高剂量短疗程改良LMB方案±利妥昔单抗治疗初治儿童伯基特淋巴瘤的疗效及预后影响因素  

Clinical Efficacy and Prognostic Factors of Newly Diagnosed Children with Burkitt Lymphoma Treated by High-Dose and ShortCourse Modified LMB Regimen±Rituximab

作　　者：王波涛[1] 党惠兵[1] 魏玉静[1] WANG Bo-Tao;DANG Hui-Bing;WEI Yu-Jing(Department of Hematology,The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳医学高等专科学校第一附属医院血液内科,河南南阳473000

出　　处：《中国实验血液学杂志》2020年第2期529-534,共6页Journal of Experimental Hematology

摘　　要：目的:探讨高剂量短疗程改良LMB方案±利妥昔单抗治疗初治儿童伯基特淋巴瘤的疗效及预后影响因素,为临床诊治提供更多参考。方法:选取本院2007年1月-2016年8月收治初治伯基特淋巴瘤患儿共91例,采用高剂量短疗程改良LMB方案针对不同危险度患儿进行分层治疗,其中高危组加用利妥昔单抗;分析患儿临床特征和疗效,并评价影响预后相关因素。结果:91例患儿随访5年总生存率和无事件生存率分别为(89.27±2.69)%和(87.16±2.30)%;低危组、中危组及高危组随访5年无事件生存率分别为100%、(94.51±2.97)%和(84.60±3.40)%;高危组随访5年无事件生存率显著低于中危组(P<0.05)。单因素分析结果显示,合并颌面部和中枢神经系统侵犯、LDH>1000 U/L、骨髓肿瘤细胞比例>25%、器官受累部位>4个、St.Jude分期IV期、早期化疗不敏感及中期评估可见肿瘤病灶是初治儿童伯基特淋巴瘤预后的不良危险因素(P<0.05)。多因素分析结果显示,合并中枢神经系统侵犯、早期化疗不敏感及中期评估可见肿瘤病灶是初治儿童伯基特淋巴瘤预后不良的独立危险因素(P<0.05)。接受化疗+利妥昔单抗方案治疗高危患儿随访5年EFS率显著高于单纯化疗方案治疗的患者(P<0.05)。结论:高剂量短疗程改良LMB治疗初治儿童伯基特淋巴瘤疗效确切,其中合并中枢神经系统侵犯、早期化疗不敏感及中期评估可见肿瘤病灶患者预后更差;而加用利妥昔单抗则更有助于改善高危患儿的远期预后。Objective:To investigate the clinical efficacy and prognostic factors of high-dose and short-course modified LMB regimen±Rituximab in the treatment of newly diagnosed children with Burkitt lymphoma,soas to provide more reference for clinical diagnosis and treatment with follow-up.Methods:91 newly diagnosed children with Burkitt lymphoma treated in our hospital from January 2007 to August 2016 were chosen.High-dose and short-course modified LMB regimen were used to treat children at different risk levels-Rituximab were added in treatment of high-risk group.The clinical characteristics and efficacy of the treatment were analyzed,and the related prognostic factors were evaluated.Results:The overall survival rate and event-free survival rate in 5-year with follow-up of 91 children were separately(89.27±2.69)%,(87.16±2.30)%;the event-free survival rate of patients in 5-year with follow-up in low-risk,moderate-risk and high-risk group were separately 100%,(94.51±2.97)%,(84.60±3.40)%.The event-free survival rate in 5-year with follow-up of high-risk group were significantly lower than that of moderate-risk group(P<0.05).Univariate analysis showed that the combination of maxillofacial and central nervous system invasion,LDH>1000 U/L,proportion of bone marrow tumor cell>25%,organ involvement number>4,St.Jude stage for IV stage,early chemotherapy insensitivity and tumor lesion in mid-term evaluation were risk factor for poor prognosis in newly diagnosed children with Burkitt lymphoma(P<0.05).Multivariate analysis showed that the combination of maxillofacial and central nervous system invasion,early chemotherapy insensitivity and tumor lesion in mid-term evaluation were the independent risk factor for poor prognosis of children with Burkitt lymphoma(P<0.05).The EFS rate in 5-year with follow-up of high-risk children treated with chemotherapy+rituximab was significantly higher than that of chemotherapy alone(P<0.05).Conclusion:High-dose and short-course modified LMB regimen in the treatment of newly diagnosed children w

关 键 词：儿童 伯基特淋巴瘤 化疗 利妥昔单抗 预后 

分 类 号：R733.1[医药卫生—肿瘤]