摘要
目的:分析原发睾丸弥漫大B细胞淋巴瘤(PT-DLBCL)的临床表现、治疗及预后。方法:回顾性分析2010年1月至2021年4月期间符合条件的38例住院患者,总结其临床特点、诊断、治疗方案和疗效。结果:患者中位年龄为56(38-79)岁。双侧病变4例(10.5%),左侧病变13例(34.2%),右侧病变21例(55.3%)。有B症状者2例(5.3%)。生发中心型(GCB型)6例(15.8%),非生发中心型(non-GCB型)32例(84.2%)。36例患者可评价疗效,其中采用CHOP方案10例,R-CHOP方案21例(含R-CHOP方案化疗间歇应用利妥昔单抗联合大剂量甲氨蝶呤化疗7例),其他方案5例。36例患者中,初始化疗最佳疗效评估ORR为86.1%,CR 29例(80.6%),PR 2例(5.5%)。R-CHOP和CHOP方案组ORR分别为95.2%和60.0%(P=0.027),CR率分别是90.4%和50.0%(P=0.022)。36例患者中,出现中枢复发7例,对侧睾丸复发4例,与CHOP方案组相比,R-CHOP方案组中枢复发率显著降低(4.8%vs 50.0%,P=0.007),睾丸复发率也低于CHOP方案组,但差异无统计学意义(4.8%vs 30.0%,P=0.087)。中位随访时间27(3-135)个月,5年的PFS和OS分别是71%和74%。Kaplan-Meier单因素分析结果显示,与CHOP方案组相比,R-CHOP方案组患者的PFS(P=0.024)和OS(P=0.025)显著延长。结论:PT-DLBCL以综合性治疗为主,R-CHOP方案组CR率及ORR高于CHOP方案组,且减少了中枢及对侧睾丸复发,改善了患者的生存。大剂量甲氨蝶呤联合利妥昔单抗方案对预防中枢复发可能有益。
Objective:To analyze the clinical manifestations,therapeutic response and prognosis of patients with primary testicular diffuse large B-cell lymphoma(PT-DLBCL).Methods:Thirty-eight patients with PT-DLBCL were enrolled,who hospitalized from January 2010 to April 2021,and their clinical characteristics,treatment regimen and efficacy were collected and analyzed retrospectively.Results:The median age of the patients was 56 years old(ranged from 38 to 79 years).There were 4 cases(10.5%)with bilateral lesions,13 cases(34.2%)with left lesions,and 21 cases(55.3%)right lesions.There were 2 cases(5.3%)with B symptoms,6 cases(15.8%)of germinal center B-cell-like(GCB)subtype and 32 cases(84.2%)of non-GCB subtype.Efficacy was evaluated in 36 cases,including 10 cases with CHOP regimen,21 cases with R-CHOP regimen(7 cases were treated with rituximab combined with high-dose methotrexate injection chemotherapy at intervals of R-CHOP regimen),and 5 cases with other regimens.In 36 patients,the efficacy evaluation of initial chemotherapy showed that the overall response rate(ORR)was 86.1%,29 cases(80.6%)reached complete response(CR),and 2 cases(5.5%)reached partial response(PR).The R-CHOP group was superior to CHOP group in ORR(95.2%vs 60.0%,P=0.027)and CR(90.4%vs 50.0%,P=0.022).of the 36 patients,7 cases had central nervous system(CNS)recurrence and 4 cases had contralateral testicular recurrence.Compared with the CHOP group,the CNS recurrence rate in the R-CHOP group was significantly lower(4.8%vs 50.0%,P=0.007),and the testicular recurrence rate in the R-CHOP group was also lower than the CHOP group,but the difference was not statistically significant(4.8%vs 30.0%,P=0.087).The median follow-up time was 27(3-135)months,and the 5-year PFS and OS were 71%and 74%,respectively.Kaplan-Meier univariate analysis showed that the R-CHOP regimen significantly improved the patients’PFS(P=0.024)and OS(P=0.025)compared with the CHOP regimen.Conclusion:PT-DLBCL is mainly treated with comprehensive treatment.Compared with CHOP regimen,R-CHOP regimen can improve the CR rate and ORR,reduce CNS recurrence and contralateral testicular recurrence,and improve the patients’survival.Patients may benefit from high-dose methotrexate combined with rituximab interlaced with R-CHOP regimen.
作者
张晓丽
俞文娟
朱亚男
许惠丽
杨春梅
肖峰
麦文渊
ZHANG Xiao-Li;YU Wen-Juan;ZHU Ya-Nan;XU Hui-Li;YANG Chun-Mei;XIAO Feng;MAI Wen-Yuan(Department of Hematology,Pingdingshan First People′s Hospital,Pingdingshan 467000,Henan Province,China;Department ofHematology,The First Affiliated Hospital of Zhejiang University,School of Medicine,Hangzhou 310003,Zhejiang Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2023年第5期1372-1378,共7页
Journal of Experimental Hematology