广泛浸润弥漫性大B细胞淋巴瘤临床诊治分析  

Diagnosis and Treatment of Extensively Infiltrated Diffuse Large B Cell Lymphoma

作　　者：黄晨[1] 张会超[2] 武莉丽[1] 刘月平[3] 刘丽宏[1] 

机构地区：[1]河北医科大学第四医院暨河北省肿瘤医院血液内科,河北省石家庄市050011 [2]河北医科大学第四医院暨河北省肿瘤医院检验科,河北省石家庄市050011 [3]河北医科大学第四医院暨河北省肿瘤医院病理科,河北省石家庄市050011

出　　处：《中国全科医学》2015年第35期4369-4373,共5页Chinese General Practice

摘　　要：弥漫性大B细胞淋巴瘤(DLBCL)是一种常见的非霍奇金淋巴瘤(NHL),利妥昔单抗的出现明显改善了DLBCL患者的预后。对于DLBCL预后的评估,目前临床上普遍应用的是国际预后指数(IPI),但IPI仅结合了部分临床指标,单纯依靠IPI评估预后已经不能满足临床需要。本文总结了4例经河北省肿瘤医院诊治的广泛浸润DLBCL患者,IPI评分为中高危或高危,同时还具有累及范围广、血清蛋白明显减低、Ki-67较高、多为非生发中心来源等特点,提示预后不佳;经RCHOP方案(利妥昔单抗+环磷酰胺+多柔比星+长春新碱+泼尼松)治疗后均获得了良好疗效。为此,联合血液科、病理科、检验科对本组患者诊治与预后进行多学科协作讨论,进一步探讨DLBCL的治疗措施和预后评价指标,推动多学科间的合作。Diffuse large B cell lymphoma（ DLBCL） is a common non Hodgkin＇s lymphoma（ NHL）. Rituximab has greatly improved the prognosis of patients with DLBCL. At present,international prognostic index（ IPI） has been widely applied in prognosis prediction of DLBCL,while it only combines a portion of clinical indicators,thus the sole use of IPI in the prognosis prediction of DLBCL has been unable to satisfy current clinical demands. The paper summarized the clinical data of 4 patients with widely infiltrated diffuse large B cell lymphoma who received treatment in the Fourth Hospital of Hebei Medical University. The 4patients had moderately high risk or high risk shown by IPI score, and their features were wide range, obvious decrease of albumin,higher Ki-67 and mostly nongerminal center-derived. Their suggested prognosis was not favorable. After the treatment with rituximab combining CHOP therapy（ cyclophosphamide ＋ doxorubicin ＋ vincristine ＋ metacortandracin）,favorable efficacy was achieved in all the 4 patients. With the multi-disciplinary coordination among Department of Hematology,Pathology and Laboratory on the treatment and diagnosis of the 4 patients,the indicators for the treatment means and prognosis prediction of DLBCL were further explored,with a view to promote inter-disciplinary cooperation.

关 键 词：淋巴瘤 B细胞 淋巴瘤 非霍奇金 预后 利妥昔单抗 抗肿瘤联合化疗方案 

分 类 号：R733.4[医药卫生—肿瘤]