104例B细胞非霍奇金淋巴瘤患儿疗效分析  

Outcomes of 104 children with B-cell non-Hodgkin lymphoma

作　　者：叶启东 潘慈[1] 薛惠良[1] 陈静[1] 周敏[1] 江华[1] 沈树红[1] 汤燕静 王坚敏 汤静燕[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,200127

出　　处：《中华血液学杂志》2013年第5期399-403,共5页Chinese Journal of Hematology

摘　　要：目的总结分析儿童B细胞非霍奇金淋巴瘤（B—NHL）短程化疗方案的远期疗效及预后影响因素。方法前瞻性制定B—NHL的诊断与治疗方案。收集接受短程B—NHL2001化疗方案治疗和随访的104例B—NHL患儿资料，并进行统计学分析。结果104例B—NHL患儿中，男79例、女25例，中位年龄7．1（0．9～16．0）岁；96例病理类型明确的患儿中，Burkitt淋巴瘤60例、弥漫大B细胞淋巴瘤32例、介于弥漫大B细胞淋巴瘤与霍奇金淋巴瘤的B细胞淋巴瘤4例；另有8例为通过体液形态学和免疫表型分析诊断。诊断时I、Ⅱ、Ⅲ和Ⅳ期患儿分别为4、27、55和18例；低危、中危和高危组患儿分别为1、26和77例。采用短程B—NHL2001化疗方案治疗后，16例患儿出现肿瘤溶解综合征，3例患儿未获得缓解，9例患儿在缓解后复发，复发时间为停药后1～7个月，7例患儿在化疗结束后接受自体造血干细胞移植治疗，6例患儿在疗程中加用利妥昔单抗。中位随访24（4～92）个月，104例患儿5年无事件生存（EFS）率为（86．7±3．5）％。单因素分析显示诊断时疾病分期、LDH水平、血清铁蛋白水平和2个疗程后是否达缓解与患儿预后有显著相关性（P值均〈0．05），而年龄、性别、病理类型、原发部位、是否有骨骼或骨髓浸润、c—mye断裂和治疗分组等对患儿预后无影响（P值均〉0．05）。多因素COX分析显示血清铁蛋白水平与患儿预后有显著相关性（P〈0．05）。结论短程B-NHL2001治疗方案对儿童B—NHL疗效肯定，预后与疾病分期、LDH、血清铁蛋白水平和早期治疗反应显著相关。Objective To analyze outcomes and prognostic factors of children with B-cell non-Hodgkin lymphoma （B-NHL）. Methods One hundred and four newly diagnosed B-NHL children were enrolled in protocol of B-NHL 2001. The statistics were performed by SPSS 13.0. Results Of 104 children （79 males, the median age of 7.1 years ） , 60, 32 and 4 patients were diagnosed with Burkitt lymphoma, diffuse large B-cell lymphoma and unclassifiable B-cell lymphoma, respectively. Four patients were in stage I , 27 stage l] , 55 stage Ill and 18 stage 1V ; 1,26 and 77 patients were allocated into R1, R2 and R3 risk groups, respectively. Three patients never got complete remission （CR）, 9 patients relapsed after CR with the duration of relapse from 1 to 7 months after chemotherapy. The estimated 5-year EFS of 104 patients was （86.7 ：t： 3.5 ） %. Univariable analyses identified that risk factors for recurrence were of higher staging, elevated LDH, serum ferritin and poor early response. Age, sex, pathologic diagnosis, original tumor, bone or marrow involvement, C-MYC and risk group were not found to be associated with the risk of failure to treatment. Muhivariable COX regression models confirmed serum ferritin as a significant independent prognostic marker. Conclusion B-NHL 2001 protocol was reasonable for B-NHL children. Higher staging, elevated LDH, serum ferritin and poor early response increased risk for recurrence.

关 键 词：儿童 淋巴瘤 B细胞 疗效 预后 

分 类 号：R733[医药卫生—肿瘤]