伴有骨髓侵犯的滤泡性淋巴瘤临床特征与预后分析
目的:总结伴有骨髓侵犯的滤泡性淋巴瘤（FL）患者临床特征及预后，并对治疗模式进行探讨。方法:纳入2013年1月至2022年12月中国医学科学院血液病医院连续收治的183例伴有骨髓侵犯且接受正规治疗的FL患者。回顾性收集并分析患者临床资料，采用Kaplan-Meier法及Cox回归模型进行生存预后的单因素及多因素分析。结果:中位年龄48（19~78）岁，男女比例0.9∶1。所有患者均有骨髓侵犯，LDH升高比例为27.8%，淋巴细胞计数>5×10 9/L比例为42.1%，染色体异常及淋巴组织Ki-67指数≥30%比例分别为18.4%及48.6%；不同亚组比较：强化治疗组的淋巴细胞计数>...
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| Published in | 中华血液学杂志 Vol. 45; no. 12; pp. 1085 - 1090 |
|---|---|
| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
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%天津医学健康研究院，天津 301600
14.12.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0253-2727 |
| DOI | 10.3760/cma.j.cn121090-20240613-00222 |
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| Abstract | 目的:总结伴有骨髓侵犯的滤泡性淋巴瘤（FL）患者临床特征及预后，并对治疗模式进行探讨。方法:纳入2013年1月至2022年12月中国医学科学院血液病医院连续收治的183例伴有骨髓侵犯且接受正规治疗的FL患者。回顾性收集并分析患者临床资料，采用Kaplan-Meier法及Cox回归模型进行生存预后的单因素及多因素分析。结果:中位年龄48（19~78）岁，男女比例0.9∶1。所有患者均有骨髓侵犯，LDH升高比例为27.8%，淋巴细胞计数>5×10
9/L比例为42.1%，染色体异常及淋巴组织Ki-67指数≥30%比例分别为18.4%及48.6%；不同亚组比较：强化治疗组的淋巴细胞计数>5×10
9/L、受累淋巴结数目≥5个以及发生骨髓染色体异常比例，均较R-CHOP（利妥昔单抗+环磷酰胺+阿霉素+长春地辛+泼尼松）组及核苷类似物（包括CD20单抗联合氟达拉滨及苯达莫司汀）组更高（均
P<0.05）。R-CHOP组完全缓解率为39.1%，较强化治疗组（55.1%）及核苷类似物组（62.5%）低（
P=0.042）。生存分析：滤泡性淋巴瘤国际预后指数（FLIPI）高危[
HR=1.910（95%
CI 1.036~3.522），
P=0.038]、染色体异常核型[
HR=2.666（95%
CI 1.333~5.331），
P=0.006]以及R-CHOP方案治疗[
HR=2.287（95%
CI 1.140~4.591），
P=0.020]被证实为影响无进展生存（PFS）的独立不良预后因素；而24个月内疾病进展（POD24）为影响总生存的唯一独立不良预后因素[
HR=9.581（95%
CI 3.000~30.593），
P<0.001]。
结论:伴有骨髓侵犯的FL患者容易合并淋巴细胞计数增高、染色体异常及淋巴组织Ki-67指数增高等临床特征，FLIPI评分、染色体异常核型以及不同治疗方案均为影响PFS的不良预后因素。对于这部分患者，R-CHOP方案疗效欠佳。 |
|---|---|
| AbstractList | 目的:总结伴有骨髓侵犯的滤泡性淋巴瘤（FL）患者临床特征及预后，并对治疗模式进行探讨。方法:纳入2013年1月至2022年12月中国医学科学院血液病医院连续收治的183例伴有骨髓侵犯且接受正规治疗的FL患者。回顾性收集并分析患者临床资料，采用Kaplan-Meier法及Cox回归模型进行生存预后的单因素及多因素分析。结果:中位年龄48（19~78）岁，男女比例0.9∶1。所有患者均有骨髓侵犯，LDH升高比例为27.8%，淋巴细胞计数>5×10
9/L比例为42.1%，染色体异常及淋巴组织Ki-67指数≥30%比例分别为18.4%及48.6%；不同亚组比较：强化治疗组的淋巴细胞计数>5×10
9/L、受累淋巴结数目≥5个以及发生骨髓染色体异常比例，均较R-CHOP（利妥昔单抗+环磷酰胺+阿霉素+长春地辛+泼尼松）组及核苷类似物（包括CD20单抗联合氟达拉滨及苯达莫司汀）组更高（均
P<0.05）。R-CHOP组完全缓解率为39.1%，较强化治疗组（55.1%）及核苷类似物组（62.5%）低（
P=0.042）。生存分析：滤泡性淋巴瘤国际预后指数（FLIPI）高危[
HR=1.910（95%
CI 1.036~3.522），
P=0.038]、染色体异常核型[
HR=2.666（95%
CI 1.333~5.331），
P=0.006]以及R-CHOP方案治疗[
HR=2.287（95%
CI 1.140~4.591），
P=0.020]被证实为影响无进展生存（PFS）的独立不良预后因素；而24个月内疾病进展（POD24）为影响总生存的唯一独立不良预后因素[
HR=9.581（95%
CI 3.000~30.593），
P<0.001]。
结论:伴有骨髓侵犯的FL患者容易合并淋巴细胞计数增高、染色体异常及淋巴组织Ki-67指数增高等临床特征，FLIPI评分、染色体异常核型以及不同治疗方案均为影响PFS的不良预后因素。对于这部分患者，R-CHOP方案疗效欠佳。 |
| Abstract_FL | Objective:This study aimed to summarize the clinical characteristics and prognosis of patients with bone marrow invasive follicular lymphoma (FL) and discuss the treatment modalities.Methods:This study included 183 consecutive patients with FL accompanied by bone marrow invasion and receiving regular treatment at the Hospital of Hematology, Chinese Academy of Medical Sciences, from January 2013 to December 2022. Clinical data were retrospectively collected and analyzed, and single and multifactorial analyses of survival prognosis were conducted with the Kaplan-Meier method and Cox regression model.Results:The median age was 48 (range: 19 - 78) years, and the male-to-female ratio was 0.9∶1. All of the patients had bone marrow invasion, 27.8% had increased lactate dehydrogenase levels, 42.1% had lymphocyte counts of >5×10
