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白血病·淋巴瘤
白血病·淋巴瘤杂志编辑部
白血病·淋巴瘤

白血病·淋巴瘤杂志编辑部

陈赛娟

月刊

1009-9921

bxblbl@163.com

0351-4650389

030013

山西省太原市职工新街3号

白血病·淋巴瘤/Journal Journal of Leukemia & LymphomaCSTPCD
查看更多>>中华医学会、山西省肿瘤研究所、山西省肿瘤医院主办。本刊是以白血病、淋巴瘤、多发性骨髓瘤为主的血液系统恶性肿瘤专业的学术期刊。办刊宗旨：反映血液系统恶性肿瘤领域的科研成果及学术动态，临床与基础并举，但侧重于临床；普及与提高兼顾，但侧重于提高。为从事白血病、淋巴瘤、多发性骨髓瘤等血液系统恶性肿瘤基础研究与临床诊治的工作者提供交流经验、沟通信息的园地。读者对象为中高级医务工作者。主要栏目有述评、专论、专家讲坛、论著、短篇论著、调查报告、综述、会议速递、讲座、短篇及个案报告等。为中国科技论文统计源期刊（中国科技核心期刊）、中国生物医学核心期刊、中国肿瘤学类核心期刊。被美国《化学文摘》（CA）等国际著名检索期刊及国内各大检索数据库收录。
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    新型冠状病毒感染背景下的CAR-T治疗管理中国专家共识（2024年版）

    马军张文宏郎华张俊伟...
    65-73页
    查看更多>>摘要：嵌合抗原受体T细胞（CAR-T）疗法作为恶性肿瘤治疗领域的焦点之一，在血液系统恶性肿瘤尤其是淋巴瘤的临床实践中表现出良好疗效和安全性。实际应用中，由于CAR-T的生产工艺复杂、接受治疗的患者存在个体差异，在治疗期间需实时监测并按需调整方案。新型冠状病毒的暴发流行对CAR-T治疗提出了更大的挑战。新型冠状病毒普遍易感、传播迅速，且潜伏期长短不等，可能损害免疫系统功能。血液系统恶性肿瘤患者经历多线治疗后可出现T细胞功能受损、免疫功能下降等，若同时感染新型冠状病毒，则可能诱发更严重的并发症。CAR-T治疗的特殊要求、新型冠状病毒感染的疾病特点及患者的极易感性给临床带来了多重挑战。文章基于国内外指南共识、权威文献及国内该领域相关专家临床诊疗经验，针对新型冠状病毒感染背景下CAR-T治疗全流程的临床应用及注意事项给予建议，供临床医生和专业诊疗机构参考。 Chimeric antigen receptor T cell (CAR-T) therapy, as one of the focuses in the field of malignant tumor treatment, has shown favorable efficacy and safety in patients with hematological malignancies, particularly in lymphoma. In clinical practice, due to the intricate manufacturing process of CAR-T product and individualized differences among the patients, it is necessary to monitor in real-time and adjust the regimens during the treatment based on the patients' needs. The SARS-CoV-2 is characterized with high susceptibility, rapid spread and short or wide incubation period, which may impair the function of the immune system and has added a greater challenge for CAR-T therapy in malignancies. Patients with hematological malignancies receiving multiple lines of treatment are normally observed with impaired T cell function and weakened immune function. This may induce more severe complications to those vulnerable patients if they experienced SARS-CoV-2 infection. Therefore, the special requirements of CAR-T therapy, the disease characteristics of SARS-CoV-2 infection and the heightened susceptibility of the patients have brought several challenges in clinic. The consensus is developed based on domestic and international guidelines, consensus and authoritative literature in recent years, as well as the practical experiences from various clinical professionals and experts in China. The aim of the consensus is to provide references and suggestions regarding the clinical application and the whole management process of CAR-T therapy in the context of SARS-CoV-2 infection for clinicians and professional institutions.

