原发中枢神经系统弥漫大B细胞淋巴瘤23例临床分析

2018-09-26 03:24吴荣娟郑瑞玑
中外医学研究 2018年14期
关键词:甘露醇淋巴瘤甲氨蝶呤

吴荣娟 郑瑞玑

【摘要】 目的:研究原发中枢神经系统弥漫大B细胞淋巴瘤(primary diffuse large B cell lymphoma of central nervous system,PCNS-DLBCL)的临床特征、治疗及预后。方法:回顾性分析2012年1月-2017年6月于笔者所在科室治疗的PCNS-DLBCL患者23例的临床资料,所有患者经病理证实并接受“利妥昔单抗(Rituximab,R)+甲氨蝶呤(MTX)2 g/m2”方案化疗,用药前加用20%甘露醇,分析治疗效果及预后。结果:完全缓解12例,部分缓解5例,疾病稳定3例,疾病进展3例;5例部分缓解患者中4例接受原方案加“培门冬酶(Pegaspargase)”继续化疗2个疗程后再次评估,3例达完全缓解,1例稳定;9例患者在3年内疾病复发或进展死亡,中位生存时间26(17,31)个月;治疗期间7例患者出现轻度白细胞减少,4例患者出现口腔溃疡,5例患者出现转氨酶升高,应用“培门冬酶”的患者中有3例出现低纤维蛋白原血症。结论:“R+MTX(2 g/m2)”方案治疗PCNS-DLBCL副作用小,疗效较满意。培门冬酶可作为治疗选择之一。

【关键词】 原发中枢神经系统弥漫大B细胞淋巴瘤; 利妥昔; 甲氨蝶呤; 培门冬酶; 甘露醇

doi:10.14033/j.cnki.cfmr.2018.14.008 文献标识码 B 文章编号 1674-6805(2018)14-00-02

Clinical Analysis of 23 Patients with Primary Diffuse Large B Cell Lymphoma of Central Nervous System/WU Rongjuan,ZHENG Ruiji.//Chinese and Foreign Medical Research,2018,16(14):22-23

【Abstract】 Objective:To explore the clinical characteristics,treatment and prognosis of primary diffuse large B cell lymphoma of central nervous system(PCNS-DLBCL).Method:The clinical data of 23 patients with PCNS-DLBCL treated in the authors department from January 2012 to June 2017 were retrospectively analyzed.All patients were confirmed by pathology and accepted,"Rituximab(R)+Methotrexate(MTX) 2 g/m2” regimen was used for chemotherapy,and 20% Mannitol was added before treatment,the treatment effect and prognosis were analyzed.Result:CR in 12 cases,PR in 5 cases,SD in 3 cases,and PD in 3 cases.Of the 5 PR patients,4 cases were reassessed after receiving the original regimen plus “Pegaspargase” for 2 cycles of continuous chemotherapy,3 cases achieved CR and 1 case in SD.9 cases died within 3 years because of relapse or disease progression.The median survival time was 26(17,31) months.7 patients had mild leukopenia,4 patients had oral ulcers,and 5 patients had elevated transaminases during the treatment period.3 patients who received “Pegase” had hypofibrinogenemia.Conclusion:The regimen of R-MTX(2 g/m2) is effective in PCNS-DLBCL with acceptable side effects.Pegaspargase can be one of the treatment options.

【Key words】 Primary diffuse large B cell lymphoma of central nervous system; Rituximab; Methotrexate; Pegaspargase; Mannitol

First-authors address:Affiliated Zhangzhou Hospital of Fujian Medical University,Zhangzhou 363500,China

原發性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)是指病变局限于中枢神经系统的淋巴瘤,包括脑实质、脊髓、眼和颅神经,不伴中枢神经系统以外部位浸润[1],其病理类型约95%为弥漫大B细胞淋巴瘤,故WHO将“原发中枢神经系统弥漫大B细胞淋巴瘤(Primary DLBCL of CNS,PCNS-DLBCL)”作为一个单独的亚型。现对笔者所在科室近年来治疗的PCNS-DLBCL共23例做一总结。

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