伴单克隆免疫球蛋白的惰性B细胞非霍奇金淋巴瘤临床特征及预后  

Clinical characteristics and prognosis of indolent B-cell non-Hodgkin lymphoma with monoclonal immunoglobulin

作　　者：范洪明 郭丹 洪乐旻 黄春群 卢金凤 徐宏慧 陈洁[1] 黄红铭[1] 杨熙[1] FAN Hongming;GUO Dan;HONG Lemin;HUANG Chunqun;LU Jinfeng;XU Honghui;CHEN Jie;HUANG Hongming;YANG Xi(Department of Hematology,Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)

机构地区：[1]南通大学附属医院血液科,江苏南通226001

出　　处：《中国临床研究》2024年第6期925-928,954,共5页Chinese Journal of Clinical Research

摘　　要：目的探讨伴单克隆免疫球蛋白(McIg)惰性B细胞非霍奇金淋巴瘤(iB-NHL)患者临床特征及预后。方法回顾性分析2013年11月至2021年10月南通大学附属医院的82例初诊iB-NHL患者的临床与病理资料,根据血清免疫固定电泳(SIFE)结果分为阳性组(30例)和阴性组(52例),对其临床特征、实验室检查结果、总生存期(OS)进行分析。结果伴McIg的iB-NHL好发于男性,以IgM-κ最为多见,临床分期多为Ⅲ~Ⅳ期,以边缘区淋巴瘤(MZL)为主。与阴性组患者相比,阳性组患者更易出现骨髓浸润、国际预后指数(IPI)评分≥3分、白细胞计数减少、贫血、低白蛋白血症、球蛋白升高和胱抑素C升高(P<0.05)。Cox单因素分析显示,IPI≥3分、McIg阳性与患者较差的OS相关,多因素分析显示McIg阳性是患者OS独立预后不良因素(HR=0.074,95%CI:0.009~0.609,P=0.015)。随访截止于2021年10月31日,阳性组的中位OS为52个月,不伴McIg的患者中位OS未达到,差异有统计学意义(P<0.01)。结论在初诊iB-NHL患者中,伴有McIg患者的预后相对较差,需要在临床诊治中重点关注。Objective To investigate the clinical characteristics of indolent B-cell non-Hodgkin lymphoma(iB-NHL)with monoclonal immunoglobulin(McIg).Methods The clinical and pathological data of 82 newly diagnosed iB-NHL patients in the Affiliated Hospital of Nantong University from November 2013 to October 2021 were retrospectively analyzed.According to the results of serum immunofixation electrophoresis(SIFE),they were divided into McIg positive group(30 cases)and negative group(52 cases).The clinical characteristics,laboratory examination results and overall survival(OS)were analyzed.Results iB-NHL with McIg were more common in males,with IgM-κbeing the most common,and the clinical stage was mostly stageⅢ-Ⅳ,with marginal zone lymphoma(MZL)as the main stage.Compared with the negative group,patients in the positive group were more likely to have bone marrow infiltration,international prognostic index(IPI)≥3,decreased white blood cell count,anemia,hypoalbuminemia,elevated globulin and cystatin C(P<0.05).Cox univariate analysis showed that IPI≥3 and McIg positivity were associated with worse OS in patients.Multivariate analysis showed that McIg positivity was an independent adverse prognostic factor for OS of patients(HR=0.074,95%CI:0.009-0.609,P=0.015).Follow-up ended on October 31,2021.The median OS of the positive group was 52 months,but the median OS of the patients without McIg was not reached,and the difference of OS between two groups had statistical significance(P<0.01).Conclusion Among the newly diagnosed patients with iB-NHL,the prognosis of patients with McIg is relatively poor,which needs to be paid more attention in clinical diagnosis and treatment.

关 键 词：惰性B细胞非霍奇金淋巴瘤 边缘区淋巴瘤 单克隆免疫球蛋白 血清免疫固定电泳 骨髓浸润 国际预后指数 

分 类 号：R733.4[医药卫生—肿瘤]