血管免疫母细胞性T细胞淋巴瘤患者的临床特点及其预后相关因素分析  

Analysis of clinical characteristics and prognosis factors in patients with angioimmunoblastic T-cell lymphoma

作　　者：夏效升 顾宏涛 董宝侠 张涛 梁蓉 白庆咸 高广勋 杨岚 张娜 Xia Xiaosheng;Gu Hongtao;Dong Baoxia;Zhang Tao;Liang Rong;Bai Qingxian;Gao Guangxun;Yang Lan;Zhang Na(Department of Hematology,First Affiliated Hospital of Air Force Medical University,Xi′an 710032,Shaanxi Province,China)

机构地区：[1]空军军医大学第一附属医院血液内科,西安710032

出　　处：《国际输血及血液学杂志》2020年第1期27-33,共7页International Journal of Blood Transfusion and Hematology

基　　金：国家自然科学基金资助项目(81970190)。

摘　　要：目的探讨血管免疫母细胞性T细胞淋巴瘤(AITL)患者的临床特点及预后因素。方法选择2012年1月至12月,空军军医大学第一附属医院收治的44例初诊AITL患者为研究对象。其中,男性患者为36例,女性为8例,年龄为18~78岁,中位年龄为57.5岁。44例AITL患者接受CHOP(环磷酰胺+吡柔比星+长春新碱+泼尼松)方案治疗,其中4例联合应用西达苯胺、硼替佐米,6例接受自体造血干细胞移植(auto-HSCT)。回顾性分析AITL患者的临床特点。采用Kaplan-Meier法绘制接受与未接受auto-HSCT患者的总体生存(OS)曲线。采用Log-rank检验对未接受auto-HSCT患者OS率进行单因素分析,纳入分析的影响因素包括性别、国际预后指数(IPI)评分、外周T细胞淋巴瘤预后指数(PIT)评分、年龄、B症状、皮疹、胸腔/腹腔积液、骨髓受累、白细胞计数(WBC)、血红蛋白(Hb)值、血小板计数、血清乳酸脱氢酶(LDH)水平、铁蛋白水平、β2-微球蛋白(MG)水平。将单因素分析结果中有统计学意义,以及有临床指导意义的影响因素,纳入COX比例风险回归模型进行多因素分析。本研究遵循的程序符合2008及2013年修订版《世界医学会赫尔辛基宣言》的要求。结果①本研究44例AITL患者中,有B症状的患者为34例(77.3%)。Ann Arbor分期为Ⅰ~Ⅱ期的患者为5例(11.4%),Ⅲ~Ⅳ期者为39例(88.6%);美国东部协作肿瘤组体能状况评分(ECOG-PS)<2分者为20例(45.5%),ECOG-PS≥2分者为24例(54.5%);IPI评分系0~1分者为9例(20.5%),2分者为12例(27.2%),3~5分者为23例(52.3%);PIT评分系0分者为10例(22.7%),1分者为5例(11.4%),2分者为12例(27.3%),3~4分者为17例(38.6%)。②本研究44例AITL患者血常规检查结果示,中位WBC为6.2×109/L,中位Hb值为125 g/L,中位血小板计数为163×109/L。中位血清LDH水平为292 U/L,中位铁蛋白水平为171μg/L,中位β2-MG水平为3.8 mg/L。14例(31.8%)患者原发病累及骨髓。免疫组织化学检查结果示,27例(61.4Objective To investigate the clinical characteristics and prognostic factors of patients with angioimmunoblastic T-cell lymphoma(AITL).Methods From January to December,2012,a total of 44 AITL patients admitted to Department of Hematology,First Affiliated Hospital of Air Force Medical University were included as study subjects.There were 36 males and 8 females,with age of 18-78 years and median age of 57.5 years.All 44 patients were treated with CHOP(cyclophosphamide+pirarubicin+vincristine+prednisone)regimen,4 of them were combined with chidamide or bortezomib,6 of them were combined with autologous hematopoietic stem cell transplantation(auto-HSCT).Clinical characteristics of AITL patients were retrospectively analyzed.Kaplan-Meier method was used to map overall survival(OS)curves of patients treated with and without auto-HSCT.And univariate analysis of OS rate was performed in patients treated without auto-HSCT using Log-rank test.Influencing factors included gender,age,International Prognostic Index(IPI)score,Prognostic Index for peripheral T-cell lymphoma(PIT)score,B symptoms,skin rashes,chest/abdominal cavity effusion,bone marrow involvement,white blood cell count(WBC),hemoglobin(Hb)value,platelet count,serum lactate dehydrogenase(LDH)level,ferritin level,β2-microglobulin(MG)level.Factors with statistical significance in univariate analysis and clinical guiding significance were included in COX proportional hazards regression model for multivariate analysis.The procedure of this study was accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2008 and 2013.Results①Among 44 AITL patients,34 cases(77.3%)had B symptoms.Five cases(11.4%)were Ann ArborⅠ-Ⅱstage,39 cases(88.6%)wereⅢ-Ⅳstage.Twenty cases(45.5%)had Eastern Cooperative Oncology Group,performance status(ECOG-PS)score<2,24 cases(54.5%)had ECOG-PS score≥2.Nine cases(20.5%)had IPI score of 0-1,12 cases(27.2%)had score of 2,23 cases(52.3%)had score of 3-5.Ten cases(22.7%)had PIT score of 0,5 cases(11

关 键 词：淋巴瘤 免疫母细胞淋巴结病 药物疗法 造血干细胞移植 预后 血管免疫母细胞性T细胞淋巴瘤 回顾性研究 

分 类 号：R733[医药卫生—肿瘤]