| Purpose and Background: MCL is a highly invasive subtype of B-cell non-Hodgkin’s lymphoma,which has low incidence. Patients generally present with lymphadenopathy、 bone marrow、 gastrointestinal tract and peripheral blood involvement.A chromosomal translocation t(11; 14)(q13; q32) is the molecular hallmark of MCL, resulting the overexpression of cell cycle protein Cyclin D1,and negative for Cyclin D1 is found in MCLwith t(2;12) or t(12;14).The disease is highly heterogeneous, mainly in clinical features, pathological types, the differences between the response to treatment and prognosis of inconsistency. This article is intended to analyze the relationship between clinical features of patients with MCL, laboratory examination and treatment on prognosis of influence, to guide treatment.Metheod: 44 patients with clear diagnosis of MCL were collected in January 2006 and December 2006 from the Third Affiliated Hospital of Jilin University. Through the observation and analysis of the patient’s gender, age, the primary symptom,group B symptoms,bone marrow involvement,spleen involvement,performance status,clinical staging、 β2 microglobulin,peripheral blood leukocyte count,lactate dehydrogenase(LDH),mantle cell lymphoma international Prognostic Index(Mantle Internationnal Prognostic Index, MIPI) risk stratification,tumor growth Index(Ki- 67) and whether the application rituximab,whether to maintain, using SPSS17.0 software, application of Kaplan Meier method to calculate the survival rate and survival function, application Log-Rank test for single factor analysis, using COX regression model for analysis of multiple factors, we investigate the relationship between the factors and prognosis of MCL.Results:In this article 44 patients with MCL, male to female ratio was 3:1, less than or equal 60 years old was accounted for 50.00%(22 cases), median onset age was 59 years old. Primary symptoms mainly were superficial lymph node enlargement, accounting for 40.91%, and a common(56.82%) in the neck. Common extranodal sites included the spleen(54.55%), bone marrow(21 cases, 47,73 %), gastrointestinal tract(6 cases, 13.64%), Waldeyer’s ring(6 cases, 13.64%),and so on. Group B symptoms was accounted for 21 cases(47.73%), peripheral blood involvement in 11 cases(25.00%). Abdominal and retroperitoneal lymph node were mostly common deep invasion. accounting for 40.91% and 40.91% respectively. ECOG scores of 10 cases(22.72%) were 2 points or more. 2 patients presented with clinical stage I, 6 cases with stage II, 12 cases with stage III, 24 cases with stage IV.Clinical stage III and IV was accounted for 81.82%(36 cases), MIPI prognosis grouping, low-risk group was 47.72%(21 cases), intermediate risk group 31.82%(14 cases) and high-risk group was 20.45%(9 cases). LDH increased 29.55%(13 cases), β2 microglobulin increased 34.09%(15 cases), leukocyte rise 18.18%(8 cases). 36 cases routine immunohistochemical detection of Cyclin D1, 35 cases were positive(97.22%), 1 case negative(2.78%), the negative case had Ig GCCND1 gene by FISH detection and the SOX-11+.Positive rates of CD5,CD20,CD79 a,Bcl – 2,PAX- 5 were 90.32%,97.22%, 96.43%,97.22%,100%.Negative rate of CD3,CD10,Bcl-6,CD23 were 74.29%,88.89%,89.47% and 73.33% respectively; 36 patients were tested Ki-67 level,18 cases(50.00%)had Ki-67 staining on ≥40% and 18 cases(50.00%)had Ki-67 on <40%, the median value of 35%(5%-80%). 12 cases underwent PET/CT examination, bone marrow examination demonstrated disease in 9 cases,but only 1 case of them was evaluated bone marrow involvement by PET/CT. In the treatment of chemotherapy regimens including rituxan, both CR rate and rate of 1-year PFS, 2-years PFS, were better than the pure chemotherapy group. In the single factor analysis between clinical features and prognosis, age,MIPI score, peripheral blood leukocyte count, LDH level, ECOG, Application of Rituximab, maintenance therapy are the prognostic factors of MCL, P values were 0.024, 0.023, 0.006, 0.013, 0.045, 0.016, 0.045. Gender, group B symptoms, bone marrow involvement, splenomegaly, clinical stage,β2 microglobulin level,Ki-67 had no effect; Multiple factors analysis with COX model showed that: besides Rituxiamb, other factors had no relationship with the prognosis(P > 0.05).Conclusion: 1.MCL usually occurred in older men. The majority of cases at the beginning characterized by superficial lymph node enlargement, especially in the neck lymph nodes, deep lymph node invasion in abdominal cavity and retroperitoneal lymph nodes were common. Many had been already in Ⅲ-Ⅳ period when were found.2.In immunology phenotype, CD5(+), Cyclin D1(+), CD10(-), CD23(-) was the characteristic performance, at the same time immune phenotypic variation exists and genetic testing was necessary in the special case.3. PET- CT could be recommended as an auxiliary means for MCL clinical staging, but bone marrow involvement diagnosis rate was low, and we needed rely on bone marrow examination.4. Age, MIPI score, peripheral blood leukocyte count, LDH level, ECOG, application of Rituximab treatment, maintenance therapy were the factors affecting the prognosis of MCL.5. Application of Rituximab treatment was the independent prognostic factors of MCL. Chemotherapy with rituximab could improve the CR rate of MCL, PFS and the median survival period. |
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