儿童伯基特淋巴瘤62例临床特征及预后分析

Clinical features and prognosis of children with Burkitt's lymphoma: an analysis of 62 cases

摘要:

目的 分析儿童伯基特淋巴瘤（Burkitt's lymphoma，BL）的临床特点、化疗疗效，以及利妥昔单抗治疗对BL患儿预后的影响。 方法 回顾性收集62例BL患儿的临床资料，对BL患儿的临床特点、疗效及预后相关因素进行分析，采用Cox回归分析BL患儿预后不良的相关因素。根据是否应用利妥昔单抗治疗将晚期（Ⅲ/Ⅳ期）BL患儿分为化疗联合利妥昔单抗组和单纯化疗组，比较两组预后情况。 结果 62例患儿发病时中位年龄5（范围1~14）岁，男58例（94%），女4例（6%）。原发部位为腹腔者41例（66%），头颈部者16例（26%）。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患儿分别为1例（2%）、8例（13%）、33例（53%）、20例（32%）。中位随访时间29个月，进展/复发患儿15例（24%），3年总生存率、无事件生存率分别为82.8%±5.2%、77.3%±5.8%。Ⅲ/Ⅳ期患儿中，化疗联合利妥昔单抗组（n=16）与单纯化疗组（n=30）3年总生存率分别为93.3%±6.4%、65.6%±9.9%，差异有统计学意义（P=0.042）；3年无事件生存率分别为86.2%±9.1%、61.8%±10.1%，差异无统计学意义（P>0.05）。Cox回归分析结果显示：中枢神经系统侵犯、乳酸脱氢酶水平>1 000 U/L、早期未完全缓解为BL患儿预后不良的相关因素（P<0.05）。 结论 化疗联合利妥昔单抗治疗能改善Ⅲ、Ⅳ期BL患儿预后；中枢神经系统侵犯、乳酸脱氢酶水平升高、早期未完全缓解可能提示BL患儿预后不良。 引用格式：中国当代儿科杂志，2022，24（5）：561-565

Abstract:

Objective To study the clinical features and chemotherapy response of Burkitt's lymphoma (BL) in children and the influence of rituximab on the prognosis of children with BL. Methods A retrospective analysis was performed for the medical data of 62 children with BL, including clinical features, therapeutic efficacy, and prognostic factors. The Cox regression model was used to identify the factors associated with poor prognosis in children with BL. According to whether rituximab was used, the children with advanced (stage III/IV) BL were divided into two groups: chemotherapy plus rituximab and chemotherapy alone. The prognosis was compared between the two groups. Results For these 62 children, the median age of onset was 5 years (range 1-14 years), and there were 58 boys (94%) and 4 girls (6%). The primary site was abdominal cavity in 41 children (66%), and head and neck in 16 children (26%). There were 1 child with stage I BL (2%), 8 with stage II BL (13%), 33 with stage III BL (53%), and 20 with stage IV BL (32%). The median follow-up time was 29 months, with progression/recurrence observed in 15 children (24%), and the 3-year overall survival (OS) rate and event-free survival (EFS) rate were 82.8%±5.2% and 77.3%±5.8%, respectively. For the children with stage III/IV BL, there was a significant difference in the 3-year the OS rate between the chemotherapy plus rituximab group (16 children) and the chemotherapy alone group (30 children) (93.3%±6.4% vs 65.6%±9.9%, P=0.042), while there was no significant difference in the 3-year EFS rate between the two groups (86.2%±9.1% vs 61.8%±10.1%, P>0.05). The Cox regression analysis showed that central nervous system involvement, lactate dehydrogenase >1 000 U/L, and early incomplete remission were the factors associated with poor prognosis (P<0.05). Conclusions Chemotherapy combined with rituximab can improve the prognosis of children with stage III/IV BL. Central nervous system involvement, elevated lactate dehydrogenase level, and early incomplete remission may indicate a poor prognosis in children with BL. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(5): 561-565