T细胞非霍奇金淋巴瘤91例回顾性分析  

Retrospective analysis of 91 patients with T cell non-Hodgkin＇s lymphoma

作　　者：杨萍[1] 王晶[1] 董菲[1] 景红梅[1] 克晓燕[1] 

机构地区：[1]北京大学第三医院血液科,100191

出　　处：《白血病．淋巴瘤》2012年第5期264-268,共5页Journal of Leukemia & Lymphoma

摘　　要：目的探讨T细胞非霍奇金淋巴瘤（T—NHL）的治疗和预后因素。方法回顾性分析91例T-NHL患者的临床资料，对患者的临床特征、病理类型及实验室指标以及生存、预后因素进行分析。结果91例T-NHL患者中位年龄38岁，国际预后指数（IPI）评分中高危／高危58例（63．7％），72例（79．1％）处于疾病进展期，59例（64．8％）存在结外侵犯。治疗总体反应率为63．8％（51例），预计3年及5年生存率分别为55．5％和41．3％。治疗方案中依托泊苷的应用相对于CHOP样方案更能够改善患者预后，对NK／T细胞淋巴瘤或伴纵隔大包块的患者局部放疗可提高疗效，化疗联合造血干细胞移植能够进一步改善患者预后、减少复发。临床分期、B症状、ECOG评分、血清乳酸脱氢酶水平、结外器官受累、贫血、近期疗效、IPI评分、血清蛋白水平、血纤维蛋白原水平为预后相关因子；多因素分析显示近期疗效及B症状是影响生存的独立危险因素。IPI、修改的T细胞淋巴瘤预后指数的危险分层均可作为判断预后的指标。结论T—NHL是一组高度异质性肿瘤，预后较差，需探索新的治疗方案，新药治疗及造血干细胞移植可能是较好的选择。Objective To analyse treatments and prognostic factors of T cell non-Hodgkin lymphoma （T-NHL）. Methods Ninety-one patients with T-NHL were retrospectively analyzed, and clinical features, histopathology, laboratory data were included in Kaplan-Meier and prognostic analysis. Results Median age was 38 years, 58 （63.7 %） had high-intermediate and high risk by IPI, 72 （79.1%） presented with advanced stage disease,extranodal disease was present in 64.8 % of patients. The overall response rate （ORR） for the whole group was 63.8 %, and the estimated 3,5-year ORR were 55.5 %, 41.3 % respectively. Compared with CHOP-like regimen, the addition of etoposide could improve the survival of patients, meanwhile radiation therapy could improve the outcome of patients with NK/T cell lymphoma and mediastinal bulky disease, and consolidation chemotherapy with HSCT could improve the survival and reduce the recurrence of patients. Clinical stage, B symptoms, ECOG score, the level of LDH, extranodal involvment, anemia, initial treatment outcome, IPI score, the level of serum albumin and fibrinogen were predictive to overall survival. Cox muhivariate analysis showed initial treatment outcome and B symptoms were independent prognostic factors. IPI and m-PIT were useful for stratified patients into different prognostic risk groups. Conclusion T-NHL is a heterogeneous group of malignancies with an inferior long term outcome. New treatment modality needs to be explored for these patients, and new drugs and HSCT may be good choices.

关 键 词：淋巴瘤 T细胞 预后 回顾性研究 临床特征 

分 类 号：R733.1[医药卫生—肿瘤]