非霍奇金B细胞淋巴瘤患者化疗后中性粒细胞缺乏相关危险因素及其与疗效的关系

Risk factors for neutropenia in patients with non-Hodgkin B-Cell lymphoma after chemotherapy and their relationship with outcomes

目的探索非霍奇金B细胞淋巴瘤患者化疗后发生中性粒细胞缺乏、感染的潜在危险因素,及其与化疗效果之间的关系。方法选取2016年6月至2021年6月期间于北京清华长庚医院血液肿瘤科就诊的非霍奇金B细胞淋巴瘤患者作为研究对象,化疗方案包括标准R-CHOP、减量R-CHOP、R-CVP等,纳入研究的因素包括性别、初诊年龄、BMI、分期、分组、是否罹患乙肝、化疗程数,以及历次化疗过程中是否发生过中性粒细胞缺乏及其累计持续时长、是否发生过严重感染、基线实验室检验指标,通过混合效应及二元Logistic回归进行分析。结果39例患者的253人次化疗中,有58.97%发生过中性粒细胞缺乏,罹患乙肝、分期为Ⅳ期是发生中性粒细胞缺乏及其持续时间延长的危险因素,其中,罹患乙肝同时是发生严重感染的危险因素;中性粒细胞缺乏及其持续时间延长均是治疗结果不佳的危险因素。结论乙肝、分期为Ⅳ期可能是非霍奇金B细胞淋巴瘤患者化疗发生粒细胞缺乏的危险因素,并可能导致化疗结果不佳。

Objective To identify potential risk factors for the occurrence of neutropenia and infection in patients diagnosed with B-cell lymphoma,and explore their relationship with outcomes of chemotherapy.Methods Patients with non-Hodgkin B-cell lymphoma who were treated at the Department of Oncology and Hematology,Tsinghua Chang Gung Hospital,Beijing from June 2016 to June 2021 were included.The chemotherapy regimens were generally based on the standard R-CHOP regimen.The factors analyzed in the study included gender,age at first diagnosis,body mass index,tumor stage&group,the presence of hepatitis B or not,chemotherapy courses,whether neutropenia occurred during the present chemotherapy course and its cumulative duration,whether there was severe infection,and baseline laboratory test indicators.The analyses were performed by mixed effects and binary logistic regression.Results Among the 253 times of chemotherapy in 39 patients,58.97%had neutropenia.Hepatitis B and stage IV were the risk factors for neutropenia and its prolongation.Hepatitis B was also a risk factor for serious infection.Neutropenia and its prolonged duration were risk factors for poor treatment outcome.Conclusion Hepatitis B and stage IV may be risk factors for agranulocytosis during chemotherapy in patients with B-cell lymphoma,and may lead to poor chemotherapy outcomes.