弥漫大B细胞淋巴瘤老年患者预后因素的研究现状

Research status of prognostic factors in elderly patients with diffuse large B-cell lymphoma

弥漫大B细胞淋巴瘤(DLBCL)是非霍奇金淋巴瘤(NHL)中最常见的亚型,具有高度异质性。DLBCL患者的中位发病年龄约为60岁,并且发病率随年龄增长呈上升趋势。由于DLBCL老年患者器官功能减退、合并基础疾病,大多数无法耐受标准剂量R-CHOP(利妥昔单抗+环磷酰胺+多柔比星+长春新碱+泼尼松)方案化疗。此外,DLBCL老年患者可能具有更高危的分子遗传学特征,这些因素均导致DLBCL老年患者预后较差。寻找新的临床参数和生物标志物,从而更好地对DLBCL老年患者进行预后分层,准确识别高危患者,成为近年的研究热点。笔者拟对DLBCL老年患者的综合状态评估、分子遗传学特征、肿瘤微环境(TME)、EB病毒(EBV)感染和正电子发射断层显像(PET)/CT评估等预后因素的最新研究现状进行阐述,旨在为其精准预后分层提供理论依据。

Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non-Hodgkin lymphoma(NHL)with high heterogeneity.Median age at the time of diagnosis is about 60 years old,and the incidence tends to increase with age.Most elderly patients with DLBCL are unable to tolerate standard dose of R-CHOP(rituximab+cyclophosphamide+doxorubicin+vincristine+prednisone)regimen chemotherapy due to decreased organ function and comorbidity.In addition,elderly patients with DLBCL may have higher risk molecular genetic characteristics,and all these factors contribute to poorer prognosis of elderly patients with DLBCL.The search for new clinical parameters and biomarkers to better stratify the prognosis of elderly patients with DLBCL and to accurately identify high-risk patients has become a hot research topic in recent years.This article elaborates on the latest research status of prognostic factors of elderly patients with DLBCL,including comprehensive status assessment,molecular genetic characteristics,tumor microenvironment(TME),Epstein-Barr virus(EBV)infection and positron emission tomography(PET)/CT assessment,to provide a theoretical basis for its precise prognostic stratification.