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目的:探讨单纯Hyper-CVAD方案与Hyper-CVAD方案联合自体造血干细胞移植一线巩固治疗淋巴母细胞淋巴瘤(lymphoblastic lymphoma,LL)的疗效。方法:回顾性分析26例青少年和成人初治采用改良Hyper-CVAD方案的LL患者资料。其中,22例不伴骨髓受侵的患者中,11例接受单纯改良Hyper-CVAD方案治疗,另外11例接受改良Hyper-CVAD方案联合HDT/AH-SCT巩固治疗。结果:全组61.5%(16/26)的患者初治达完全缓解(complete remission,CR)或不确定的CR(unconfirmed CR,CRu),中位随访29.5个月,5年的总生存(overall survival,OS)率和无进展生存(progress-free survival,PFS)率分别为66.8%和50.2%。22例无骨髓受侵的患者中,单纯Hyper-CVAD组与联合HDT/AHSCT组的5年OS率分别为60.0%和70.7%(P=0.438),5年PFS率分别为43.6%和62.3%(P=0.209),均无统计学差异。单因素预后分析结果显示,初治缓解后1年内疾病进展或复发与预后不良相关(P=0.012)。结论:改良Hyper-CVAD方案是青少年和成人LL一线有效的治疗方案。对于无骨髓侵犯的患者,单纯改良Hyper-CVAD已能取得较好疗效,联合HDT/AHSCT巩固治疗未能进一步改善预后。
Objective: To investigate the curative effect of first-line consolidation of Hyper-CVAD and Hyper-CVAD combined with autologous hematopoietic stem cell transplantation in the treatment of lymphoblastic lymphoma (LL). Methods: A retrospective analysis of 26 adolescents and adults treated with modified Hyper-CVAD regimen LL patients. Of the 22 patients without bone marrow involvement, 11 were treated with Hyper-CVAD alone and 11 were treated with Hyper-CVAD plus HDT / AH-SCT. Results: The complete remission (CR) or unconfirmed CR (CRu) was achieved in 61.5% (16/26) of the patients in the whole group. The median follow-up was 29.5 months. The overall 5-year overall survival survival, OS, and progression-free survival (PFS) rates were 66.8% and 50.2%, respectively. The 5-year OS rates of Hyper-CVAD alone group and HDT / AHSCT group were 60.0% and 70.7%, respectively (P = 0.438). The 5-year PFS rates were 43.6% and 62.3% (P = 0.209), no statistical difference. Univariate prognostic analysis showed that disease progression or recurrence was associated with poor prognosis (P = 0.012) within 1 year of initial remission. Conclusion: The modified Hyper-CVAD regimen is an effective first-line treatment for adolescents and adults. For patients without bone marrow involvement, simple modification of Hyper-CVAD has been able to achieve better results, combined with HDT / AHSCT consolidation therapy failed to further improve the prognosis.