22例高级别B细胞淋巴瘤非特指型的临床分析

Clinical analysis of 22 patients with high grade B-cell lymphomas-not otherwise specified

目的分析高级别B细胞淋巴瘤非特指型(HGBL-NOS)的临床特点、治疗与预后。方法回顾性分析郑州大学第一附属医院2013年1月至2019年6月收治的22例HGBL-NOS患者的临床病理资料。结果22例HGBL-NOS患者的2 a疾病无进展生存(PFS)率及总生存(OS)率分别为40.9%和59.1%。高强度方案(R-CODOX-M/IVAC方案或R-HyperCVAD/MA方案)组的总有效率较R-CHOP/EPOCH方案组稍高,但差异无统计学意义(P=0.381)。在远期疗效对比中,高强度方案组PFS和OS均优于R-CHOP/EPOCH组(PFSP=0.009;OS P=0.041)。亚组分析中,双表达淋巴瘤(DEL)患者的PFS和OS稍短于non-DEL患者,但差异均无统计学意义(PFSP=0.165;OSP=0.085)。与单打击淋巴瘤(SHL)患者相比,non-SHL患者的OS与PFS稍好,但差异均无统计学意义(PFSP=0.078;OSP=0.297)。对临床病理特征进行单因素分析发现,IPI评分3~5分患者的预后较差(P=0.037)。结论HGBL-NOS恶性程度高,生存期短,高强度化疗可改善预后,IPI评分3~5分是预后不良因素。

Objective To analyze the clinical characteristics,treatment and prognosis of high-grade B-cell lymphomas-not otherwise specified(HGBL-NOS).Methods The clinical and pathological data of 22 patients with HGBL-NOS admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2019 were retrospectively analyzed.Results The 2-year progression-free survival(PFS)and overall survival(OS)rate of 22 patients were 40.9%and 59.1%,respectively.The overall response rate of the high-intensity regimen(R-CODOX-M/IVAC or R-Hyper CVAD/MA)chemotherapy group was better than the R-CHOP/EPOCH regimen chemotherapy group,but the difference was not statistically significant(P=0.381).In comparison of long-term efficacy,the PFS and OS in the high-intensity regimen chemotherapy group were better than those in the R-CHOP/EPOCH chemotherapy group(PFS:P=0.009;OS:P=0.041).In the subgroup analysis,the PFS and OS of patients with double expressor lymphoma(DEL)were shorter than those of non-DEL,but the difference was not statistically significant(PFS:P=0.165;OS:P=0.085).Compared with single-hit lymphoma(SHL)patients,the OS and PFS of non-SHL were slightly better,but the difference was not significant(PFS:P=0.078;OS:P=0.297).Univariate analysis of clinical and pathological features showed that patients with IPI scores of 3-5 had a poor prognosis(P=0.037).Conclusion HGBL-NOS is associated with a high degree of malignancy and short survival period,high-intensity chemotherapy can improve the prognosis,IPI scores of 3-5 is a poor prognostic factor.