CAJ | 학술논문

目的总结分析儿童B细胞非霍奇金淋巴瘤(B-NHL)短程化疗方案的远期疗效及预后影响因素.方法前瞻性制定B-NHL的诊断与治疗方案.收集接受短程B-NHL 2001化疗方案治疗和随访的104例B-NHL患儿资料,并进行统计学分析.结果 104例B-NHL患儿中,男79例、女25例,中位年龄7.1(0.9 ～ 16.0)岁；96例病理类型明确的患儿中,Burkitt淋巴瘤60例、弥漫大B细胞淋巴瘤32例、介于弥漫大B细胞淋巴瘤与霍奇金淋巴瘤的B细胞淋巴瘤4例；另有8例为通过体液形态学和免疫表型分析诊断.诊断时Ⅰ、Ⅱ、Ⅲ和Ⅳ期患儿分别为4、27、55和18例；低危、中危和高危组患儿分别为1、26和77例.采用短程B-NHL 2001化疗方案治疗后,16例患儿出现肿瘤溶解综合征,3例患儿未获得缓解,9例患儿在缓解后复发,复发时间为停药后1～7个月,7例患儿在化疗结束后接受自体造血干细胞移植治疗,6例患儿在疗程中加用利妥昔单抗.中位随访24(4 ～92)个月,104例患儿5年无事件生存(EFS)率为(86.7±3.5)％.单因素分析显示诊断时疾病分期、LDH水平、血清铁蛋白水平和2个疗程后是否达缓解与患儿预后有显著相关性(P值均＜0.05),而年龄、性别、病理类型、原发部位、是否有骨骼或骨髓浸润、C-myc断裂和治疗分组等对患儿预后无影响(P值均＞0.05).多因素COX分析显示血清铁蛋白水平与患儿预后有显著相关性(P＜0.05).结论短程B-NHL 2001治疗方案对儿童B-NHL疗效肯定,预后与疾病分期、LDH、血清铁蛋白水平和早期治疗反应显著相关.
목적 총결분석인동B세포비곽기금림파류(B-NHL)단정화료방안적원기료효급예후영향인소.방법 전첨성제정B-NHL적진단여치료방안.수집접수단정B-NHL 2001화료방안치료화수방적104례B-NHL환인자료,병진행통계학분석.결과 104례B-NHL환인중,남79례、녀25례,중위년령7.1(0.9 ～ 16.0)세；96례병리류형명학적환인중,Burkitt림파류60례、미만대B세포림파류32례、개우미만대B세포림파류여곽기금림파류적B세포림파류4례；령유8례위통과체액형태학화면역표형분석진단.진단시Ⅰ、Ⅱ、Ⅲ화Ⅳ기환인분별위4、27、55화18례；저위、중위화고위조환인분별위1、26화77례.채용단정B-NHL 2001화료방안치료후,16례환인출현종류용해종합정,3례환인미획득완해,9례환인재완해후복발,복발시간위정약후1～7개월,7례환인재화료결속후접수자체조혈간세포이식치료,6례환인재료정중가용리타석단항.중위수방24(4 ～92)개월,104례환인5년무사건생존(EFS)솔위(86.7±3.5)％.단인소분석현시진단시질병분기、LDH수평、혈청철단백수평화2개료정후시부체완해여환인예후유현저상관성(P치균＜0.05),이년령、성별、병리류형、원발부위、시부유골격혹골수침윤、C-myc단렬화치료분조등대환인예후무영향(P치균＞0.05).다인소COX분석현시혈청철단백수평여환인예후유현저상관성(P＜0.05).결론 단정B-NHL 2001치료방안대인동B-NHL료효긍정,예후여질병분기、LDH、혈청철단백수평화조기치료반응현저상관.
Objective To analyze outcomes and prognostic factors of children with B-cell non-Hodgkin lymphoma (B-NHL).Methods One hundred and four newly diagnosed B-NHL children were enrolled in protocol of B-NHL 2001.The statistics were performed by SPSS 13.0.Results Of 104 children (79 males,the median age of 7.1 years),60,32 and 4 patients were diagnosed with Burkitt lymphoma,diffuse large B-cell lymphoma and unclassifiable B-cell lymphoma,respectively.Four patients were in stage Ⅰ,27 stage Ⅱ,55 stage Ⅲ and 18 stage Ⅳ ; 1,26 and 77 patients were allocated into RI,R2 and R3 risk groups,respectively.Three patients never got complete remission (CR),9 patients relapsed after CR with the duration of relapse from 1 to 7 months after chemotherapy.The estimated 5-year EFS of 104 patients was (86.7 ± 3.5)％.Univariable analyses identified that risk factors for recurrence were of higher staging,elevated LDH,serum ferritin and poor early response.Age,sex,pathologic diagnosis,original tumor,bone or marrow involvement,C-MYC and risk group were not found to be associated with the risk of failure to treatment.Multivariable COX regression models confirmed serum ferritin as a significant independent prognostic marker.Conclusion B-NHL 2001 protocol was reasonable for B-NHL children.Higher staging,elevated LDH,serum ferritin and poor early response increased risk for recurrence.