56例霍奇金淋巴瘤的回顾性分析

Retrospective study of 56 cases with Hodgkin lymphoma

目的:总结56例霍奇金淋巴瘤(HL)的临床特点、疗效,分析影响缓解及生存的危险因素。方法:回顾性分析56例HL患者资料,选择ABVD作为一线方案,进展及复发患者给予二线治疗,根据分期及有无不良预后因素等决定治疗疗程,放疗指征参照NCCN指南。治疗结束后做疗效及不良反应评价。采用SPSS17.0统计软件分析影响缓解率及生存的危险因素。结果:HL占同期新发淋巴瘤患者总数的7.6%,≤40岁患者占总患者数的53.6%,未见发病年龄双峰特征。56例患者病理类型100%为cHL,结节硬化型和混合细胞型共占到89.2%,二者的比例为1∶1;首次就诊71.4%患者处于Ⅲ期及Ⅳ期,60.7%患者有B组症状。巨块型病例占12.5%。纵膈、颈部、腋下淋巴结最易受累。24例(42.9%)存在结外累及,其中11例有骨累及,10例累及肺部。47例患者可进行疗效评价,其中完全缓解68.1%,部分缓解6.4%,病情稳定14.9%,病情进展10.6%。观察到ABVD方案期间出现Ⅲ度血液学毒性、肺部并发症各有4例患者。在平均随访的34个月,共有5例达到CR患者复发,6例死亡。2年及3年无病生存、总体生存分别为76.5%、60.0%;85.3%、75.0%。结论:早期识别预后不良年轻患者并给予强化治疗,加强并发症监测,HL的生存情况将得到进一步提高。

Objective：To summarize the clinical features and therapeutic outcomes,and to analyze risk factors affecting response and survival in 56 patients with Hodgkin lymphoma（HL）.Method：We reviewed datas retrospectively from 56 patients,receiving ABVD as initial regimen.Those resistant to primary therapy or relapsed were treated with second-line regimens.Radiotherapy were performed according to NCCN guideline.Responses and adverse effects were assessed at the completion of treatment.We analysed risk factors affecting outcome by using statistical software SPSS17.0.Result：HL accounted for 7.6% of total newly diagnosed lymphomas in the corresponding period,patients younger than 40 years old constituted 53.6% of the total,no bimodal age distribution was observed.Pathological study revealed that 100% were classical Hodgkin lymphoma,nodular sclerosing and mixed cellularity accounted for 89.2% with a ratio of 1∶1.Pre-treatment evaluation showed that 71.4% of the patients were in stage Ⅲor Ⅳ,and 60% were with B symptoms.12.5% had bulky disease.Lymph nodes in mediastinum,neck and axillaries were most likely involved,24 patients（42.9%）presented with extra nodal tissues involvement,of which 11 patients had osseous involvement,10 patients had lungs infiltrated.Fouty-seven patients were assessable for responses and adverse effects at the completion of treatment,complete remission rate was 68.1%,partial remission 6.4%,stable disease 14.9%,disease progression 10.6%.Grade 3 neutropenia and pulmonary toxicity occurred in 3 cases respectively.At 34 months median follow-up,there were 6 deaths and 5 relapses.Two-year and 3-year disease free survival rates and overall survival rates were 76.5%,60.0%;85.3%,75.0% respectively.Conclusion：To identify young patients who are at high risk of poor prognosis more early and to treat them with more intensive chemotherapy,meanwhile monitor toxicity more carefully,survival of HL could be further improved.