| Objective:Lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia is a kind of non Hodgkin's lymphoma that a variety of small lymphocytes and plasmacytoid lymphocytes involved,often invading bone marrow,spleen and lymph nodes,and other small B cell lymphoma diagnosis is excluded.WM is LPL invasion of bone marrow accompanied by serum monoclonal Ig M,more than 90% of LPL is WM.In this study,the data of WM patients were retrospectively analyzed.The data were collected and analyzed to reduce the misdiagnosis rate and missed diagnosis rate.Methods:22 cases of WM were selected from the second hospital of Shanxi Medical University hospitalized patients(2006.01.01-2017.01.01)patients to summarize the clinical date,including clinical manifestation,pathology,laboratory findings,treatment,therapeutic effect and prognosis of scheme and so on.The application of two samples were compared using independent samples t test,multiple samples or two independent samples nonparametric test and Fisher exact probability method,the influence factors on the treatment effect of the disease were analyzed and discussed.Results:The date were collect from 22 patients with WM,including male and female in each of the 11 cases,the ratio of male to female was 1:1,the overall age distribution range was 53-83 years old,with an average age of 68.4 years.The main clinical symptoms and signs are: fatigue,liver and spleen and lymph nodes;laboratory,imaging and pathological examination: all patients has anemia,some patients with leukopenia and pancytopenia;bone marrow to active hyperplasia,hyperplasia of individual low number of patients,the majority of patients with bone marrow plasma like lymphocytes accounted for more than 50% of rouleau;bone marrow biopsy showed different degrees of plasmacytoid lymphocyte infiltration,in which individual patients had bone marrow fibrosis;22 cases of patients with monoclonal Ig M in the range of 17-135g/L(average49.18 g/L),most of the low proteinemia,individual patients with Sjogren syndrome and chronic renal failure;radionuclide bone scan the individual existence of multiple bone metabolic abnormalities;The first choice of treatment: 3 patients of 22 WM did not receive treatment,3 patients of 19 patients that give consent to medical treatment,which befordhand accepted plasmapheresis,chemopathy is mainly FC,individual cases selective therapy are FCD,CTD,FCP,FVAC VD,FD;the first treatment effect of PR occurred in 6 cases(31.6%),MR occurred in 2 cases(10.5%).There were 2 cases of PD(10.5%),9 cases of SD(40.9%);During in the course of treatment,patients occurred in 5cases with DIC complication and chronic renal failure occurred in 2 cases,from which 1case was found when they were diagnosed,1 case with nephrotic syndrome,2 cases with hyperviscosity syndrome,2 cases with myocardial infarction,1 cases with autoimmune hemolytic anemia,1 cases with Sjogren's syndrome.The white blood cell counts,hemoglobin concentration,platelet count,neutrophil count,folic acid concentration,total protein,globulin,albumin count,erythrocyte sedimentation rate,bone marrow plasma like lymphocyte ratio and CD19+ lymphocyte percentage,ferritin concentration,concentration of Vit B12,Ig M,LAM and KAP quantitative,?2-MG concentration and PR MR,the effects of two independent samples t test and rank sum test that each variable has no influence on the treatment effect.In the PR and MR of two different treatment effect and hepatomegaly,splenomegaly,abnormal blood coagulation,ISSWM score of chi square test showed therapeutic effect are not related to the hepatomegaly,splenomegaly,abnormal coagulation and ISSWM score.Conclusion:WM is an indolent and incurable non Hodgkin's lymphoma,which is common in the middle and old aged people.There is no specificity in clinical manifestation and laboratory examination.Although the survival times is long,the disease is easy to recur.Therefore,the patients with unexplained anemia,ESR and other suspicious patients timely blood routine examination,immunoglobulin and bone marrow morphology and bone marrow biopsy examination should be done in times,early diagnosis and appropriate treatment options,which can reduce recurrence,improve the survival and quality of life. |
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