血管免疫母细胞性T细胞淋巴瘤临床特点及疗效分析

Clinical Features and Treatment of Angioimmunoblastic T-cell Lymphoma

  • 摘要: 回顾性分析本院单中心近年收治的血管免疫母细胞性T细胞淋巴瘤(AITL)的临床特点及常规化疗近期疗效。方法:1999年9月~2010年9月于本院明确诊断AITL患者23例,其中21例接受治疗。初次治疗17例予CHOP样或CHOP方案,4例予左旋门冬酰胺酶+博莱霉素+地塞米松+长春地辛方案;化疗后予受累野照射每组各1例,予自体造血干细胞移植巩固治疗每组各1例。复发后予ICE、DHAP或ProMACE/CytaBOM方案化疗。维持治疗采用干扰素或联合沙利度胺治疗者5例,采用西达苯胺者3例。结果:发病中位年龄60岁,男 :女为1.9:1,Ann Arbor Ⅲ~Ⅳ期占96%,57%患者有B组症状,22%患者合并脾受侵/脾肿大。实验室检查结果示,39%患者乳酸脱氢酶升高,75%患者β2微球蛋白升高,80%患者D-二聚体升高。病理组织免疫组化结果显示,CXCL13阳性率100%(12/12),EBER阳性率80%(8/10)。疗效结果分析,CHOP样方案组7例获CR,8例获PR;含左旋门冬酰胺酶方案组1例获CR,1例获PR。21例患者中位生存27(2.9~51.1)个月,3年、5年总生存率分别为44%、29%。化疗后90%患者出现Ⅲ~Ⅳ度骨髓抑制,33%患者出现肺部感染,1例患者发生带状疱疹。结论:AITL为具有独特临床病理和生物学行为的外周T细胞肿瘤,多数患者同时存在凝血机制异常。AITL患者因并发免疫功能异常,化疗后骨髓抑制及感染问题不容忽视。

     

    Abstract: To retrospectively analyze patients with angioimmunoblastic T cell lymphoma ( AITL ) from a single institution, and to define the clinical features and effect of chemotherapy. Methods: Up to 23 patients with AITL in our department from Sept.1999 to Sept. 2010 were enrolled, but only 21 patients received treatment. Up to 17 patients received CHOP-1ike regimens as initial chemotherapy treatments, 4 patients received L-asparaginase ( L-asp ) + bleomycin + dexamethasone + vindesine regimen; 1 patient was treated with radiotherapy in every group and 1 patient with high-dose chemotherapy followed by autologous stem cell transplantation ( HDT-ASCT ) in every group as upfront consolidation therapy. Salvage regimen was ICE, DHAP or ProMACE/CytaBOM. Five patients received interferon or combined thalidomide for maintenance therapy; 3 patients received chidamide. Results: The median age of the 23 patients was 60 years; the male to female ratio was 1.9:1. Among all patients, 96% were in Ann Arbor stage Ⅲ or Ⅳ, 57% presented with B symptoms, 22% had splenic involvement or splenomegaly. In terms of laboratory features, 39% had elevated lactate dehydrogenase ( LDH ), 75% had elevated beta-2 microglobulin ( β2-MG ), and D-dimer levels exceeding 255 ng/mL were observed in 80% patients at diagnosis. Immunohistochemistry indicated that the positive rate for CXCL13 was 100% ( 12/12 ) and EBER was 80% ( 8/10 ). Analysis of the therapeutic effect revealed 7 patients achieved complete remission ( CR ) and 8 patients achieved partial remission ( PR ) after initial treatment with CHOP-1ike regimens; 1 patient achieved CR and 1 patient achieved PR after initial treatment with L-asp-based regimens. The median overall survival ( OS ) was 27 ( 2.9-51.1 ) months, whereas the 3- and 5-year OS was 44% and 29%. Up to 90% of the patients suffered from bone marrow depression Ⅲ or Ⅳ, 33% patients suffered from pneumonia, and 1 patient suffered herpes zoster after chemotherapy. Conclusion: AITL is a distinct subtype of peripheral T-cell lymphoma with unique clinical and pathologic features. In our study, most of the patients had abnormal clotting mechanisms. AITL patients often exhibit immunodeficiency; thus, bone marrow depression and opportunistic infections during therapy cannot be neglected.

     

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