DU Xiao-Yan, Hu Kai, Zhao Wei, Yang Ping, Wan Wei, Jing Hong-Mei, Ke Xiao-Yan
Department of Hematology, Peking University Third Hospital, Beijing 100191,China.
Department of Hematology, Peking University Third Hospital, Beijing 100191,China. E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2018 Jun;26(3):756-764. doi: 10.7534/j.issn.1009-2137.2018.03.021.
To investigate the clinical manifestation, therapeutic efficacy and related prognostic factors of patients with follicular lymphoma.
A retroretrospective study was conducted on 94 patients with follicular lymphoma who were admitted to our hospital from March 1999 to June 2016. The total of 94 newly diagnosed FL patients were analyzed in terms of clinical manifestation, laboratory data, pathological examination, clinical stage and so on, so as to find out the related prognostic factors.
Ninety-four patients were included in this study. The median age at onset was 50.60 years old, more common in women, and ratio of male to female was 1:1.35. The superficial lymphadenopathy was found to be the first symptom in 72.3% patients, 25.5% patients had B symptoms when diagnosed, 57.4% cases had extranodal organ invasion when diagnosed, of which bone marrow invasion is the most common, accounting for 36.2%, followed by the digestive tract, bone, spleen and so on. The detected rate of BCL-2 / IGH gene rearrangement was 33.9%. Patients with grade 3 of FL accounted for 24.5%. Cases of clinical stage III-IV accounted for 71.2% in these FL patients. The overall response rate (ORR) was 92.0%, and the complete remission (CR) rate was 79.3% and the recurrence rate was 35.2%. The cumulative overall survival rates of 3, 5 and 10 years were 92.1% , 84.6% and 77.4% respectively, and the cumulative progression-free survival(PFS) rate in 3,5 and 10 years was 68.5%, 61.4% and 41.9%, respectively. The results showed that the CR rate was 85.2% in patients treated with rituximab and 69.7% in patients treated without rituximab. The OS and PFS in patients treated with rituximab were better than those in patients treated without rituximab, but there was no significant difference between them(P>0.05). Univariate analysis showed that FL stage, ECOG score, Hb and LDH levels, digestive tract involvement or not, CR or not after initial treatment had a significant impact on OS(P<0.05), while BCL-2, CD10, ECOG score, albumin, Hb and LDH levels, percentage of lymphocytes, erythrocyte sedimentation rate, digestive tract involvement had a significant impact on PFS (P<0.05). Multivariate analysis showed that digestive tract involvement or not, CR or not after initial treatment were independent risk factors for OS(P<0.05), while CR or not after initial treatment, digestive tract invdvement or not, LDH level and ECOG score were independent risk factors for PFS(P<0.05).
The FL is more common in middle-aged women, the FL was in late stage at confirmed diagnosis, bone marrow involvement is more common. The CD10 negative is poor prognostic factor for FL. The digestive tract involvement or not, CR or not after initial treatment are independent risk factors for OS, while CR or not after initial treatment, digestive tract involvement or not, LDH level and ECOG score are independent risk factors for PFS.
探讨滤泡性淋巴瘤患者的临床表现、治疗效果及相关预后因素。
对1999年3月至2016年6月我院收治的94例滤泡性淋巴瘤患者进行回顾性研究。对94例新诊断的滤泡性淋巴瘤患者的临床表现、实验室数据、病理检查、临床分期等进行分析，以找出相关预后因素。
本研究共纳入94例患者。发病年龄中位数为50.60岁，女性更为常见，男女比例为1:1.35。72.3%的患者首发症状为浅表淋巴结肿大，25.5%的患者确诊时伴有B症状，57.4%的患者确诊时伴有结外器官侵犯，其中骨髓侵犯最为常见，占36.2%，其次为消化道、骨骼、脾脏等。BCL-2/IGH基因重排检测率为33.9%。滤泡性淋巴瘤3级患者占24.5%。这些滤泡性淋巴瘤患者中临床Ⅲ-Ⅳ期病例占71.2%。总缓解率（ORR）为92.0%，完全缓解（CR）率为79.3%，复发率为35.2%。3年、5年和10年的累积总生存率分别为92.1%、84.6%和77.4%，3年、5年和10年的累积无进展生存率（PFS）分别为68.5%、61.4%和41.9%。结果显示，接受利妥昔单抗治疗的患者CR率为85.2%，未接受利妥昔单抗治疗的患者CR率为69.7%。接受利妥昔单抗治疗的患者的总生存期（OS）和无进展生存期（PFS）均优于未接受利妥昔单抗治疗的患者，但差异无统计学意义（P>0.05）。单因素分析显示，滤泡性淋巴瘤分期、ECOG评分、血红蛋白（Hb）和乳酸脱氢酶（LDH）水平、是否累及消化道、初始治疗后是否达到CR对OS有显著影响（P<0.05），而BCL-2、CD10、ECOG评分、白蛋白、Hb和LDH水平、淋巴细胞百分比、红细胞沉降率、是否累及消化道对PFS有显著影响（P<0.05）。多因素分析显示，是否累及消化道、初始治疗后是否达到CR是OS的独立危险因素（P<0.05），而初始治疗后是否达到CR、是否累及消化道、LDH水平和ECOG评分是PFS 的独立危险因素（P<0.05）。
滤泡性淋巴瘤在中年女性中更为常见，确诊时多处于晚期，骨髓侵犯较为常见。CD10阴性是滤泡性淋巴瘤预后不良的因素。是否累及消化道、初始治疗后是否达到CR是OS的独立危险因素，而初始治疗后是否达到CR、是否累及消化道、LDH水平和ECOG评分是PFS的独立危险因素。
