| Objectives: Mantle cell lymphoma(MCL)is a kind of B-cell non Hodgkin's malignant lymphoma with high degree of aggression,complex and diverse of pathological types,and poor prognosis.It is an aggressive disease of aggressive lymphoma and a incurable disease with indolent lymphoma.The disease often occurs in elderly male patients,which has a lot of superficial lymphadenopaties and extensive organ invasions.There are characteristic ectopic t(11;14)(q13;q32),which leads to overexpression of Cyclin D1.At present,there is no uniform standard of treatment for MCL.it is usually difficult to cure,and the prognosis is affected by many factors.To provide a theoretical basis for guiding clinical treatment and predicting prognosis,we retrospectively analyzed the clinical datas,pathological features,treatment methods,clinical efficacy and prognostic factors of patients with MCL in our hospital.Methods: 52 cases of primary MCL patients were retrospectively analyzed,initially treated in Tianjin Cancer Hospital and Tianjin Uion Hospital from Dec.2007 to Dec.2015.We observed and analyzed the clinical datas including patient's age,gender,physical condition,the starting position,disease involvement,clinical staging,treatment and so on,pathological and immunohistochemical features,the short-term curative effects and long-term follow-up datas.Count data were compared using Pearson?2 test;measurement data using t-test.Survival were estimated by Kaplan-Meier and log-rank test;Cox hazard model multivariate analyzed prognosis.Results:1.Clinical characteristics: In 52 cases of MCL,male accounted for 73.1%,the ratio of male to female was 2.71:1;the median age was 62 years,lymph node was the most common primary tumor site(42 cases,80.7%),extranodal involvement seen in spleen(11cases,21.2%),followed by bone marrow(10cases,19.2%),gastrointestinal tract(7cases,13.5%)and Webster's ring(5cases,9.6%).ECOG PS?2 in 15.4%,B symptom in 36.5%,the increase of LDH and?2-MG were accounting for 61.5%,36.5%.Ann-arbor stage III/IV was 40 cases(76.9%),MIPI score: low risk group 19 cases(36.5%),low risk group 22 cases(42.3%),high risk group11 cases(21.2%).2.Pathological features: The positive rates of CD20,CyclinD1,CD5,CD79 a,CD19,CD10 and Bcl-2 were 100%,98%,85.4%,91.5%,76.2%,81.4%,respectively.17 cases were detected by SOX11,the positive rate was 88.2%.51 cases were detected with Ki-67 index,the positive rate was 10%-90%,Ki-67>30% accounted for 41.2%? 3.Clinical efficacy :The ORR of R-CHOP like group was higher than that of CHOP group(84.2%vs52.4%,P=0.032).4.Survival: the median follow-up time was 35 months.The median PFS and OS were17.1(15.5-18.7)and 40.7(28.8-54.6)months.The1,2,3 year of PFS rates were 75.5%,39.1% and 20.6%,respectively.The 3,5 year OS rate were 61.7% and 27.2%.The median OS was significantly improved by the Rituximab plus chemotherapy(51.8vs 37.2 months,P=0.009).5.Pprognostic factors: univariate analysis showed that the age,ECOG,MIPI,bone marrow involvement,LDH and ESR increased,Ki-67%,Rituximab and maintenance therapy were the adverse prognostic factors(P<0.05).Cox multivariate analysis showed that Rituximab and ECOG were t independent risk factors(P=0.007,0.009).Conclusions:1.MCL is found in the middle and old aged men,and many of them were in advanced stage(III/IV).The clinical manifestations include lymphadenectasis and extranodal involvements in spleen,bone marrow,gastrointestinal tract and Waldeyer's ring.The expression of B cell immune markers(CD20,CD19,CD79a)and Cyclin D1(+),CD5(+),CD10(-)and CD23(-)is its characteristics.2.The R-CHOP like scheme is the common treatment for MCL patients,improving the clinical efficacy,progression free survival and survival.For young patients,Hematopoietic stem cell transplantation can be used as consolidation therapy.3.R±Hyper-CVAD/MA program with large side effects and poor tolerance,not recommended.4.Whether use of Rituximab and ECOG PS score are the independent risk factors. |
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