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74例淋巴母细胞淋巴瘤的临床特点及预后分析

Clinical Features and Prognosis of 74 Cases of Lymphoblastic Lymphoma

  • 摘要:
    目的 分析淋巴母细胞淋巴瘤(lymphoblastic lymphoma, LBL)的临床特点,比较B淋巴母细胞淋巴瘤(B lymphoblasts lymphoma, B-LBL)与T淋巴母细胞淋巴瘤(T lymphoblasts lymphoma, T-LBL)的临床及预后特点及不同化疗方案对LBL的预后影响。
    方法 选择2007—2014年天津医科大学肿瘤医院收治的74例经免疫组织化学确诊为LBL的患者。采用描述统计方法分析LBL的疾病谱特征。
    结果 74例LBL患者的中位年龄为19.5岁,其中45例为男性,60例为晚期起病(Ann-Arbor分期Ⅲ~Ⅳ期),42例存在B症状,32例发生骨髓受累。治疗总有效率为70.2%,完全缓解率为48.6%,3年和5年总生存率(overall survival, OS)分别为38.0%和26.6%,3年和5年无进展生存率(progression-free survival, PFS)分别为34.8%和23.2%。其中B-LBL患者17例,T-LBL患者57例。B-LBL较T-LBL更倾向发生于儿童,起病时多伴有贫血,二者生存意义比较差异无统计学意义。单因素分析显示年龄是否小于18岁、有无贫血、β2微球蛋白水平、诱导治疗方案、近期疗效为预后相关因素。
    结论 淋巴母细胞淋巴瘤是一种高度侵袭性的恶性非霍奇金淋巴瘤,生存期短,多发生于青少年,起病时多为晚期,易发生骨髓转移。采用ALL类化疗方案的患者预后可能优于CHOP样方案。

     

    Abstract:
    Objective To analyze clinical features of lymphoblastic lymphoma(LBL), compare clinical and prognostic characteristics of B lymphoblasts lymphoma (B-LBL) and T lymphoblasts lymphoma (T-LBL), and the prognosis of various chemotherapy regimens on LBL.
    Methods Total 74 patients with LBL were collected from 2007 to 2014 at Tianjin Medical University Cancer Institute and Hospital. Descriptive analysis was used to analyze the disease spectrum characteristics of LBL.
    Results The median age of 74 LBL patients was 19.5 years, among which 45 cases were male, 60 cases were late onset (Ann-Arbor stage Ⅲ-Ⅳ), 42 patients had B symptoms, 32 cases had bone marrow involvement. The overall response rate (ORR) of the whole group was 70.2%, the complete response rate was 48.6%, and the 3-and 5-year overall survival rates were 38.0% and 26.6%, respectively. The 3-and 5-year progression-free survival rates were 34.8% and 23.2%, respectively. Seventeen patients were B-LBL and 57 cases were T-LBL. Compared with T-LBL, B-LBL was more likely to occur in children and associated with the onset of anemia. There was no significant difference in the survival between B-LBL and T-LBL patients. Univariate analysis showed that whether age < 18 years old, whether with anemia, the level of β2-MG, induction therapy regimens, the short-term efficacy were the related factors for prognosis.
    Conclusion Lymphoblastic lymphoma is a highly aggressive malignant non-Hodgkin' s lymphoma, with short lifetime, easy to occur in young people, usually late in the onset of the disease prone to bone marrow metastasis. Patients with ALL chemotherapy regimens may have better prognosis than those with CHOP-like regimens.

     

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