| ObjectiveTo analyze the clinical characteristics of B-NHL CD20(+)in children and the clinical efficacy,long-term recurrence and safety of anti-CD20 immunotherapy combined with chemotherapy for CD20(+)non-Hodgkin’s lymphoma(NHL),so as to explore a more effective treatment regimen for CD20(+)non-Hodgkin’s lymphoma in children.MethodThe clinical data of 71 children with CD20(+)non-Hodgkin’s lymphoma admitted to the Hematology/Oncology Department of Children’s Hospital from January 2013 to January 2019 were retrospectively analyzed.Fifty-eight children were divided into R1,R2,R3 and R4 groups according to B-NHL-2009-8-1 chemotherapy regimen.In each group,the children treated with B-NHL-2009-8-1 regimen alone were selected as the chemotherapy group,and the children treated with rituximab combined with B-NHL-2009-8-1 regimen were selected as the immunization + chemotherapy group.The ? 2 test and t test to compare Ⅱ,Ⅲ,Ⅳ immune + chemotherapy group and chemotherapy group in the three groups of gender,age,course of whether there is a difference,The Fisher’s exact test comparison Ⅱ,Ⅲ,Ⅳ period immune + chemotherapy group and chemotherapy group after 2 courses of remission rate difference between;Kaplan-Meier analysis was used to compare the effects of LDH,uric acid,blood routine,CRP,Epstein-Barr virus infection,central/bone marrow infiltration,St.Jude stage,remission of the second course of treatment,chemotherapy combined with rituximab on the survival and prognosis of the children at the first diagnosis.Kaplan-Meier analysis was used to compare the effect of Burkitt lymphoma immunotyping on survival prognosis.Cox regression model was used to analyze the independent risk factors affecting the prognosis of B-NHL CD20(+)children.Adverse reactions during treatment were recorded.Results1.Among the subjects,49 cases(69%)were male and 22 cases(31%)were female.The ratio of male to female was 2.2:1;The age of onset ranged from 1 August to 13 October,and the median age was 6 1 month.Among them,37 cases(52.1%)were in school age,26 cases(36.6%)were in early school age,5 cases(7.1%)were in infancy,3cases(4.2%)were in adolescence,and 0 cases(0%)were in infancy and neonatal stage.2.The causes of the first diagnosis were abdominal pain or distension in 37 cases(52.1%),one of which was accompanied by weakness of both lower limbs.Neck mass was found in 23 cases(32.4%),of which 1 case was associated with hearing loss.Maxillofacial mass was found in 7 cases(9.9%),of which 1 case was associated with hearing loss.Perineal mass in 1 case(1.4%).One case(1.4%)had right hand dyskinesia.Thrombocytopenia was 1 case(1.4%).Anemia in 1 case(1.4%).3.There were 47 cases(66.2%)of extradodal involvement,including 37 cases(78.7%)of peritoneal involvement,11 cases(23.4%)of ileocecal involvement,11 cases(23.4%)of bone marrow involvement,and 1 case(1.7%)of spinal cord occupation paraplegia,7 cases(17.1%)of central involvement,and 7 cases(17.4%)of maxillofacial involvement.4.Ⅱ period in children,one of seven chemotherapy group,six of them after 2courses of treatment to achieve CR(85.7%).There were 10 patients in the immunization + chemotherapy group,10 of whom reached CR(100%)after 2 courses of treatment.Ⅲ period,in children with chemotherapy group,a total of nine people,including five people after 2 courses of treatment to achieve CR(55.6%).There were 28 patients in the immunization + chemotherapy group,19 of whom reached CR(67.9%)after 2 courses of treatment.Ⅳ period,in children with chemotherapy group have 5people,0 people after 2 courses of treatment to achieve CR(0%).Immune +chemotherapy group a total of 12 people,including five people after 2 courses of treatment to achieve CR(58.3%),including Ⅳ period in children with immune +chemotherapy group after 2 courses of complete remission rate was significantly higher than chemotherapy group(P = 0.044 < 0.05),with statistical differences.5.The KM survival curve and the log-rank test respectively on the single factor analysis is made on various factors: the incipient lactate dehydrogenase < > 800 u/L,hemoglobin,120 g/L,no central infiltration,st.Jude stage Ⅱ,2 period of treatment to achieve CR and chemotherapy after joint rituxan EFS and OS were higher than 4 years of lactate dehydrogenase 800 u/L or higher to begin with,120 g/L or less hemoglobin,accompanied by central infiltration,st.Jude stage Ⅲ / Ⅳ,2 treatment fails to meet the CR,and joint rituxan(P values are: 0.003,0.01,0.045,0.007,0.000,0.040),with statistical difference.6.Among the subjects,63 cases were Burkitt lymphoma(88.7%),6 diffuse large B-cell lymphoma(8.5%),and 2 anaplastic large cell lymphoma(2.8%).The KM survival curve and Log-rank test were used to compare the positive and negative Bcl-6in Burkitt’s lymphoma,and P=0.022<0.05 was statistically significant.7.Cox regression model analysis showed that the poor prognosis of B-NHL-CD20(+)children were not treated with rituximab(HR0.328,95%CI: 0.142-0.759),did not achieve remission in the second course of treatment(HR0.314,95%CI: 0.137-0.0.719)and central infection(HR4.742,95%CI: 1.355-16.591).8.The R2,R3 and R4 group respectively,the immunization + chemotherapy group and chemotherapy group adverse reactions(oral mucosa reaction,conjunctivitis,the digestive tract,the digestive tract hemorrhage,respiratory infections,kidney function damage,bone marrow suppression,fungal infections,skin reaction,pancreatitis,cardiac toxicity,body pain,high blood pressure)on statistical analysis of incidence of use by Fisher’s exact test to compare the incidence of adverse reactions,obtained P values >0.05,no statistical difference.Conclusion1.Among the 71 children involved in the study,the incidence of male children was twice as high as that of female children,and the incidence of school-age children was more than half.Among the reasons for the first diagnosis,most of them visited the doctor for "abdominal pain or abdominal distension",accounting for more than half.2.The survival prognosis of Bcl-6 positive patients with Burkitt’s lymphoma is better than that of negative patients;3.Lactate dehydrogenase,hemoglobin,presence of central infiltration,St.Jude stage Ⅱ and CR after the second course of treatment all affected the survival and prognosis of children.4.Cox regression model analysis showed that central infiltration and failure to achieve complete remission after the second treatment were independent risk factors for CD20(+)NHL in children.5.Combination rituxan treatment can improve the Ⅳ phase 2 period of treatment in children with complete response rates.6.Combined treatment with rituximab was a protective factor for CD20(+)NHL in children.7.Rituximab combined with chemotherapy does not increase the incidence of adverse reactions of the disease,and the drug safety is good. |
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