Clinical Data Analysis Of Serum Homocysteine Levels In Newly Diagnosed Diffuse Large B-cell Lymphoma

Objective:The purpose of this study was to investigate the clinical characteristics and prognostic effects of serum homocysteine（HCY）level in newly diagnosed diffuse large B-cell lymphoma（DLBCL）patients.Methods:A total of 105 DLBCL patients initially diagnosed in the Hematology Department of The First Hospital of Lanzhou University from January 1,2016 to December 31,2021 were collected.The serum HCY levels of 105 patients who met the criteria were divided into groups according to the reference range of laboratory tests in our hospital:HCY（0-20umol/ L）was divided into two groups,the HCY elevated group and the normal HCY group,of which 42 cases（40%）were HCY elevated group.Sixty three patients（60%）were in the normal HCY group.Serum HCY level and gender,age,lactate dehydrogenase（LDH）,folic acid level,vitamin B12 level,cell source,B symptom,bone marrow involvement,Ann Arbor of DLBCL patients in the two groups were compared Clinical data and survival status,including stage,ECOG score,international prognostic index（IPI）score,positive bcl-2 /Myc dual expression,number of extrapodular involvement,primary tumor site,tumor proliferation index（KI-67）,β2microglobulin,and chemotherapy plan selection,were retrospectively analyzed,and survival status was evaluated by overall survival（OS）.Results:1.among the 105 newly diagnosed DLBCL patients,there were 59 males（56.2%）and 46 females（43.8%）.The median age of onset was 61（20-84）years,and the mean age was 59.5 years.There were 63 patients in the HCY normal group with a median age of 61（22-84）years and an average age of 59.4 years.There were 42 patients in the HCY elevation group,with a median age of 61（20-81）years and an average age of 59.6years.There were 57 cases aged > 60 years old,or about 54.3%.64 cases（61.0%）had elevated LDH.β2 microglobulin was elevated in 43 cases（41.0%）.There were 49 cases with Ann Arbor stage III/IV,accounting for about 46.7%;ECOG score ≥2 in 27 cases,accounting for 25.7%;62 cases（59.0%）had more than 2 extrinsic involvement.51cases（48.6%）had IPI score of 3-5.Bone marrow was involved in 14 cases（13.3%）.54cases（51.4%）had B symptom.Germinal center was found in 40 cases（38.1%）.The primary site was extranodal in 62 cases（59%）.Ki-67≥70 was found in 75 cases（71.4%）.27 cases（25.7%）were positive for double expression of Bcl-2/Myc.Eighty-three patients（79.0%）were treated with R-CHOP.2.The increase of β2 microglobulin was 30.2%（19/63）in the normal HCY group,and 57.1%（24/42）in the elevated HCY group.There was a significant difference between the two groups（P=0.006）.LDH was 49.2%（31/63）in the normal HCY group and 78.6%（33/42）in the elevated HCY group.There was a significant difference between the two groups（P=0.003）.About 36.5%（23/63）of patients in the normal HCY group had stage III/IV clinical stage,and about 61.9%（26/42）of patients in the elevated HCY group had stage III/IV clinical stage.There was a significant difference between the two groups（P=0.011）.42.9%（27/63）of patients with normal HCY had symptoms of B,and 64.3%（27/42）of patients with elevated HCY had symptoms of B,indicating a difference between the two groups（P=0.031）.About 50.8（32/63）of the cells in the normal HCY group were derived from non-GCB,and about 78.6%（33/42）of the cells in the HCY elevated group were derived from non-GCB,indicating significant difference between the two groups（P=0.004）.The levels of vitamin B12 and folic acid in the HCY elevated group were statistically significant compared with those in the normal group（P = 0.033 and 0.024,respectively）.The distribution of other basic clinical characteristics,such as gender,age,ECOG score,IPI score,positive bcl-2 /Myc double expression,number of extrapodular involvement,primary tumor site,Ki-67,bone marrow involvement and chemotherapy scheme selection,had no statistical significance（P > 0.05）.3.The 3-year OS rates of the normal group and the HCY elevated group were 81.8%and 18.2%,respectively,indicating that the 3-year OS of the two groups was significant（P=0.000）.Age > 60 years,IPI score 3-5 points,clinical stage III/IV,LDH > the upper limit of normal had shorter 3-year OS（P 0.000）.Patients with symptom B also showed a significant correlation at 3-year OS（P=0.003）.4.Elevated HCY（P=0.004）,age > 60 years（P=0.007）,Ann Arbor stage III/IV（P=0.001）,LDH > the upper limit of normal value（P=0.009）,AND IPI score 3-5（P=0.000）were risk factors for poor prognosis of DLBCL patients.However,gender,ECOG score,cell origin,symptom B,bone marrow involvement,positive bcl-2 /Myc double expression,extrapodular accumulation,primary tumor site,Ki-67 and chemotherapy regimen choice had no significant difference in 3-year OS rate of DLBCL patients（P > 0.05）.The above risk factors were further analyzed by COX risk ratio model,and the results showed that IPI score of 3-5（HR=0.399,95%CI 0.178-0.935 P=0.034）was an independent adverse prognostic factor affecting 3-year OS in DLBCL patients.5.An IPI score of 3-5 was an independent risk factor for poor prognosis of DLBCL（HR=0.408,95%CI 0.178-0.935,P=0.034）.Conclusion:1.There was no obvious difference in the average age of onset and the median age of onset in patients with elevated HCY,and they were prone to elevated LDH and β2microglobulin,decreased folic acid and vitamin B12,and late clinical staging,while DLBCL patients with high HCY had a significantly lower 3-year OS than that of the normal HCY group;2.Elevated HCY can be used as a risk factor affecting the prognosis of patients with DLBCL.