利妥昔单抗联合高强度化疗治疗散发性成人伯基特淋巴瘤的疗效及预后分析  

Rituximab combined with intensive immunochemotherapy for sporadic adult Burkitt lymphoma:efficacy and prognosis analyse

作　　者：董长明 邹鹤松 张文 刘薇 王轶 刘慧敏 谢婷 李恒 王齐 黄文阳 易树华 安刚 邱录贵 邹德慧 Dong Changming;Zou Hesong;Zhang Wen;Liu Wei;Wang Yi;Liu Huimin;Xie Ting;Li Heng;Wang Qi;Huang Wenyang;Yi Shuhua;An Gang;Qiu Lugui;Zou Dehui(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Tianjin Institutes of Health Science,Tianjin 301600,China)

机构地区：[1]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),血液与健康全国重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津300020 [2]天津医学健康研究院,天津301600

出　　处：《中华血液学杂志》2025年第2期134-139,共6页Chinese Journal of Hematology

摘　　要：目的探讨利妥昔单抗联合高强度化疗治疗散发性成人伯基特淋巴瘤(BL)的治疗效果及预后因素。方法回顾性分析2011年6月至2023年2月在中国医学科学院血液病医院诊治的30例初诊BL患者的临床和生存信息,采用Kaplan-Meier法计算生存率,运用Log-rank检验对预后因素进行单因素分析。结果30例患者的中位年龄为43(24~66)岁,男女比例为3∶2。80.0%患者伴结外侵犯、53.3%伴骨髓侵犯、10.0%伴中枢神经系统侵犯,Ann Arbor分期Ⅲ~Ⅳ期占86.7%。伯基特淋巴瘤国际预后指数(BL-IPI)评分为低危(0分)、中危(1分)和高危(≥2分)者分别占比20.0%、43.3%和36.7%。所有患者均接受利妥昔单抗联合高强度化疗作为初始诱导治疗方案,客观缓解率和完全缓解率分别为80.0%和76.7%。中位随访时间为49(6~153)个月,5年的无进展生存(PFS)率和总生存(OS)率均为(76.7±7.7)%。4例局限期患者均获得持续的完全缓解(CCR)。10例对诱导治疗敏感的高危、进展期患者序贯一线auto-HSCT巩固治疗,除1例伴中枢神经系统侵犯的患者发生早期疾病进展而死亡,其余9例均获得CCR。BL-IPI低危、中危和高危组患者的5年PFS率分别为(83.3±15.2)%、100.0%和(45.5±15.0)%(P=0.0069),OS率分别为(83.3±15.2)%、100.0%和(45.5±15.0)%(P=0.0075)。诱导治疗期间的主要不良反应为骨髓抑制和继发感染,但均可对症处理。单因素分析显示,结外侵犯部位≥2个(HR=4.90,95%CI 1.02~23.45,P=0.0329)、BL-IPI评分≥2分(HR=12.62,95%CI 2.59~61.62,P=0.0021)和诱导治疗未达首次完全缓解(CR1)(HR=31.86,95%CI 4.19~242.20,P<0.0001)与更短的PFS期相关。结论成人BL具有高度侵袭性,强烈免疫化疗方案整体上具有良好的疗效和安全性。局限期患者疗效佳,BL-IPI高危患者预后欠佳。诱导治疗敏感的高危、进展期患者序贯一线auto-HSCT巩固治疗可能进一步改善疗效。BL-IPI评分≥2分、结外侵犯部位≥2个和诱导治疗未达CR1是ObjectiveTo explore the therapeutic efficacy and prognostic factors of combined rituximab and intensive chemotherapy for sporadic adult Burkitt lymphoma(BL).MethodsThis retrospective study examined the clinical and survival data of 30 patients newly diagnosed with BL between July 2011 and February 2023 at the Blood Diseases Hospital.Kaplan-Meier method was used for survival analysis,and the log-rank test was used for univariate analysis of prognostic factors.ResultsThe median age of the 30 patients was 43 years(24-66 years),and the male to female ratio was 3:2.Extranodal invasion was present in 80%of the patients,with involvement of the bone marrow in 53.3%and central nervous system in 10.0%.The Ann Arbor stage wasⅢandⅣin 86.7%.According to the number of Burkitt Lymphoma International Prognostic Index(BL-IPI)risk factors,patients were classified as low risk(0)in 20.0%,intermediate risk(1)in 43.3%,and high risk(≥2)in 36.7%.All patients were treated with an induction regimen of rituximab combined with intensive chemotherapy,with objective and complete response rates of 80.0%and 76.7%,respectively.The median follow-up was 49 months(6-153 months),and the 5-year progression-free survival(PFS)and overall survival(OS)rates were both(76.7±7.7)%.All patients with limited stage(n=4)achieved continuous complete remission(CCR).Patients who had high risk,advanced stage sensitive to induction therapy(n=10)sequentially received first-line autologous hematopoietic stem cell transplantation(auto-HSCT)as consolidation therapy;9 patients achieved CCR,whereas 1 patient with central nervous system invasion developed early disease progression and died.The BL-IPI low,intermediate,and high risk groups had respective 5-year PFS rates of(83.3±15.2)%,100.0%,and(45.5±15.0)%(P=0.0069)and OS rates of(83.3±15.2)%,100.0%,and(45.5±15.0)%(P=0.0075).The main adverse effects of induction therapy were myelosuppression and secondary infections,which were effectively managed by appropriate symptomatic treatment.Univariate analysis demonstra

关 键 词：伯基特淋巴瘤 强烈免疫化疗方案 疗效 预后因素 

分 类 号：R733.1[医药卫生—肿瘤]