9/L, 18.4% had abnormal chromosomal karyotypes, and 48.6% had Ki-67 index of ≥30% in lymphoid tissue. Comparison of different subgroups: lymphocyte counts of >5×10
9/L, number of lymph nodes of ≥5 involved, and proportion of bone marrow chromosomal abnormalities occurring were higher in the anthracycline-intensive treatment group than in the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) protocol and the nucleoside analog (including CD20 monoclonal antibody in combination with fludarabine and bendamustine) groups (all
P<0.05). The complete remission rate was 39.1% in the conventional R-CHOP group, which was lower and statistically significant than that in the intensive treatment group (55.1%) and the nucleoside analog group (62.5%) (
P=0.042). The multivariate analysis for survival analysis revealed high risk of FLIPI (
HR= 1.910, 95%
CI 1.036 - 3.522,
P=0.036), chromosomal abnormalities karyotype (
HR=2.666, 95%
CI 1.333-5.331,
P=0.006), and conventional R-CHOP treatment (
HR=2.287, 95%
CI 1.140-4.591,
P=0.020) were the independent adverse prognostic factors affecting progression-free survival (PFS), whereas POD24 was the only independent adverse prognostic factor affecting overall survival (OS) adverse prognostic factor (
HR=9.581, 95%
CI 3.000 - 30.593,
P<0.001) .
Conclusions:The clinical presentations of patients with bone marrow invasive FL were easy to combine the clinical features, including increased lymphocyte count, chromosomal abnormalities, and Ki-67 index in lymphoid tissues. The FLIPI score, chromosomal abnormal karyotype, and high-lymphoid-tissue Ki-67 index were the poor prognostic factors influencing PFS. R-CHOP therapy demonstrated a poor prognosis in this group of patients. |
| Author | 王婷玉 于颖 邹德慧 吕瑞 刘薇 徐燕 王齐 熊文婕 阎禹廷 黄文阳 安刚 邱录贵 易树华 |
| AuthorAffiliation | 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%天津医学健康研究院，天津 301600 |
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| Author_FL | Wang Tingyu Yan Yuting Huang Wenyang An Gang Xu Yan Zou Dehui Yu Ying Qiu Lugui Wang Qi Liu Wei Xiong Wenjie Lyu Rui Yi Shuhua |
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| DOI | 10.3760/cma.j.cn121090-20240613-00222 |
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| Keywords | FLIPI评分 染色体核型 Bone marrow invasive 淋巴瘤，滤泡性 FLIPI score R-CHOP方案 骨髓侵犯 Lymphoma, follicular Karyotype R-CHOP therapy |
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| PublicationTitle | 中华血液学杂志 |
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| PublicationYear | 2024 |
| Publisher | 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%天津医学健康研究院，天津 301600 |
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| Snippet | 目的:总结伴有骨髓侵犯的滤泡性淋巴瘤（FL）患者临床特征及预后，并对治疗模式进行探讨。方法:纳入2013年1月至2022年12月中国医学科学院血液病医院连续收治的183例伴有骨髓... |
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| Title | 伴有骨髓侵犯的滤泡性淋巴瘤临床特征与预后分析 |
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