伴弥漫大B细胞成分的初诊滤泡淋巴瘤患者的临床特征及生存  

Clinical features and outcomes of newly diagnosed follicular lymphoma concurrent with diffuse large B-cell lymphoma component

作　　者：林志娟 查洁 易树华 李志峰 平凌燕 何晓华[4] 余海峰 郑重 徐卫[7] 陈菲莉 谢颖[9] 陈碧云[9] 张会来 王莉[7] 丁凯阳 李文瑜[8] 杨海燕 赵维莅[6] 邱录贵 李志铭[4] 宋玉琴[3] 徐兵 Lin Zhijuan;Zha Jie;Yi Shuhua;Li Zhifeng;Ping Lingyan;He Xiaohua;Yu Haifeng;Zheng Zhong;Xu Wei;Chen Feili;Xie Ying;Chen Biyun;Zhang Huilai;Wang Li;Ding Kaiyang;Li Wenyu;Yang Haiyan;Zhao Weili;Qiu Lugui;Li Zhiming;Song Yuqin;Xu Bing(Department of Hematology,the First Affiliated Hospital of Xiamen University and Institute of Hematology,School of Medicine,Xiamen University,Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy,Xiamen 361003,China;State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Medical Oncology,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;Department of Lymphoma,Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Hangzhou 310022,China;Shanghai Institute of Hematology,State Key Laboratory of Medical Genomics,National Research Center for Translational Medicine at Shanghai,Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Hematology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu Province Hospital,Nanjing 210029,China;Lymphoma Division,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Shengli Clinical Medical College of Fujian Medical University,Department of Hematology,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China;Department of Lymphoma,Tianjin Medical University Cancer Hospital,Tianjin 300060,China;Department of Hematology,The First Affiliated Hospital of USTC Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]厦门大学第一附属医院血液科,厦门大学医学院血液研究所,厦门市恶性血液病诊断与治疗重点实验室,厦门361003 [2]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,天津300020 [3]北京大学肿瘤医院,恶性肿瘤发病机制与转化研究教育部重点实验室,北京100142 [4]中山大学肿瘤防治中心,广州510060 [5]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)淋巴瘤科,杭州310022 [6]上海血液学研究所,医学基因组学国家重点实验室,国家转化医学研究中心,上海交通大学医学院附属瑞金医院,上海200025 [7]南京医科大学第一附属医院,江苏省人民医院血液科,南京210029 [8]广东省医学科学院广东省人民医院淋巴瘤科,广州510080 [9]福建医科大学福建省立医院血液科,福州350001 [10]天津医科大学肿瘤医院淋巴瘤科,天津300060 [11]中国科学技术大学附属第一医院(安徽省立医院)血液科,合肥230001

出　　处：《中华血液学杂志》2022年第6期456-462,共7页Chinese Journal of Hematology

基　　金：国家自然科学基金(82170180);厦门市医疗卫生重点项目(3502Z20209003);中国抗癌协会基金项目(CORP-117)。

摘　　要：目的探索初诊伴弥漫大B细胞成分的滤泡淋巴瘤(FL)患者的临床特征及生存.方法纳入国内11个医学中心2000-2020年间分级1-3a级、年龄≥18岁初诊FL患者1845例,筛选伴弥漫大B细胞成分的患者.回顾性分析患者的临床资料及生存数据,应用单因素及多因素分析筛选影响预后的因素.结果146例(7.9%)初诊FL患者病理伴弥漫大B细胞成分,中位年龄56(25~83)岁,男79例(54.1%).127例患者病理提示弥漫大B细胞成分比例,依据弥漫大B细胞比例是否≥50%将患者分为2组.研究发现,弥漫大B细胞成分≥50%患者较弥漫大B细胞成分<50%患者有更高的3级比例(94.3%对91.9%,P=0.010)、Ki-67指数≥70%比例(58.5%对32.9%,P=0.013)及PET-CT的SUVmax≥13比例(72.4%对46.3%,P=0.030).所有患者均接受CHOP或CHOP样±利妥昔单抗方案化疗,总反应率(ORR)为88.2%,完全缓解(CR)率为76.4%.在不同比例弥漫大B细胞成分组中,诱导治疗后缓解率及治疗后2年内疾病进展(POD24)发生率的差异均无统计学意义(P值均>0.05).总体预计5年无进展生存(PFS)率为58.9%,5年总生存(OS)率为90.4%,POD24患者的5年OS率较非POD24患者下降(70.3%对98.5%,P<0.001).与利妥昔单抗不维持治疗相比,利妥昔单抗维持治疗不能使患者的5年PFS率获益(57.7%对58.8%,P=0.543),5年OS率具有获益趋势,但差异无统计学意义(100%对87.8%,P=0.082).多因素分析显示,诱导治疗后未达到CR是影响患者PFS的独立危险因素(P=0.006),而LDH高于正常值是影响患者OS的独立危险因素(P=0.031).结论伴弥漫大B细胞成分≥50%的FL患者,临床及病理特征更具侵袭性,CHOP/CHOP样±利妥昔单抗方案可以改善患者的临床疗效,利妥昔单抗维持治疗不能使患者的PFS和OS获益,诱导治疗后未达到CR是影响患者PFS的独立危险因素.Objective To explore the clinical features and survival of newly diagnosed follicular lymphoma(FL)patients with diffuse large B-cell lymphoma(DLBCL)component.Methods 1845 newly diagnosed FL patients aged≥18 years with grades 1-3a in 11 medical centers in China from 2000 to 2020 were included,and patients with DLBCL component were screened.The clinical data and survival data of the patients were retrospectively analyzed,and the prognostic factors were screened by univariate and multivariate analysis.Results 146 patients(7.9%)with newly diagnosed FL had DLBCL component.The median age was 56(25-83)years,79 males(54.1%).The pathology of 127 patients showed the proportion of DLBCL component.Patients were divided into two groups according to whether the proportion of DLBCL component was≥50%.The study found that patients with DLBCL component≥50%had higher grade 3 ratio(94.3%vs 91.9%,P=0.010),Ki-67 index≥70%ratio(58.5%vs 32.9%,P=0.013)and PET-CT SUVmax≥13 ratio(72.4%vs 46.3%,P=0.030)than patients with DLBCL component<50%.All patients received CHOP or CHOP like±rituximab chemotherapy.The overall response rate(ORR)was 88.2%,and the complete response(CR)rate was 76.4%.In the groups with different proportions of DLBCL component,there was no significant difference in the remission rate after induction treatment and the incidence of disease progression within 2 years after initiation of treatment(POD24)(P<0.05).The overall estimated 5-year progression free survival(PFS)rate was 58.9%,and the 5-year overall survival(OS)rate was 90.4%.The 5-year OS rate of POD24 patients was lower than that of non POD24 patients(70.3%vs 98.5%,P<0.001).Compared with non maintenance treatment of rituximab,maintenance treatment of rituximab could not benefit the 5-year PFS rate(57.7%vs 58.8%,P=0.543),and the 5-year OS rate had a benefit trend,but the difference was not statistically significant(100%vs 87.8%,P=0.082).Multivariate analysis showed that failure to reach CR after induction treatment was an independent risk factor for PFS(P=0.

关 键 词：淋巴瘤 滤泡性 淋巴瘤 大B细胞 弥漫性 中国 

分 类 号：R733.1[医药卫生—肿瘤]