原发中枢神经系统弥漫大B细胞淋巴瘤23例临床分析

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。