    新型冠状病毒感染嵌合抗原受体T细胞淋巴瘤,非霍奇金

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    埃普奈明治疗复发难治多发性骨髓瘤临床应用指导原则（2024年版）

    马军陈文明郎华陈磊...
    74-81页
    查看更多>>摘要：埃普奈明是重组环化变构的人肿瘤坏死因子相关凋亡诱导配体，通过激活死亡受体4/死亡受体5（DR4/DR5）诱导不依赖p53的细胞凋亡，是全球首个获批上市的DR4/DR5激动剂，用于治疗复发难治多发性骨髓瘤（RRMM）。RRMM患者接受埃普奈明单药或联合用药治疗具有较好的疗效及安全性。鉴于目前我国临床医生缺乏对该药的临床应用经验，中国临床肿瘤学会（CSCO）组织国内专家制定了埃普奈明在RRMM中的临床应用指导原则，旨在为临床医生提供参考。 Aponermin is a recombinant circularly permuted tumor necrosis factor-related apoptosis-inducing ligand that induces p53 independent cell apoptosis by activating death receptor 4/death receptor 5 (DR4/DR5). It is the first globally approved DR4/DR5 agonist for the treatment of relapsed/refractory multiple myeloma (RRMM). RRMM patients receiving aponermin monotherapy or the combination therapy with other drugs have good efficacy and safety. In view of the lack of experience in clinical use, the Chinese Society of Clinical Oncology (CSCO) has organized experts to formulate the clinical application principles of aponermin in RRMM, aiming to provide a reference for clinicians.

    多发性骨髓瘤埃普奈明肿瘤坏死因子相关凋亡诱导配体死亡受体4死亡受体5

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    不典型急性早幼粒细胞白血病关键发病和全反式维甲酸耐药机制研究进展

    周晓苏陈佳琦陈雪刘红星...
    82-85页
    查看更多>>摘要：由于全反式维甲酸（ATRA）和砷剂的成功应用，PML：：RARA融合基因阳性的急性早幼粒细胞白血病（APL）的治疗已经获得极大成功。但仍有部分患者细胞形态、免疫表型和基因表达谱表现为APL表型，但PML：：RARA阴性，也被称为不典型APL。在不典型APL患者中已报道20余种维甲酸受体相关的融合基因，并且发现所有可评估的RARG融合基因阳性患者和约半数少见型RARA融合基因阳性患者对ATRA耐药，但目前缺乏相关的分子机制研究。结合第65届美国血液学会年会报告，对我国在不典型APL的关键发病和ATRA耐药机制方面取得的重要进展进行报道。 Due to the successful application of all-trans retinoic acid (ATRA) and arsenic, the treatment of acute promyelocytic leukemia (APL) with PML::RARA fusion gene has achieved great success. However, some patients are presented with APL phenotype in cellular morphology, immunophenotype, and gene expression profile, while PML::RARA is negative, which is known as atypical APL (aAPL). In aAPL patients, more than 20 fusion genes related to retinoic acid receptors have been reported. It has been discovered that all evaluable patients with RARG fusion genes and approximately half of those with rare RARA fusion genes are resistant to ATRA, however, the molecular mechanisms of this resistance remain poorly studied. Combining with the reports in the 65th American Society of Hematology Annual Meeting, this paper reports great progresses of the key pathogenesis of aAPL and ATRA resistance mechanisms.

