髓系抗原在T淋巴母细胞淋巴瘤中表达的临床意义  

Significance of myeloid antigen expression in precursor T lymphoblastic lymphoma

作　　者：蔡月[1,2] 孙晓非[1,2] 严苏丽[1,3] 甄子俊[1,2] 夏奕[1,2] 凌家瑜[1,2] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心内科,广东广州510060 [3]中山大学肿瘤防治中心检验科,广东广州510060

出　　处：《癌症》2010年第3期337-342,共6页Chinese Journal of Cancer

摘　　要：背景与目的：前驱T淋巴母细胞淋巴瘤（precursor Tlym phob lasticlymp hom a,T-LBL）是一类高侵袭型恶性淋巴系统肿瘤,部分患者合并有髓系抗原表达,其临床意义值得探索。本文通过分析T-LBL患者合并髓系抗原表达的临床特点以及与近期疗效的关系,探讨其预后价值。方法：收集2000年1月至2008年7月中山大学肿瘤防治中心内科收治的45例初治的T-LBL患者资料,患者年龄5.5-66岁,中位年龄14岁,根据患者骨髓或胸水流式细胞术免疫分型分为髓系抗原阳性表达[My（＋）组]和阴性表达[My（-）组]两组。观察和分析髓系抗原的表达与临床特征、近期疗效及2年总生存率的关系。结果：45例T-LBL患者中My（＋）组18例（40.0%）,My（-）组27例（60.0%）。全组髓系抗原表达与患者初治的LDH水平呈负相关,与其他临床特征无明显相关性。My（＋）组诱导期完全缓解（completere mission,CR）率为38.8%,My（-）组诱导期CR率为70.3%,两组相比差异有统计学意义（P=0.028）。My（＋）组2年总生存为51.9%,My（-）组2年总生存时间（overall survival,OS）为78.7%,两组相比差异有统计学意义（P=0.036）。不同年龄亚组分析显示儿童青少年LBL患者髓系抗原阳性组与阴性组在近期疗效和2年总生存率方面无明显差异;成人LBL患者髓系抗原阳性组在近期疗效和2年总生存均低于阴性组患者。单因素和多因素分析显示年龄和髓系抗原表达是T-LBL的不良预后因素。结论：本研究显示髓系抗原阳性表达的成人T-LBL较阴性表达者近期CR率低,2年总生存率较低;而对儿童青少年T-LBL近期疗效和生存率无明显影响。Background and Objective： Precursor T lymphoblastic lymphoma （T-LBL） is a highly aggressive lymphoma. Myeloid antigen expression was found in some of the patients,and its clinical significance is worth studying. This study was to compare the clinical features,short-term efficacy and survival of T-LBL patients with or without myeloid antigen expression so as to evaluate its prognostic significance. Methods： Forty-five T-LBL patients,with a median age of 14 years,were treated at Sun Yat-sen University Cancer Center between January 2000 and July 2008. These patients were divided into myeloid antigen-positive group （My＋group） and myeloid antigen-negative group （My-group） based on the flow cytometric （FCM） analysis in bone marrow or pleural fluid. Myeloid antigen expression and its correlation with the short-term efficacy and overall survival were assessed in the two groups. Results： There were 18 patients （40.0%） in the My＋group and 27 （60.0%） in the My-group. The myeloid antigen expression was negatively correlated with the initial level of lactate dehydrogenase （LDH）,but not with other clinical features. The remission rate was lower in the My＋group than in the My-group （38.8% vs. 70.3%, P=0.028）. The 2-year overall survival rate was lower in the My＋group than in the My-group （51.9% vs. 78.7%,P=0.036）. By age subgroup analysis,there were no differences in response and survival rate among children and adolescents with or without myeloid antigen expression. But the remission rate and the 2-year overall survival rate were significantly lower in adult patients with myeloid antigen expression than in patients without it. Univariate and multivariate analysis demonstrated that age and myeloid antigen expression were adverse prognostic factors. Conclusion： Myeloid antigen expression is a predictor of a poor response to chemotherapy,and adverse prognostic factor in adult T-LBL,but not in children with T-LBL.

关 键 词：淋巴瘤 髓系抗原表达 流式细胞术 疗效及预后 

分 类 号：R733.1[医药卫生—肿瘤]