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成人伯基特淋巴瘤的放射治疗:大型大学中心的回顾性分析

Radiotherapy in Adult Burkitt Lymphoma: A Retrospective Analysis in a Large University Center.

作者信息

Pereira Ricardo Ferrari, Mauro Geovanne Pedro, Medici Carolina Trindade Mello, Casimiro Lucas Coelho, Weltman Eduardo

机构信息

Department of Radiation Oncology, Santa Casa de Misericórdia de Sorocaba, Sorocaba, Brazil.

Department of Radiotherapy, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil.

出版信息

Indian J Hematol Blood Transfus. 2022 Jul;38(3):508-515. doi: 10.1007/s12288-021-01495-w. Epub 2021 Oct 15.

Abstract

Radiotherapy is not usually a part of standard Burkitt lymphoma treatment. We aim to assess patient and treatment characteristics of Burkitt lymphoma, particularly RT use, and how they relate to survival. Retrospective cohort of adult patients treated from 2008 to 2019 in an academic hospital. All patients had biopsy-proven Burkitt's lymphoma staged I to IV according to St. Jude's/Murphy staging system. Patients were followed for at least six-months or until death. Forty-eight consecutive patients were selected. Median age at diagnosis was 36.9 years (18-62). Median follow-up was 7.78 months (0.5-187.5). Most were male (81.3%) and had good performance by ECOG scale on their first hematologist appointment (56.2% were ECOG 0). Median OS and PFS were 8.4 months (interquartile range Q1-Q3: 3.96-152.2) and 8.3 months (interquartile range Q1-Q3: 6.7-not reached), respectively, with 32 deaths. A total of 43 patients (89.6%) were HIV-positive and had a median CD4 + level of 193.5 cells/mm at diagnosis. Patients that did not present a drop in CD4 + levels after treatment had better OS than those that did ( = 0.020). 11 patients underwent radiotherapy (22.9%) who had better OS than those who did not ( = 0.015). Our findings show that adult patients living with HIV presenting Burkitt lymphoma who maintained their immune status throughout treatment had better prognosis than those who presented CD4 + cells drops. Also, patients treated with radiotherapy-either with palliative intent or as consolidation after chemotherapy-had statistically significant better OS than those not irradiated. Prospective data is warranted for radiotherapy as a consolidative and as a palliative treatment.

摘要

放射治疗通常不是标准伯基特淋巴瘤治疗的一部分。我们旨在评估伯基特淋巴瘤患者及治疗特征,尤其是放疗的使用情况,以及它们与生存率的关系。对2008年至2019年在一家学术医院接受治疗的成年患者进行回顾性队列研究。所有患者均经活检证实为伯基特淋巴瘤,根据圣裘德/墨菲分期系统分期为I至IV期。对患者随访至少6个月或直至死亡。选取了48例连续患者。诊断时的中位年龄为36.9岁(18 - 62岁)。中位随访时间为7.78个月(0.5 - 187.5个月)。大多数为男性(81.3%),初次血液科就诊时ECOG量表显示身体状况良好(56.2%为ECOG 0)。中位总生存期和无进展生存期分别为8.4个月(四分位间距Q1 - Q3:3.96 - 152.2)和8.3个月(四分位间距Q1 - Q3:6.7 - 未达到),有32例死亡。共有43例患者(89.6%)为HIV阳性,诊断时CD4⁺水平的中位数为193.5个细胞/mm³。治疗后CD4⁺水平未下降的患者总生存期优于CD4⁺水平下降的患者(P = 0.020)。11例患者接受了放射治疗(22.9%),其总生存期优于未接受放疗的患者(P = 0.015)。我们的研究结果表明,患有伯基特淋巴瘤的成年HIV感染者在整个治疗过程中保持免疫状态者比CD4⁺细胞水平下降者预后更好。此外,接受放射治疗的患者,无论是姑息性放疗还是化疗后巩固性放疗,其总生存期在统计学上均显著优于未接受放疗的患者。需要前瞻性数据来证实放疗作为巩固性治疗和姑息性治疗的效果。

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本文引用的文献

6
Low-intensity therapy in adults with Burkitt's lymphoma.成人伯基特淋巴瘤的低强度治疗。
N Engl J Med. 2013 Nov 14;369(20):1915-25. doi: 10.1056/NEJMoa1308392.

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