高级别B细胞淋巴瘤的临床特征、治疗及预后分析(附67例)

Clinical characteristics,treatment,and prognosis analysis of high-grade B-cell lymphoma(67 cases)

目的:对比分析两种类型高级别B细胞淋巴瘤(high-grade B-cell lymphoma,HGBL)的临床特征、治疗及预后。方法:回顾性分析2013年01月至2022年06月收治的67例HGBL患者(其中包括HGBL,R和HGBL,NOS)的临床资料,对比分析两种类型淋巴瘤患者的临床特征、治疗方案及预后。结果:67例患者中,HGBL,R 39例(58.2%),HGBL,NOS 28例(41.8%)。骨髓侵犯、结外病变受侵器官数多、Ann Arbor分期处于晚期、国际预后指数(IPI)评分高、治疗前LDH升高在HGBL,R组更常见,且差异具有统计学意义(P<0.05)。对患者的预后分析结果显示,HGBL,R组患者的总生存时间(OS)和无进展生存时间(PFS)均显著短于HGBL,NOS组(P<0.05)。接受高强度化疗的HGBL患者与一线接受R-CHOP方案的患者相比OS和PFS更长(OS:χ^(2)=8.194,P=0.004;PFS:χ^(2)=9.006,P=0.002)。多因素分析结果显示,方案强度是影响患者无进展生存和总生存的独立危险因素(P<0.05)。结论:HGBL,R患者较HGBL,NOS患者预后差,与一线接受R-CHOP方案的患者相比,接受高强度化疗(DA-EPOCH-R,R-CODOX-M/IVAC或R-HyperCVAD)的患者的PFS和OS更长。

Objective:Comparative analysis of clinical characteristics,treatment and prognosis of the two types of high-grade B-cell lymphoma(HGBL).Methods:The clinical data of 67 patients with HGBL(including HGBL,R and HGBL,NOS)from January 2013 to June 2022 were analyzed retrospectively.The clinical characteristics,treatment and prognosis of patients with two types of HGBL were compared and analyzed.Results:Among 67 patients,39 cases(58.2%)were determined as HGBL,R,and 28 cases(41.8%)were HGBL,NOS.Bone marrow infiltration,extranodal disease,in the advanced clinical stage,high IPI(international prognostic index)score and elevated LDH level are more likely to occur in HGBL,R group(P<0.05).Prognostic analysis showed that overall survival(OS)time and progression-free survival(PFS)in HGBL,R group were significantly shorter than those in HGBL,NOS group(all P<0.05).Further analysis demonstrated that the patients with HGBL who received high-intensity chemotherapy regimens had longer PFS and OS(OS:χ^(2)=8.194,P=0.004;PFS:χ^(2)=9.006,P=0.002).Multivariate analysis showed that high-intensity chemotherapy regimens were independent risk factors for PFS and OS(P<0.05).Conclusion:HGBL,R patients have worse prognosis than HGBL,NOS patients,and high-intensity chemotherapy(DA-EPOCH-R,R-CODOX-M/IVAC or R-HyperCVAD)may improve the patients'prognosis.