累及心脏的非霍奇金淋巴瘤临床特征及预后危险因素分析

Clinical characteristics and prognosis risk factors of non-Hodgkin’s lymphoma involving the heart

目的:分析累及心脏的非霍奇金淋巴瘤(NHL)的临床特征及预后危险因素,评估不同治疗方案对患者预后的影响。方法:回顾性分析南京鼓楼医院血液科诊治的66例累及心脏的NHL患者的临床资料,结合随访资料进行统计学分析。结果:累及心脏的NHL以B细胞淋巴瘤为主(95.24%)。患者接受手术治疗5例,化疗40例,化疗联合放疗/手术治疗21例,中位总生存期为9个月,中位无进展生存期为7个月,中位随访时间31个月,利妥昔单抗治疗组、应用脂质体阿霉素组的中位生存期明显延长(P<0.05)。性别、IPI评分、心脏外累及病灶、心电图异常、乳酸脱氢酶水平、β2微球蛋白水平对预后有显著影响;其中IPI评分、心电图异常是影响患者生存的独立危险因素(P<0.05)。结论:含利妥昔单抗及脂质体阿霉素的化疗方案为累及心脏的NHL患者治疗首选,但该病总体预后差,需尽早发现、尽早诊断以提高患者生存率。

Objective:To summarize the clinical characteristics and risk factors of non-Hodgkin’s lymphoma involving the heart,and evaluate the impact of different treatment options on prognosis.Methods:Sixty-six patients with non-Hodgkin’s lymphoma involving the heart diagnosed in the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School were included.Clinical and follow-up data were analyzed retrospectively.Results:B cell lymphoma accounted for 95.24%of NHL involving the heart.Sixty-six NHL patients with heart involvement,5 received surgical treatment alone,40 received chemotherapy alone and 21 received chemotherapy combined with radiotherapy/surgical treatment.Median OS was 9 months and median PFS was 7 months.The median follow-up time was 31 months.The median OS of patients receiving Rituximab or liposomal doxorubicin was significantly longer(P<0.05).The sex,IPI score,multisystem involvement,ECG abnormalities,LDH level,serumβ2-microglobulin level were relevant factors affecting prognosis(P<0.05).IPI score and arrhythmia were independent risk factors affecting PFS and OS(P<0.05).Conclusion:Chemo-regimen including rituximab or liposomal doxorubicin is the first-line therapy for patients with NHL involving the heart,but its overall prognosis is poor.Timely diagnosis is necessary to improve patients’clinical outcome.