摘要
目的探讨套细胞淋巴瘤(MCL)的临床特点、治疗及预后因素。方法回顾分析2000年4月至2008年12月中国医学科学院血液病医院27例MCL患者的临床资料及不同治疗方案疗效及预后因素。结果27例患者中位发病年龄59岁,男女比例2.4∶1,其中88.9%骨髓侵犯、临床分期为Ⅳ期,59.3%脾大,33.3%B症状,11.1%肝大,44.4%乳酸脱氢酶(LDH)升高,21例染色体检查结果中7例(33.3%)伴附加染色体异常。20例外院诊断结果中,15例(75%)误诊。24例初治患者中,8例利妥昔单抗联合化疗者完全缓解(CR/CRu)、3年总存活(OS)、无进展生存(PFS)率显著高于常规化疗组(分别为87.5%对31.3%,87.5%对24.1%,70.0%对26.9%;P均<0.05)。预后分析显示,年龄>60岁、B症状、肝大、乳酸脱氢酶(LDH)升高、血红蛋白<110g/L、白蛋白<40g/L及染色体异常≥4种为预后不良因素,而骨髓侵犯、脾大、临床分期对预后无显著影响。伴复杂染色体异常者预后极差,中位生存仅3.5个月。结论中国MCL误诊率高,其临床特点与国外报道类似。利妥昔单抗联合化疗可明显提高CR/CRu,并改善生存。
Objective To analyze the clinical characteristics, therapeutic outcome and prognostic factors of mantle cell lymphoma（MCL） in China. Methods Clinical records of 27 MCL patients were retrospectively ana- lyzed. The results of rituximab combined therapy and conventional therapy regimens were compared,and prognostic factors were analyzed. Results The median age of the 27 patients was 59, with marked male predominance （ 2. 4 ： 1 ）. There were 88.9% patients with bone marrow involvement at clinical stage Ⅲ-Ⅳ ,59. 3% with spleen involvement ,44.4% with LDH elevated ,33. 3% with B symptoms and 11.1% with liver involvement. Among the 21 patient with conventional cytogenetic results ,7 patients had additional chromosome aberration and 4 patients had more than 4 chromosomes aberration. 15/20 patients were misdiagnosed in local hospitals, most of which were diagnosed as CLI）SLL.Ⅲ 24 untreated patients, the CR/CRu,3 years＇ OS and PFS in rituximab combined therapy （RCT group）were all significantly higher than those in CT group（ 87.5% vs 31.3% ,87.5% vs 24. 1% ,70.0% vs 26.9% ,P 〈 0. 05 respectively）. Age older than 60, B symptoms, liver involvement, elevated LDH, hemoglobin less than 110 g/L,albumin less than 40 g/L and more than 3 chromosomes aberration were negative prognostic factors, but bone marrow involvement ;spleen involvement and clinical stage didn＇t affect prognosis. 4 patients with more than 4 chromosomes aberration had the worse outcome with median survival of only 3.5 months. Conclusion The clinical characteristics of MCL in China are comparable with those in other countries, but with high misdiagnosis,whieh is worth more investigation. The rituximab combined therapy regimen should be the first line therapy option for MCL.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2010年第4期324-327,共4页
Chinese Journal of Practical Internal Medicine
基金
卫生部临床学科重点项目资助
天津市科技支撑计划重点项目(09ZCGYSF01000)
