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高危结外 NK/T 细胞淋巴瘤患者可从异基因造血干细胞移植作为巩固治疗中获益更多：中国真实世界多中心分析

英文原题：High-risk extranodal natural killer/T-cell lymphoma patients could benefit more from allogeneic hematopoietic stem cell transplantation as consolidation: A real-world multicenter analysis in China.

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High-risk extranodal natural killer/T-cell lymphoma patients could benefit more from allogeneic hematopoietic stem cell transplantation as consolidation: A real-world multicenter analysis in China.

PubMed 2025/10/30（内容时间） Chin J Cancer Res Q1 · IF 6.7（JCR 2025）

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技术：NK 细胞技术：造血干细胞淋巴瘤地区：中国
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研究概要

具有高风险特征的 ENKTCL 患者可能从 allo-HSCT 作为巩固治疗中获益更多。

研究思路结论见上方概要

目的

异基因造血干细胞移植（allo-HSCT）和自体造血干细胞移植（ASCT）均是结外NK/T细胞淋巴瘤（ENKTCL）的重要治疗方法；然而，尚无大规模、多中心研究比较allo-HSCT与ASCT在这些患者中的疗效和安全性。我们的多中心真实世界研究旨在评估allo-HSCT与ASCT作为巩固治疗在达到完全缓解（CR）或部分缓解（PR）的ENKTCL患者中的结局。

方法

这是一项在中国九家医院开展的多中心回顾性研究，共纳入114例ENKTCL患者。60例接受ASCT，54例接受allo-HSCT。主要结局为无进展生存期（PFS）。在敏感性分析中，采用倾向性评分匹配（PSM）分析以校正基线预后因素。采用里程碑分析以尽量减少永生时间偏倚。

结果

allo-HSCT组的患者表现出更多不良预后因素。在Ann Arbor III/IV期疾病患者中（PFS：100% vs. 82.0%，P=0.023；疾病进展率：0 vs. 25.4%，P=0.024）、自然杀伤淋巴瘤预后指数（PINK）评分为中/高的患者中（PFS：100% vs. 84.4%，P=0.034；疾病进展率：0 vs. 22.1%，P=0.034）、国际预后指数（IPI）评分为中/高的患者中（PFS：100% vs. 82.0%，P=0.038；疾病进展率：0 vs. 25.4%，P=0.038），或在PR时接受HSCT的患者中（PFS：100% vs. 50%，P=0.046；疾病进展率：0 vs. 50%，P=0.046），在1.5-4.0随访时，allo-HSCT组相比ASCT组显示出显著更好的PFS和更低的疾病进展率。在多变量分析中，接受ASCT与较差的PFS[风险比（HR）=2.23，P=0.038]和总生存期（OS）（HR=2.45，P=0.045）显著相关。在敏感性分析中，倾向评分匹配后，接受allo-HSCT的患者相比接受ASCT的患者显示出显著更好的PFS（70.3% vs. 39.1%，P=0.039）、OS（73.9% vs. 42.0%，P=0.044）和更低的疾病进展率（22.6% vs. 57.0%，P=0.017）。

展开英文摘要原文
OBJECTIVE

Both allogeneic hematopoietic stem cell transplantation (allo-HSCT) and autologous HSCT (ASCT) are important therapies for extranodal natural killer/T-cell lymphoma (ENKTCL); however, no large-scale, multicenter study has compared the efficacy and safety between allo-HSCT and ASCT in these patients. Our multicenter, real-world study aimed to evaluate the outcomes of allo-HSCT vs . ASCT as consolidation in ENKTCL patients who had achieved a complete response (CR) or partial response (PR).

METHODS

This was a multicenter, retrospective study with nine hospitals in China, and 114 patients with ENKTCL were enrolled. Sixty patients received ASCT and 54 received allo-HSCT. The primary outcome was progression-free survival (PFS). In the sensitivity analysis, propensity score matching (PSM) analyses were conducted to adjust for baseline prognostic factors. Landmark analysis were conducted to minimize immortal-time bias.

RESULTS

Patients in the allo-HSCT group presented with more adverse prognostic factors. Allo-HSCT group showed a significantly better PFS and a lower disease progression rate compared with ASCT group in patients with Ann Arbor stage III/IV disease (PFS: 100% vs. 82.0%, P=0.023; disease progression rate: 0 vs. 25.4%, P=0.024), those with intermediate/high prognostic index of natural killer lymphoma (PINK) scores (PFS: 100% vs. 84.4%, P=0.034; disease progression rate: 0 vs. 22.1%, P=0.034), those with intermediate/high international prognostic index (IPI) scores (PFS: 100% vs. 82.0%, P=0.038; disease progression rate: 0 vs. 25.4%, P=0.038), or those receiving HSCT at PR (PFS: 100% vs. 50%, P=0.046; disease progression rate: 0 vs . 50%, P=0.046) at the 1.5-4.0 follow-up. In multivariate analysis, receiving ASCT was significantly associated with a poorer PFS [hazard ratio (HR)=2.23, P=0.038] and overall survival (OS) (HR=2.45, P=0.045). In the sensitivity analysis, patients receiving allo-HSCT showed a significantly better PFS (70.3% vs. 39.1%, P=0.039), OS (73.9% vs. 42.0%, P=0.044), and a lower disease progression rate (22.6% vs. 57.0%, P=0.017) compared with those receiving ASCT after propensity score matching.

CONCLUSIONS

ENKTCL patients with high-risk characteristics could benefit more from allo-HSCT as consolidation.

论文信息

作者
Wang Y、Xia Y、Gu Z、Chang Y、Yang L、Yang P、Zhao Y、Zhang C
单位
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Cell and Gene Therapy for Hematologic Malignancies, Peking University, Beijing 100044, China.China
期刊
Chinese journal of cancer research = Chung-kuo yen cheng yen chiu2025 Oct 30
原文标识
PubMed 41229976　·　DOI 10.21147/j.issn.1000-9604.2025.05.03

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