原发纵隔大B细胞淋巴瘤分析  

A CLINICAL ANALYSIS OF 36 CASES OF PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA

作　　者：张欣[1] 许宏[1] 史雪[1] 郭振清[1] 崔中光[1] 赵洪国[1] ZHANG Xin;XU Hong;SHI Xue;GUO Zhenqing;CUI Zhongguang;ZHAO Hongguo(Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao 266003, Chin)

机构地区：[1]青岛大学附属医院血液内科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2018年第3期362-366,共5页Journal of Qingdao University(Medical Sciences)

摘　　要：目的探讨原发纵隔大B细胞淋巴瘤(PMBCL)的临床特点、病理特征、治疗方法及预后影响因素。方法回顾性分析36例PMBCL病人的临床资料。结果 36例PMBCL病人中位年龄39岁,临床表现以上腔静脉阻塞综合征(52.8%)、胸腔积液(36.1%)、纵隔巨块(33.3%)多见。Ann Arbor分期Ⅰ~Ⅱ期25例(69.4%),Ⅲ~Ⅳ期11例(30.6%);合并B症状6例(16.7%)。初治时手术切除4例,其中术后联合放疗1例,术后联合化疗2例,手术后未行其他治疗1例;放化疗相结合3例,其中1例联合自体造血干细胞移植;单纯化疗29例,化疗周期为2~11周期,其中3例加行自体干细胞移植。治疗后13例完全缓解,15例部分缓解,5例病情平稳,2例病情进展,1例失访。截止到随访终止,3例失访,5例死亡(其中1例为疾病复发,4例为疾病进展),中位生存时间37月,病人2、3、4、5年总生存率分别为83.3%、76.2%、68.8%、56.2%,其中R-CHOP组、R-DA-EPOCH组、CHOP组、CHOPE组2年生存率分别为91.7%、100.0%、85.7%、66.7%,4例行自体造血干细胞移植病人均存活(生存时间分别为84、28、18、18月)。纵隔巨块、乳酸脱氢酶(LDH)水平(高于上限2倍)为预后不良指标。结论 PMBCL发病中位年龄小,临床表现以早期纵隔压迫症状为主,分期一般较早;LDH水平、包块大小影响预后;利妥昔单抗联合化疗效果确切,纵隔放疗可作为辅助治疗措施;干细胞移植对初治未达完全缓解病人有意义。Objective To investigate the clinical features,pathological features,treatment methods,and prognostic factors of primary mediastinal large B-cell lymphoma（PMBCL）. Methods A retrospective analysis was performed on the clinical data of 36 patients with PMBCL. Results The median age of these 36 patients with PMBCL was 39 years.The main clinical manifestations included superior vena cava obstruction syndrome（52.8%）,pleural effusion（36.1%）,and mediastinal mass（33.3%）.According to the Ann Arbor staging system,25（69.4%）patients were classified as stageⅠ-Ⅱ and 11（30.6%）as stageⅢ-Ⅳ.Six（16.7%）patients had B symptoms.Among 4 patients with newly diagnosed PMBCL undergoing surgical resection,1 received radiotherapy after surgery,2 received chemotherapy after surgery,and 1 did not receive any other therapy after surgery;three cases received radiochemotherapy and one of them received autologous hematopoietic stem cell transplantation in addition to radiochemotherapy;twenty-nine cases received chemotherapy alone for 2-11 cycles and 3 of them received autologous stem cell transplantation in addition to chemotherapy.After treatment,13 cases achieved complete remission,15 cases achieved partial remission,5 cases had a stable disease,2 cases had a progressive disease,and 1 case was lost to follow-up.By the end of follow-up,3 cases were lost to follow-up and 5 cases died（1 case died of recurrence and other 4 cases died of progressive disease）.The median survival time was 37 months.The 2-,3-,4-,and 5-year overall survival rates were 83.3%,76.2%,68.8%,and 56.2%,respectively.The 2 year survival rates in R-CHOP group,R-DA-EPOCH group,CHOP group,and CHOPE group were 91.7%,100.0%,85.7%,and 66.7%,respectively.Four cases who received autologous stem cell transplantation survived by the end of follow-up,with survival time of 84,28,18,and 18 months,respectively.Mediastinal mass and lactate dehydrogenase（LDH）level of 3-fold higher than the upper limit were the poor prognostic factors. Conclusion For P

关 键 词：淋巴瘤 大B细胞 弥漫性 纵隔 利妥昔单抗 预后 

分 类 号：R733[医药卫生—肿瘤]