高龄弥漫大B细胞淋巴瘤患者的临床特征及预后分析

Clinical characteristics and prognosis of elderly patients with diffused large B cell lymphoma

目的探讨高龄弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征和预后情况。方法回顾性分析2016年1月至2018年12月上海交通大学医学院附属第九人民医院收治的13例高龄(年龄≥75岁)DLBCL患者的临床病理资料,均接受了R-CHOP方案为基础的个体化治疗,观察其临床特征、治疗疗效及预后情况。结果高龄DLBCL患者的中位年龄82岁(范围:75~89岁);69.2%(9/13)的患者Ann Arbor分期为Ⅲ~Ⅳ期;84.6%(11/13)的患者ECOG评分≥2;46.2%(6/13)的患者存在多处淋巴结外器官受累;8例(61.5%)完成了3个周期以上的化疗,客观缓解率(ORR)为15.4%(2/13)。2年无进展生存率为23.1%,2年生存率为53.8%。61.5%(8/13)的患者出现了3级及以上中性粒细胞减少,30.8%(4/13)的患者出现了3级及以上血小板减少;76.9%(10/13)的患者出现了肺部感染。单因素预后分析显示,改良国际预后指数(IPI)评分高、R-CHOP方案不足3个周期及合并多种基础疾病者生存率低(P<0.05)。结论高龄DLBCL患者往往表现为侵袭性强、不良反应率较高及总生存率低等特点,R-CHOP方案可一定程度上改善其预后。

Objective To investigate the clinical characteristics and prognosis of elderly patients with diffused large B cell lymphoma(DLBCL).Methods A retrospective analysis including 13 DLBCL patients(≥75 years),came from Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2016 to December 2018 was carried out.All patients were treated with individualized treatment based on R-CHOP regimen.Their clinical characteristics and laboratory index were observed and the survival and prognostic factors were calculated.Results Median age of elderly patients with DLBCL was 82 years(75-89).Patients with Ann Arbor stageⅢ~Ⅳaccounted for 69.2%(9/13),and patients with ECOG score≥2 accounted for 84.6%(11/13).46.2%(6/13)had more than one extra nodal organ involvement.Eight patients(61.5%)completed more than three cycles of chemotherapy,and the objective remission rate(ORR)was 15.4%(2/13).The 2-year progression survival rate and 2-year overall survival rate was 23.1%and 53.8%,respectively.61.5%(8/13)patients had neutropenia of grade 3 and above,and 30.8%(4/13)had thrombocytopenia of grade 3 or above.76.9%(10/13)patients experienced pulmonary infections during treatment.The high National Comprehensive Cancer Network International Prognostic Index(NCCN-IPI)scores,less than 3 cycles of R-CHOP regimen and multiple complications were predictive of poor overall survival(P<0.05).Conclusion Elderly DLBCL patients were highly aggressive with increased chemotherapy adverse reactions rate and poor survival.To a certain extent,R-CHOP regimen can improve the prognosis of these patients.