超高龄老年弥漫大B细胞淋巴瘤患者的临床特征和疗效分析  

Analysis of clinical characteristics,treatment and survival of elderly patients with large diffuse B-cell lymphoma

作　　者：李春源 杨萍[1] 董菲[1] 田磊[1] 万伟[1] 赵伟[1] 李其辉[1] 庞萌 甄敬飞 景红梅[1] Li Chunyuan;Yang Ping;Dong Fei;Tian Lei;Wan Wei;Zhao Wei;Li Qihui;Pang Meng;Zhen Jingfei;Jing Hongmei(Department of Hematology,Third Hospital of Peking University,Beijing 100191,China)

机构地区：[1]北京大学第三医院血液科,北京100191

出　　处：《中华医学杂志》2020年第42期3296-3302,共7页National Medical Journal of China

基　　金：北京医学奖励基金会基金(YXJL-2018-0301-0041)。

摘　　要：目的探讨超高龄老年弥漫大B细胞淋巴瘤(DLBCL)患者的临床特征并分析其疗效。方法回顾性分析2002至2018年北京大学第三医院收治的46例超高龄(年龄≥80岁)的DLBCL患者的临床资料,对患者临床特征及实验室指标进行分析,同时进行生存和预后因素分析。结果超高龄老年DLBCL患者占本中心老年DLBCL患者的15.7%(46/293),患者中位年龄83岁,Ⅲ/Ⅳ期患者占78.3%(36/46),63%(29/46)的患者存在≥2个淋巴结外器官受累;53.7%(22/41)患者增殖指数Ki-67≥80%,27例患者经免疫组化及荧光染色体原位杂交(FISH)除外双打击/三打击后显示双表达患者占37.0%。初始治疗总有效率(ORR)为63.0%,完全缓解(CR)率为36.4%,2和3年无进展生存(PFS)率分别为49.9%和41.7%,2和3年总体生存(OS)率分别为54.6%和43.6%。含蒽环类药物化疗组ORR为81.8%,不含蒽环类药物化疗ORR为55.0%,3年OS率分别为50.0%和39.0%,但两者差异无统计学意义(P>0.05)。45.5%的患者出现了Ⅲ级及以上的血液学毒性,56.8%的患者出现了感染;死亡的患者中,查尔森合并症指数(CCI)高评分组的治疗相关死亡率高(43.8%比16.7%,P=0.03)。单因素预后分析显示国家综合癌症网络国际预后指数(NCCN-IPI)评分,受累淋巴结区域≥3个,化疗周期是否满足6个周期,CCI评分,近期疗效及是否为难治复发状态与预后相关,多因素分析显示CCI评分(HR=6.463,P=0.008)和近期疗效(HR=0.086,P=0.001)为预后独立相关因素。结论超高龄老年DLBCL患者的临床生物学及病理均呈现高度侵袭性,化疗耐受性差,不良反应率高,未观察到蒽环类药物的应用可以改善患者预后。CCI高的患者治疗相关死亡率高,低CCI评分可能有助于识别适合较强化疗剂量的超高龄患者。Objective To analyze the clinical feature,treatment and survival outcome of elderly patients older than 80 years with large diffuse B-cell lymphoma.Methods A total of 46 patients aged over 80 years with large diffuse B-cell lymphoma who were treated in Third Hospital of Peking University during the period from 2002 to 2018 were retrospectively analyzed,and the clinical features,laboratory data,survival and prognostic factors were included in Kaplan-Meier and prognostic analysis.Results Patients older than 80 years old accounted for 15.7%(46/293)in all elderly patients,and the median age was 83 years old.There were 78.3%(36/46)patients who belonged to stageⅢorⅣ,63%(29/46)who had more than two extranodal organ involvement,and the higher proliferation index(Ki-67≥80%)was present in 53.7%(22/41)patients.Immunohistochemistry showed that 37%patients in 27 cases were double-expressed DLBCL.With a median follow-up of 25 months,the overall response rate(ORR)for the whole group was 63.0%,the complete response(CR)rate was 36.4%,the 2,3-year progression-free survival(PFS)rate was 49.9%and 41.7%,the 2,3-year overall survival(OS)rate was 54.6%and 43.6%respectively.The ORR for patients who received anthracycline-based therapies and non-anthracycline-based therapies were 81.8%and 55.0%,and the 3-year OS rate were 50.0%and 39.0%,respectively,but the difference was not statistically significant(P>0.05).45.5%patients had hematologic toxicity of GradeⅢor above,and 56.8%patients experienced infections during the treatment.Among the patients who died,the treatment-related mortality rate in group with high score of Charlson comorbidity index(CCI)was higher(43.8%vs 16.7%,P=0.03).The National Comprehensive Cancer Network International Prognostic Index(NCCN-IPI)score,nodal involvement area≥3,6 cycles of chemotherapy,CCI score,initial treatment outcome and refractory-relapsed were predictive of overall survival.Multivariate analysis indicated the CCI score(HR=6.463,P=0.008)and initial treatment outcome(HR=0.086,P=0.001)were indep

关 键 词：淋巴瘤 大B细胞 超高龄 查尔森合并症指数 

分 类 号：R733.1[医药卫生—肿瘤]