Gandarillas M A, Conde E, Mazorra F, Cuadrado M A, Baro J, Garijo J, Recio M, Richard C, Iriondo A, Zubizarreta A
Servicio de Hematología y Hemoterapia, Hospital Universitario Marqués de Valdecilla, Santander.
Sangre (Barc). 1998 Jun;43(3):185-90.
Prognostic factors in low grade non-Hodgkin's lymphoma (LGL) are not well established. The aim of this study is to investigate prognostic factors on LGL treated in our institution during the last decade.
The study was carried out on 70 cases of newly diagnosed LGL, most treated with CVP or clorambucil and prednisone. The median follow-up was 37 months (1-132). Variables reported as prognostic factors in previous series were subjected to bivariate and multivariate analysis.
Relevant clinical features were: Ann Arbor III-IV stage 74%, ECOG > or = 2-17%, bone marrow involvement 60% and large tumor burden according to MD Anderson criteria 21%. Complete response (CR) was achieved in 50% and partial response in 29%. In bivariate analysis factors related with poor CR were B symptoms, large tumor burden, high LDH and more than one extranodal site involvement. Logistic regression showed that large tumor burden (p = 0.02; OR = 0.07) and B symptoms (p = 0.07; OR = 0.14) were the best prognostic factors of poor CR. Five year global survival (GS) was 55%, with a median of 76 months. In univariate analysis factors related with GS were ECOG > or = 2, B symptoms, bulky, large tumor burden, retroperitoneo involvement and absence of CR. In multivariate analysis the only factor related with poor GS was large tumor burden (p < 0.00001; RR = 5.93). When therapeutic response was included in the model, absence of CR (p = 0.008; RR = 3.40) and large tumour burden (p = 0.005; RR = 3.86) were the factors selected.
In LGL tumor burden was the most important prognostic variable. Tumor response showed less importance than in high grade lymphomas.
低度非霍奇金淋巴瘤（LGL）的预后因素尚未完全明确。本研究旨在调查过去十年间在我院接受治疗的LGL患者的预后因素。
本研究纳入70例新诊断的LGL患者，多数接受了CVP方案或苯丁酸氮芥联合泼尼松治疗。中位随访时间为37个月（1 - 132个月）。对先前研究系列中报道的作为预后因素的变量进行双变量和多变量分析。
相关临床特征如下：Ann Arbor III - IV期占74%，美国东部肿瘤协作组（ECOG）评分≥2分者占17%，骨髓受累者占60%，按照MD安德森标准存在大肿瘤负荷者占21%。完全缓解（CR）率为50%，部分缓解率为29%。双变量分析显示，与CR不佳相关的因素包括B症状、大肿瘤负荷、高乳酸脱氢酶（LDH）以及一个以上结外部位受累。逻辑回归分析表明，大肿瘤负荷（p = 0.02；比值比[OR] = 0.07）和B症状（p = 0.07；OR = 0.14）是CR不佳的最佳预后因素。五年总生存率（GS）为55%，中位生存时间为76个月。单变量分析显示，与GS相关的因素包括ECOG评分≥2分、B症状、肿块大、大肿瘤负荷、腹膜后受累以及未达到CR。多变量分析显示，与GS不佳相关的唯一因素是大肿瘤负荷（p < 0.00001；风险比[RR] = 5.93）。当将治疗反应纳入模型时，未达到CR（p = 0.008；RR = 3.40）和大肿瘤负荷（p = 0.005；RR = 3.86）是被选中的因素。
在LGL中，肿瘤负荷是最重要的预后变量。与高度淋巴瘤相比，肿瘤反应的重要性较低。
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