非霍奇金淋巴瘤85例临床及预后分析

目的：分析多种因素对非霍奇金淋巴瘤(NHL)预后的影响。方法：通过SABC法进行免疫分型，采用Kaplan—Meier法分析患者治疗后的生存期，采用Cox比例风险模型分析影响预后的因素。结果：B细胞来源-NHL(B-NHL)发病率为63．3％。T细胞来源-NHL(T—NHL)为36．7％；低度恶性占17．6％，中、高度恶性占74．1％。1、2、3、5年生存率：低度恶性患者为92．1％、84．5％、65．1％、45．1％；中、高度恶性患者为84．9％、67．5％、47．6％、28．4％。I、Ⅱ期患者为98．8％、91.5％、87．5％、70．3％；Ⅲ期、Ⅳ期患者为62．1％、55．5％、40．1％、23．8％。T—NHL为70．8％、53．5％、47．7％、30．2％；B-NHL为82．1％、70．5％、61．1％、50．1％。结论：年龄、乳酸脱氢酶水平、恶性程度、临床分期、免疫分型、身体状况评分(PS)是影响NHL预后的重要因素。     

艾滋病合并霍奇金淋巴瘤3例临床分析

霍奇金淋巴瘤（（Hodgkinlymphoma,HL）是艾滋病病人抗病毒治疗（Anti—retroviraltherapy,ART）后常见的恶性肿瘤之一。武汉大学中南医院艾滋病中心从2004年初至2012年底,共诊治艾滋病合并恶性肿瘤病人130余例,其中HL3例。     

老年人非霍奇金淋巴瘤临床分析

为了探讨影响老年人非霍奇金淋巴瘤 (ＮＨＬ)疗效及生存的因素 ,对 113例老年人ＮＨＬ的临床资料进行回顾性调查分析及随访。一、资料与方法1 对象 :113例老年人ＮＨＬ为 1990～ 2 0 0 0年在我院血液科及肿瘤科经病理组织学检查确诊的住院患者。男 71例 ,女 4 2例 ,男∶女 =1 7∶1,年龄 6 0～ 82岁 ,平均年龄 6 8 5岁。2 首发表现及部位 :以浅表淋巴结肿大伴或不伴发热 ,消瘦者 5 9例 ,骨髓浸润 6例 ,中枢神经系统受累 1例 ;发生部位依次为颈部、腋下、腹股沟、滑车上、窝。首发于结外淋巴组织及深部淋巴结 5 4例 ,骨髓浸润 11例 ,中枢神…     

原发性消化道非霍奇金淋巴瘤31例临床分析

目的探讨原发性消化道非霍奇金淋巴瘤(primary gastrointestinal non-Hodgkin’s lymphoma,PGI-NHL)的临床特征和预后。方法回顾性分析新疆石河子大学医学院第一附属医院2006年1月-2012年12月收治的31例经病理确诊的PGI-NHL患者的临床资料。结果临床表现包括纳差、腹痛、腹胀、呕吐、黑便、发热、乏力、消瘦等,其中最主要临床表现为纳差、腹胀。病理分型均为B细胞性淋巴瘤。Kaplan-Meler分析,Log Rank比较显示,性别、年龄、是否行手术、是否有B组症状与生存无显著相关性(P0.05),分期与生存有显著相关性(P0.05)。结论 PGI-NHL分期发现越早预后越好,因此,PGI-NHL的早期诊断有重要的临床意义。     

T细胞性非霍奇金淋巴瘤103例的预后分析

目的T细胞性非霍奇金淋巴瘤（T—NHL）是一组异质性疾病,恶性度高,疗效差,在我国相对高发,目前尚无有效的预后指标可以用来预见其治疗效果。本研究回顾性分析103例T—NHL的临床特征与预后的关系。方法收集1998年12月至2004年12月在中山大学肿瘤防治中心确诊、有完整临床资料的T-NHL,所有病例按照WHO2001淋巴瘤分类标准进行病理分型,并对临床资料进行分析,总结其与预后的关系。结果103例患者中位年龄35（2～78）岁,男68例,女35例,中位生存时间24．1（0．8～84）个月,5年总生存率24．3％（25／103）,其中25例（24．3％）采用放、化联合治疗,70例（68．0％）采用单纯化疗,3例采用单纯放疗,5例在获得完全缓解后进行造血干细胞移植。单因素生存分析年龄≥160岁、晚期病例（Ⅲ、Ⅳ）、结外侵犯、巨大包块、B症状、体质状况（PS）≥2,LDH升高、低白蛋白血症、高危国际预后指数（IPI）（IPI≥12）与预后不良有关,但是多因素分析证实年龄≥60岁、低蛋白血症、PS≥12是独立的预后不良因素。结论本研究证实了年龄、血清白蛋白水平、PS是T—NHL的独立预后因素。     

