原发骨淋巴瘤42例临床分析

Clinical analysis of primary bone lymphoma:report of 42 cases

目的：探讨原发骨淋巴瘤（ PBL）的临床特点及预后。方法入选西京医院2006年至2014年期间收治的PBL患者42例，男24例，女18例，中位年龄45．6（11～78）岁，收集患者的临床资料，包括性别、年龄、有无全身症状、发病部位、临床分期、病理类型、治疗方案、疗效评价等，进行回顾性分析，通过电话和门诊随访至2015年3月。结果42例患者均以病变部位疼痛或牵涉性麻木为首发临床表现。病理分型均为非霍奇金淋巴瘤（ NHL ），50％（21／42）为弥漫大 B 细胞淋巴瘤（DLBCL）。其中17例患者接受了治疗，5例放化疗联合，12例单纯化疗，两组比较，近期疗效差异无统计学意义（P＞0．05）。4个疗程后评估近期疗效，年龄、性别、分期、乳酸脱氢酶（LDH）水平、有无全身症状、病理分型、美国东部肿瘤协作组（ECOG）评分、国际预后指数（ IPI ）评分、是否应用利妥昔单抗治疗、是否联合放疗等对完全缓解率（ CR ）的影响无统计学意义（P＞0．05）。中位随访时间13（2～48）个月，无进展生存期＞3年的4例患者中3例应用了利妥昔单抗。结论42例PBL患者病理类型主要为DLBCL，治疗以化疗为主，联合放疗未明显提高疗效，应用利妥昔单抗可能会改善预后，尚需扩大样本量进行研究。

Objective To analyze the clinical features and prognosis of primary bone lymphoma （PBL）.Methods Clinical data of 42 PBL patients admitted in our hospital from 2006 to 2014 were collected and analyzed retrospectively .They were 24 males and 18 females, at an age ranging from 11 to 78 （median 45.6） years.Their clinical data, including sex, age, systemic symptoms, location of disease, clinical stage, pathological type, treatment regimen, and efficacy evaluation, were collected.They were followed up till March 2015 through phone call follow-up or outpatient revisit .Results Pain in the lesion and numbness in the surrounding area were the first presentation in all the patients .Their pathological types were all identified as non-Hodgkin lymphoma （ NHL） , mainly diffuse large B-cell lymphoma （DLBCL, 21/42, 50%）.Among them, 17 subjects received medical treatment, including 5 with radiotherapy and chemotherapy , and 12 with simple chemotherapy .There was no significant difference in short-term efficacy between two groups （P〉0.05）.After 4 courses of treatment, short-term effect evaluation showed age , sex, stage, lactate dehydrogenase （LDH） level, systemic symptoms, pathological type, Eastern Cooperative Oncology Group （ECOG） score, international prognostic index （IPI）, retuximab injection, and combination with radiotherapy had no obvious effects on complete remission （ CR ） in the subjects （P〉0.05）.During the median follow-up of 13（2-48） months, 3 patients of the 4 patients with 〉3 years progression-free survival received retuximab injection .Conclusion Among the 42 subjects, DLBCL is the main pathological type .Chemotherapy is the main treatment , and combination of radiotherapy has no obvious effect .Retuximab injection may improve prognosis , but further research with a larger sample size is still needed .