新诊断原发中枢神经系统弥漫大B细胞淋巴瘤49例临床特征及预后分析  

Clinical characteristics and prognosis of 49 newly diagnosed primary central nervous system diffuse large B-cell lymphoma

作　　者：宋嘉[1] 刘惠[1] 沈红利 岳兰竹[1] 杨学军[2] 宋文静[3] 孙翠云[4] 于士柱[4] 丁凯[1] 王一浩[1] 李丽娟[1] 于虹[1] 邵媛媛[1] 王超盟 岳树元[2] 付蓉[1] SongJia;Liu Hui;Shen Hongli;Yue Lanzhu;Yang Xuejun;Song Wenjing;Sun Cuiyun;Yu Shizhu;Ding Kai;Wang Yihao;Li Lijuan;Yu Hong;Shao Yuamyuan;Wang Chaomeng;Yue Shuyuan;Fu Rong(Department of Hematology,General Hospital of Tianjin Medical University,Tianjin 300052,China;Department of Neurosurgery,General Hospital of Tianjin Medical University,Tianjin 300052,China;Department of Pathology,General Hospital of Tianjin Medical University,Tianjin 300052,China;Institute of Neurology,General Hospital of Tianjin Medical University,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院血液内科,天津300052 [2]天津医科大学总医院神经外科,天津300052 [3]天津医科大学总医院病理科,天津300052 [4]天津医科大学总医院神经病学研究所,天津300052

出　　处：《中华血液学杂志》2021年第11期917-922,共6页Chinese Journal of Hematology

摘　　要：目的回顾性分析原发中枢神经系统淋巴瘤中弥漫大B细胞淋巴瘤(PCNSL-DLBCL)患者的临床特征及不同治疗方案对患者生存及预后的影响。方法回顾性分析天津医科大学总医院自2014年7月至2020年12月收治的49例PCNSL-DLBCL患者的临床资料,根据治疗方案分为MTX组、R-CDOP组、BTKi-R-MTX组和RLZT组,计算各组中位总生存(OS)与无进展生存(PFS)时间,并进行单因素、多因素预后分析,比较各组患者的生存预后。结果MTX组,R-CDOP组BTKi-R-MTX组和RLZT组的中位OS时间分别为16.5个月、4.5个月、42个月和未达到(P<0.001),中位PFS时间分别为7个月、1.5个月、20个月和5个月(P=0.005)。多因素预后分析表明是否双表达,IESLG评分和治疗方案是PCNSL-DLBCL患者的预后影响因素。结论PCNSL-DLBCL患者的生存预后受治疗方案影响,CD20单抗在PCNSL-DLBCL治疗中的作用尚有争议,含BTKi的治疗方案有巨大潜力,RLZT方案对于高龄﹑不耐受大剂量化疗及放疗患者有良好前景。Objective The clinical characteristics of patients with primary central nervous systemlymphoma-diffuse large B-cell lymphoma(PCNSL-DLBCL)and the effects of different treatment schemeson their survival and prognosis were analyzed retrospectively.Methods A total of 49 patients withPCNSL-DLBCL who presented at the Tianijin Medical University General Hospital from July 2014 toDecember 2020 were included,and their clinical data were retrospectively analyzed.They were dividedinto four groups:the MTX group,the R-CDOP group,the BTKi-R-MTX group,and the RLZT group.Themedian overall survival(OS)and progression-frec survival(PFS)were calculated,and the survivalprognosis was compared by univariate and multivariate prognostic analysis.ResultsThe median OS timeof the MTX group,the R-CDOP group,the BTKi-R-MTX group,and the RLZT group was 16.5 months.4.5 months,42 months,and not reached,respectively(P<0.001).The median PFS time of the MTXgroup,the R-CDOP group,the BTKi-R-MTX group,and the RLZT group was 7 months,1.5 months,20months,and 5 months,respectively(P=0.005).Multivariate prognostic analysis showed that doubleexpressor lymphoma,IESLG risk gradc,and different treatment methouds were the prognostic lfactors ofPCNSL-DLBCL.Conclusion The survival and prognosis of PCNSL-DLBCL are affected by differenttreatment schemes.The role of CD20 monoclonal antibody in the treatment of PCNSL-DLBCL is still controversial.The treatment scheme containing BTKi has great potential for PCNSL-DLBCL.RLZTscheme has a good prospect for elderly paticnts who cannot tolerate high-dose chemotherapy andradiotherapy.

关 键 词：中枢神经系统 淋巴瘤 大B细胞 弥漫性 布鲁顿酪氨酸激酶 预后 

分 类 号：R733.1[医药卫生—肿瘤]