The Analysis Of Clinical Features And Prognosis Of 69 Patients With Newly Treated Mantle Cell Lymphoma

Background and objective:Mantle cell lymphoma(MCL)is a subtype of non-Hodgkin lymphoma(NHL)with a median age of onset of about 60 years.Its main pathogenesis is the formation of fusion genes caused by t(11;14)(q13;q32)translocation,which leads to high expression of cyclin D1 and uncontrolled cell cycle.Current first-line treatments have limited efficacy for MCL,with a median overall survival of 3 to 5 years,and it is still incurable tumors.Therefore,we collected information on newly diagnosed MCL patients admitted to our center for more than 10 years.The clinical characteristics,efficacy of the protocol,and survival time obtained by follow-up were retrospectively analyzed and studied.Methods:Retrospective analysis of newly diagnosed MCL patients admitted to the Department of Hematology,Bethune First Hospital Cancer Center,Jilin University from January 1,2008 to September 30,2019.69 patients were analyzed by screening.The age,gender,pathological diagnosis,and Ann Arbor staging of cases were collected.Patients were followed up,and the follow-up deadline was January 3,2020.Using SPSS software to describe the measurement data,and apply rank sum test,K-M survival analysis,univariate and multivariate analysis to statistical analysis of clinical characteristics,protocol efficacy,prognosis score,etc.,and logistic regression analysis of hematological toxicity levels relationship to program effectiveness.Results:1.Our center received patients with lymphoma in the same period,of which 84 were mantle cell lymphoma patients.The incidence of MCL accounted for 3.8% of lymphomas.The median age of onset was 61.5 years(42-81 years).More men than women(3:1).After enrollment and exclusion,69 cases were available for analysis,including 26 patients ?65 years old.There were 29 cases with B symptoms,32 cases with extranodal lesions ?2,6 cases with chromosomal abnormalities,and 9 cases with TP53 gene mutation..2.The data of 69 MCL patients included in the analysis,the treatment effective rate(ORR)was 60.9%,the median progression-free survival(PFS)was 19 months,and the median overall survival(OS)was 27 Month,2 years of non-progressive time was 40.6%,and 2 years of OS was 59.4%.There were significant differences in PFS and OS between the chemotherapy group,R combined chemotherapy group and VR combined chemotherapy group(P <0.001);there were significant differences in PFS between the CHOP and CHOP-like groups and the high-dose Ara C group in the chemotherapy group(P = 0.016),no significant difference was found between the two groups of OS(P = 0.051);there was no significant difference between PFS and OS in the R-CHOP and CHOP-like groups and the group containing high-dose Ara C(P> 0.05);There is no significant difference between PFS and OS in VR combined chemotherapy group and R-containing high-dose group(P> 0.05).3.B symptoms,Ann Arbor stage III-?,extranodal lesions ?2,white blood cell count ?15 × 109 / L,abnormal hemoglobin(adult male <120g / L,adult female <110g/ L),program effectiveness,Albumin <30 g / L,precursor albumin <0.18 g / L,application of rituximab,TP53 gene mutation,the above has a statistically significant effect on the prognosis of MCL PFS(P <0.05);Ann Arbor staging Stage III-IV,bone marrow involvement,number of extranodal lesions ?2,lactate dehydrogenase ?1.5times,application of rituximab,effectiveness of the program,precursor albumin <0.18g/ L,TP53 gene mutation,above The impact on the prognosis OS of MCL is statistically significant(P <0.05).4.B symptom,Ann Arbor stage III-IV,regimen effectiveness,hemoglobin abnormality,TP53 gene mutation,the above are independent prognostic factors of PFS of MCL(P <0.05);regimen effectiveness is an independent prognostic factor of OS of MCL(P <0.05).5.Univariate analysis found that the s MIPI score had a significant difference in PFS differentiation in MCL patients(P = 0.005),and univariate analysis showed that the s MIPI score had no significant difference in OS differentiation(P > 0.05).The MIPI-c score had no significant difference between PFS and OS in patients with MCL(P > 0.05).6.Correlation analysis between treatment-related adverse reactions and the effectiveness of the protocol found that the initial treatment effectiveness of patients with hematological toxicity of grade 3 was 12.25 times that of patients without hematological toxicity(OR = 12.25,95%CI: 1.78-83.94,P = 0.011);the initial treatment of patients with hematological toxicity grade 4 was 10.5 times more effective than patients without hematological toxicity(OR = 10.50,95%CI: 1.62-68.07,P =0.014),and patients with hematological toxicity grade 3-4 would be more effective.Patients with different treatment strategies had different levels of adverse reactions in neutropenia,anemia,and thrombocytopenia,and there was no difference in renal toxicity and liver toxicity(P <0.05).Conclusions:1.The median age of onset of MCL is 61.5 years.There are more men than women,often accompanied by B symptoms and extranodal lesions.Chromosomal abnormalities and TP53 gene mutation can occur in genetic heterogeneity.2.For the specific treatment of newly treated MCL,the R-high-dose Ara C regimen is preferred,and it is suitable for transplantation for ASCT consolidation treatment;for elderly patients with intolerance,VR combined with chemotherapy can be used instead;for those who cannot tolerate targeted therapy,Prefer to use the containing high-dose Ara C regimen.3.B symptoms,Ann Arbor stage III-IV,program effectiveness,hemoglobin reduction,TP53 gene mutation,these are independent prognostic factors for PFS of MCL;program effectiveness is an independent prognostic factor for OS of MCL..