血管免疫母细胞性T细胞淋巴瘤的临床特点和预后分析

Clinical characteristics and prognosis of angioimmunoblastic T-cell lymphoma

目的:探讨血管免疫母细胞性T细胞淋巴瘤(AITL)患者的临床特征和预后影响因素。方法:回顾性分析68例AITL患者的临床资料。68例中,37例采用CHOP/CHOPE方案化疗,31例采用以吉西他滨和铂类药物为基础的GDPT方案化疗。结果:68例年龄33~85岁,≥60岁39(57.4%)例,男女比例为2.1∶1,Ann Arbor分期Ⅲ~Ⅳ期62(91.2%)例,ECOG评分>1分27(39.7%)例,出现B症状41(60.3%)例,出现皮疹/瘙痒20(29.4%)例;血清乳酸脱氢酶(LDH)水平升高40(58.8%)例,血浆β2微球蛋白含量升高31(45.6%)例,贫血24(35.3%)例,低白蛋白血症24(35.3%)例。48(70.6%)例IPI评分>2分,38(55.9%)例PIT评分>2分。整体治疗后客观缓解率达75.2%;GDPT方案一线治疗的总生存期和无进展生存期均长于CHOP/CHOPE方案。Cox回归分析结果显示,血浆β2微球蛋白含量升高、出现皮疹/瘙痒、ECOG>1分是OS的危险因素,HR(95%CI)分别为2.300(1.159~4.368)、2.568(1.316~4.974)、1.958(1.054~3.591);年龄≥60岁和ECOG>1分是PFS的危险因素,HR(95%CI)分别为2.135(1.292~3.763)、1.784(1.247~3.035)。结论:患者年龄、治疗前ECOG评分、是否出现皮疹/瘙痒症状及血浆β2微球蛋白含量可作为AITL预后危险度评估的参考因素;GDPT可考虑为AITL的一线治疗选择。

Aim:To analyze the clinical characteristics and the influencing factors of prognosis angioimmunoblastic T-cell lymphoma(AITL).Methods:The clinical and pathological data of 68 patients with AITL were reviewed.Among 68 cases,37 cases were treated with CHOP/CHOPE regimen,and 31 cases were treated with GDPT regimen based on gemcitabine and platinum drugs.Results:The patients were 33-85 years old,and 39(57.4%)cases were over 60 years old;the ratio of male to female was 2.1∶1;62(91.2%)cases was Ann Arbor stageⅢ-Ⅳ;27(39.7%)cases with ECOG score>1;41(60.3%)cases with B symptoms,20(29.4%)cases with rash/pruritus;serum lactate dehydrogenase(LDH)increased in 40(58.8%)cases,plasmaβ2-microglobulin increased in 31(45.6%)cases,24(35.3%)cases with anemia,hypoalbuminemia in 24(35.3%)cases;48(70.6%)cases with IPI score>2,and 38(55.9%)cases with PIT score>2.The objective remission rate was 75.2%after treatment,and overall survival(OS)and progression-free survival(PFS)of GDPT group were longer than those of CHOP/CHOPE group.The results of Cox regression showed that high plasmaβ2-microglobulin level,rash/pruritus,and ECOG>1 were the risk factors of OS,HR(95%CI)was 2.300(1.159-4.368),2.568(1.316-4.974),1.958(1.054-3.591),respectively;≥60 years old and ECOG>1 were the risk factors of PFS,HR(95%CI)was 2.135(1.292-3.763),1.784(1.247-3.035).Conclusion:Age,ECOG score before treatment,rash/pruritus and plasmaβ2-microglobulin level can be used as reference factors to evaluate the prognosis risk of AITL;GDPT regimen can be considered as the first-line treatment choice of AITL.