中华老年多器官疾病杂志
中華老年多器官疾病雜誌
중화노년다기관질병잡지
CHINESE JOURNAL OF MULTIPLE ORGAN DISEASES IN THE ELDERLY
2013年
8期
575-580
,共6页
杨申淼%江倩%江滨%陈定宝%王婧%江浩%路瑾%卢锡京%鲍立%石红霞%刘艳荣%黄晓军
楊申淼%江倩%江濱%陳定寶%王婧%江浩%路瑾%盧錫京%鮑立%石紅霞%劉豔榮%黃曉軍
양신묘%강천%강빈%진정보%왕청%강호%로근%로석경%포립%석홍하%류염영%황효군
淋巴瘤%骨髓检查%自身免疫
淋巴瘤%骨髓檢查%自身免疫
림파류%골수검사%자신면역
lymphoma%bone marrow examination%autoimmunologic
目的研究淋巴结边缘区淋巴瘤（NMZL）的临床特点。方法回顾性分析了14例经淋巴结活检确诊为NMZL患者的临床资料。结果14例患者中13例（92.9%）就诊时外周血细胞计数异常：6例（42.9%）白细胞（ WBC）＞10.0×109/L ；4例白细胞（28.6%）＜4.0×109/L；7例（50%）淋巴细胞比例＞50%，绝对值＞5.0×109/L；10例（71.4%）血红蛋白＜120g/L；6例（42.9%）血小板＜100×109/L。2系血细胞减少4例（28.6%），全血细胞减少2例（14.3%）。10例（71.4%）患者骨髓受累，其中5例（50%）存在单克隆轻链限制型B细胞。外周血淋巴细胞百分比与骨髓NMZL细胞百分比正相关（r＝0.811，P＝0.008）。免疫球蛋白升高的检出率为100%（12/12），其中单克隆免疫球蛋白升高者10例（10/12，83.3%）。≥1种自身抗体阳性8例（8/11，72.7%）。14例患者Ann Arbor分期均在Ⅲ或Ⅳ期。免疫化疗作为初始治疗10例；利妥昔单抗单药治疗1例；单纯化疗治疗2例；干扰素治疗1例。完全缓解8例（57.1%），部分缓解3例（21.4%）。中位随访23个月，2年总体生存（OS）率为84.6%，2年无疾病进展生存（PFS）率为71.4%，预期的中位总体生存时间90个月，预期的中位无疾病进展生存时间为39个月。结论Ⅲ/Ⅳ期NMZL患者血细胞计数异常、骨髓侵犯、免疫异常多见，外周血淋巴细胞增多可能提示NMZL骨髓浸润。
目的研究淋巴結邊緣區淋巴瘤（NMZL）的臨床特點。方法迴顧性分析瞭14例經淋巴結活檢確診為NMZL患者的臨床資料。結果14例患者中13例（92.9%）就診時外週血細胞計數異常：6例（42.9%）白細胞（ WBC）＞10.0×109/L ；4例白細胞（28.6%）＜4.0×109/L；7例（50%）淋巴細胞比例＞50%，絕對值＞5.0×109/L；10例（71.4%）血紅蛋白＜120g/L；6例（42.9%）血小闆＜100×109/L。2繫血細胞減少4例（28.6%），全血細胞減少2例（14.3%）。10例（71.4%）患者骨髓受纍，其中5例（50%）存在單剋隆輕鏈限製型B細胞。外週血淋巴細胞百分比與骨髓NMZL細胞百分比正相關（r＝0.811，P＝0.008）。免疫毬蛋白升高的檢齣率為100%（12/12），其中單剋隆免疫毬蛋白升高者10例（10/12，83.3%）。≥1種自身抗體暘性8例（8/11，72.7%）。14例患者Ann Arbor分期均在Ⅲ或Ⅳ期。免疫化療作為初始治療10例；利妥昔單抗單藥治療1例；單純化療治療2例；榦擾素治療1例。完全緩解8例（57.1%），部分緩解3例（21.4%）。中位隨訪23箇月，2年總體生存（OS）率為84.6%，2年無疾病進展生存（PFS）率為71.4%，預期的中位總體生存時間90箇月，預期的中位無疾病進展生存時間為39箇月。結論Ⅲ/Ⅳ期NMZL患者血細胞計數異常、骨髓侵犯、免疫異常多見，外週血淋巴細胞增多可能提示NMZL骨髓浸潤。
목적연구림파결변연구림파류（NMZL）적림상특점。방법회고성분석료14례경림파결활검학진위NMZL환자적림상자료。결과14례환자중13례（92.9%）취진시외주혈세포계수이상：6례（42.9%）백세포（ WBC）＞10.0×109/L ；4례백세포（28.6%）＜4.0×109/L；7례（50%）림파세포비례＞50%，절대치＞5.0×109/L；10례（71.4%）혈홍단백＜120g/L；6례（42.9%）혈소판＜100×109/L。2계혈세포감소4례（28.6%），전혈세포감소2례（14.3%）。10례（71.4%）환자골수수루，기중5례（50%）존재단극륭경련한제형B세포。외주혈림파세포백분비여골수NMZL세포백분비정상관（r＝0.811，P＝0.008）。면역구단백승고적검출솔위100%（12/12），기중단극륭면역구단백승고자10례（10/12，83.3%）。≥1충자신항체양성8례（8/11，72.7%）。14례환자Ann Arbor분기균재Ⅲ혹Ⅳ기。면역화료작위초시치료10례；리타석단항단약치료1례；단순화료치료2례；간우소치료1례。완전완해8례（57.1%），부분완해3례（21.4%）。중위수방23개월，2년총체생존（OS）솔위84.6%，2년무질병진전생존（PFS）솔위71.4%，예기적중위총체생존시간90개월，예기적중위무질병진전생존시간위39개월。결론Ⅲ/Ⅳ기NMZL환자혈세포계수이상、골수침범、면역이상다견，외주혈림파세포증다가능제시NMZL골수침윤。
