淋巴母细胞型淋巴瘤40例临床疗效及预后分析

Treatment results and prognosis of lymphoblastic lymphoma: A report on 40 patients

目的 :回顾性分析淋巴母细胞型淋巴瘤药物治疗为主的疗效和预后因素。方法 :1 978年 4月至 2 0 0 1年 7月间收治的淋巴母细胞型淋巴瘤共 40例 ,以联合化疗为主 ,总结和分析临床疗效及预后因素。结果 :全组完全缓解率 47.5 % ,近期总有效率 67.5 %。分析显示外周血象正常者完全缓解率显著高于外周血白血病样变者 ,含蒽环类的诱导方案完全缓解率高于不含蒽环类的诱导方案。化疗后随访 1～ 1 2年 ,失访 4人 ,随访率 90 %。 30例已相继死亡 ,按寿命表法统计全组 1 ,2 ,3 ,4,5 ,6 ,8,1 2年生存率分别为 54 .4% ,32 .7% ,2 7.2 % ,2 4 .4% ,2 4 .4% ,2 4 .4% ,1 9.5 % ,1 9.5 %。COX回归多因素分析显示不良预后因素包括未达完全缓解 ,Ⅳ期病例 ,≥ 2个结外病变 ,骨髓侵犯 ,纵隔病变 ,中枢神经系统侵犯 ,外周血白血病样变者。结论 :含蒽环类的方案能提高完全缓解率 ,而能否达到完全缓解 ,病情的早晚是影响预后的两个主要因素。以含蒽环类方案的足量化疗为主 。

Purpose:Retrospective analysis of treatment results and prognostic factors in 40 patients with lymphoblastic lymphoma.Methods:40 patients with lymphoblastic lymphoma treated by combined chemotherapy from Apr,1978 to Jul,2001 were analysed.Results:The complete response rate was 47.5%,the overall response rate was 67.5%.The CR rates of patients with normal hematology and treated by anthracycline based regimens are better than those with abnormal hematology and treated by regimens without anthracyclines.The 1,2,3,4,5,6,8,12 year suvival rates were 54.4%,32.7%,27.2%,24.4%,24.4%,24.4%,19.5%,19.5%, respectively.Multivariate COX regression analysis indicated that lack of complete response, Ⅳ stage, ≥2 extranodal lesions,bone marrow involvement,mediastinal involement,abnormal hematology and central nerve system involvement were unfavorable prognostic factors.Conclusions:Anthracycline based regimens can increase CR rate. Achievement of CR and early stages are the two important prognostic factors for lymphoblastic lymphoma.Intensive chemotherapy based on anthracyclines and achieving CR are the main means to improve long term survival rate of lymphoblastic lymphoma.