5例浆母细胞淋巴瘤临床病例分析和文献回顾

Case Report on 5 Plasmablastic Lymphoma Patients and Literature Review by Retrospective Analysis

目的探讨浆母细胞淋巴瘤的临床和病理特征、免疫表型、治疗及预后。方法收集2007年2月~2016年10月中南大学湘雅二医院和湖南省肿瘤医院收治的5例浆母细胞淋巴瘤患者的临床资料,对其临床和病理特征、免疫表型、治疗及预后进行分析,并进行文献回顾。结果 5例浆母细胞淋巴瘤患者均为HIV阴性,1例女性,4例男性;中位诊断年龄53.8岁(42~66岁);4例患者有B症状。所有患者均表现出免疫母细胞的形态学特征和浆细胞免疫表型。3例患者接受以蒽环类药物为基础的化疗,其中2例使用了硼替佐米。1例患者接受GEMOX(吉西他滨,奥沙利铂)和受累野放疗。1例患者仅接受了右半结肠切除术。3例患者获得了持续的完全缓解并且目前仍然存活,生存时间分别为24、10、23个月。2例患者出现进展,分别于入组3个月和6个月后死亡。结论浆母细胞淋巴瘤是一种的罕见淋巴瘤,形态学上与免疫母细胞相似,但具有浆细胞的免疫表型,临床进展快,预后差,治疗仍然是一个挑战,更有效的方案有待进一步研究。

Objective To investigate the clinical and pathologic feature, immunophenotype, treatment and prognosis of plasmablastic lymphoma patients. Methods The clinical data of 5 plasmablastic lymphoma patients who were admitted into the Second Xiangya Hospital of Central South University and Hunan Cancer Hospital between 2010 and 2016 was collected. We analyzed the clinical and pathologic fea-tures, immunophenotype, treatment and prognosis of these five cases, followed by a review of related literature in China and abroad. Results A1l of these 5 patients were diagnosed as HIV-negative PBL, 4 of 5 patients were males, and only one was female. The median age was 53.8（42-66） years old. Four had B symptoms. All the 5 patients showed the morphologicalfeature of immunoblasts but plasma cell immu-nophenotype. Three patients received a thracycline based chemotherapy, two patients received bortezomib. One patient received GEMOX （Gemcitabine, Oxaliplatin） and involved field radiotherapy. Only one patient underwent right hemicolectomy. Three patients achieved dura-ble complete response and are still alive with survival times of 24, 10, 23 months respectively. Two patients had progressive disease and died 3 and 6 months after admission. Conclusion We conclude that plasmablastic lymphoma is a rare lymphoma which resembles immunoblasts morphologically but showed plasma cell immunophenotype, and this tumor progress rapidly clinically and have poor prognosis, the treatment remains a challenge, more effective treatment regimen is urged to be investigated.