Objective To investigate the clinical characteristics of nodal marginal zone lymphoma (NMZL). Methods Data of 14 NMZL patients diagnosed by lymph nodes histological examination were retrospectively analyzed. Results Among the 14 patients, 13(92.9%) had abnormal complete blood counts(CBC). Leukocytosis [white blood cells(WBC)≥10.0×109/L] was observed in 6 patients (42.9%); leukocytopenia (WBC<4.0×109/L) in 4 patients(28.6%); absolute lymphocyte counts>5.0×109/L in 7 patients (50%);hemoglobin concentration<120g/L in 10 patients(71.4%), thrombocytopenia(platelet<100×109/L) in 6 patients(42.9%); cytopenia in more than 2 lineages in 4 patients (28.6%);pancytopenia in 2 cases(14.3%). Ten patients(71.4%) had bone marrow involvement. Among them, monoclonal B cells with a light chain restriction was found in 5 patients (50%). Percentage of lymphocytes in peripheral blood correlated positively with percentage of NMZL cells in bone marrow(r=0.811,P=0.008). Hyperimmunoglobulinemia was found in all patients (12/12, 100%). Among them, serum monoclonal paraprotein was found in 10 patients(10/12, 83.3%). At least one auto-antibody positivity was found in 8 out of 11 patients (72.7%). All of 14 patients had Ann Arbor stage Ⅲ or Ⅳ. Immunochemotherapy was administered in 10 patients. Rituximab was given as a single agent to 1 patient. Chemotherapy was given to 2 patients, and interferon alpha was given to 1 patient. Complete response was achieved in 8 patients (57.1%), and partial response in 3 patients (21.4%). Median duration of follow-up was 23 months. Accumulated 2-year overall survival (OS) rate and 2-year progression-free survival (PFS) rate were 84.6% and 71.4%, respectively. Estimated median OS and PFS were 90 and 39 months, respectively. Conclusion NMZL patients at stage Ⅲ/Ⅳ have high a incidence of CBC abnormality, bone marrow involvement and autoimmunologic abnormality. Peripheral blood lymphocytosis might indicate NMZL bone marrow involvement.
