ABSTRACT
Objective To investigate the clinical manifestations, treatment outcomes and prognosis factors of the patients with primary systemic anaplastic lymphoma kinase negative anaplastic large cell lymphoma (ALK-ALCL). Methods The clinical data of 32 patients histologically confirmed with ALK-ALCL from January 2011 to December 2017 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Kaplan-Meier method, Log-rank test and Cox proportional hazards model were used for the survival analysis. Results There were 19 males and 13 females in 32 patients, and the median age of onset was 50 years old (14-78 years old). The proportion of the patients with B symptom, extranodal involved, stageⅢ-Ⅳ, International Prognostic Index (IPI) sore 2-3 were 34.4 % (11 cases), 53.1 % (17 cases), 59.4 % (19 cases) and 50.0 % (16 cases) respectively. Chemotherapy alone and chemotherapy plus radiotherapy were the main methods, and a few patients received surgery alone, surgery plus chemotherapy, chemotherapy plus autologous stem cell transplantation or palliative care. The efficacy of 28 cases could be evaluated. The objective effective rate was 85.7 % (24/28), the complete remission (CR) rate was 42.9 % (12/28), and the partial remission (PR) rate was 42.9 % (12/28). The median progression-free survival (PFS) time was 28 months (95 % CI 13-42 months) and the median overall survival (OS) time was 43 months (95 % CI 24-61 months). The anticipated 5-year OS rate was 36.6 % . Single factor analysis results revealed that patients who was female (χ2＝7.654, P＝0.006), with normal serum lactic dehydrogenase (LDH) level (χ2＝7.575, P＝0.006), normal serum β2microglobulin level (χ2＝4.770, P＝0.029) and without B symptom (χ2＝9.418, P＝0.002), IPI score 0-1 (χ2＝4.119, P＝0.042) had a better prognosis. Multivariate survival analysis indicated that symptoms B ( HR＝ 12.460, 95 % CI 2.645-58.708, P＝ 0.001) and IPI score ( HR＝7.521, 95 % CI 1.624-34.841, P＝0.010) were the independent factors for prognosis. Conclusion The prognosis of the patients with primary systemic ALK-ALCL is poor, especially for the worse prognosis of the patients with symptoms B and IPI sore 2-3.
ABSTRACT
Objective:To investigate the treatment,clinical characteristics,and outcomes of patients with primary central nervous sys-tem lymphoma(PCNSL).Methods:A total of 75 patients histologically confirmed with PCNSL from November 2011 to November 2015 in the frist affiliated hospital of Zhengzhou Unversity were enrolled in this retrospective study.The clinical characteristics,treatment outcomes and prognostic factors of the patients were analyzed.The Kaplan-Meier method was used for univariate analysis of survival, with assessment of differences by the Log-rank test.Multivariate analysis was performed using the Cox proportional hazards model. Results:The median age at diagnosis of the 75 patients with PCNSL was 55 years(range:9-79 years),and a male-to-female ratio of 1.1:1 was observed.Major clinical characteristics observed in the patients were increased intracranial pressure and focal neurological defi-cits.All patients were diagnosed with diffuse large B-cell lymphoma(DLBCL).Of the 69 patients with follow-up data,the median pro-gression-free survival(PFS)of the chemotherapy combined with radiotherapy group(n=25),chemotherapy group(n=28),radiotherapy group(n=9)and surgery group(n=7)were 23.6(95% CI:16.0-31.3),6.4(1.0-11.8),9.8(4.7-14.9),and 5.0(4.9-5.2)months,respective-ly.The median overall survival(OS)of these four groups was 45.7(95% CI:44.2-47.2),11.0(7.1-15.0),16.1(15.3-17.0),and 6.9(1.9-12.0)months,respectively.All differences in PFS and OS between the groups were statistically significant(all P<0.01).No statistical dif-ferences were observed in the incidence of treatment-induced toxicity among these groups(P>0.05).Survival analysis showed that both age and Eastern Cooperative Oncology Group(ECOG)performance status were significantly associated with OS,and thus were in-dependent risk factors.Conclusions:PCNSL predominantly occurred in elderly people.Diffuse large B-cell lymphoma was the main type of PCNSL diagnosed.Increased intracranial pressure and focal neurological deficits were the major clinical characteristics of the patients.Age(60 years or younger),ECOG performance status score≤1,and the comprehensive treatment modality were significantly associated with improved OS.