42例中高危以上弥漫大B细胞淋巴瘤临床分析

Clinical Analysis of 42 Diffuse Large B Cell Lymphoma Patients with Intermediate-high and High Risk

目的:探讨中高危以上弥漫大B细胞型非霍奇金淋巴瘤(diffuse large B cell lymphoma,DLBCL)的临床特征、治疗措施与预后。方法:对42例中高危以上的弥漫大B细胞型非霍奇金淋巴瘤患者进行国际标准化预后指数(IPI)评分、Ann Arhor分期,将采用联合化疗为主和造血干细胞移植为主的两组患者的治疗疗效进行回顾性临床分析。结果:按国际预后指数(IPI)评分,中高危25例(59.52%),高危17例(40.48%);按Ann Arhor分期,Ⅱ期2例(4.76%),Ⅲ期29例(69.05%),Ⅳ期11例(26.19%):10例(23.81%)伴骨髓受侵,其中5例诊断为淋巴肉瘤细胞白血病;38例(90.48%)LDH值升高,其中最高达10000U/L以上;伴B症状共35例(83.33%)。治疗总有效率达71.43%,其中完全缓解25例(59.52%),部分缓解5例(11.90%),病情稳定1例(2.38%)。死亡11例(26.19%),4年总生存率为73.81%;采取造血干细胞移植治疗的患者完全缓解率为72.73%,高于化疗组54.84%(P<0.05),中位生存期35.38个月,较化疗组(29.25个月)延长。综合分析显示IPI评分、临床分期、治疗策略的选择、造血干细胞移植术是影响预后的重要因素。结论:规范及强力化疗方案是治疗中高危以上弥漫大B细胞淋巴瘤的主要措施;造血干细胞移植是治疗弥漫大B细胞淋巴瘤的最佳治疗策略。

Objective： To analyze the clinical characteristics, treatment and prognosis of patients with diffuse large B cell lymphoma （DLBCL） with intermediate-high and high risk. Methods： Forty-two patients with diffuse large B cell lymphoma classified into intermediate-high and high risk were collected, along with the IPI score and Ann Arbor staging. The curative effects of chemotherapy and hematopoietic stem cell transplantation were analyzed. Results： According to the international prognostic index （IPI）, there were 25 cases （59.52%） with intermediate-high risk and 17 cases （40.48%） with high risk. According to Ann Arbor staging, there were 2 phase Ⅱ cases （4.76%）, 29 phase Ⅲ cases （69.05%） and 11 phase Ⅳ cases （26.19%）. Ten cases （23.81%） were accompanied with bone marrow invasion. Of the total cases, 5 were diagnosed as lymphosarcoma cell leukemia; 38 cases （90.48%） had an increase in LDH level and the maximum exceeded 10000U/L; 35 cases （83.33%） had B symptom. The response rate （RR） for the whole group was 71.43%, the complete remission （CR） rate was 59.52% （25 cases）, the partial remission （PR） rate was 11.90% （5 cases）, the stable disease rate was 2.38% （1 case） and the death rate was 26.19% （11 cases）. The 4-year survival rate was 73.81%. The complete remission rate was 72,73% in the hematopoietic stem cell transplantation group and 54.84% in the chemotherapy group. The meta-life span was 35.38 months for patients in the hematopoietic stem cell transplantation group and 29.25 months for patients in chemotherapy group. Multivariate analysis showed that IPI score, clinical stage, therapy modality and hematopoietic Stem cell transplantation were significant factors for prognosis. Conclusion： The major treatment for diffuse large B cell lymphoma is standard chemotherapy. Hematopoietic stem cell transplantation is the best choice for treating patients with diffuse large B cell lymphoma.