初治原发性骨淋巴瘤患者的临床特征和长期预后分析

目的:分析原发骨淋巴瘤患者的临床特征及长期预后。方法:回顾性分析2005年至2018年首都医科大学附属北京世纪坛医院血液淋巴肿瘤中心收治的21例恶性淋巴瘤患者的临床资料,分析其临床特点及影响预后的因素。结果:21例患者均为初治原发骨淋巴瘤,中位发病年龄40岁,其中19例患者以疼痛起病,9例患者为单发骨病灶。全组有12例患者为弥漫大B细胞淋巴瘤,其余为间变大细胞淋巴瘤(6例)和T淋巴母细胞淋巴瘤(2例)。所有患者均接受化疗,部分患者联合放疗和/或自体造血干细胞移植,18例临床缓解(CR 15例,PR 3例)。中位随访时间为48个月,5年PFS、OS率分别为63.7%和67.5%。单因素分析显示,自体造血干细胞移植有利于提高PFS(P=0.045),单发骨病变更有利于提高OS(P=0.015);患者年龄、性别、分期、ECOG评分、LDH水平、B症状、放疗对PFS、OS的影响均无统计学差异(P>0.05)。结论:原发骨淋巴瘤发病年龄较轻,弥漫大B细胞淋巴瘤为最常见病理类型,自体造血干细胞移植和是否单发骨病变对预后有一定影响。

Clinical Characteristics and Long-term Prognosis Analysis of Patients with Primary Bone Lymphoma

Objective:To analyze the clinical characteristics and long-term prognosis of patients with primary bone lymphoma(PBL).Methods:The clinical data of 21 patients with PBL treated in our center from 2005 to 2018 were analyzed retrospectively,the clinical characteristics and the factors affecting prognosis of the patients were analyzed.Results:The median age of all the 21 newly diagnosed PBL patients was 40(12-71) years old.Ostealgia was the initial symptom in most of the patients(19/21,90.5%).42.9%(9/21) of the patients showed single bone lesion only.57.1%(12/21) of the patients showed diffuse large B cell lymphoma.28.6%(6/21) of the patients showed anaplastic large cell lymphoma and 9.5%(2/21) of the patients showed T cell lymphoblastic lymphoma.All the patients received chemotherapy(CHOP or CHOP like regimen,33.3% plus rituximab) with or without radiotherapy and/or autologous hematopoietic stem cell transplantation(ASCT).18 patients achieved clinical remission(including 15 for CR and 3 for PR).The median follow-up time was 48 months.The 5-year overall survival rate and progression-free survival rate of the patients were was 67.5% and 63.7%,respectively.The single factors analysis showed that ASCT was the important prognostic factor of PFS,while the single or multiple bone lesion was the factors affecting OS of the patients.There were no statistical differences with the effects of age,sex,stage,ECOG score,LDH level,B symptoms and radiotherapy for the prognosis of patients.Conclusion:Diffuse large B cell lymphoma is the most common pathological type of PBL.Chemotherapy is the main treatment,which can be combined with radiotherapy and/or ASCT.The ASCT and the number of bone lesion are the factors for long time survival of the patients.