非霍奇金淋巴瘤并发高钙血症5例临床报告

目的:探讨非霍奇金淋巴瘤(NHL)并发高钙血症患者的发病机制及临床特点。方法:回顾性分析5例伴高钙血症的NHL患者的临床病历资料。结果:5例患者中,伴骨髓侵犯4例,其中2例已达白血病期;血钙浓度3.5~4.93 mmol/L,乳酸脱氢酶(LDH)441~6 470 mmol/L,血β2微球蛋白3.86~7.71 mg/L,Ki67(增殖细胞核抗原)70%~95%,甲状旁腺激素(PTH)降低4例,多发骨破坏1例,骨质疏松1例。所有患者均给予降钙治疗,1例顽固性高钙血症在加用糖皮质激素后血钙降至正常,1例出现急性肾功能不全行血液透析。所有患者均给予原发病的治疗,未再出现高钙血症,其中1例外周T细胞淋巴瘤患者共完成8个疗程化疗,但出现病情进展,生存期仅9个月;另1例弥漫大B细胞淋巴瘤患者已完成6个疗程免疫化疗,但疗效仅达部分缓解(PR)。结论:NHL并发高钙血症常见于中高度NHL,临床分期常较晚期,常伴有血清LDH升高、肿瘤细胞高负荷及高增殖活性,对化疗疗效欠佳,生存期短,预后不良。     

老年非霍奇金淋巴瘤的临床特点及预后分析

目的 探讨老年非霍奇金淋巴瘤（NHL）的临床特征和预后。方法 回顾性地分析2002年12月至2012年12月昆明医科大学第三附属医院收治的≥65岁NHL患者120例的临床资料。结果 老年NHL高发病年龄段为65～75岁;弥漫大B细胞淋巴瘤（55.0%）为最常见病理类型。患者从出现首发症状至确诊的中位时间为78d。确诊时ECOG评分0～1分者较多（62.5%）;45%的患者有伴发疾病,最常见的伴发疾病为高血压病。临床分期、全身症状、ECOG评分、国际预后指数（IPI）与总生存时间有相关性（P＜0.05）。结论 老年NHL患者合并症多,症状不典型,诊断困难,但病情发展较慢。临床分期、全身症状、ECOG评分、IPI与总生存时间有相关性。     

肺原发性霍奇金淋巴瘤临床病理分析

目的 探讨肺原发性霍奇金淋巴瘤的诊断与鉴别诊断.方法 回顾性分析3例肺霍奇金淋巴瘤病例并复习相关文献.结果 3例患者均为男性,以咳嗽症状为主,肿瘤较大,平均直径为5 cm,可伴有肺门及纵隔淋巴结肿大,镜下均可见典型的RS细胞,背景细胞内有较明显嗜酸粒细胞浸润,并见干尸细胞,免疫组化CD15和CD30阳性.化疗、骨髓移植可使病情缓解,长期生存.结论 肺原发性霍奇金淋巴瘤病理学及免疫表型具有一定的特征,恰当的治疗预后良好.     

非霍奇金淋巴瘤18例误诊分析

非霍奇金淋巴瘤（NHL）没有特异的临床症状和体征。早期诊断困难,容易误诊,我院曾收治的25例非霍奇金淋巴瘤的住院患者,其中误诊18例,误诊时间最长为7个月,现报道如下。     

成人经典霍奇金淋巴瘤28例临床分析

霍奇金淋巴瘤（HL）是起源于淋巴结和淋巴组织的恶性肿瘤，一般预后较好，但不同病理类型、不同临床分期的HL，其生物学行为、治疗手段、预后等均有所不同。我院1990年6月至2006年6月住院诊治的28例经典型HL（CHL）患者临床资料进行了回顾性总结。     

Patterns of subsequent malignancies after Hodgkin lymphoma in children and adults