    急性早幼粒细胞白血病融合基因全反式维甲酸耐药

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    双特异性抗体治疗复发难治多发性骨髓瘤研究进展

    颜可泰林全德宋永平杨璐...
    86-90页
    查看更多>>摘要：近年来，包括靶向B细胞成熟抗原（BCMA）×CD3和G蛋白偶联孤儿受体C类第5组成员D（GPRC5D）×CD3在内的双特异性抗体（BsAb）用于治疗复发难治多发性骨髓瘤（RRMM）患者进行了广泛的研究。新药Teclistamab（BCMA×CD3）于2022年成为首个获得美国食品药品管理局（FDA）批准治疗RRMM的BsAb，埃纳妥单抗（Elranatamab）也于2023年获得批准。靶向BCMA×CD3的BsAb包括Alnuctamab、WVT078、ABBV-383、Linvoseltamab和F182112以及靶向GPRC5D×CD3的Talquetamab和LBL-034目前正在临床试验中进行评估。结合第65届美国血液学会年会报告，对BsAb治疗RRMM的研究进展进行报道。 In recent years, bispecific antibodies (BsAb), including targeting B cell maturation antigen (BCMA) ×CD3 and G protein-coupled orphan receptor class C group 5 member D (GPRC5D) ×CD3, have been extensively studied for relapsed/refractory multiple myeloma (RRMM) patients. Teclistamab (BCMA×CD3) was the first BsAb approved for RRMM in 2022 by Food and Drug Administration (FDA), and elranatamab was approved in 2023. BsAb targeting BCMA×CD3 including alnuctamab, WVT078, ABBV-383, linvoseltamab, and F182112, as well as talquetamab and LBL-034 targeting GPRC5D×CD3 are currently being evaluated in clinical trials. Combining with the reports in the 65th Annual Meeting of the American Society of Hematology (ASH), this paper reviews the progress of BsAb in treatment of RRMM.

    多发性骨髓瘤抗体,双特异性免疫疗法

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    弥漫大B细胞淋巴瘤患者血清脂蛋白a水平及其对预后的影响

