Sandlund J T, Ribeiro R, Lin J S, Ayers D, Santana V M, Furman W L, Mahmoud H, Berard C W, Hutchison R E, Crist W M
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38101.
Med Pediatr Oncol. 1994;23(4):350-3. doi: 10.1002/mpo.2950230406.
To evaluate the clinical characteristics and treatment outcome of childhood non-Hodgkin lymphoma (NHL) cases with bone marrow involvement, we studied 13 lymphoblastic, 15 small noncleaved cell, and 8 large cell cases with tumor cells in their marrow. They represented 16%, 11%, and 9% of consecutive NHL cases with these respective histologic subtypes. The treatment outcome differed significantly according to histologic subtype--the 5-year event-free survivals (EFS +/- SE) for large cell NHL, small non-cleaved cell NHL, and lymphoblastic NHL cases were 11 +/- 8%, 40 +/- 20%, and 62 +/- 15%, respectively. Increased serum lactate dehydrogenase (LDH) levels (> 500 U/L) were associated with a poorer EFS (5-year EFS, 0% vs. 50 +/- 10%; P < 0.001). Children < or = 5 years of age had a poorer EFS survival than older children (5-year EFS, 14 +/- 9% vs. 44 +/- 10%; P = 0.03). The degree of bone marrow involvement (< 5% vs. > or = 5%) and race were not significantly associated with treatment outcome. Although intensive chemotherapy has substantially improved survival for patients with advanced stage lymphoblastic or small noncleaved cell lymphoma, patients with large cell NHL and associated marrow involvement continue to have a dismal outcome and require novel or more intensive therapy.
为评估骨髓受累的儿童非霍奇金淋巴瘤（NHL）病例的临床特征及治疗结果，我们研究了13例淋巴母细胞型、15例小无裂细胞型和8例大细胞型且骨髓中有肿瘤细胞的病例。它们分别占连续性NHL病例中这些组织学亚型的16%、11%和9%。治疗结果根据组织学亚型有显著差异——大细胞型NHL、小无裂细胞型NHL和淋巴母细胞型NHL病例的5年无事件生存率（EFS±SE）分别为11±8%、40±20%和62±15%。血清乳酸脱氢酶（LDH）水平升高（>500 U/L）与较差的EFS相关（5年EFS，0%对50±10%；P<0.001）。年龄≤5岁的儿童比大龄儿童的EFS生存率更低（5年EFS，14±9%对44±10%；P = 0.03）。骨髓受累程度（<5%对≥5%）和种族与治疗结果无显著关联。尽管强化化疗已显著提高了晚期淋巴母细胞型或小无裂细胞型淋巴瘤患者的生存率，但大细胞型NHL及相关骨髓受累患者的预后仍然很差，需要新的或更强化的治疗。
