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目的探讨高危侵袭性 T 细胞非霍奇金淋巴瘤(T-NHL)的临床特征、治疗与预后。方法对国际预后指数(IPI)评分为中高危或高危的54例侵袭性 T-NHL 患者,按 WHO 分类标准分型,对其进行回顾性分析。结果 T 淋巴母细胞淋巴瘤(TLBL)12例(22.2%),非特殊型外周 T 细胞淋巴瘤(PTCL-U)31例(57.4%),肝脾 T 细胞淋巴瘤(HSTCL)11例(20.4%)。IPI 评分中高危12例(22.2%),高危42例(77.8%);其中侵犯骨髓49例(90.7%),侵犯脑膜7例(13.0%)。治疗总体反应率为86.5%,完全缓解率为67.3%,3年总生存(OS)率为16.0%;采取造血干细胞移植治疗的患者3年 OS 率为44.4%,明显高于化疗组(8.3%)。多因素分析显示治疗方案的选择、能否达缓解是影响预后的重要因素。结论 T-NHL 是一组高度异质性肿瘤。中高危、高危 T-NHL,尤其是 PTCL-U 和TLBL,虽然化疗反应率较高,但远期疗效很差,需要探索新的治疗方案,自体造血干细胞移植可能是较好的选择。
Objective To investigate the clinical characteristics, treatment and prognosis of high-risk invasive T-cell non-Hodgkin’s lymphoma (T-NHL). Methods Fifty-four patients with invasive T-NHL who had an International Prognostic Index (IPI) score of high-risk or high-risk were classified according to the WHO classification criteria and analyzed retrospectively. Results Twelve cases (22.2%) of T lymphoblastic lymphoma (TLBL), 31 (57.4%) cases of non-specific peripheral T cell lymphoma (PTCL-U) and 11 cases of hepatosplenic T cell lymphoma %). The IPI score was high risk in 12 cases (22.2%) and high risk in 42 cases (77.8%). 49 cases (90.7%) infiltrated the bone marrow and 7 cases (13.0%) infiltrated the meninges. The overall response rate was 86.5%, the complete remission rate was 67.3%, and the 3-year overall OS rate was 16.0%. The 3-year OS rate was 44.4% in patients treated with hematopoietic stem cell transplantation, which was significantly higher than that in chemotherapy group (8.3% ). Multivariate analysis showed that the choice of treatment options, remission or not is an important factor affecting the prognosis. Conclusion T-NHL is a group of highly heterogeneous tumors. High-risk, high-risk T-NHL, especially PTCL-U and TLBL, although the high response rate of chemotherapy, but long-term curative effect is poor, need to explore new treatment options, autologous stem cell transplantation may be a better choice.