摘要目的 探讨增强剂量免疫化疗联合或不联合自体造血干细胞移植(ASCT)治疗年轻、初治、中高危/高危弥漫大B细胞淋巴瘤(DLBCL)患者的疗效.方法 以29例年龄≤60岁,年龄调整的国际预后指数(aaIPI)积分≥2分的初治DLBCL患者为研究对象,进行疗效及相关预后因素的分析.结果 29例患者中位年龄43岁,其中12例患者接受ASCT强化治疗.29例患者的完全缓解(CR)率为69％,部分缓解(PR)率为21％,总有效率为90％.中位随访14个月,中位无进展生存(PFS)及总体生存(OS)时间尚未达到,预期2年PFS率和OS率分别为64％和70％.CR患者的PFS和OS时间较PR患者延长(P值分别为0.015和0.061),2例前期化疗仅达PR的患者经ASCT后获得CR,并且随访3年以上仍持续CR.多因素分析结果显示,仅骨髓侵犯是影响患者PFS的不良预后因素(P=0.009).按照诊断时有无骨髓侵犯及骨髓侵犯的程度,将患者分为BM-0(无骨髓侵犯)、BM-1(骨髓侵犯程度≤10％)和BM-2(骨髓侵犯程度＞10％)三组,结果显示BM-1与BM-0组患者的PFS和OS时间均显著优于BM-2组(P值分别为0.001和0.045).多因素分析结果显示,诊断时患者骨髓为BM-2状态是影响其PFS和中枢神经系统(CNS)复发/进展的独立危险因素(P值分别为0.024和0.031).结论 增强剂量免疫化疗联合或不联合ASCT可改善年轻、中高危/高危DLBCL患者一线治疗的疗效,诊断时骨髓侵犯程度＞10％是影响患者PFS和CNS复发/进展的独立危险因素.

abstractsObjective To assess the efficacy of dose-intensive immunochemotherapy with or without autologous hematopoietic stem cell transplantation (ASCT) for newly diagnosed young patients with medium/high risk diffuse large B-cell lymphoma (DLBCL).Methods The retrospective study was performed in 29 cases of young patients (≤60 years) with newly diagnosed DLBCL and an age-adjusted International Prognostic Index (aaIPI) score of 2 or 3.All of them were treated with dose-intensive regimens (DA-EPOCH or Hyper-CVAD/MA) combined with Rituximab and some were consolidated with first-line ASCT.The efficacy and the potential predictors were evaluated.Results The median age of 29 patients was 43 years old.Of them,12 patients were consolidated with high-dose chemotherapy and ASCT The complete remission (CR) rate was 69％,the partial remission (PR) rate 21％ and the overall response rate 90％.After a median follow-up of 14 months,the estimated progression-free survival (PFS) and overall survival (OS) at two years were 64％ and 70％,respectively.The median PFS and OS were significantly longer in CR patients than that in PR patients (P=0.015 and 0.061,respectively).Two patients achieved PR after induction therapy converted to CR after ASCT and were in continuous CR after follow-up above three years.In multivariate analysis,only bone marrow involvement (BMI) at diagnosis had an adverse influence in PFS (P=0.009),but not in OS.Based on whether there was BMI or not and the extent of BMI at diagnosis,the patients were divided into three groups as BM-0 (without BMI),BM-Ⅰ (the extent of BMI≤10％) and BM-2 (the extent of BMI＞10％).Patients in BM-2 group had significantly shorter PFS and OS than those in BM-0 and BM-1 groups (P=0.001 and 0.045,respectively).In multivariate analysis,the extent of BMI＞10％ was the independent poor prognostic factor for PFS and CNS relapse or prognosis.Conclusion Dose-intensive immunochemotherapy followed by ASCT or not has significant effect on efficacy of first-line treatment for young and untreated patients with medium/high risk DLBCL.The extent of BMI＞10％ at diagnosis is an independent risk factor associated with poor PFS and increased CNS relapse or progression.