    朱瑛刘四红吴夏陈明...
    91-96页
    查看更多>>摘要：目的 探讨弥漫大B细胞淋巴瘤（DLBCL）患者血清脂蛋白a[Lp（a）]的水平及其临床意义。 方法 回顾性队列研究。回顾性分析2017年1月至2022年6月就诊于常熟市第二人民医院87例DLBCL患者的临床资料（初治DLBCL组），选择健康体检者78名为对照组。比较初治DLBCL组和对照组Lp（a）的水平，及治疗后获得不同疗效的DLBCL患者Lp（a）水平。绘制受试者工作特征（ROC）曲线，分析血清Lp（a）预测DLBCL患者疗效的效能，计算曲线下面积（AUC），确定最佳临界值。根据最佳临界值，将DLBCL患者分为低Lp（a）组和高Lp（a）组，比较不同Lp（a）水平患者的临床病理特征；采用Cox比例风险模型分析DLBCL患者预后的影响因素；采用Kaplan-Meier法比较不同Lp（a）水平DLBCL患者无复发生存（RFS）和总生存（OS）。 结果 初治DLBCL组患者Lp（a）水平为（0.24±0.09）g/L，对照组为（0.09±0.06）g/L，DLBCL组高于对照组，差异有统计学意义（t＝3.61，P＝0.019）。87例患者中，治疗后达完全缓解（CR）54例，部分缓解（PR）23例，疾病进展（PD）10例。CR、PR、PD患者Lp（a）水平分别为（0.09±0.09）g/L、（0.12±0.08）g/L、（0.25±0.15）g/L，CR、PR患者Lp（a）水平均低于初治DLBCL患者Lp（a）水平[（0.24±0.09）g/L]，差异均有统计学意义（均P<0.05），PD组Lp（a）水平与初治DLBCL患者比较差异无统计学意义（P>0.05）。ROC曲线结果显示，血清Lp（a）预测DLBCL患者疗效的最佳临界值为0.25 g/L，AUC为0.776（95%CI：0.676～0.876，P<0.05），其灵敏度及特异度分别为66.67%、82.76%。根据Lp（a）的最佳临界值（0.25 g/L），将患者分为低Lp（a）组（≤0.25 g/L）（57例）和高Lp（a）组（>0.25 g/L）（30例）。高Lp（a）组患者中，乳酸脱氢酶>227 U/L、Ann Arbor分期Ⅲ～Ⅳ期、结外器官受累>1个的患者比例均高于低Lp（a）组，差异均有统计学意义（均P<0.05）。Cox多因素分析结果显示，Ann Arbor分期Ⅲ～Ⅳ期、国际预后指数（IPI）评分3～5分及Lp（a）>0.25 g/L是影响DLBCL患者OS的独立危险因素（均P<0.05）；Ann Arbor分期Ⅲ～Ⅳ期、IPI评分3～5分是影响DLBCL患者RFS的独立危险因素（均P<0.05）。低Lp（a）组中位OS时间未达到；高Lp（a）组中位OS时间为21个月，两组OS比较差异有统计学意义（P＝0.001）。低、高Lp（a）组中位RFS时间均为未达到，两组RFS比较差异无统计学意义（P＝0.102）。 结论 DLBCL患者Lp（a）水平升高，Lp（a）可能是影响DLBCL预后的因素。 Objective To investigate the level of serum lipoprotein a [Lp (a)] in patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance. Methods A retrospective cohort study was performed. The clinical data of 87 patients with DLBCL who were treated at Changshu No.2 People's Hospital from January 2017 to June 2022 (the newly treated DLBCL group) were retrospectively analyzed, and 78 healthy physical examination subjects were selected as the control group. The level of Lp(a) in the two groups and the level of Lp(a) in DLBCL patients achieving different therapeutic effects after treatment were compared. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of serum Lp(a) in predicting the therapeutic effect of DLBCL patients, and the area under the curve (AUC) was calculated to determine the optimal critical value. Based on the optimal critical value, patients with DLBCL were divided into low Lp(a) group and high Lp(a) group, and the clinicopathological characteristics of DLBCL patients with different Lp(a) levels were compared. Cox proportional hazards model was used to analyze the factors affecting the prognosis of DLBCL patients. Kaplan-Meier method was used to compare the relapse-free survival (RFS) and overall survival (OS) of DLBCL patients with different Lp(a) levels. Results The level of Lp (a) in the newly treated DLBCL group was higher than that in the control group[ (0.24±0.09) g/L vs. (0.09±0.06) g/L], and the difference was statistically significant (t = 3.61, P = 0.019). Among 87 patients, 54 achieved complete remission (CR), 23 achieved partial remission (PR), and 10 achieved progression of the disease (PD). The Lp (a) levels of patients achieving CR, PR, and PD were (0.09±0.09) g/L, (0.12±0.08) g/L, and (0.25±0.15) g/L, respectively. The Lp (a) levels in patients achieving CR and PR were lower than those in the newly treated DLBCL patients [(0.24±0.09) g/L], and the differences were statistically significant (all P < 0.05). There was no statistically significant difference in the Lp (a) levels between patients achieving PD and the newly treated DLBCL patients ( P > 0.05). The ROC curve results showed that the optimal critical value of serum Lp (a) in predicting the efficacy of DLBCL patients was 0.25 g/L, AUC was 0.776 (95% CI: 0.676-0.876, P < 0.05), and its sensitivity and specificity was 66.67%, 82.76%, respectively. According to the optimal critical value of Lp (a) (0.25 g/L), patients were divided into the low Lp (a) group (≤ 0.25 g/L) (57 cases) and the high Lp (a) group (>0.25 g/L) (30 cases). The proportion of patients with lactate dehydrogenase level >227 U/L, Ann Arbor stage Ⅲ-Ⅳ, and extranodal organ involvement >1 in the high Lp (a) group was higher than that in the low Lp (a) group, and the differences were statistically significant (all P < 0.05). Cox multivariate analysis results showed that Ann Arbor stage Ⅲ-Ⅳ, international prognostic index (IPI) score 3-5, and Lp (a)>0.25 g/L were independent risk factors for OS in DLBCL patients (all P < 0.05) Ann Arbor stage Ⅲ-Ⅳ and IPI score 3-5 were independent risk factors for RFS in DLBCL patients (all P < 0.05). The median OS in the low Lp (a) group was not reached the median OS of the high Lp (a) group was 21 months, and there was a statistically significant difference in OS between the two groups ( P = 0.001). The median RFS time was not reached in the low Lp (a) group and the high Lp (a) group and there was no statistically significant difference in RFS between the two groups (P = 0.102) . Conclusions Lp(a) level of DLBCL patients is increased, and Lp(a) could be a factor influencing the prognosis of DLBCL.

