cases of non- Hodgkin Lymphoma and is distinguished from T-ALL by nodal involvement/mass lesion (typically mediastinal), and less than 25% bone marrow blasts. Although the recommendations since the early 2000s are for T-LBL to be treated similarly to T-ALL, there is a paucity of data describing outcomes for these patients, and comparative SCT outcomes between these two entities. We aimed to evaluate SCT outcomes of T-LBL, and compare them with outcomes of patients with T-ALL. 介绍：T-LBL在非霍奇金淋巴瘤中占不到2%，与T-ALL的区别在于淋巴结累及和大肿块（通常在纵隔），以及骨髓中原始细胞比例低于25%。尽管自2000年以来建议在T-LBL的治疗上参考T- ALL，但是对于这两类患者在移植后的临床结局上缺乏比较数据。我们的研究旨在评估T-LBL移植后的结局，并与T-ALL进行比较。
Methods: Given only 2 patients had autologous SCT, only patients with a diagnosis of T-LBL who received allogeneic (ALLO) SCT at MD Anderson from 2000-2014 were included. We analyzed outcomes of T-LBL alone, and in comparison to a T-ALL cohort who received ALLO during the same time period. 方法：鉴于从2000年到2014年间在MD Anderson癌症中心只有两位患者进行了自体干细胞移植，因此我们的研究只纳入了异体移植的T-LBL患者，并与同期接受了移植的T-ALL患者进行比较。
Results: Eighteen patients received ALLO SCT. Median age was 31, 56% were male, 56% had stage III/IV disease, median number of chemo cycles was 2, 39% were in complete remission (CR), and 17% had active disease at SCT. 89% of patients received myeloablative conditioning (MAC), and 39% received total-body irradiation (TBI). OS and PFS was 44% at 3-years, 35% at 5 years, and 23% at 10 years, with 2 cases of second malignancy in the post-transplant period causing late mortality. There was improved PFS (71% vs 27%, p=0.031) with TBI-based conditioning, and improved PFS in those transplanted in CR versus not CR (27% vs 69%, p=0.035) at 3 years. 结果：18位患者接受了异体移植，中位年龄31岁，56%为男性，56%是III/IV期疾病，中位接受的化疗疗程数为2，39%是完全缓解（CR），17%在移植时疾病维缓解。89%接受了清髓性预处理（MAC），39%接受了全身放疗（TBI）。3年OS和PFS是44%，5年是35%，10年是23%，有两位患者在移植后出现二次肿瘤而导致迟发的死亡。3年的PFS，在基于TBI的预处理（71% vs 27%，p=0.031）以及移植时处于CR状态（27% vs 69%, p=0.035)的因素下得以改善。
We then compared 18 patients with T-LBL who received ALLO to 72 patients with T-ALL treated with ALLO from 2000-2014. More patients in the T-LBL group were not in CR (61% vs 21%, p=0.001), and had a matched sib (89% vs 54%, p=0.005). OS at 5 years for T-ALL vs T-LBL was 32% vs 35%, (p=0.828), though when transplanted in first CR, T-ALL patients had 5-year OS of 56% vs 69% (p=0.59). There was no PFS/OS difference between the non-CR T-ALL and T-LBL patents (p=0.789). NRM was 9% in the T-ALL group at 1 year, versus 28% at 1-year in the T-LBL group, and was higher in the T-LBL group at 10 years (49% vs 11%, p=0.01)，due to two cases of second malignancy. There was a trend toward difference between T-ALL and T-LBL in cumulative incidence (CI) relapse mortality (RM) at 1-year (42% vs 22%) and 10 years (57% vs 28%, p=0.1). There was no difference between T-LBL and T-ALL ALLO CI grade II-IV acute GVHD (48% vs 50%) and CI extensive chronic GVHD (16% vs 24%). 接下去我们将这18位T-LBL的患者与2000-2014年间接受了异体移植的72位T-ALL的患者进行了比较。更多的T-LBL患者在移植时没有CR（61% vs 21%, p=0.001），但有更高比例的亲缘相合供体（89% vs 54%, p=0.005）。T-ALL和T-LBL的5年OS为32% vs 35% (p=0.828)，在首次CR下进行移植的T-ALL的5年OS是56% vs 69% (p=0.59)。非CR下移植的T-LBL和T-ALL在PFS/OS上没有区别（p=0.789）。T-ALL的1年的非复发死亡率（NRM）是9%，T-LBL则是28%，但是在10年后则是T-ALL更高(49% vs 11%, p=0.01)，主要是因为出现了两例二次肿瘤。在累积复发死亡率上，T-ALL和T-LBL有出现不同的趋势，1年为42% vs 22%，10年为57% vs 28% (p=0.1)。T-LBL和T-ALL在II-IV级急性GVHD (48% vs 50%)和广泛的慢性GVHD (16% vs 24%)上没有区别。
Figure 1. Comparison of Overall Survival in Allogeneic Stem Cell Transplant Recipients for T-ALL and T-LBL. 图一：T-ALL和T-LBL异体移植后总生存率的比较
Figure 2. Overall Survival in Allogeneic Stem Cell Transplant Recipients for T-ALL and T-LBL in First Complete Remission. 图二：T-ALL和T-LBL在首次CR后异体移植的总生存率
Figure 3. Cumulative Incidence of Non-Relapse Mortality and Relapse in Allogeneic Stem Cell Transplant Recipients for T-ALL and T-LBL 图三：T-ALL和T-LBL异体移植后累积非复发死亡率和复发率
Conclusions: In the modern era, ALLO SCT is an effective therapy for T-LBL, with improved outcomes when patients receive SCT in first CR, and with TBI. In comparison to reports from the 1990s, ALLO-SCT had similar outcomes, though AUTO SCT was not commonly utilized (10% of SCTs) at our institution. There was no difference between ALLO SCT outcomes between T-ALL and T-LBL, despite lower CR rates in the T-LBL group, suggesting these patients can be considered together in future analyses and prospective trials in SCT. However, analysis in a larger cohort is needed.
结论：在当今时代，异体移植是T-LBL的有效治疗手段，在首次CR后移植并且采用TBI的预处理可以改善临床结局。与上个世纪90年代的报告相比较，异体移植的结局相似。自体移植在我们中心不常采用（约10%的移植是自体移植）。尽管在T-LBL中移植时处于CR的比例较低，但是异体移植后T-LBL与T-ALL的结局并没有什么不同，提示这些患者可以在未来的分析以及关于移植的前瞻性研究中统一考虑。当然，需要在更大的队列中来分析。
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