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目的:分析EBV阳性的老年弥漫大B细胞淋巴瘤临床特点。方法:采用EBV编码微小RNA(EBV encoded miRNA,EBERs)原位杂交检测方法确定EBV感染的老年弥漫大B细胞淋巴瘤6例。结果:6例患者中男、女各3例;中位发病年龄为59.2(50~66)岁;疾病分期在Ⅱ期的有3例,Ⅳ期3例;IPI评分<2分的患者有3例,≥2分的患者3例;有B症状的患者3例,无B症状的患者3例;ECOG<2分的患者4例,ECOG≥2分的患者2例;LDH升高的患者3例,LDH正常的患者3例。生发中心外的患者3例,生发中心内的患者3例;CD30阳性的患者5例,CD30阴性的患者1例。原发于淋巴结外的患者有5例,原发于淋巴结的患者1例。6例患者治疗均采用CHOP样方案,其中1例应用R-CHOP方案化疗6周期,疾病达PR,1例应用CHOP方案化疗6周期,疾病达CR,2个月后疾病进展,给予放疗及CHOP方案化疗2周期效果不佳死亡,1例应用R-CHOP方案化疗4周期,疾病完全缓解后应用R单药维持治疗,1例应用R-CHOP方案化疗4周期疾病达PR,再次给予R-CHOPE方案治疗后疾病快速进展死亡,1例应用CHOPE方案化疗5周期后疾病达PR,1例应用R-CHOP方案化疗2周期后放疗疾病进展死亡。上述病例死亡3例,部分缓解2例,完全缓解1例,中位生存时间为10个月。结论:EBV阳性的老年弥漫大B细胞淋巴瘤患者发病率较低,对治疗的敏感性差,即使疾病达到完全缓解亦很快进展死亡,且常以淋巴结结外侵犯为主,伴有CD30阳性,本实验由于病例有限,仍需多家中心联合统计,进一步探究治疗EBV阳性的老年弥漫大B细胞淋巴瘤具有针对性的有效治疗方案,最大程度的改善患者预后。
Objective: To analyze the clinical features of EBV-positive elderly diffuse large B cell lymphoma. Methods: Sixty cases of EBV-infected diffuse large B-cell lymphoma were identified by using EBV encoded miRNA (EBERs) in situ hybridization. Results: There were 3 males and 6 females in each of the 6 patients. The median age of onset was 59.2 (50-66) years old. The disease stage was in stage II and 3 cases in stage IV. The patients with IPI score <2 had 3 3 cases with ≥2 points, 3 cases with B symptoms, 3 cases without B symptoms, 4 cases with ECOG <2 points, 2 cases with ECOG≥2 points, 3 cases with elevated LDH Cases, 3 patients with normal LDH. Three patients were excluded from the germinal center and three were from the germinal center; five were CD30-positive and one was CD30-negative. Five cases were found in primary lymph nodes and one in primary lymph nodes. Six patients were treated with CHOP-like regimen. One patient was treated with R-CHOP chemotherapy for 6 cycles, the disease was PR, the other 6 patients were treated with CHOP chemotherapy, the disease was CR, the disease progressed after 2 months, and radiotherapy and CHOP Chemotherapy 2 cycles ineffective death, 1 case of R-CHOP chemotherapy 4 cycles, complete remission of disease R monotherapy maintenance treatment, 1 case of R-CHOP chemotherapy 4 cycles of disease up to PR, and again given R-CHOPE After the treatment of the disease, the disease progressed rapidly and died. One patient was treated with CHOPE regimen for 5 cycles and the disease was PR. The other was R-CHOP regimen for 2 cycles. The above-mentioned cases died in 3 cases, partial relief in 2 cases, complete remission in 1 case, median survival time was 10 months. Conclusions: The incidence of EBV-positive elderly patients with diffuse large B-cell lymphoma is low, and their sensitivity to treatment is poor. Even if the disease is completely relieved, the disease progresses rapidly and often leads to extranodal invasion of lymph nodes accompanied by CD30 positive, Due to the limited number of cases, this experiment still needs a number of centers of joint statistics, to further explore the treatment of EBV-positive elderly diffuse large B cell lymphoma with targeted and effective treatment programs to maximize the prognosis of patients.