滤泡性淋巴瘤转化的弥漫大B细胞淋巴瘤患者临床特征分析  

Clinical Features of Diffuse Large B-Cell Lymphoma Transformed from Follicular Lymphoma

作　　者：张晓丽[1,2] 俞文娟 朱亚男[2] 杨春梅 肖峰[2] 麦文渊[2] ZHANG Xiao-Li;YU Wen-Juan;ZHU Ya-Nan;YANG Chun-Mei;XIAO Feng;MAI Wen-Yuan(Department of Hematology,Pingdingshan First People’s Hospital,Pingdingshan 467000,Henan Province,China;Department of Hematology,The First Affiliated Hospital of Zhejiang University,Hangzhou 310003,Zhejiang Province,China)

机构地区：[1]河南省平顶山市第一人民医院血液科,河南平顶山467000 [2]浙江大学医学院第一附属医院血液科,浙江杭州310003

出　　处：《中国实验血液学杂志》2022年第6期1772-1778,共7页Journal of Experimental Hematology

摘　　要：目的:分析滤泡淋巴瘤(FL)转化的弥漫大B细胞淋巴瘤(DLBCL)患者的临床表现、病理、疗效及预后的特点。方法:选择并回顾性分析2010年1月至2021年1月符合条件的45例FL转化为DLBCL的患者,总结其临床特点、诊断、治疗方法和疗效。结果:45例患者中,诊断时即发生转化的27例,选择观察等待之后发生转化的7例,FL治疗后发生转化的11例;男23例,女22例;中位年龄56(27-76)岁。低级别转化8例,高级别转化37例,26例出现结外侵犯,骨髓累及16例,贫血17例,高肿瘤负荷(GELF标准)32例,伴B症状12例,Ki-67≥50%患者38例。43例转化为GCB型DLBCL。45例患者可评价疗效,所有患者初始化疗疗效评估总有效率(ORR)为80.0%,完全缓解(CR)率为60.0%,部分缓解(PR)率20%;R-CHOP和其他方案组患者ORR分别是86.11%和55.55%(P=0.063),CR率分别是66.67%和33.33%(P=0.126)。诊断时即转化组患者ORR(85.18%)及CR率(74.07%)最高。全部患者中位随访时间26(4-120)个月,中位PFS未达到(2-120个月),3年的PFS率为55%;中位OS未达到(5-120个月),3年的OS是70%。单因素分析显示,ORR、POD24是影响PFS的因素(P<0.05)。患者IPI评分、ORR、POD24、B症状、贫血是影响OS的因素(P<0.05)。多因素分析结果显示,ORR、POD24是影响PFS的独立预后因素(P<0.05),IPI评分是影响OS的独立预后因素(P<0.05)。结论:FL转化为DLBCL患者诊断时即转化组ORR及CR率高;患者贫血及B症状、POD24及高危组预后差;IPI评分是影响OS的独立预后因素。Objective:To analyze the clinical manifestations,pathological characteristics,therapeutic effect and prognosis of diffuse large B-cell lymphoma(DLBCL)transformed from follicular lymphoma(FL).Methods:A total of 45 inpatients were eligible for criteria of histologic transformation from FL to DLBCL from January 2010 to January 2021,and their clinical characteristics,diagnosis,treatment and efficacy were collected and analyzed retrospectively.Results:Among the 45 patients,transformation occurred at diagnosis in 27 cases,during“watch and wait”phase in 7 cases and after treatment of FL in 11 cases.The median age was 56 years old(ranged from 27 to 76 years),with 23 male and 22 female.The transformations were observed in 8 cases with low-grade and 37 cases with high-grade FL.Extranodal involvement was present in 26 cases,including bone marrowinfiltration in 16 cases.There were 17 cases with anemia and 32 cases met the GELF criteria of high tumor burden.B symptoms were present in 12 cases.There were 38 cases with Ki-67≥50%.The germinal center B-cell-like(GCB)subtype of DLBCL was observed in 43 cases.Efficacy was evaluated in 45 cases.The OR,CR and PR rate were 80.0%,60.0%and 20.0%,respectively.The OR,CR rate of patients received R-CHOP was higher than those of patients received other regimens(86.11%vs 55.55%,P=0.063;66.67%vs 33.33%,P=0.126),but there was no significant statistical difference.The early transformation(at diagnosis)group showed the highest OR rate(85.18%)and CR rate(74.07%).The median follow-up time of all patients was 26(4-120)months,and the median PFS(2-120 months)and median OS(5-120 months)had not yet reached.The 3-year PFS and OS were 55%and 70%,respectively.In univariate analysis,factors affecting PFS includ OR rate and POD24,and factors affecting OS includ IPI score,OR rate,POD24,B symptoms and anemia(P<0.05).M ultivariant analysis indicated that OR rate and POD24 were the independent prognostic factors for PFS(P<0.05)and IPI score was an independent prognostic factor for OS(P<0.05).Conclusion:Th

关 键 词：滤泡淋巴瘤 转化 弥漫大B细胞淋巴瘤 预后 

分 类 号：R733.1[医药卫生—肿瘤]