儿童霍奇金淋巴瘤20例临床分析  

Hodgkin lymphoma in children： clinical analyses of 20 cases

作　　者：郑湧智 李健[1] 华雪玲[1] 郑浩[1] 陈再生[1] 郑灵[1] 陈彩[1] 李梅[1] 蔡春霞 杨景辉[1] 陈以乔[1] 陈莹莹[1] 高琴丽[1] 乐少华[1] 胡建达[1] Zheng Yongzhi;Li Jian;Hua Xueling;Zheng Hao;Chen Zaisheng;Zheng Ling;Chen Cai;Li Mei;Cal Chunxia;Yang Jinghui;Chen Yiqiao;Chen Yingying;Gao Qinli;Le Shaohua;Hu Jianda(Department of Pediatric Hematology,Fujian Medical University Union Hospital,Fujian Institute of Hematology,Fujian Provincial Key Laboratory of Hematology,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院小儿血液科福建省血液病研究所福建省血液病学重点实验室,福州350001

出　　处：《白血病．淋巴瘤》2018年第10期595-599,共5页Journal of Leukemia & Lymphoma

基　　金：福建省血液医学中心建设项目[闽政办（2017）4号];国家临床重点专科建设项目[闽财指（2011）1006号];福建省临床重点专科建设项目[闽卫科教（2012）149号]

摘　　要：目的 探讨ABVD方案治疗儿童霍奇金淋巴瘤（HL）的安全性及远期疗效.方法 回顾性分析2010年7月至2017年6月福建医科大学附属协和医院收治的20例HL患儿的临床资料.20例HL患儿中,男性15例,女性5例,初诊中位年龄6.5岁（3～12岁）;病理类型：结节样淋巴细胞为主型HL（NLPHL）1例,经典型HL（cHL）19例（混合细胞型9例,结节硬化型9例,富于淋巴细胞型1例）;按照Ann Arbor分期系统,Ⅰ期1例,Ⅱ期4例,Ⅲ期10例,Ⅳ期5例;低危组3例,中危组7例,高危组10例;有B症状9例.所有患儿均采用ABVD方案化疗.结果 20例患儿均完成所有化疗疗程.2个疗程后评估疗效,有效率100％（20/20）,其中完全缓解（CR）12例,部分缓解（PR）8例;疗程结束后评估,CR 19例,1例于6个疗程结束时评估有残留病灶.随访至2018年2月,临床CR 18例,复发2例（均为高危组）;中位随访时间42个月（10.1～87.9个月）,总生存率100％（20/20）,预计5年无治疗失败生存（FFTF）率（89.1±7.3）％.结论 儿童cHL根据危险度分层接受ABVD方案治疗的安全性及远期疗效均较好,低危组、中危组患儿即使2个疗程后未达CR、不放疗,预后仍良好.Objective To summarize the long-term outcomes and safety of childhood Hodgkin lymphoma （HL） with protocol ABVD. Methods The clinical data of 20 children with HL admitted to the Union Hospital of Fujian Medical University from July 2010 to June 2017 were retrospectively analyzed. Among the 20 children with HL, 15 were male and 5 were female. The median age of initial diagnosis was 6.5 years old （3-12 years old）. The pathological types were as follow： 1 case was nodular lymphocyte-predominant HL （NLPHL） and 19 cases were classical HL （cHL）, including 9 cases of mixed cell type, 9 cases of nodular sclerosis type and 1 case of lymphocyte rich type. Basing on Ann Arbor staging system, 1 patient was evaluated as stage Ⅰ, 4 patients were stage Ⅱ, 10 patients were stage Ⅲ, and 5 patients were stage Ⅳ. There were 3 patients in the low-risk group, 7 patients in the intermediate-risk group, and 10 patients in the high-risk group. There were 9 patients with B symptoms. All patients were treated with the ABVD regimen. Results All the 20 patients completed all chemotherapy courses. After 2 courses, the effective rate was 100%（20/20）, including 12 cases of complete remission （CR） and 8 cases of partial remission （PR）. After the treatment, 19 cases achieved CR, and at the end of the 6 courses, the evaluation showed that 1 case had residual lesions. Follow-up to February 2018, clinical symptoms of 18 cases achieved CR, 2 cases relapsed （all high-risk group）; the median follow-up time was 42 months （10.1-87.9 months）, the overall survival rate was 100 % （20/20）, the estimated 5-year rate of freedom from treatment failure （FFTF） was （89.1 ±7.3） %.Conclusions According to the risk stratification, ABVD regimen has good safety and long-term efficacy for children with cHL. Even the patients in low-risk or intermediate-risk group do not achieve CR after 2 courses and do not receive radiotherapy, the prognosis of them is still good.

关 键 词：淋巴瘤 霍奇金 儿童 抗肿瘤联合化疗方案 治疗结果 

分 类 号：R733.1[医药卫生—肿瘤]