21例套细胞淋巴瘤临床治疗及预后分析  

Analysis of Clinical Treatment and Prognostic Factors of 21 Cases of Mantle Cell Lymphoma

作　　者：熊竹娟[1] 周祥[2] 吴萍[1] 周进[1] 魏雯[1] 敬小梅[1] 任苑蓉[1] 李力[1] 张智慧[1] 

机构地区：[1]四川省肿瘤医院肿瘤内科,成都610041 [2]四川省肿瘤医院胃肠外科,成都610041

出　　处：《肿瘤预防与治疗》2015年第4期190-195,222,共7页Journal of Cancer Control And Treatment

摘　　要：目的:探讨套细胞淋巴瘤(MCL)的临床特征、治疗效果及预后影响因素。方法:回顾性分析我科21例MCL患者的临床资料,分别比较CHOP方案与RCHOP方案以及联合沙利度胺治疗MCL患者的总有效率(ORR)、无进展生存时间(PFS)、总生存期(OS),分析患者年龄、性别、ECOG评分、肿瘤分期、国际预后指数(IPI)评分、B症状、白细胞计数、乳酸脱氢酶(LDH)、骨髓受侵等对预后的影响。结果:21例MCL患者治疗后ORR为81%(17/21),CHOP类方案治疗组ORR为71%(10/14),RCHOP类方案治疗组ORR为100%(6/6),3年OS率、PFS率分别为34%、13%与63%、33%,两组的ORR、OS、PFS率差异无统计学意义(P>0.05);联合沙利度胺组与常规治疗组的ORR、OS、PFS率分别为71%(5/7)、64%、43%与86%(12/14)、23%、11%,但两组差异无统计学意义(P>0.05)。分期晚、骨髓受侵、LDH增高、白细胞增高的患者预后更差,差异有统计学意义(P<0.05),年龄、性别、IPI评分、B症状、ECOG评分对治疗效果及OS的影响差异无统计学意义(P>0.05)。结论:MCL多为老年男性,分期晚,以CHOP方案化疗为基础的治疗仍是主要的治疗方式,虽治疗有效率较高,但治愈率低,联合沙利度胺辅助治疗有望提高疗效、延长生存期,分期晚、骨髓受侵、LDH增高、白细胞增高是预后不良因素。Objective： To study the clinical characteristics,treatment efficacy and prognostic factors for mantle cell lymphoma（ MCL）. Methods： Clinical data of 21 patients diagnosed as MCL in our department were analyzed retrospectively. The overall response rate（ ORR）,progression free survival（ PFS） and overall survival（ OS） were compared between CHOP and RCHOP regimen,thalidomide combined group and the conventional chemotherapy group. The age,gender,ECOG score of performance status,Ann-Arbor stage,B symptoms,international prognostic index（ IPI） score,lactate dehydrogenase（ LDH）,leukocyte number and bone marrow invasion were analyzed for prognosis. Results： The ORR was81%（ 17 /21） in total 21 cases,which was 71%（ 10 /14） in CHOP group,and（ 100%）（ 6 /6） in RCHOP group. The three year OS and PFS was 34%,13% and 63%,33% in CHOP group and RCHOP group respectively with no significant difference between these two groups（ P〈0. 05）. The ORR,OS and PFS were 71%（ 5 /7） 、64% 、43% vs 86%（ 12 /14） 、23% 、11% in thalidomide combined group and the conventional chemotherapy group respectively without significant difference（ P〈0. 05）. The patients with bone marrow invasion,late Ann Arbor stage,increased LDH level and leukocyte number got poorer prognosis（ P〈0. 05）. The age,gender,international prognostic index（ IPI） score,B symptoms and ECOG score of performance status were found having no significant influence on the treatment efficacy and OS（ P〈0. 05）. Conclusion： Most patients with MCL are older male and ususlly at late stage. CHOP regimen-based chemotherapy is the commonly used treatment which can get higher ORR while lower curative rate. The treatment combination of thalidomide are expected to improve treatment efficacy and prolong survival.Late Stage,bone marrow invasion,elevated LDH level and leukocyte number are correlated with poor prognosis.

关 键 词：淋巴瘤 套细胞 治疗 预后指数 

分 类 号：R733.1[医药卫生—肿瘤]