    淋巴瘤,大B细胞,弥漫性脂蛋白（A）预后

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    心脏弥漫大B细胞淋巴瘤11例临床病理特征、疗效、预后和突变分析

    赵娜施晴程澍王黎...
    97-103页
    查看更多>>摘要：目的 探讨心脏弥漫大B细胞淋巴瘤（DLBCL）患者的临床病理特征、突变情况、疗效及预后影响因素。 方法 回顾性病例系列研究。回顾性分析2016年1月至2020年10月上海交通大学医学院附属瑞金医院收治的11例心脏DLBCL患者的临床资料。采用NovaSeq测序平台对5例患者基因突变进行检测，通过公共数据库对测序数据进行生物信息学分析，确定致病性基因突变位点。采用Kaplan-Meier法分析患者无进展生存（PFS）、总生存（OS），采用单因素Cox比例风险模型分析影响患者预后相关因素。 结果 11例心脏DLBCL患者中男性5例，女性6例；年龄[M（Q1，Q3）]61岁（45岁，70岁）；均为非生发中心B细胞（non-GCB）型；原发性2例，继发性9例；Ann Arbor分期Ⅲ～Ⅳ期9例；乳酸脱氢酶（LDH）升高10例；国际预后指数（IPI）评分≥3分9例。11例患者中，9例接受了以R-CHOP（利妥昔单抗、环磷酰胺、表柔比星/盐酸多柔比星脂质体、长春新碱、泼尼松）为基础的一线治疗方案，其中8例获得完全缓解（CR），1例疾病稳定（SD）；1例接受了IR2（伊布替尼、利妥昔单抗、来那度胺）方案治疗，疗效为SD；1例患者仅接受支持治疗，疗效为疾病进展。随访39.9个月（25.6个月，57.3个月），11例患者3年PFS率为54.5%，3年OS率为77.9%。单因素Cox回归分析显示，性别、B症状、Ann Arbor分期、LDH水平、结外病变数、IPI评分与患者的PFS和OS均无相关性（均P>0.05）。5例行基因检测患者中，KMT2D和PIM1突变各2例，且KMT2D突变仅出现在继发性心脏DLBCL患者中（2/3），PIM1突变仅出现在原发性心脏DLBCL患者中（2/2）。 结论 心脏DLBCL患者多为non-GCB型，患者临床分期较高，可获益于R-CHOP方案。PIM1和KMT2D是心脏DLBCL的常见突变基因。 Objective To investigate the clinicopathological features, mutation, therapeutic efficacy and the factors influencing the prognosis of patients with cardiac diffuse large B-cell lymphoma (DLBCL). Methods A retrospective case series study was performed. The clinical data of 11 cardiac DLBCL patients in Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from January 2016 to October 2020 were retrospectively analyzed. NovaSeq sequencing platform was used to detect gene mutations in 5 patients, and bioinformatics analysis of sequencing data was conducted through public database to identify the mutation sites of pathogenic genes. Kaplan-Meier method was used to analyze the progression-free survival (PFS) and the overall survival (OS). Univariate Cox proportional risk model was used to analyze the influencing factors of prognosis. Results Among 11 patients with cardiac DLBCL, 5 were male and 6 were female. The age [M (Q1, Q3)] was 61 years (45 years, 70 years). All 11 patients were non-germinal center B-cell (non-GCB) type. There were 2 primary cases and 9 secondary cases 9 cases with Ann Arbor stage of Ⅲ-Ⅳ, 10 cases with increased lactate dehydrogenase (LDH) and 9 cases with international prognostic index (IPI) score equal to or higher than 3 scores. Among 11 patients, 9 cases received a first-line treatment based on the R-CHOP (rituximab, cyclophosphamide, epirubicin/doxorubicin hydrochloride liposomes, vincristine and prednisone) regimen, of which 8 patients achieved complete remission (CR), and 1 patient achieved stable disease (SD) 1 patient received IR2 (ibrutinib + rituximab + lenalidomide) treatment regimen and achieved SD, and 1 patient received supportive treatment only and achieved progression of the disease. The follow-up time was 39.9 months (25.6 months, 57.3 months). The 3-year PFS rate and 3-year OS rate of 11 patients was 54.5%, 77.9 %, respectively. Univariate Cox regression analysis showed that gender, B symptoms, Ann Arbor stage, LDH level, number of extranodal lesions, IPI score were not correlated with PFS and OS of patients (all P > 0.05). Among 5 cases undergoing gene detection, KMT2D mutations and PIM1 mutations were detected in 2 cases,respectively. Interestingly, KMT2D mutations were only found in secondary cardiac DLBCL patients (2/3), while PIM1 mutations were only detected in primary cardiac DLBCL patients (2/2). Conclusions Most cardiac DLBCL patients are non-GCB type and have advanced clinical stage, while may benefit from R-CHOP treatment regimen. PIM1 and KMT2D are the commonly mutated genes in cardiac DLBCL.

