移植和一些临床因素对弥漫大B细胞淋巴瘤患者预后影响

本研究回顾性分析经正规R-CHOP方案治疗弥漫大B细胞淋巴瘤（DLBCL）患者的生存状况,探讨自体造血干细胞移植（auto-HSCT）、病理类型、国际预后指数（IPI）等因素对预后的影响。收集2004-2011年在本院接受R-CHOP21≥6次化疗的DLBCL患者116例。分析单纯化疗及化疗联合自体造血干细胞移植取得的疗效,以及不同免疫病理类型、临床观察指标如IPI、超敏C反应蛋白（HSCRP）、a-羟丁酸脱氨酶（HBDH）等因素对DLBCL患者预后的影响,包括对总体生存率（OS）、无进展生存率（PFS）的系统观察。结果表明,接受R-CHOP21方案治疗的116例DLBCL患者5年OS为72.4%,其中30例患者接受自体造血干细胞移植（Ann Arbor分期均为Ⅲ-Ⅳ期）。30例移植组患者预后较86例单纯化疗组好（5年OS为82.5%vs 69.0%,5年PFS为77.1%vs 68.3%）（P〈0.05）;生发中心（GCB）型组患者预后较活化亚型（ABC）组好（P〈0.05）;IPI 3-5分、年龄≥60岁、B症状、LDH升高、HSCRP升高、HBDH升高是预后不良因素（P〈0.05）,其中LDH升高、年龄≥60岁、B症状是本研究患者的独立危险因素（P〈0.05）。结论：自体造血干细胞移植联合R-CHOP治疗方案能明显改善DLBCL患者的预后,GCB型患者预后优于ABC型,B症状、IPI评分、LDH、HSCRP、HBDH是预后的影响因素。

Influence of Transplantation and Some Clinical Factors on Prognosis of Patients with Diffuse Large B-cell Lymphoma

This study was aimed to analyze the survival status of patients with diffuse large B-cell lymphoma （ DL- BCL ） and to investigate the influence of autologous hematopoietic stem cell transplantation（ auto-HSCT）, different pathologicai types, International Prognosis Idex（IPI） on prognosis. One hundred and sixteen cases of DLBCL were analyzed retrospectively. The treatment efficacy of R-CHOP alone and R-CHOP combined with auto-HSCT as well as the influence of different immunopathologic types, IPI, hypersensitive C-reative protein（HSCRP）, a-hydroxybutyric acid deaminase （HBDH） on the prognosis of DLBCL patients including overall survival （OS） rate, progression-free survival （PFS） rate were analyzed. The results indicated that the 5-year OS for all patients was 72.4%. in which 30 patients with Ann Arbor staging Ⅲ - IV received auto-HSCT plus R-CHOP. The prognosis of the 30 patients was better than that of 86 cases received R-CHOP chemotherapy alone （5-year OS was 82.5% vs 69.0%, 5-year PFS was 77.1% vs 68. 3 % ） （ P 〈 0.05 ）. The prognosis of patients in germinal center B-cell-like group （ GCB group） was better than that of patients in activated B-cell-like group（ABC group）. Some clinical features were associated with poor prognosis including OS and PFS, such as age, B symptoms, IPI scores, the level of LDH, HSCRP and HBDH （ P 〈 0.05 ） in which the level of LDH, age〉60 years and B symptoms were independent prognostic factors in DLBCL patients （P 〈 0.05）. It is concluded that auto-HSCT combined with R-CHOP can improve the long-term survival of DLBCL patients. The prognosis of patients in GCB group is better than that of patients in the ABC group. The clinical features such as age, B symptoms, IPI scores and LDH are associated with oronosis.