23例套细胞淋巴瘤的特征及预后因素临床分析
[Clinical analysis of the character and prognostic factors of 23 cases of mantle cell lymphoma].
作者信息
Liang R, Wang Z, Zhu M N, Hao C X, Zhang N, Wang J H, Zhang T, Yang L, Gu H T, Dong B X, Bai Q X, Gao G X, Chen X Q
机构信息
Department of Hematology, Xijing Hosptial, Fourth Military Medical University, Xi'an 710032, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2016 Jun 14;37(6):491-6. doi: 10.3760/cma.j.issn.0253-2727.2016.06.010.
OBJECTIVE
To investigate the clinical characteristics and prognostic factors of mantle cell lymphoma (MCL) patients.
METHODS
The clinical data of 23 MCL patients were retrospectively analyzed. Immunohistochemical stain was performed to detect the protein expressions of Mcl-1, pNF-κB p65 and 14-3-3ζ of MCL patients to analyze its prognostic factors.
RESULTS
Among 23 MCL patients, there were 17(73.9%) patients with IPI 0-2 (low risk group) and 6(26.1%) patients with IPI 3-4. Only the rate of 2y-progression-free survival (PFS) of group IPI 0-2 was superior to that of group IPI 3-4 patients (47.1% vs 0, P=0.049); There were 16 (69.5%) patients with MIPI < 5.7, whose rates of overall response rate (ORR), 2y overall survival (OS) and PFS were better than those of the ones with MIPI ≥ 5.7(ORR: 81.3% vs 33.3% P=0.032; OS: 68.8% vs 16.7% P=0.041; PFS: 50% vs 0, P=0.040 respectively). The rates of ORR, 2y-OS and 2y-PFS (100.0%, 80.0% and 70.0%) of patienets received regimen R+CHOP(E) were all superior to those (38.5%, 30.8% and 7.7%) of ones received regimen CHOP(E) (P=0.002, P= 0.024, P=0.003, respectively). Among 12 patients, 2 out of 6 cases with Mcl-1 positive expression achieved good response (CR+PR) and 2y-OS, 1 case 2y-PFS; All 6 cases with Mcl-1 negative expression achieved good response (CR+PR) and 2y-OS, 5 cases 2y-PFS. 3 out of 6 cases with pNF-κB p65 positive expression achieved good response (CR+PR) and 2y-OS, 1 case 2y-PFS; 5 out of 6 cases with pNF-κB p65 negative expression achieved good response (CR+ PR) and 2y-OS/PFS. 5 out of 8 cases with 14-3-3ζ positive expression achieved good response (CR+PR), 4 cases 2y-OS, and 3 cases 2y-PFS. 3 out of 4 cases with 14-3-3ζ negative expression achieved CR, 4 cases 2y-OS, and 3 cases 2y-PFS.
CONCLUSION
MCL patients had high heterogeneity. MIPI has better prognostic significance than IPI. R+CHOP(E) as first line treatment improved the rates of OS/PFS. The expressions of Mcl-1, pNF-κB p65 and 14-3-3ζ proteins in MCL might be related to prognosis.
目的
探讨套细胞淋巴瘤（MCL）患者的临床特征及预后因素。
方法
回顾性分析23例MCL患者的临床资料。采用免疫组织化学染色检测MCL患者Mcl-1、pNF-κB p65和14-3-3ζ蛋白表达，分析其预后因素。
结果
23例MCL患者中，国际预后指数（IPI）0-2分（低危组）17例（73.9%），IPI 3-4分6例（26.1%）。仅IPI 0-2分组的2年无进展生存率（PFS）高于IPI 3-4分组患者（47.1%比0，P=0.049）；中危-惰性国际预后指数（MIPI）<5.7的患者16例（69.5%），其总缓解率（ORR）、2年总生存率（OS）和PFS均优于MIPI≥5.7的患者（ORR：81.3%比33.3%，P=0.032；OS：68.8%比16.7%，P=0.041；PFS：50%比0，P=0.040）。接受R+CHOP（E）方案治疗患者的ORR、2年OS和2年PFS率（分别为100.0%、80.0%和70.0%）均高于接受CHOP（E）方案治疗的患者（分别为38.5%、30.8%和7.7%）（P=0.002、P=0.024、P=0.003）。12例患者中，Mcl-1阳性表达的6例患者中有2例达到良好缓解（完全缓解+部分缓解）及2年OS，1例2年PFS；Mcl-1阴性表达的6例患者均达到良好缓解（完全缓解+部分缓解）及2年OS，5例2年PFS。pNF-κB p65阳性表达的6例患者中有3例达到良好缓解（完全缓解+部分缓解）及2年OS，1例2年PFS；pNF-κB p65阴性表达的6例患者中有5例达到良好缓解（完全缓解+部分缓解）及2年OS/PFS。14-3-3ζ阳性表达的8例患者中有5例达到良好缓解（完全缓解+部分缓解），4例2年OS，3例2年PFS。14-3-3ζ阴性表达的4例患者中有3例达到完全缓解，4例2年OS，3例2年PFS。
结论
MCL患者具有高度异质性。MIPI比IPI具有更好的预后意义。R+CHOP（E）作为一线治疗可提高OS/PFS率。MCL中Mcl-1、pNF-κB p65和14-3-3ζ蛋白表达可能与预后相关。
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