老年弥漫大B细胞淋巴瘤的临床病理学特征及疗效分析-附15例报告

Clinicopathological features of elderly patients with diffuse large B-cell lymphoma and its therapeutic effect: A report of 15 cases

  • 摘要: 目的 探讨老年弥漫大B细胞淋巴瘤 (diffuse large B-cell lymphoma, DLBCL) 的临床病理学特征和疗效。 方法 对2003年1月-2012年12月我院收治的15例老年DLBCL患者的临床资料进行回顾性分析, 包括患者的一般临床特征、病理特点、化疗方案选择及疗效, 并结合电话随访收集患者生存资料。 结果 15例患者中位年龄84岁;所有患者合并至少2种其他疾病, 其中以高血压病和冠状动脉粥样硬化性心脏病最常见, 有4例合并第二肿瘤;出现B组症状 (发热、盗汗及体重下降) 的占13例;病理亚型中以非生发中心细胞型 (non-GCB) 居多 (10/15) ;Ann-Arbor分期Ⅱ期1例, Ⅲ/Ⅳ期14例;国际预后指数 (international prognostic index, IPI) 评分3~5分14例;初诊时有10例血清乳酸脱氢酶 (LDH) 高于正常。全组病例均采用R-CHOP (利妥昔单抗联合CHOP) 为基础的个体化方案化疗, 4个疗程后完全缓解 (CR) 4例, 部分缓解 (PR) 8例, 疾病稳定 (SD) 1例, 疾病进展 (PD) 2例, 治疗总反应12例;全组病例半年总生存10例, 1年总生存8例;半年、1年无进展生存分别为7例、6例。 结论 老年DLBCL初诊时合并基础疾病多、分期较晚、病理分型以non-GCB亚型为主, 预后很差;应在强化支持治疗的基础上, 根据不同预后, 采用个体化R-CHOP方案化疗。

     

    Abstract: Objective To study the clinicopathological features of elderly patients with diffuse large B-cell lymphoma(DLBCL) and its therapeutic effect. Methods Fifteen elderly DLBCL patients with a mean age of 84 years admitted to our hospital from January 2003 to December 2012 were included in this study.Their clinical data including general clinical characteristics,pathological features,chemotherapy and its effect were retrospectively analyzed. Results Of the 15 DLBCL patients who suffered from at least 2 underlying diseases with hypertension and coronary arteriosclerotic heart disease being most predominant,4 were complicated by a secondary tumor,13 had B symptoms(such as fever,night sweat and loss of body weight),10 were diagnosed as non-GCB type,1 was classified as Ann-Arbor Ⅱ and 14 were classified as Ann-Arbor Ⅲ/Ⅳ,1 had an IPI score ≤ 2 and 14 had an IPI score of 3-5.The serum LDH level was elevated in 10 patients at their first visit.The patients underwent R-CHOP-based individual chemotherapy with complete remission,partial remission,stable disease,and progressive disease achieved in 4,8,1 and 2 patients,respectively,after 4 cycles of chemotherapy.Twelve patients responded to chemotherapy.The overall survival(OS) time was 6 months in 10 patients and 1 year in 8 patients.The progression-free survival(PFS) time was 6 months in 7 patients and 1 year in 6 patients. Conclusion DLBCL in elderly patients is usually complicated by other pre-existing diseases and diagnosed at its late stage,with non-GCB as its pain pathological subtype and a poor prognosis.Elderly DLBCL patients should receive R-CHOP-based individual chemotherapy on the basis of intensified supportive treatment.

     

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