The Clinical Relationship Study Between Prognosis Factors And Therapeutic Effect Of Primary Bone Malignant Lymphoma

Background:The incidence of Primary Bone lymphoma(PBL) is infrequency, only occupy5%of lymphoma. Oberling described it for the first time in1928. Parker et al first reported17cases of bone primary reticulum cell sarcoma in1939, so established a primary bone malignant lymphoma as an independent clinical disease. In recent years, The incidence of Primary Bone lymphoma(PBL) is increasing, Possibly because of:1. Depth study of the disease, Making the original may be misdiagnosed for other diseases of bone primary lymphoma of the correct diagnosis;2. In recent years, Epidemiological surveyed:The overall incidence of lymphoma is in an upward trend, The reason for the deterioration is the environment and the virus infection-related. Bone of primary malignant lymphoma as an important part of extranodal lymphomas, also affected and showed an increase in incidence。Clinical manifestations of the lymphoma has such differences, Prognosis is usually well. However, due to the different source of primary bone malignant lymphoma cells, the pathological type of it is various.Its etiology and pathogenesis is still limited, Further research for its sub-type phases and different installments to take different measures of treatment has a positive meaning.Coupled with an increase in incidence of the disease in recent years, Therefore, to study and explore the prognostic factors affected bone with primary malignant lymphoma and correlation with treatment efficacy has clinical significance. To improve the cure rate of this type of lymphoma, to reduce the relapse, and provide relevant clinical data, we carry out this study.Objective:1.To investigate the prognosis of the extranodal Primary Bone lymphoma(PBL), analyse the relationship between the prognosis and CR.2.To analyse the dependability of CR with clinical factors.3.Furthermore, we also investigated the applicability of the International Prognostic Index (IPI),LDH and so on,which has been widely shown to be predictive of treatment outcome in malignant lymphomas of different grades, to the prognostication of the Primary Bone lymphoma(PBL).Methods:1.35patients with Primary Bone lymphoma(PBL) were analyzed retrospectively. All the patients were address with the age, gender, ECOG score, B symptom, IPI score, Pathological types, lactatedehydrogenase (LDH), β2-MG、haemoglobin、 WBC、the pattern of theropy, therapeutic effect, Time of progression(TTP) and survival time(ST).2.To find out the clinical factors which affect the prognosis of the extranodal Primary Bone lymphoma(PBL).3.To analyse the relationship between TTP and CR by SPSS13.0, all patients were divided two groups according to whether acquiring complete response(CR) or not.4.To analyse the statistical significance between CR and the clinical fators.Results:1.Of the35patients,16(45.7%) cases were in stage Ⅰ-Ⅱ and19(54.3%) cases were in stage Ⅲ-Ⅳ. The most common symptoms were progressive bone pain, local swelling and pathological fracture, Nerve root compression can also be manifestations of radiating pain and nerve disfunction. Due to rare disease clinical, It is easily missed. Before pathological diagnosis, Patients with duration of1to24months, five cases (14.3%) has fever, night sweats, and weight decreased significantly and B symptoms.2.14(40.0%) patients were treated with chemotherapy alone,21(60.0%) patients were treated with radiochemotherapy. The first-line chemotherapy regimens were mainly CHOP. The overall response rate (CR+PR) was77.1%(27/35) with complete remission (CR) rate of28.6%(10/35). The response rate of chemotherapy alone group was75.0%(9/12) with CR rate of8.3%(1/12). The response rate of combined modality group was80.0%(8/10) with CR rate of50.0%(5/10).3.Univariate analysis showed that ECOG score, B symptom, IPI score, extranodal organs, Pathological types, lactatedehydrogenase(LDH), β2-MG, Ann Arbor stage, therapeutic effect have the relationship with the prognostics.4.Multivariable analysis showed that B symptom, LDH, ECOG score, β2-MG, Ann Arbor stage and therapeutic effect were independent prognostic factors of PBL.5.B symptom, extranodal organs, LDH, stage, ECOG score have the correlation with the patient whether or not acquired CR after treatment.Conclusion:1.The primary bone malignant lymphoma is low incidence, Systemic symptoms is light, The majority of patients because of local pain and other symptoms are misdiagnosed as synovitis, Arthritis, bone tuberculosis, multiple myeloma, Ewing tumor, etc. Biopsy and immunohistochemical staining of the lesion is the primary means of diagnosis.2.The primary bone malignant lymphoma in the bones of the body may be involved, But the most common lower extremity long bone involvement. The femur, Followed by the pelvis, spine and other, Prompts the bone involvement parts and bone marrow actively growing parts of the match, Especially in flat bones and long bone metaphysis.3.Primary malignant lymphoma of bone histopathological analysis showed that the majority of cases are aggressive non-Hodgkin’s lymphoma, And more for DLBCL, Lymphoma, a rare low-invasive (inert), Widely recognized principle of treatment of aggressive non-Hodgkin’s lymphoma with chemotherapy, Therefore, the PBL’s treatment with chemotherapy, Additional bulky and post-chemotherapy residual lesions field radiotherapy, Can get better treatment. Single local radiotherapy with good control of the local lesions in the treatment of wild, But often fail in the system lesions.4.Operation applies only to lift orthopedic A&E, Get pathology and repair of pathological fractures, The disease is long-term survival is still not satisfied, Need to seek to improve the treatment of primary malignant lymphoma of bone program or new treatments. Joint hematopoietic stem cell transplantation after high-dose radiotherapy and chemotherapy is an effective way to improve the long-term survival.5.The B symptom, abnormal LDH, advanced stage and the worse performance status are high risk factors,which affect the survival of the Primary Bone Lymphoma patients.6.The term efficacy is an important factor affecting the prognosis of patients. After radiotherapy and chemotherapy,35patients, the symptoms of19people complete remission (CR), Eight were in partial remission (PR),6person symptoms progress (PD), stable symptoms of2people (SD). By the comparison between groups, P values less than0.05. Complete remission rate was significantly higher than the partial response rate, progression rate and stable rates; Complete remission compared to the combination of partial remission in patients with (CR+PR,27) with stable symptoms of the patients (SD,2), P values less than0.05; The symptoms of complete remission, partial remission and stable patients (CR+PR+SD,29) and the symptoms progress of the patients (PD,6), P values less than0.05; The symptoms progress, patients (PD,6) and symptoms in patients with stable (SD,2) compared to P values greater than0.05, the results not statistically significant.7.Many clinical factors including B symptom, LDH, Stage, ECOG score, IPI score and extranodal organs had the correlation with CR.