[Outcomes of 104 children with B-cell non-Hodgkin lymphoma].

: 目的 总结分析儿童B细胞非霍奇金淋巴瘤 (B-NHL)短程化疗方案的远期疗效及预后影响因素。方法 前瞻性制定B-NHL的诊断与治疗方案。收集接受短程B-NHL 2001化疗方案治疗和随访的104例B-NHL患儿资料，并进行统计学分析。结果 104例B-NHL患儿中，男79例、女25例，中位年龄7.1（0.9~16.0）岁；96例病理类型明确的患儿中，Burkitt淋巴瘤60例、弥漫大B细胞淋巴瘤32例、介于弥漫大B细胞淋巴瘤与霍奇金淋巴瘤的B细胞淋巴瘤4例；另有8例为通过体液形态学和免疫表型分析诊断。诊断时Ⅰ、Ⅱ、Ⅲ和Ⅳ期患儿分别为4、27、55和18例；低危、中危和高危组患儿分别为1、26和77例。采用短程B-NHL 2001化疗方案治疗后，16例患儿出现肿瘤溶解综合征，3例患儿未获得缓解，9例患儿在缓解后复发，复发时间为停药后1~7个月，7例患儿在化疗结束后接受自体造血干细胞移植治疗，6例患儿在疗程中加用利妥昔单抗。中位随访24（4～92）个月，104例患儿5年无事件生存（EFS）率为（86.7±3.5）%。单因素分析显示诊断时疾病分期、LDH水平、血清铁蛋白水平和2个疗程后是否达缓解与患儿预后有显著相关性（P值均 0.05）。多因素COX分析显示血清铁蛋白水平与患儿预后有显著相关性（P<0.05）。结论 短程B-NHL 2001治疗方案对儿童B-NHL疗效肯定，预后与疾病分期、LDH、血清铁蛋白水平和早期治疗反应显著相关。 METHODS: One hundred and four newly diagnosed B-NHL children were enrolled in protocol of B-NHL 2001. The statistics were performed by SPSS 13.0. RESULTS: Of 104 children (79 males, the median age of 7.1 years), 60, 32 and 4 patients were diagnosed with Burkitt lymphoma, diffuse large B-cell lymphoma and unclassifiable B-cell lymphoma, respectively. Four patients were in stage Ⅰ, 27 stage Ⅱ, 55 stage Ⅲ and 18 stage Ⅳ; 1, 26 and 77 patients were allocated into R1, R2 and R3 risk groups, respectively. Three patients never got complete remission (CR), 9 patients relapsed after CR with the duration of relapse from 1 to 7 months after chemotherapy. The estimated 5-year EFS of 104 patients was (86.7 ± 3.5)%. Univariable analyses identified that risk factors for recurrence were of higher staging, elevated LDH, serum ferritin and poor early response. Age, sex, pathologic diagnosis, original tumor, bone or marrow involvement, C-MYC and risk group were not found to be associated with the risk of failure to treatment. Multivariable COX regression models confirmed serum ferritin as a significant independent prognostic marker. CONCLUSION: B-NHL 2001 protocol was reasonable for B-NHL children. Higher staging, elevated LDH, serum ferritin and poor early response increased risk for recurrence.