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目的探讨老年弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的临床病理学特征和疗效。方法对2003年1月-2012年12月我院收治的15例老年DLBCL患者的临床资料进行回顾性分析,包括患者的一般临床特征、病理特点、化疗方案选择及疗效,并结合电话随访收集患者生存资料。结果 15例患者中位年龄84岁;所有患者合并至少2种其他疾病,其中以高血压病和冠状动脉粥样硬化性心脏病最常见,有4例合并第二肿瘤;出现B组症状(发热、盗汗及体重下降)的占13例;病理亚型中以非生发中心细胞型(non-GCB)居多(10/15);Ann-Arbor分期Ⅱ期1例,Ⅲ/Ⅳ期14例;国际预后指数(international prognostic index,IPI)评分3~5分14例;初诊时有10例血清乳酸脱氢酶(LDH)高于正常。全组病例均采用R-CHOP(利妥昔单抗联合CHOP)为基础的个体化方案化疗,4个疗程后完全缓解(CR)4例,部分缓解(PR)8例,疾病稳定(SD)1例,疾病进展(PD)2例,治疗总反应12例;全组病例半年总生存10例,1年总生存8例;半年、1年无进展生存分别为7例、6例。结论老年DLBCL初诊时合并基础疾病多、分期较晚、病理分型以non-GCB亚型为主,预后很差;应在强化支持治疗的基础上,根据不同预后,采用个体化R-CHOP方案化疗。
Objective To investigate the clinicopathological features and therapeutic effects of diffuse large B-cell lymphoma (DLBCL) in elderly patients. Methods The clinical data of 15 elderly patients with DLBCL treated in our hospital from January 2003 to December 2012 were retrospectively analyzed, including the general clinical features, pathological features, choice of chemotherapy regimen and curative effect. Patients were followed up by telephone Survival information. Results The median age of 15 patients was 84 years old. All patients had at least 2 other diseases combined. Among them, hypertension and coronary heart disease were the most common, 4 cases had second tumor. Symptoms of group B (fever , Night sweats and weight loss) accounted for 13 cases; the majority of pathological subtypes were non-GCB (10/15); Ann-Arbor stage II was 1 and stage III / IV 14 cases. International The score of international prognostic index (IPI) was 3 to 5 in 14 cases. Serum lactate dehydrogenase (LDH) was higher than normal in the first visit. All patients were treated with R-CHOP (Rituximab combined with CHOP) as the basis of individualized chemotherapy. Four courses of complete remission (CR), four cases of partial remission (PR), eight cases of stable disease (SD) 1 case, 2 cases of disease progression (PD), and 12 cases of total response. The total group of patients had a total survival of 10 in half a year and a total of 8 cases in 1 year. Six months and 1 year of progression-free survival were 7 and 6, respectively. CONCLUSIONS: In the elderly patients with newly diagnosed DLBCL complicated with underlying diseases and later stages, the non-GCB subtype is the main pathological type with poor prognosis. On the basis of intensive supportive care, individualized R-CHOP regimen should be adopted according to different prognosis Chemotherapy.