CAJ | 학술논문

目的：探讨老年弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma，DLBCL)的临床病理学特征和疗效。方法对2003年1月-2012年12月我院收治的15例老年DLBCL患者的临床资料进行回顾性分析，包括患者的一般临床特征、病理特点、化疗方案选择及疗效，并结合电话随访收集患者生存资料。结果15例患者中位年龄84岁；所有患者合并至少2种其他疾病，其中以高血压病和冠状动脉粥样硬化性心脏病最常见，有4例合并第二肿瘤；出现B组症状(发热、盗汗及体重下降)的占13例；病理亚型中以非生发中心细胞型(non-GCB)居多(10/15)；Ann-Arbor分期Ⅱ期1例，Ⅲ/Ⅳ期14例；国际预后指数(international prognostic index，IPI)评分3~5分14例；初诊时有10例血清乳酸脱氢酶(LDH)高于正常。全组病例均采用R-CHOP(利妥昔单抗联合CHOP)为基础的个体化方案化疗，4个疗程后完全缓解(CR)4例，部分缓解(PR)8例，疾病稳定(SD)1例，疾病进展(PD)2例，治疗总反应12例；全组病例半年总生存10例，1年总生存8例；半年、1年无进展生存分别为7例、6例。结论老年DLBCL初诊时合并基础疾病多、分期较晚、病理分型以non-GCB亚型为主，预后很差；应在强化支持治疗的基础上，根据不同预后，采用个体化R-CHOP方案化疗。
목적：탐토노년미만대B세포림파류(diffuse large B-cell lymphoma，DLBCL)적림상병이학특정화료효。방법대2003년1월-2012년12월아원수치적15례노년DLBCL환자적림상자료진행회고성분석，포괄환자적일반림상특정、병리특점、화료방안선택급료효，병결합전화수방수집환자생존자료。결과15례환자중위년령84세；소유환자합병지소2충기타질병，기중이고혈압병화관상동맥죽양경화성심장병최상견，유4례합병제이종류；출현B조증상(발열、도한급체중하강)적점13례；병리아형중이비생발중심세포형(non-GCB)거다(10/15)；Ann-Arbor분기Ⅱ기1례，Ⅲ/Ⅳ기14례；국제예후지수(international prognostic index，IPI)평분3~5분14례；초진시유10례혈청유산탈경매(LDH)고우정상。전조병례균채용R-CHOP(리타석단항연합CHOP)위기출적개체화방안화료，4개료정후완전완해(CR)4례，부분완해(PR)8례，질병은정(SD)1례，질병진전(PD)2례，치료총반응12례；전조병례반년총생존10례，1년총생존8례；반년、1년무진전생존분별위7례、6례。결론노년DLBCL초진시합병기출질병다、분기교만、병리분형이non-GCB아형위주，예후흔차；응재강화지지치료적기출상，근거불동예후，채용개체화R-CHOP방안화료。
Objective To study the clinicopathological features of elderly patients with diffuse large B-cell lymphoma (DLBCL) and its therapeutic effect. Methods Fifteen elderly DLBCL patients with a mean age of 84 years admitted to our hospital from January 2003 to December 2012 were included in this study. Their clinical data including general clinical characteristics, pathological features, chemotherapy and its effect were retrospectively analyzed. Results Of the 15 DLBCL patients who suffered from at least 2 underlying diseases with hypertension and coronary arteriosclerotic heart disease being most predominant, 4 were complicated by a secondary tumor, 13 had B symptoms (such as fever, night sweat and loss of body weight), 10 were diagnosed as non-GCB type, 1 was classified as Ann-ArborⅡand 14 were classified as Ann-ArborⅢ/Ⅳ, 1 had an IPI score≤2 and 14 had an IPI score of 3-5. The serum LDH level was elevated in 10 patients at their first visit. The patients underwent R-CHOP-based individual chemotherapy with complete remission, partial remission, stable disease, and progressive disease achieved in 4, 8, 1 and 2 patients, respectively, after 4 cycles of chemotherapy. Twelve patients responded to chemotherapy. The overall survival (OS) time was 6 months in 10 patients and 1 year in 8 patients. The progression-free survival (PFS) time was 6 months in 7 patients and 1 year in 6 patients. Conclusion DLBCL in elderly patients is usually complicated by other pre-existing diseases and diagnosed at its late stage, with non-GCB as its pain pathological subtype and a poor prognosis. Elderly DLBCL patients should receive R-CHOP-based individual chemotherapy on the basis of intensified supportive treatment.