摘要
目的总结伴有睾丸侵犯的儿童伯基特淋巴瘤的临床特征,以及应用大剂量甲氨蝶呤(HD-MDX,5-8g/m2)等联合化疗取代睾丸放疔的临床疗效及预后。方法收集16例伴有睾丸侵犯的伯基特淋巴瘤患儿资料,分析其临床特征,按前瞻性方案设计及分层。全部患儿进入高危组分层治疗,并定期追踪随访。方案采用北京儿童医院淋巴瘤治疗方案中的NHL-BCH-2009.成熟B细胞淋巴瘤方案(来自改良的LMB-89方案联合利妥昔单抗治疗)。结果137例伯基特淋巴瘤患儿中伴睾丸侵犯的患儿16例(11.7%)。16例患儿均为Ⅳ期,发病中位年龄为6.5(2.25~13.5)岁。16例患儿中8例存在骨髓侵犯(其中5例已达白血病期),9例存在中枢神经系统受累(其中5例为中枢神经系统白血病,4例为颅内或脊髓占位);5例为双侧睾丸侵犯,11例为单侧睾丸侵犯;1例病初存在近期EBV感染(EBV-IgM+)。中位随访时间为31.8(0.5~79.0)个月,16例患儿中死亡2例(1例因早期化疗合并症放弃治疗死亡,1例于早期停药后复发死亡);1例停药2年8个月后出现膀胱部位肿瘤复发,经治疗目前处于完全缓解;13例无事件生存,无睾丸复发。3年总生存率为87.5%,3年无事件生存率为72.9%。追踪其中〉10岁患儿(3例)的睾酮水平,均在正常范围。结论对于伴有睾丸侵犯的伯基特淋巴瘤患儿,为减少放疗的远期不良反应、保留睾丸功能,应用HD-MTX等联合化疗取代睾丸放疗,疗效好,不增加睾丸复发率,性腺功能正常,但远期不良反应及睾丸功能仍有待观察。
Objective To analyze the clinical features and outcomes of Burkitt lymphoma with testicular involvement and study the efficiency of high dose methotrexate (HD-MTX: 5-8g/m2) in those patients without radiation therapy. Method Retrospective analysis was conducted in 16 Burkitfs lymphoma cases with testicular lymphoma involvement between Jan 2009 and Dec 2014. We followed the BCH-NHL-2009 protocol, modified from FAB LMB 89 combined with rituximab. All patients were enrolled in high-risk group (treated by Group C protocol). Results Of 137 Burkitt lymphoma, 16 (11.67%) had testicular involvement. All the patients were in stage IV, the median age was 6.65 years (ranges: 2.25 to 13.5 years). 8 cases had bone marrow involvement, 9 with central nervous system involvement, 5 with bi-testicular involvement, 1 with EB virus infection (EBV-IgM+). The median follow- up was 31,8 months (ranges: 0.5 to 79 months). During the study period, 2 cases died, 1 due to the disease relapse, the other one due to chemo-related dead. 1 had disease relapse 32 months after off treatment; the other 13 cases were all event free survival. 3-year OS was 87.5%, 3-year EFS was 72.9%. We also found the level of testosterone in ten adolescent were normal before and after chemotherapy. Conclusion For the Burkitt lymphoma with testicular involvement, we abandon radiotherapy, and administer HD-MTX to lower the toxicity. The short-term survival is better, long-term survival still needs to be clarified.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2016年第9期768-773,共6页
Chinese Journal of Hematology
关键词
伯基特淋巴瘤
睾丸肿瘤
儿童
抗肿瘤联合化疗方案
Burkitt lymphoma
Testicular neoplasms
Child
Antineoplastic combined chemotherapy protocols