[Analysis of prognostic risk factors in patients with diffuse large B-cell lymphoma].

OBJECTIVE

To explore the relationship of clinical features, therapeutic measures, laboratory findings, the origin of tumor cells as well as prognosis in Chinese patients with diffuse large B-cell lymphoma (DLBCL).

METHODS

One hundred and six patients with DLBCL were retrospectively assayed and followed up, the international prognostic index (IPI) score, Ann Arbor staging, ECOG score, the origin of tumor cells and different therapeutic methods were analyzed.

RESULTS

According to the IPI, there were 61 cases (57.5%) with low-intermediate risk and 45 (42.5%) with intermediate-high risk. According to Ann Arbor staging, there were 8 phase I cases (7.5%), 16 phase II (15.0%), 54 phase III (51.0%) and 28 phase IV (26.5%). Twenty-five cases (23.6%) were accompanied with bone marrow invasion, 16 of them were diagnosed as lymphosarcoma cell leukemia; 38 cases with ECOG score ≥ 2; 67 cases (63.2%) had an increased LDH level; 59 cases (55.7%) had B symptom. The response rate (RR) for the whole group was 71.7%, the complete remission (CR) rate was 59.4% (63 cases), the partial remission (PR) rate was 12.3% (13 cases), the stable disease rate was 2.8% (3 cases) and the death rate was 27.4% (29 cases). The 4-year survival rate was 72.6%. Univariate analysis indicated that eight factors were related with prognosis (P < 0.05), including IPI score, Ann Arbor staging, ECOG score, the origin of tumor cells, LDH level, bone marrow invasion, different therapeutic methods and whether or not CR. Multivariate analysis showed that the origin of non-germinal center (HR = 4.24, P = 0.001), bone marrow invasion (HR = 2.08, P = 0.012), whether or not CR (HR = 2.72, P = 0.006) and therapy modality (HR = 2.58, P = 0.009) were significant factors for prognosis.

CONCLUSION

The bone marrow invasion and the origin of tumor cells are independent risk factors for prognosis. The rituximab combined with chemotherapy can significantly improve the therapeutic effect of the DLBCL, and hematopoietic stem cell transplantation is the best choice for treating patients with DLBCL.