To evaluate the impact of reduced radiation and combined modality therapy (CMT) in the treatment of Hodgkin lymphoma, we assessed the risk of second malignant neoplasms (SMNs) in patients who received extended-field radiotherapy only and patients who underwent CMT. Among 404 patients treated at Yale during 1970-2004, the risk of solid SMNs was elevated in the radiotherapy only group (n = 198, median follow-up = 21·1 years) compared to the general population, with a standardized incidence ratio (SIR) of 1·85 [95% confidence interval (CI): 1·17-2·78]. No increase was observed in the CMT group (n = 206, median follow-up = 14·3 years), although potential differences in SMN risk were indicated across the age spectrum in subgroup analysis. Patients who received mustard-containing regimens had increased risks for haematological SMNs (SIR = 8·74) and all SMNs (SIR = 1·85). When the analysis was stratified by age at diagnosis, children (0-20 years) had a significantly higher risk of SMNs (SIR = 5·24, 95% CI: 2·26-10·33), regardless of the treatment received. These findings suggest that recent treatment options utilizing lower dose radiation and less intense alkylator chemotherapy might be associated with lower incidences of SMNs among adults but not necessarily children.     

Reduced intensity VEPEMB regimen compared with standard ABVD in elderly Hodgkin lymphoma patients: results from a randomized trial on behalf of the Fondazione Italiana Linfomi (FIL)

Survival rates for elderly Hodgkin Lymphoma (HL) have not improved substantially in recent years, mainly because of a lack of prospective randomized studies, due to difficulties in enrolling patients. Between 2002 and 2006, 54 untreated HL patients, aged between 65 and 80 years and considered ‘non‐frail’ according to a comprehensive geriatric evaluation, were enrolled into a phase III randomized trial to compare a reduced‐intensity regimen (vinblastine, cyclophosphamide, procarbazine, prednisone, etoposide, mitoxantrone, bleomycin; VEPEMB) with standard ABVD (adriamycin, bleomycin, vinblastine, dacarbazine). Primary endpoint was progression‐free survival (PFS). Seventeen patients were in early stage (I‐IIA), while 37 were advanced stage. Median age was 72 years and median follow‐up was 76 months. Five‐year PFS rates were 48% vs. 70% [adjusted Hazard ratio (HR) = 2·19, 95% confidence interval (CI) = 0·94–5·10, P = 0·068] and 5‐year overall survival (OS) rates were 63% vs. 77% (adjusted HR = 1·67, 95% CI = 0·69–4·03, P = 0·254) for VEPEMB compared to ABVD. Overall treatment‐related mortality was 4%. World Health Organization grade 4 cardiac and lung toxicity occurred in four patients treated with ABVD versus no cases in the VEPEMB arm. Standard ABVD regimen resulted in better PFS and OS than the VEPEMB, although the differences were not statistically significant. The low toxicity of both treatments was probably attributable to stringent selection of patients based on a Comprehensive Geriatric Assessment that excluded frail patients.     

Therapy-related classical Hodgkin lymphoma after a primary haematological malignancy: a report on 13 cases

The risk of developing Hodgkin lymphoma (HL) is increased in immunodeficiencies or during the treatment of some autoimmune diseases. The development of new therapeutic agents has highlighted the risk of unusual lymphoid proliferations, particularly classical HL (cHL). We report the clinicopathological findings of 13 cHL arising in patients treated for a primary haematological malignancy. Eight patients had received an immunomodulator, protein tyrosine-kinase inhibitor or monoclonal antibody, which may have contributed to the cHL development. Most patients had disseminated disease with poor prognostic factors at cHL diagnosis. Despite the initial presentation, good outcomes were achieved with standard cHL chemotherapy.     

以腹部包块起病的恶性淋巴瘤35例临床研究

目的总结以腹部包块起病的恶性淋巴瘤患者的临床表现、病理及治疗反应等临床特点。方法对1998~2003年解放军总医院收治的35例以腹部包块起病的恶性淋巴瘤患者的病例及随访资料进行回顾性分析。随访时间16~96个月。结果男性患者占74·3%;以腹膜后淋巴结肿大最多(71·4%);非霍奇金淋巴瘤(NHL)占91·4%(32/35),霍奇金病占8·6%(3/35);非霍奇金淋巴瘤患者中40~50岁发病占15/32(46·9%);NHL中B细胞来源非霍奇金淋巴瘤(B-NHL)比例65·6%(21/32),T细胞来源非霍奇金淋巴瘤(T-NHL)占28·1%(9/32),2例未分型占6·3%;3例霍奇金病患者中1例死于复发,非霍奇金淋巴瘤患者死亡9例,其中常规化疗组6例,移植组3例;起病时伴有肝功能异常及腹水的患者4例中2例死亡。结论以腹部包块起病的恶性淋巴瘤男性多见;B-NHL多见;临床表现以腹部症状为主,包块巨大、有腹水及肝功异常者预后差。     

Chemotherapy only for localized Hodgkin lymphoma

Radiation therapy (RT) alone and more recently in combination with chemotherapy (combined modality therapy; CMT) has been the cornerstone of curative treatment for early-stage Hodgkin lymphoma (HL) for over 40 years. Because of increasing awareness of the late morbidity and mortality associated with RT, recent treatment regimens have attempted to limit its use. Chemotherapy only has been demonstrated to be a treatment option for most patients with localized HL. Current clinical trials have targeted subgroups of such patients who may be at an increased risk of recurrence for the addition of limited RT to chemotherapy.     

