血管免疫母细胞t细胞淋巴瘤的临床特点及预后因素分析

国际输血及血液学杂志 Pub Date : 2020-01-20 DOI:10.3760/CMA.J.ISSN.1673-419X.2020.01.006

X. Xia, H. Gu, Baoxia Dong, Tao Zhang, R. Liang, Q. Bai, G. Gao, Lan Yang

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Kaplan-Meier method was used to map overall survival (OS) curves of patients treated with and without auto-HSCT. And univariate analysis of OS rate was performed in patients treated without auto-HSCT using Log-rank test. Influencing factors included gender, age, International Prognostic Index (IPI) score, Prognostic Index for peripheral T-cell lymphoma (PIT) score, B symptoms, skin rashes, chest/abdominal cavity effusion, bone marrow involvement, white blood cell count (WBC), hemoglobin (Hb) value, platelet count, serum lactate dehydrogenase (LDH) level, ferritin level, β2-microglobulin (MG) level. Factors with statistical significance in univariate analysis and clinical guiding significance were included in COX proportional hazards regression model for multivariate analysis. 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引用次数: 0

摘要

目的探讨血管免疫母细胞T细胞淋巴瘤（AITL）的临床特点及预后因素。方法选择空军医科大学第一附属医院血液科2012年1月至12月收治的44例AITL患者作为研究对象。男36例，女8例，年龄18-78岁，中位年龄57.5岁。44例患者均采用CHOP（环磷酰胺+吡柔比星+长春新碱+泼尼松）方案治疗，其中4例联合四酰胺或硼替佐米，6例联合自体造血干细胞移植（auto-HSCT）。回顾性分析AITL患者的临床特点。Kaplan-Meier方法用于绘制接受和不接受自体HSCT治疗的患者的总生存率（OS）曲线。并使用对数秩检验对未接受自体HSCT治疗的患者的OS发生率进行单因素分析。影响因素包括性别、年龄、国际预后指数（IPI）评分、外周T细胞淋巴瘤预后指数（PIT）评分、B症状、皮疹、胸腹腔积液、骨髓受累、白细胞计数（WBC）、血红蛋白（Hb）值、血小板计数、血清乳酸脱氢酶（LDH）水平、铁蛋白水平、β2-微球蛋白（MG）水平。将单变量分析中具有统计学意义和临床指导意义的因素纳入COX比例风险回归模型进行多变量分析。本研究的程序符合2008年和2013年修订的《世界医学会赫尔辛基宣言》的要求。结果①在44例AITL患者中，34例（77.3%）出现B症状。Ann ArborⅠ-Ⅱ期5例（11.4%），Ⅲ-Ⅳ期39例（88.6%）。20例（45.5%）为东方肿瘤协作组，表现状态（ECOG-PS）评分60年，差异有统计学意义（χ2=0.139，P=0.023），血清β2-MG水平≥4mg/L（HR=4.927，P=0.004）是AITL预后的独立危险因素。结论AITL患者多为中老年男性，常伴有皮疹和浆液性积液。这种疾病在安娜堡首次被诊断为晚期。年龄>60岁，骨髓受累，血清β2-MG水平≥4mg/L，可作为非自体造血干细胞移植患者预后不良的独立指标。新的药物如四酰胺和硼替佐米可以提高AITL患者的疗效。自体造血干细胞移植可有效改善患者OS。关键词：淋巴瘤；免疫母细胞性淋巴结病；药物治疗；造血干细胞移植；预后；血管免疫母细胞T细胞淋巴瘤；限制性研究

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Analysis of clinical characteristics and prognosis factors in patients with angioimmunoblastic T-cell lymphoma

Objective To investigate the clinical characteristics and prognostic factors of patients with angioimmunoblastic T-cell lymphoma (AITL). Methods From January to December, 2012, a total of 44 AITL patients admitted to Department of Hematology, First Affiliated Hospital of Air Force Medical University were included as study subjects. There were 36 males and 8 females, with age of 18-78 years and median age of 57.5 years. All 44 patients were treated with CHOP (cyclophosphamide + pirarubicin + vincristine + prednisone) regimen, 4 of them were combined with chidamide or bortezomib, 6 of them were combined with autologous hematopoietic stem cell transplantation (auto-HSCT). Clinical characteristics of AITL patients were retrospectively analyzed. Kaplan-Meier method was used to map overall survival (OS) curves of patients treated with and without auto-HSCT. And univariate analysis of OS rate was performed in patients treated without auto-HSCT using Log-rank test. Influencing factors included gender, age, International Prognostic Index (IPI) score, Prognostic Index for peripheral T-cell lymphoma (PIT) score, B symptoms, skin rashes, chest/abdominal cavity effusion, bone marrow involvement, white blood cell count (WBC), hemoglobin (Hb) value, platelet count, serum lactate dehydrogenase (LDH) level, ferritin level, β2-microglobulin (MG) level. Factors with statistical significance in univariate analysis and clinical guiding significance were included in COX proportional hazards regression model for multivariate analysis. The procedure of this study was accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2008 and 2013. Results ① Among 44 AITL patients, 34 cases (77.3%) had B symptoms. Five cases (11.4%) were Ann Arbor Ⅰ-Ⅱ stage, 39 cases (88.6%) were Ⅲ-Ⅳ stage. Twenty cases (45.5%) had Eastern Cooperative Oncology Group, performance status (ECOG-PS) score 60 years, and the difference was statistically significant (χ2=0.139, P=0.023). The 5-year OS rate in patients with serum β2-MG level 60 years (HR=2.716, P=0.031), bone marrow involvement (HR=2.696, P=0.042), serum β2-MG level≥4 mg/L (HR=4.927, P=0.004) were independent risk factors for AITL prognosis. Conclusions Majority of AITL patients are middle-aged and elderly males, often accompanied by skin rash and serous effusion. The disease was first diagnosed late-stage in Ann Arbor. Age>60 years, bone marrow involvement and serum β2-MG level≥4 mg/L, can be used as independent indicators of poor prognosis of patients treated without auto-HSCT. New drugs such as chidamide and bortezomib could improve curative effect of AITL patients. auto-HSCT coukl effectively improve the OS of patients. Key words: Lymphoma; Immunoblastic lymphadenopathy; Drug therapy; Hematopoietic stem cell transplantation; Prognosis; Angioimmunoblastic T-cell lymphoma; Restrospective studies

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来源期刊

国际输血及血液学杂志

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10610

期刊介绍： The International Journal of Transfusion and Hematology was founded in September 1978. It is a comprehensive academic journal in the field of transfusion and hematology, supervised by the National Health Commission and co-sponsored by the Chinese Medical Association, West China Second Hospital of Sichuan University, and the Institute of Transfusion Medicine of the Chinese Academy of Medical Sciences. The journal is a comprehensive academic journal that combines the basic and clinical aspects of transfusion and hematology and is publicly distributed at home and abroad. The International Journal of Transfusion and Hematology mainly reports on the basic and clinical scientific research results and progress in the field of transfusion and hematology, new experiences, new methods, and new technologies in clinical diagnosis and treatment, introduces domestic and foreign research trends, conducts academic exchanges, and promotes the development of basic and clinical research in the field of transfusion and hematology.