    淋巴瘤,大B细胞,弥漫性心脏肿瘤治疗结果预后

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    营养控制状态评分对晚期弥漫大B细胞淋巴瘤患者预后的预测价值

    单慧蓉陈玺丞张颢苗雨青...
    104-109页
    查看更多>>摘要：目的 探讨营养控制状态（CONUT）评分对晚期弥漫大B细胞淋巴瘤（DLBCL）患者预后的预测价值。 方法 回顾性病例系列研究。回顾性收集2009年10月至2022年1月淮海淋巴瘤协作组中7家医疗中心确诊的654例初诊晚期DLBCL患者的临床资料，所有患者均接受以利妥昔单抗为基础的免疫化疗方案治疗。按照7∶3比例将患者随机分配为训练集（458例）和验证集（196例）。收集患者临床病理资料，根据清蛋白、淋巴细胞计数和总胆固醇计算CONUT评分。根据MaxStat统计量确定CONUT评分的最佳临界值。采用Kaplan-Meier法绘制生存曲线；采用Cox比例风险模型对总生存（OS）的影响因素进行单因素、多因素分析；采用受试者工作特征（ROC）曲线评估CONUT评分分别联合国际预后指数（IPI）、改良国际预后指数（NCCN-IPI）预测OS的效能。 结果 654例患者中位随访时间为38.1个月（95% CI：35.3～40.9个月），5年OS率为49.2%。根据MaxStat统计量确定CONUT评分的最佳临界值为6分，将患者分为营养状况正常组（CONUT评分≤6分）（489例）和营养状况不良组（CONUT评分>6分）（165例）。多因素分析结果显示，CONUT评分>6分、男性、乳酸脱氢酶>240 U/L、高白细胞计数、低血红蛋白水平、年龄>60岁是晚期DLBCL患者OS的独立危险因素（均P<0.05）。整体晚期DLBCL营养状况不良组患者（CONUT评分>6分）OS较营养状况正常组（CONUT评分≤6分）差（P<0.001）；亚组分析结果表明，在ECOG PS评分<2分、IPI低中危险、IPI中高危、NCCN-IPI低中危、NCCN-IPI中高危的患者中，营养状况不良组（CONUT评分>6分）患者OS较营养状况正常组（CONUT评分≤6分）差（均P<0.05）。 结论 CONUT评分评估晚期DLBCL患者预后具有一定的价值，且CONUT评分联合IPI、NCCN-IPI的预测效能进一步提高。 Objective To investigate the predictive value of controlling nutritional status (CONUT) score in the prognosis of patients with advanced diffuse large B-cell lymphoma (DLBCL). Methods A retrospective case series study was performed. The clinical data of 654 patients newly diagnosed with advanced DLBCL diagnosed in 7 medical centers in Huaihai Lymphoma Working Group from October 2009 to January 2022 were retrospectively collected. All the patients received rituximab-based immune chemotherapy regimens. The patients were randomly assigned to the training set (458 cases) and the validation set (196 cases) in a 7:3 ratio. The clinicopathological data of patients were collected, and the CONUT score was calculated based on albumin, lymphocyte count, and total cholesterol. The optimal critical value of CONUT scote was determined by using MaxStat method. Kaplan-Meier method was used to draw survival curves Cox proportional hazards model was used to make univariate analysis and multivariate analysis on the factors influencing overall survival (OS). The efficacy of CONUT score in combination with the International prognostic index (IPI) and an enhanced IPI (NCCN-IPI) in predicting OS was evaluated by using receiver operating characteristic (ROC) curves. Results The median follow-up time of 654 patients was 38.1 months (95% CI: 35.3 months- 40.9 months), and the 5-year OS rate was 49.2%. According to the MaxStat method, the optimal critical value for CONUT score was determined to be 6 points. All the patients were classified into the normal nutritional status group (CONUT score ≤ 6 points, 489 cases) and the poor nutritional status group (CONUT score > 6 points, 165 cases). The results of the multivariate analysis showed that CONUT score > 6 points, male, lactate dehydrogenase >240 U/L, high white blood cell count, low hemoglobin level and age > 60 years were independent risk factors for OS of patients with advanced DLBCL (all P < 0.05). Patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group in the overall cohort of advanced DLBCL. Subgroup analysis revealed that among patients with Eastern Cooperative Oncology Group-performance status (ECOG PS) score < 2 points, IPI low-intermediate risk, IPI intermediate-high risk, NCCN-IPI low-intermediate risk, and NCCN-IPI intermediate-high risk, the patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group (CONUT score ≤ 6 points) (all P < 0.05). Conclusions CONUT score has a certain value in the assessment of the prognosis of patients with advanced DLBCL, and its predictive efficacy is further improved when combined with IPI and NCCN-IPI.

