CAJ | 학술논문

目的通过报道3例罕见的原发骨髓弥漫大B细胞淋巴瘤(DLBCL)患者的诊断、鉴别诊断和治疗经过,提高对该病的认识.方法分析患者的发病经过、临床特点、治疗反应和转归,对患者的骨髓标本进行细胞形态学、流式细胞术、免疫组织化学和分子生物学检测以助诊断和鉴别诊断.结果 3例患者发病年龄偏大(56、60、70岁),均以血常规异常起病,呈侵袭性经过,查体及影像学检查未发现淋巴结及肝、脾肿大,完善骨髓细胞形态学、流式细胞术、免疫组织化学等检查后可明确诊断为DLBCL,原发骨髓.予以含利妥昔单抗(R)的CHOP(环磷酰胺+表阿霉素+长春新碱+泼尼松)方案或R-EPOCH(R+依托泊苷+长春新碱+吡柔比星+环磷酰胺+泼尼松)方案化疗,近期疗效可达完全缓解,远期疗效仍待进一步评价.结论原发骨髓的DLBCL非常特殊和罕见,这是国内首次报道,相关的发病机制和治疗策略有待于进一步深入探索.
목적 통과보도3례한견적원발골수미만대B세포림파류(DLBCL)환자적진단、감별진단화치료경과,제고대해병적인식.방법 분석환자적발병경과、림상특점、치료반응화전귀,대환자적골수표본진행세포형태학、류식세포술、면역조직화학화분자생물학검측이조진단화감별진단.결과 3례환자발병년령편대(56、60、70세),균이혈상규이상기병,정침습성경과,사체급영상학검사미발현림파결급간、비종대,완선골수세포형태학、류식세포술、면역조직화학등검사후가명학진단위DLBCL,원발골수.여이함리타석단항(R)적CHOP(배린선알+표아매소+장춘신감+발니송)방안혹R-EPOCH(R+의탁박감+장춘신감+필유비성+배린선알+발니송)방안화료,근기료효가체완전완해,원기료효잉대진일보평개.결론 원발골수적DLBCL비상특수화한견,저시국내수차보도,상관적발병궤제화치료책략유대우진일보심입탐색.
Objective To report the diagnosis,differential diagnosis and treatment of three rare cases of primary bone marrow diffuse large B cell lymphoma (DLBCL),and to improve the recognition of this disease.Methods The clinical characteristics,therapeutic course and the outcome of these patients were reviewed.Meanwhile,a series of examinations including morphology,flow cytometry,immunohistochemistry and molecular biology of bone marrow samples were also performed.Results These three patients who were old at the onset age (56,60 and 70 years old),primarily revealed as abnormal blood count and experienced an aggressive course of disease.Physical and imaging examination showed no enlargement of lymph node,liver and spleen,the patients were finally diagnosed as primary bone marrow DLBCL by bone marrow morphology,flow cytometry and immunohistochemistry analyses.They were treated with rituximab combined chemotherapy,which achieved a complete response,but still need longer follow-up to further evaluate their survival.Conclusions Primary bone marrow DLBCL was encountered rarely in clinical practice,and this is the first report in China.Further investigation of pathogenesis and therapeutic strategies of this rare disease was warranted.