Analysis of clinical characteristics and outcome of patients with previously untreated diffuse large B-cell lymphoma and renal involvement in the rituximab era
Analysis of clinical characteristics and outcome of patients with previously untreated diffuse large B-cell lymphoma and renal involvement in the rituximab era
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DOI：
10.3109/10428194.2016.1157869
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发表时间：
2016-11-01
影响因子：
2.6
通讯作者：
Witzens-Harig, Mathias
中科院分区：
文献类型：
--
作者：
Lehners, Nicola;Kraemer, Isabelle;Witzens-Harig, Mathias
淋巴瘤患者的肾脏受累很少见，但预后不良。我们分析了 22 名新诊断的弥漫性大 B 细胞淋巴瘤 (DLBCL) 和肾脏受累患者的特征和结果，这些患者接受了含利妥昔单抗的治疗方案治疗。大多数患者均处于晚期疾病，86% 的患者为安娜堡分期 >= III，且 IPI 评分 >= 3。32% 的患者存在肾功能损害。结果很差，三年无进展生存率 (PFS) 为 44%，三年总生存率 (OS) 为 52%，并且与无肾脏受累的 DLBCL 相比明显更差 (p < 0.01)。与中危 IPI 患者相比，高危 IPI 患者的预后明显较差（三年 OS 0% vs. 75%，p = 0.01），肾功能不全患者也是如此。观察到中枢神经系统 (CNS) 复发率很高 (8/22)。静脉注射大剂量甲氨蝶呤和鞘内治疗显示中枢神经系统复发时间延长的趋势。因此，可以考虑对这些高危患者实施中枢神经系统预防。
Renal involvement in patients with lymphoma is rare but associated with poor prognosis. We analyzed characteristics and outcome of 22 patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) and renal involvement treated with a rituximab-containing regimen in curative intent. The majority of patients presented in advanced disease, 86% were Ann Arbor stage >= III and had an IPI score >= 3. Renal impairment was present in 32%. Outcome was poor with three-year progression-free survival (PFS) 44% and three-year overall survival (OS) 52% and significantly worse compared to DLBCL without renal involvement (p < 0.01). Patients with high risk IPI had a significantly inferior prognosis compared to intermediate-risk IPI (three-year OS 0% vs. 75%, p = 0.01) as did those with renal impairment. A high rate of central nervous system (CNS) relapse (8/22) was observed. Intravenous high-dose methotrexate and intrathecal therapy showed a trend toward prolonged time to CNS relapse. Implementation of CNS prophylaxis might therefore be considered in these high-risk patients.