    淋巴瘤,大B细胞,弥漫性营养评价预后

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    替雷利珠单抗联合泽布替尼治疗难治弥漫大B细胞淋巴瘤的效果及安全性

    左立杰杨已起李蕊董毅君...
    110-114页
    查看更多>>摘要：目的 探讨替雷利珠单抗联合泽布替尼治疗难治弥漫大B细胞淋巴瘤（DLBCL）的疗效和安全性。 方法 前瞻性观察性研究。前瞻性选取2020年11月至2023年2月中国医学科学院肿瘤医院专科医联体北京市朝阳区三环肿瘤医院收治的10例至少接受过含利妥昔单抗一线全身系统性治疗的难治DLBCL患者。所有患者接受替雷利珠单抗（200 mg静脉滴注，第1天）和泽布替尼（160 mg口服，2次/d，第1天至第21天）治疗，21 d为1个周期，其中6例2线治疗，4例≥3线治疗。后续研究方案补充可同时联合利妥昔单抗（375 mg/m2静脉滴注，第1天）。如果未发生疾病进展或其他需要退出研究的事件，则入组后12个月达到主要终点。随访至2023年3月，总结随访结果时疗效，采用Kaplan-Meier法进行生存分析，总结不良反应发生情况。 结果 10例患者中，男性6例，女性4例；年龄[M（Q1，Q3）]55岁（50岁，69岁）；均为Ⅲ～Ⅳ期。10例共完成替雷利珠单抗联合泽布替尼90个周期治疗，治疗周期数为8个（2个，24个）。完全缓解4例，部分缓解3例，疾病稳定1例；随访时间19个月（11个月，28个月），无进展生存时间为8.5个月（1.3个月，27.0个月），中位缓解持续时间和中位总生存时间均未达到。治疗相关不良反应包括中性粒细胞减少（2例）、贫血（1例）、丙氨酸氨基转移酶及天冬氨酸氨基转移酶升高（1例），均为1～2级。 结论 替雷利珠单抗联合泽布替尼治疗难治DLBCL具有良好的临床效果和安全性。 Objective To explore the efficacy and safety of tislelizumab combined with zanubrutinib in the treatment of refractory diffuse large B-cell lymphoma (DLBCL). Methods A prospective observational study was conducted. A total of 10 patients with refractory DLBCL admitted to Beijing Chaoyang District Third Ring Cancer Hospital, a specialist medical consortium of Cancer Hospital Chinese Academy of Medical Sciences from November 2020 to February 2023 were prospectively collected. All the 10 refractory DLBCL patients at least received first-line systemic therapy containing rituximab and they were given tislelizumab 200 mg, intravenous infusion, on day 1 and zanubrutinib 160 mg, orally, twice a day, day 1-day 21, with 21 days as 1 cycle 6 patients received second-line therapy and 4 patients received ≥ third-line therapy. Subsequent regimens were added with rituximab (375 mg/m2, intravenous infusion on day 1). The primary endpoint will be reached 12 months after enrollment if there was no disease progression or other events that were scheduled to withdraw from the study. The therapeutic efficacy was summarized at the end of the follow-up in March 2023. Kaplan-Meier method was used to make survival analysis and the adverse reactions were summed up. Results There were 6 males and 4 females, all at stage Ⅲ-Ⅳ and age [M (Q1, Q3)] was 55 years (50 years, 69 years). All 10 patients completed 90 cycles of treatment with tislelizumab and zanubrutinib, with the cycle number of 8 cycles (2 cycles, 24 cycles). The follow-up time was 19 months (11 months, 28 months) 4 cases achieved complete remission, 3 cases achieved partial remission and 1 case had the stable disease. The progression-free survival was 8.5 months (1.3 months, 27.0 months) the median remission duration time and median overall survival time were not reached. Treatment-related adverse reactions included 2 cases of neutropenia, 1 case of anemia, and 1 case of elevated alanine aminotransferase and aspartate aminotransferase, all of which were grade 1-2. Conclusions Tislelizumab combined with zanubrutinib has good clinical efficacy and safety in the treatment of refractory DLBCL.

