Objective: To investigate the clinical characteristics and prognostic factors of primary follicular lymphoma (FL) patients with grade 3 or large B cell transformation, so as to provide more reference for the subsequent clinical diagnosis and treatment.
Methods: Forty-seven primary FL patients with grade 3 or large B cell transformation from March 2010 to March 2018 were selected, the clinical characteristics and survival of patients were analyzed. Cox regression model were used to evaluate the related prognostic factors.
Results: The cumulative progression-free survival rate and cumulative overall survival rate of 47 patients in 3-year follow-up reached to 55.32% (26/47) and 80.85% (38/47) respectively. There were significant differences in cumulative progression-free survival rate and cumulative overall survival rate among different subgroups of IPI, FLIPI-1 and FLIPI-2 in 3-year follow-up (P<0.05). The cumulative progression-free survival rate during follow-up for 3-year in the patients with Ann Arbor staging for III-IV stage, lymph node-involved site≥5, lymph node-involved site with diameter more than 3 cm≥3 and extranodal lesions≥3 was significantly lower than other subgroups (P<0.05). The cumulative overall survival rate in 3-year follow-up of patients with LDH levels≥240 U/ml was significantly lower than patients with LDH levels < 240 U/ml (P<0.05). Univariate analysis showed that Ann Arbor stage for III-IV, lymph node-involved site number≥5, >3 cm lymph node-involved site number≥3, extranodal lesion site number≥2, IPI score=2-3, FLIPI-1 score and FLIPI-2 score≥3 were the risk factors for progression-free survival (P<0.05); LDH≥240 U/ml, IPI score=2-3 and FLIPI-2 score≥3 were risk factors for overall survival (P<0.05). Cox regression model multivariate analysis showed that IPI score=2-3 was the independent risk factor for progression-free survival and overall survival (P<0.05). FLIPI-2 score≥3 was the independent risk factor for overall survival (P<0.05).
Conclusion: Primary FL patients with grade 3 or large B cell transformation by using the existing treatment regimen might be possibly curable, and the current treatment strategies and IPI score can be used to predict the clinical prognosis of patients.
题目: 3级或伴大B细胞转化的初治滤泡淋巴瘤患者临床特征及预后影响因素研究.
目的: 探讨3级或伴大B细胞转化的初治滤泡淋巴瘤（FL）患者临床特征及预后影响因素，为后续临床诊治工作提供更多参考。.
方法: 选取本院2010年3月-2018年3月收治的3级或伴大B细胞转化的初治FL患者47例，分析患者临床特征及生存情况；采用Cox回归模型评价相关预后影响因素。.
结果: 47例患者随访3年累积无进展生存率和累积总生存率分别为55.32%（26/47）和80.85%（38/47）。IPI、FLIPI-1及FLIPI-2不同亚组患者随访3年累积无进展生存率和累积总生存率比较有显著性差异（P<0.05）；Ann Arbor分期III-IV期、淋巴结受累部位≥5个、直径3 cm以上淋巴结受累部位≥3个、结外病变部位≥3个患者随访3年累积无进展生存率显著低于I-II期、淋巴结受累部位<5个、直径3 cm以上<3个及结外病变部位<3个患者（P<0.05）；LDH水平≥240 U/ml 患者随访3年累积总生存率显著低于<240 U/ml患者（P<0.05）。单因素分析结果显示，Ann Arbor分期III-IV期、淋巴结受累部位5个及以上、>3 cm淋巴结受累部位3个及以上、结外病变部位2个及以上、IPI评分2-3分、FLIPI-1评分和FLIPI-2评分≥3分是影响患者无进展生存率的危险因素（P<0.05）； LDH≥240 U/ml、IPI评分2-3分及FLIPI-2评分≥3分是影响患者总生存率的危险因素（P<0.05）。Cox回归模型多因素分析结果显示，IPI评分2-3分是影响患者无进展生存率和总生存率的独立危险因素（P<0.05）；FLIPI-2评分≥3分是影响患者总生存率的独立危险因素（P<0.05）。.
结论: 对3级或伴大B细胞转化的初治FL患者采用目前已有治疗方案治疗存在治愈的可能，IPI评分可用于预测该类患者临床预后。.