西部单中心51例套细胞淋巴瘤患者临床特征及预后因素分析

Clinical characteristics and prognostic factors of 51 patients with mantle cell lymphoma in western China

目的:研究套细胞淋巴瘤(MCL)患者的临床特点及预后相关因素,进一步全面评估病情,探索个体化治疗。方法:回顾性分析2012年1月至2016年12月经我院病理科确诊的51例MCL患者的临床特点、住院20例患者的预后分层和不同化疗方案的近期及远期疗效,并进行随访观察。结果:20例住院治疗患者中,R-Hyper-CVAD组及R-CHOP样组的ORR(分别为100%、100%)均高于其未联合美罗华组(分别为50%、40%);MIPI评分中,低危组ORR为75.0%,明显高于中危组(16.6%);CD5-患者CR、PR均高于CD5+患者;Ki67≥30%患者CR率(20%)大于Ki67<30%组(11%),PR率则相反;Ki67<30%患者3年OS明显高于Ki67≥30%患者,有统计学差异,而PFS无统计学差异;MIPI分组中,低危组3年OS明显高于中高危组,有统计学差异,PFS无统计学差异;美罗华组无论OS还是PFS均高于非美罗华组;Hyper-CVAD组与非Hyper-CVAD组OS、PFS均无统计学差异。结论:美罗华联合化疗治疗MCL的疗效是肯定的,绝大多数患者能够耐受减低剂量的Hyper-CVAD A及B方案化疗,但统计学显示与非Hyper-CVAD组无明显差异,可能与病例数偏少相关,需要更多大样本的循证医学的支持。

To study the clinical characteristics and prognostic factors of patients with mantle cell lymphoma(MCL)for comprehensive assessment of the condition and exploring individualized treatment.Methods:The clinical characteristics of 51 MCL patients from the department of hematology of our hospital from January 2012 to December 2016 were analyzed retrospectively.The prognostic stratification,short-term and long-term effects of different chemotherapy regimens were also analyzed retrospectively in 20 inpatients.Results:The ORR of R-Hyper-CVAD group(100%)and R-CHOP like group(100%)were higher than those groups without rituximab(50%,40%).In the MIPI score,the ORR of the low risk group was 75.0%,which was significantly higher than that of the moderate risk group(16.6%).The CR and PR of CD5 patients was higher than that of CD5 patients.The CR of patients with Ki67≥30%(20%)was higher than that of patients with Ki67<30%(11%).But the tendency of PR was opposite to that of CR.The 3 years OS in Ki67<30%group was significantly higher than that in patients with Ki67≥30%.But there was no significant difference in PFS in these two crowd.In MIPI group,3 years OS in low risk group was significantly higher than that in intermediate and high risk group.However,there was no significant difference in PFS.Both OS and PFS were higher in the rituximabplus chemotherapy group than that of chemotherapy alone group.There was no statistical difference in PFS and OS between Hyper-CVAD group and non-Hyper-CVAD group.Conclusion:The efficacy of combined chemotherapy with rituximab in the treatment of MCL is definite.The vast majority of patients can toleratelow intensity of Hyper-CVAD A or B chemotherapy.However,there was no statistical difference between the Hyper-CVAD group and the non-Hyper-CVAD group.This may be attributed to the low sample size.Further study of more large samples of evidence-based medicine is needed.