套细胞淋巴瘤25例临床特征及预后分析

Clinical characteristics and prognostic analysis of 25 patients with mantle cell lymphoma

目的 分析套细胞淋巴瘤（MCL）的临床病理特点、治疗反应及预后相关因素.方法 回顾性分析北京友谊医院25例MCL患者的临床资料、治疗反应及预后因素.结果 25例患者中位发病年龄65岁,男女比例3.4∶1,其中骨髓侵犯15例（60％）,Ann Arbor分期Ⅲ期6例（24％）,Ⅳ期17例（68％）,10例（40％）患者有B症状,5例（20％）患者乳酸脱氢酶（LDH）升高,16例（64％）患者β2-微球蛋白（β 2-MG）升高.17例利妥昔单抗联合化疗者完全缓解率为64.71％、2年总生存（OS）率为69.6％、2年无进展生存（PFS）率为45.1％,高于常规化疗者（P＜0.005）.预后分析显示：母细胞变异型、骨髓侵犯、LDH升高、Ki-67指数、简化的MCL国际预后指数（sMIPI）＞ 5分.白细胞升高为预后不良因素,而国际预后指数（IPI）评分、脾大、年龄、B症状及β2-MG对预后无显著影响.结论 MCL恶性度高,预后差.利妥昔单抗联合化疗可明显提高CR率、PFS率及OS率.

Objective To investigate the clinical and pathological characteristics,treatment response and clinical follow-up for patients with mantle cell lymphoma （MCL）.Methods Clinical data,treatment efficacy and outcomes of 25 cases of MCL enrolled from Beijing Friendship Hospital were retrospectively analyzed.Results Median age of onset was 65 years old.Male to female ratio was 3.4：1,15 cases （60 %） had bone marrow invasion,Ann Arbor clinical stage Ⅲ were 6 cases （24 %）,stage Ⅳ were 17 cases （68 %）.10 cases （40 %） of patients had symptoms B.5 cases （20 %） patients had elevation of lactate dehydrogenase （LDH）.17 cases （64 %） had elevation of β2 microglobulin （β2-MG）.11 eases （64.71%） had complete remission （CR） after rituximab combined chemotherapy in 17 patients,2 years overall survival （OS） rate was 69.6 %,2 years progression-free suvival （PFS） rate was 45.1%,significantly higher than those in traditional chemotherapy group （P 〈 0.005）.Outcomes analyses showed that variants of plasma cells,bone marrow invasion,LDH elevation,Ki-67 level,sMIPI 〉 5 scores and increased leukocyte number were negative prognostic factors.IPI score,splenomeagly,age,symptoms B and elevation of [β2-MG had no predicative value.Conclusion MCL has higher invasion and poor prognosis.Rituximab combined chemotherapy could significantly improve CR,PFS and OS rates.