Whole‐body MRI reveals high incidence of osteonecrosis in children treated for Hodgkin lymphoma

Osteonecrosis is a well‐recognized complication in patients treated with corticosteroids. The incidence of osteonecrosis in children treated for Hodgkin lymphoma is unknown because prospective whole‐body magnetic resonance imaging (MRI ) studies are lacking in this patient population. Paediatric patients with newly diagnosed Hodgkin lymphoma who were treated according to a uniform paediatric Hodgkin protocol were eligible for inclusion in this prospective study. Whole‐body MRI was performed in all 24 included patients (mean age 15·1 years, 12 girls) both before treatment and after 2 cycles of chemotherapy, and in 16 patients after completion of chemotherapy. Osteonecrosis was identified in 10 patients (41·7%, 95% confidence interval: 22·0–61·4%), with a total of 56 osteonecrotic sites. Osteonecrosis was detected in 8 patients after 2 cycles of OEPA (vincristine, etoposide, prednisone, doxorubicin), and in 2 additional patients after completion of chemotherapy. Epiphyseal involvement of long bones was seen in 4 of 10 children. None of the patients with osteonecrosis had any signs of bone collapse at the times of scanning. Whole‐body MRI demonstrates osteonecrosis to be a common finding occurring during therapy response assessment of paediatric Hodgkin lymphoma. Detection of early epiphyseal osteonecrosis could allow for treatment before bone collapse and joint damage may occur.     

Modern principles in the management of nodular lymphocyte-predominant Hodgkin lymphoma

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique rare subtype of Hodgkin lymphoma (HL) which differs clinically, pathologically and biologically from classic HL, warranting a nuanced approach to treatment. CD20 expression by malignant lymphocyte-predominant cells, a tendency for late relapses, and the risk of transformation to aggressive large B-cell lymphoma are characteristic features with important implications for treatment and follow-up. Recognition of histopathological variant patterns is also critical, with important implications for prognosis and treatment. The optimal management for NLPHL is unclear and opinions differ as to whether treatment paradigms should be similar to, or differ from, those for classic HL. Therapy differs for early versus advanced stage disease and for frontline versus relapsed or refractory disease. Potential treatment strategies include radiotherapy, combined modality therapy, chemotherapy, rituximab and watchful waiting. Given the excellent overall survival of NLPHL, treatment choices should be geared towards reducing long-term toxicity and optimizing survivorship. In this review, we provide an overview of the current literature and discuss modern principles in the management of NLPHL.     

High‐dose chemo‐radiotherapy for relapsed or refractory Hodgkin lymphoma and the significance of pre‐transplant functional imaging

We previously reported that three risk factors (RF): initial remission duration <1 year, active B symptoms, and extranodal disease predict outcome in relapsed or refractory Hodgkin lymphoma (HL). Our goal was to improve event‐free survival (EFS) for patients with multiple RF and to determine if response to salvage therapy impacted outcome. We conducted a phase II intent‐to‐treat study of tailored salvage treatment: patients with zero or one RF received standard‐dose ifosfamide, carboplatin, and etoposide (ICE); patients with two RF received augmented ICE; patients with three RF received high‐dose ICE with stem cell support. This was followed by evaluation with both computed tomography and functional imaging (FI); those with chemosensitive disease underwent high‐dose chemoradiotherapy and autologous stem cell transplantation (ASCT). There was no treatment‐related mortality. Compared to historical controls this therapy eliminated the difference in EFS between the three prognostic groups. Pre‐ASCT FI predicted outcome; 4‐year EFS rates was 33% vs. 77% for patients transplanted with positive versus negative FI respectively, P = 0·00004, hazard ratio 4·61. Risk‐adapted augmentation of salvage treatment in patients with HL is feasible and improves EFS in poorer‐risk patients. Our data suggest that normalisation of FI pre‐ASCT predicts outcome, and should be the goal of salvage treatment.