Clinical Features And Prognostic Factors Of Mantle Cell Lymphoma

Background Objective: mantle cell lymphoma(MCL)is a kind of non Hodgkin’s lymphoma(NHL)with unique biological characteristics.It has the dual adverse prognostic factors of non Hodgkin’s lymphoma(NHL),such as indolence and invasion.Conventional chemotherapy can not be cured,disease-free survival and overall survival are short,At present,there is no international standard treatment mode.With the deepening understanding of the pathogenesis and prognostic factors of MCL,the application of new drugs and hematopoietic stem cell transplantation(HSCT)has significantly improved the overall survival rate of MCL patients.The purpose of this study was to investigate the clinical features and prognostic factors of mantle cell lymphoma.Methods: a total of 97 patients with newly diagnosed MCL admitted to Guangxi Medical University from January 1,2013 to July 1,2020 were retrospectively analyzed.The patients were followed up until March 30,2021.SPSS software was used to describe the measurement data.Chi square test,K-M survival analysis,univariate and multivariate analysis were used to analyze the clinical characteristics and prognostic factors.The gene expression profile(gse93291)and the corresponding prognosis data of MCL patients were downloaded from the gene expression omnibus Geo.Cibersort algorithm was used to analyze the proportion of 22 kinds of immune cells in tumor tissues,and then the relationship between tumor infiltrating immune cell subsets and prognosis was analyzed.Results : 1.The median age of 97 patients was 59.5 years(36-83years),including 80 males and 17 females,with a male to female ratio of 4.7:1.Cyclin D1 overexpression or T(11;14)(q13 32)translocation.Bone marrow infiltration was found in 47 cases(49.5%)and extranodal invasion in 33 cases(44.0%).There were 55 cases(56.7%)in low-risk group,20 cases(20.6%)in moderate risk group and 22 cases(22.7%)in high-risk group.Mipi-c score(combined with Ki-67 index and Mipi prognosis score system)showed that 36cases(37.1%)were in low-risk group,31 cases(32.0%)were in low-risk group,17cases(17.5%)were in high-risk group and 13 cases(13.4%)were in high-risk group.1.Univariate analysis showed that age(P = 0.011),ECOG score(P < 0.0001),Ann Arbor stage(P = 0.015),LDH(P = 0.0025),white blood cell count(P =0.0047),lymphocyte count(P = 0.009),age(P = 0.011),ECo G score(P < 0.0001),Ann Arbor stage(P = 0.015),LDH(P = 0.0025)β 2-mg(P = 0.00011),Ki-67(P= 0.029)and neutrophil ratio(P = 0.0014)were prognostic factors of MCL.Age,ECOG score and LDH were prognostic factors of MCL(P < 0.05).The median OS of low-risk group,medium risk group and high-risk group was 55 months,20 months and 22 months,and the difference was statistically significant(P = 0.017).The median OS of mipi-c score in low-risk group,low-risk group,high-risk group and high-risk group was 36 months,31 months,17 months and 13 months,with statistical significance(P = 0.02).There were 73 patients who received treatment and could evaluate the curative effect.The effective rate(ORR)was 82.2%,and the median overall survival(OS)was 28 months.There was no significant difference in OS among chemotherapy group,R combined chemotherapy group and vr-cap group(P > 0.05);.2.Among the tumor infiltrating immune cell subsets,b-memory cells had the highest proportion of infiltration in MCL patients.Univariate survival analysis showed that six types of tumor infiltrating immune cell subsets were the biological indicators affecting the overall survival(OS)of MCL patients(P < 0.05).They were activated dendritic cells(P < 0.00026),eosinophils(P < 0.014)and macrophages(P < 0.05)The results showed that M0 macrophages(P < 0.0035),M1 macrophages(P < 0.019),immature CD4 T cells(P < 0.0043),and β T cells(P < 0.0043).Conclusion: Mantle cell lymphoma usually occurs in elderly men.Most patients are in stage III / IV of the disease when diagnosed,and most of them are accompanied by bone marrow and extranodal invasion.Age,ECOG score,LDH,Ki-67,Ann Arbor stage,WBC,percentage of neutrophils,Mipi,mipi-c were associated with the prognosis of MCL.In the tumor infiltrating immune cell subsets,activated dendritic cells,eosinophils,M0 macrophages,M1 macrophages,immature CD4 T cells,macrophages β T cells are associated with the prognosis of MCL.