| Objective:The aim of this study was to raise our understanding of B-cell non-Hodgkin lymphoma(B-NHL)patients with an abnormal leukocyte count at diagnosis,we summarizing and analyzing the clinical,laboratorial characteristics,treatment and prognostic factors of these patients.Methods:Performed retrospective analysis of B-NHL patients with an abnormal leukocyte count in the initial diagnosis who were received during January1,2011 to December 31,2017.Three groups were stratified according to the abnormal leukocyte count:significant leukocytosis(WBC>30×10~9/L),slightly leukocytosis(WBC 10-30×10~9/L),leukopenia(WBC<4×10~9/L);The clinical features,routine laboratory tests,bone marrow examination and histopathological examination were summarized.Early responses was assessed from patients who received 3-4 courses of chemotherapy,and the factors could affect the treatment effects were analyzed.Overall survival and progression-free survival were assessed and analyzed for factors that may affect the clinical prognosis.Results:68 patients'clinical characteristics:the median age was 63(19-80)years old.The median time from first manifestation to diagnosing was 2(0.2-120)months.The ratio of men and women was 1.4:1.Marginal zone B-cell lymphoma(MZL),diffuse large B-cell lymphoma(DLBCL)and mantle cell lymphoma(MCL)were the most common pathological subtypes.The Ann Arbor stage of all patients were in III/IV stage or leukemic phase.There was 57%(39/68)of the patients having B-symptoms.There was 54%(32/59)of the patients with elevated lactic dehydrogenase(LDH).Patients accompanied with anemia and/or thrombocytopenia accounted for 67.7%(46/68).There was 56.7%(38/68)of the patients having increasing percentage of lymphocyte.The proportion of bone marrow involvement patients was 91.7%(55/60).There was 28%(15/53)of the patients accompanied with myelofibrosis.Comparisons among groups,the abnormal of anemia,trilineage hematopoiesis and increased LDH in leukopenia group were higher than that of slighter leukocytosis group(P2<0.001,P2=0.012,P2=0.002).40 patients were eligible for early response assessment,CR rate was 17.5%(7/40),and ORR was 55.0%(22/40).ORR was associated with the increased LDH,platelet count in the initial diagnosis and the improvement of bone marrow after the first treatment(P=0.028,P=0.048,P=0.031).In the slightly leukocytosis group,the higher rate of early diagnosis leaded to higher ORR(P=0.002),in leukocytosis group,patients without B symptoms got higher ORR.43 patients followed up to January 31,2018.The median follow-up time was 22(1-70)months,the median PFS and OS were 13(95%CI:2.721-23.279)months and 24(95%CI:8.722-39.278)months,respectively.On univariate analysis,aggressive or indolent,B-symptom,anemia,thrombocytopenia,the type of regimen and early treatment response were the factors of OS;LDH,treatment,abnormal leukocyte count and whether got CR or PR through early treatment were looked as a predictor of PFS.In a multivariate analysis,B-symptoms was the factors of OS,whether got CR or PR through early treatment affected OS and PFS.Conclusion:B-NHL patients with an abnormal leukocyte count had late phase even diagnosis early,and they often had B-symptoms and abnormal LDH.Bone marrow involvement was common in most patients,and they were often found anemia and thrombocytopenia.All of the patients in significant leukocytosis had bone marrow involvement.Anemia and thrombocytopenia were more common in leukopenia group.The patients achieving CR or PR after early treatment was few,and they often had a short PFS.So further studies regarding long-term outcomes are required.PFS of slighter leukocytosis group was superior to the other two groups.Whether achieved CR or PR through early treatment affected OS and PFS.Patients with leukemic phase got better CR or PR if given ALL-intensive therapy,and more studies are needed. |
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