    淋巴瘤,大B细胞,弥漫性替雷利株单抗泽布替尼难治治疗结果

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    高危慢性粒-单核细胞白血病急性变年轻患者1例并文献复习

    李惠芸袁军李杰郝洪岭...
    115-117页
    查看更多>>摘要：目的 探讨慢性粒-单核细胞白血病（CMML）年轻患者的临床特征和疗效。 方法 回顾性分析2020年4月河北省人民医院收治的1例高危CMML急性变年轻患者的疾病进程及诊疗经过，并进行文献复习。 结果 患者为23岁女性，确诊CMML后不足9个月即转为急性单核细胞白血病。接受去甲基化药物单药治疗后骨髓完全缓解，持续6个月后疾病复发，再次接受去甲基化药物治疗后骨髓完全缓解，桥接异基因造血干细胞移植，移植成功。 结论 年轻CMML患者少见，早期诊疗对患者十分重要，年轻患者应在确诊后尽早行造血干细胞移植。

    白血病,粒-单核细胞,慢性造血干细胞移植去甲基药物

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    弥漫大B细胞淋巴瘤伴朗格汉斯细胞组织细胞增多症1例并文献复习

    刘聪聪祁玉娇孙延庆王姝雅...
    117-119页
    查看更多>>摘要：目的 探讨弥漫大B细胞淋巴瘤（DLBCL）和朗格汉斯细胞组织细胞增多症（LCH）的潜在关系。 方法 回顾性分析2022年2月甘肃省人民医院收治的1例DLBCL伴LCH患者的临床资料及诊治过程，并复习相关文献。 结果 患者为63岁女性，经免疫组织化学等检查后诊断为DLBCL伴LCH。R-CDOP方案治疗4个疗程达完全缓解后行自体造血干细胞移植，最终因重症肺炎和呼吸衰竭死亡。 结论 DLBCL和LCH的病变组织均是造血和淋巴组织肿瘤，考虑DLBCL和LCH可能存在潜在的克隆关系，但尚未完全证实。

    淋巴瘤,大B细胞,弥漫性组织细胞增多症,郎格尔汉斯细胞预后

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