41例套细胞淋巴瘤患者临床特征及预后分析

Analysis of clinical features and prognosis of 41 patients with mantle cell lymphoma

背景与目的:套细胞淋巴瘤(mantle cell lymphoma,MCL)现今尚无有效的治愈方法,预后差。本回顾分析了我院有完整临床及治疗资料的MCL,分析MCL在非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)中的构成比、临床特点、治疗及预后因素。方法:回顾分析1996年1月—2009年12月在本院就诊的41例MCL患者临床资料及预后因素。结果:MCL在本院NHL中所占构成比为2.1%。男性多于女性(7.4:1),41例患者中位发病年龄57岁,分期晚,Ⅲ～Ⅳ期占75.6%,国际预后指数(International Prognostic Index,IPI)≥3分占41.4%,结外侵犯多见,消化道侵犯高达33%,骨髓侵犯达21.4%,Ⅰ～Ⅱ期10例,Ⅲ期16例,Ⅳ期15例,2例Ⅰ期患者接受手术治疗后未进一步治疗,1例晚期患者放弃治疗,3例局限期患者接受单纯放疗,35例患者接受化疗,其中CHOP方案19例,EPOCH方案10例,COP方案2例,BACOP方案3例,Hyper-CVAD方案1例,使用化疗加利妥昔单抗的有4例,大多化疗周期数为4～6个。全组首次治疗后达完全缓解者12例,部分缓解者占25例,稳定3例,进展1例。随访时间12～210个月中位随访时间为39个月,失访1例,随访满2年的病例38例,随访满3年的32例,27例进展,13例死亡。全组2、3年总生存率分别为92.68%、78.20%。2、3和5年无进展生存率分别为62.88%、35.56%和28.86%,中位无进展时间为28个月。预后分析显示分期、近期疗效,对无进展生存有影响,而年龄>60岁、骨髓侵犯、IPI评分对无进展生存无显著影响,年龄>60岁、临床分期、IPI评分对总生存期无显著影响,近期疗效及骨髓侵犯对总生存期有影响。结论:MCL治疗完全缓解率低,无疾病进展时间短,预后不佳,对部分患者应行个体化治疗。

Background and purpose：There is no effective treatment of mantle cell lymphoma（MCL）and its prognosis is poor.In this study,we analyzed the outcome and prognosis of 41 MCL cases treated in Fujian Provincial Tumor Hospital.Methods：Forty-one patients with MCL were treated in our hospital from Jan.1996 to Dec.2009 and retrospectively analyzed.Results：The constituent ratio of MCL in non-Hodgkin＇s lymphoma in our hospital was 2.1%,and there were more male patients than females patients.The median age of onset of the 41 patients was 57 years,patients with stagesⅢ-Ⅳaccounted for 75.6%,and patients with International Prognostic Index（IPI）≥3 accounted for 41.4%;extranodal extension was commonly observed with digestive tract involvement accounting for 33%and bone marrow involvement accounting for 21.4%;10 patients were at stagesⅠ-Ⅱ,16 patients were at stageⅢ,and 15 patients were at stageⅣ;2 patients at stageⅠdid not received further treatment after surgery,1 patient at advanced stage gave up treatment,3 patients at limited stage received radiotherapy alone,while 35 patients received chemotherapy including CHOP regimen in 19 patients,EPOCH regimen in 10 patients,COP regimen in 2 patients, BACOP regimen in 3 patients and Hyper-CVAD regimen in 1 patient,4 of the patients received chemotherapy plus rituximab,and most received 4 to 6 chemotherapy cycles.After initial treatment,12 of 41 patients achieved complete remission,25 patients achieved partial remission,3 patients were in stable condition,and 1 patient was in progression. Patients were followed up for 12-210 months with median follow up time of 39 months.The 2- and 3-year survival rates were 92.68%and 78.20%respectively.The progression-free 2,3 and 5-year survival rates were 62.88%,35.56%,and 28.86%respectively,and the median time to progression was 28 months.Prognostic analysis indicated that stage and the immediate treatment response had an effect on progression-free survival,and overall survival in addition to bone marrow involvement.Conclusion：In the treatment of MCL,the complete remission rate is low,the progression-free time is short,and the prognosis is poor,so it should carry out individual therapy for part of patients.