低悪性度リンパ腫の治療 化学療法について

Abstract

We analyzed 113 cases of low-grade lymphoma including follicular medium-sized cell type, follicular mixed type and diffuse small cell type of B-cell origin in the LSG classification. Diffuse medium-sized cell type of B-cell origin corresponding to diffuse small cleaved cell in working formulation and intermediate lymphocytic lymphoma, both of which are classified in indolent lymphoma by national cancer institute, was excluded because our study showed poor prognosis of this type. Chemotherapy was done as the primary therapy in 89 patients and anthracycline was used in 63 patients. Analysis of survival rate revealed better prognosis of the chemotherapy with anthracycline from 5 -to 10-year survival, although CR ratio was less than that of the chemotherapy without anthracycline. Significant differences in prognosis were found in clinical stage (I vs II), primary sites (nodal vs exnodal), serum LDH (normal vs high) and therapeutic response (CR vs PR). Follicular medium-sized cell type showed almost the same survival as that of diffuse small cell type within 5 years after onset. Ten patients with follicular medium-sized cell type, however, died more than 5 years after onset and all of 4 patints of 10-year survival were under recurrent disease. In contrast, none of patients with diffuse small cell type died after 4-year survival and all of 4 patients of 10-year survival were disease-free. Improvement of long-term survival of follicular lymphoma is a major problem in chemotherapy of low-grade lymphoma, and a more intensive chemotherapy and/or combination with radiotherapy will be necessary in the near future.