POD24在106例伴骨髓侵犯脾边缘区淋巴瘤中的预后意义

OBJECTIVE: To explore the effect of progression of disease within 24 months（POD24）on overall survival（OS）of splenic marginal lymphoma（SMZL）with bone marrow invasion, and to compare the clinical characteristics between POD24 SMZL with non-POD24 SMZL patients. METHODS: The SMZL patients with bone marrow invasions were retrospectively analyzed between January 2002 and January 2017 treated in our institute, and the patients with sufficient follow-up time to judge POD24 were evaluated the clinical characteristics and prognosis, patients who died of non-progressive factors were excluded. RESULTS: 106 patients were enrolled with a median age of 57（25-79）years old. ①Clinical characteristics: All patients presented with bone marrow invasion and splenomegaly, 59.4％（63/106）with huge spleen, 14.8％ （15/101） with hepatomegaly. Complex karyotype were found in 22.7％（18/79） patients; 13q deletion, 11q（ATM） deletion, 17p（TP53） deletion, and CEP12 abnormality patients presented with the percentage of 5.1％（4/78）, 1.3％（1/72）, 2.5％（2/80）, and 7.5％（4/53）, respectively. ②Survival analysis: Univariate analysis showed that POD24, HGB less than 100 g/L and FISH detection of trisomy 12 were poor prognostic factors of OS. Multivariate analysis showed that only POD24 had independent prognostic significance [HR＝20.116（95％ CI 2.226–181.820）, P＝0.008]. ③ Subgroup features: Patients with POD24 had significantly higher rates of mediastinal lymphadenopathy（63.6％ vs 18.9％, P＝0.005）and complex karyotype（50.0％ vs 17.9％, P＝0.024）than those without POD24. While the incidence of abdominal lymphadenopathy, anemia, thrombocytopenia, the lower albumin, and the increasing lactate dehydrogenase were higher in POD24 patients, but with no statistically difference. CONCLUSION: POD24 is an independent prognostic factor of the OS in SMZL. SMZL patients with mediastinal lymphadenopathy and complex karyotypes when diagnosed have a higher risk of POD24.