原發(fā)中樞神經(jīng)系統(tǒng)彌漫大B細(xì)胞淋巴瘤23例臨床分析

吳榮娟　鄭瑞璣

【摘要】 目的：研究原發(fā)中樞神經(jīng)系統(tǒng)彌漫大B細(xì)胞淋巴瘤（primary diffuse large B cell lymphoma of central nervous system，PCNS-DLBCL）的臨床特征、治療及預(yù)后。方法：回顧性分析2012年1月-2017年6月于筆者所在科室治療的PCNS-DLBCL患者23例的臨床資料，所有患者經(jīng)病理證實(shí)并接受“利妥昔單抗（Rituximab，R）+甲氨蝶呤（MTX）2 g/m2”方案化療，用藥前加用20%甘露醇，分析治療效果及預(yù)后。結(jié)果：完全緩解12例，部分緩解5例，疾病穩(wěn)定3例，疾病進(jìn)展3例；5例部分緩解患者中4例接受原方案加“培門冬酶（Pegaspargase）”繼續(xù)化療2個(gè)療程后再次評(píng)估，3例達(dá)完全緩解，1例穩(wěn)定；9例患者在3年內(nèi)疾病復(fù)發(fā)或進(jìn)展死亡，中位生存時(shí)間26（17，31）個(gè)月；治療期間7例患者出現(xiàn)輕度白細(xì)胞減少，4例患者出現(xiàn)口腔潰瘍，5例患者出現(xiàn)轉(zhuǎn)氨酶升高，應(yīng)用“培門冬酶”的患者中有3例出現(xiàn)低纖維蛋白原血癥。結(jié)論：“R+MTX（2 g/m2）”方案治療PCNS-DLBCL副作用小，療效較滿意。培門冬酶可作為治療選擇之一。

【關(guān)鍵詞】 原發(fā)中樞神經(jīng)系統(tǒng)彌漫大B細(xì)胞淋巴瘤； 利妥昔； 甲氨蝶呤； 培門冬酶； 甘露醇

doi：10.14033/j.cnki.cfmr.2018.14.008 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 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(fā)性中樞神經(jīng)系統(tǒng)淋巴瘤（primary central nervous system lymphoma，PCNSL）是指病變局限于中樞神經(jīng)系統(tǒng)的淋巴瘤，包括腦實(shí)質(zhì)、脊髓、眼和顱神經(jīng)，不伴中樞神經(jīng)系統(tǒng)以外部位浸潤[1]，其病理類型約95%為彌漫大B細(xì)胞淋巴瘤，故WHO將“原發(fā)中樞神經(jīng)系統(tǒng)彌漫大B細(xì)胞淋巴瘤（Primary DLBCL of CNS，PCNS-DLBCL）”作為一個(gè)單獨(dú)的亞型。現(xiàn)對(duì)筆者所在科室近年來治療的PCNS-DLBCL共23例做一總結(jié)。