The Clinical Characteristics And Prognostic Factors Of Elderly Patients With Diffuse Large B-cell Lymphoma

Objective:To analyze the relationship between clinical features,therapeutic effect and prognosis of elderly patients with diffuse large B-cell lymphoma(DLBCL).Methods:The clinical data of elderly DLBCL patients(≥60 years old)were collected,who were newly diagnosed in the Department of Hematology of the Second Hospital of Shanxi Medical University from January 2014 to January 2020.The relationship between clinical and biological characteristics of these patients and complete response(CR)rate was analyzed.COX multivariate regression model was used to analyze the risk factors influencing patients’ overall survival(OS).Results:1.From January 2014 to January 2020,a total of 137 elderly DLBCL patients were diagnosed in our hospital,including 66 males and 71 females,with a male-to-female ratio of0.93:1,and a median onset age of 71 years(60～86 years).The first symptoms were mainly enlargement of lymph nodes,abdominal pain,anorexia,etc.,87 cases were nodal DLBCL.The most common is the cervical lymph nodes and inguinal lymph nodes.Extra-nodal DLBCL had 50 cases,most of which occurred in the digestive tract and soft tissue,and 3cases involved the central nervous system.AnnArbor stage I to IV patients were 12,23,41,and 61,respectively,and 62 patients with B symptoms at initial diagnosis.The risk stratification from low to high was 25 cases,37 cases,46 cases and 29 cases,respectively。There were 10 patients with ECOG score≥2,17 patients with the maximum diameter of mass≥7.5cm,At the time of initial diagnosis,96 cases had complications,of which hypertension,type 2 diabetes and coronary heart disease were the most common.2.Among 137 elderly patients with DLBCL,there were 46 cases of GCB subtype and 91 cases of non-GCB subtype.Immunohistochemistry showed that there were 31 cases with BCL-2 positive,35 patients with MYC positive,14 patients with double expression,28 patients with CD5 positive,65 patients with Ki-67≥80%,and 18 patients with P53 positive.3 of the 41 patients who underwent FISH were double-hit.18 patients underwent molecular testing,8 patients developed gene rearrangement and 3 patients developed gene mutation.3.Among 137 elderly patients with DLBCL,121 patients completed treatment and could be evaluated for efficacy.102 cases had accepted the standard regimen of 8R-6CHOP,and19 patients with advanced age and poor tolerance received the reduced dose of 6Rmini CHOP.Of the 121 patients,71 patients achieved Objective Response(58.7%),58 patients achieved CR(47.9%),13 patients achieved Partial Remission(10.7%),the median survival time was 13.8 months and 7.1 months,respectively.10 patients had stable disease and 37 patients progressed,with a median survival of 5.3 and 4.4 months,respectively.Of the 58 patients with CR,7 received autologous hematopoietic stem cell transplantation,and6 were in a state of sustained response,with a median duration of 25.3 months.3 patients died from intracerebral hemorrhage,disseminated intravascular coagulation,and severe infection.There were 80 cases of adverse events during the treatment,and hematological toxicity,bone marrow suppression and pulmonary infection were the most common.4.Among the 121 cases of elderly patients with DLBCL,we analyzed the relationship between age,gender,cell origin,B symptoms,ECOG score,bone marrow involvement or not,the size of bulky,AnnArbor staging,IPI score,risk stratification,CRP rise or not at the begin of diagnose(by 8mg/L),albumin decrease or not(by 40g/L),LDH rise or not(by250U/L),β2-microglobulin(β2-MG)rise or not(by 2.64mg/L),serum ferritin(SF)rise or not(by 306.8ng/m L)and treatment with CR rate.Result showed that the CR rate of GCB subtype patients was higher than that of non-GCB subtype patients,the CR rate of patients with ECOG<2 was better than that of patients with ECOG≥2,the CR rate of patients without symptoms of B at first diagnosis was better than those with combined symptoms of B,the CR rate of patients with bone marrow involvement at initial diagnosis was worse than that of those without,the CR rate of AnnArbor stage at Ⅲ-Ⅳ was lower than those at I-II period,the CR rate of IPI≤2 was higher than those >2,the CR rate was higher in patients with lower risk stratification than in patients with higher risk stratification,the CR rate of CRP increased,β2-MG increased,LDH elevated and SF elevated group at initial diagnosis were lower than that in normal group,respectively,,the CR rate of the albumin reduced group was worse than that of the normal group at initial diagnosis(all P<0.05).5.The relationship between the above indexes and patients’ OS rate was analyzed.Result showed that the OS rate of patients with extra-nodal DLBCL was worse than that of patients with nodal DLBCL,the OS rate of patients with ECOG<2 was higher than that of patients with ECOG≥2,the OS rate of patients without B symptoms was higher than those with combined B symptoms,the OS rate of the patients without bone marrow involvement was better than that involved at initial diagnosis,the OS rate of patients with AnnArbor stage III-IV was lower than that of patients with AnnArbor stage I-II,patients with lower risk stratification had a higher OS rate than patients with higher risk stratification,the OS rate of CRP increased,β2-MG increased,LDH elevated and SF elevated group at initial diagnosis were lower than that in normal group,respectively,the OS rate of the albumin reduced group was worse than that of the normal group at initial diagnosis(all P<0.05).6.COX multivariate analysis showed that,bone marrow involved or not(P=0.042),albumin levels(P=0.016)and LDH levels(P=0.014)at the time of initial diagnosis is independent prognostic factors affecting elderly patients with DLBCL.Conclusion:1.Patients with extra-lymph node onset,ECOG≥2 分,combined with B symptom at initial diagnosis,non-GCB subtype of cell origin,involved bone marrow at initial diagnosis,AnnArbor stage at III-IV,IPI score>2,higher risk stratification,elevated levels of CRP,LDH,β2-MG,SF and decreased levels of albumin at initial diagnosis had a lower CR rate.2.Albumin level,LDH level and bone marrow involved or not at initial diagnosis are independent prognostic factors affecting elderly DLBCL patients.3.Auto-HSCT can deepen the remission and improve the prognosis of patients who reach CR after treatment.