33例血管免疫母细胞性T细胞淋巴瘤临床特征及预后分析

摘要

Objective To analyze the clinical characteristics and prognosis of patients with angioimmunoblastic T-cell lymphoma ( AITL) .Methods A retrospective analysis of 33 patients with AITL was performed in terms of basic clinical fea-tures, the therapeutic effect and prognostic factors.Results The median age of 33 patients was 61 years old, and 84.8%of them were male, 3 patients presented with poor performance status (ECOG score≥2), 27 cases had advanced stage (stageⅢ/Ⅳaccording to Ann Arbor classification), and 7 cases had elevated lactate dehydrogenase (LDH).Extranodal involve-ments included liver involvement (9.1%), spleen involvement (18.2%) and bone marrow involvement (9.1%).Fourteen patients presented with B symptom.Twenty four patients received CHOP regimen ( cyclophosphamide, doxorubicin, vincris-tine and prednisolone) as first-line chemotherapy.The 2-year overall survival ( OS) rate was 81.3% (95%CI: 0.734-0.892).The 2-year event-free survival (EFS) rate was 49.7%(95%CI:0.402-0.592).The elevated LDH, elevated white blood cell count and B symptom could affect 2-year OS rate (all P<0.05).ECOG score≥2, B symptom, skin rashes and a-nemia could affect 2-year EFS rate (all P<0.05).No statistical difference was found in 2-year OS rate between patients treated with non-CHOP and those with CHOP regimen.Multivariate analysis showed that ECOG score≥2 (P=0.023) was an independent adverse factor for worse EFS.B symptom (P=0.024) and the increased LDH level (P=0.034) were inde-pendent adverse factors for worse OS.Conclusions AITL usually occurs in elder men and presents with B symptom, skin ra-shes, eosinophilia, effusion and extranodal involvement.On onset of AITL, those with increased LDH and B symptom have a poor prognosis.Non-CHOP regimen in first-line chemotherapy is not superior to CHOP regimen.%目的：分析血管免疫母细胞性T细胞淋巴瘤（ AITL）患者的临床特征及预后。方法回顾性分析33例AITL患者的基本临床特征、治疗效果及预后影响因素。结果33例AITL患者中位年龄为61岁，男性占84．8％，3例患者体能状态评分差（ECOG评分≥2分），27例患者Ann Arbor分期为Ⅲ、Ⅳ期，7例乳酸脱氢酶（LDH）升高，常见结外受累[肝脏受累（9．1％）、脾脏受累（18．2％）、骨髓侵犯（9．1％）]，14例患者表现为B症状，24例患者接受CHOP方案作为诱导化疗。所有患者2年总生存率为81．3％（95％CI：0．734～0．892），2年无事件生存率为49．7％（95％CI：0．402～0．592）。 LDH升高、B症状、白细胞升高均可影响患者2年总生存率，P均＜0．05。 ECOG评分≥2分、B症状、皮疹、贫血均可影响患者的2年无事件生存率，P均＜0．05。 CHOP方案和未使用CHOP方案患者2年总生存率比较无统计学差异。多因素分析发现， ECOG评分≥2分（P＝0．023）是影响患者无事件生存的独立不良预后因素；B症状（P＝0．024）和LDH增高（P＝0．034）是影响总生存的独立因素。结论 AITL好发于老年男性，常伴有B症状、皮疹、嗜酸性粒细胞增多、体腔积液和结外侵犯等症状。 AITL起病时LDH增高、有B症状的患者预后较差，一线化疗中的非CHOP方案疗效并未优于CHOP方案。