Clinical Analysis Of Cases Of Burkitt Lymphoma With Bone Marrow Involvement

Background and ObjectsBurkitt Lymphoma(BL)is a highly invasive B-cell Lymphoma related to Epstein Barr Virus(EBV)and Human Immunodeficiency Virus(HIV)infection.It is the malignant tumor with the highest proliferation index and has special pathological manifestations,often accompanied by t(8,14)chromosome abnormalities.c-myc gene splice with Ig enhancer due to chromosome translocation.Enhancers can bind to cell-specific transcription factors and cause abnormal activation of c-myc gene,resulting in high expression of c-myc protein.Mutations caused by translocation or other mechanisms will also lead to the inactivation of the negative regulatory sequence in c-myc gene,further enhancing the expression activity of c-myc.The"starry sky" is often seen in tissue sections.Clinically it can be divided into local type(endemic Burkitt Lymphoma,eBL),distributed type(sporadic Burkitt Lymphoma,sBL)associated with immune deficiency type(immunodeficient Burkitt Lymphoma,iBL)three types.BL is often associated with bone marrow involvement(BMI).In clinical work,it has been found that BL with BMI has worse prognosis,but the specific biological characteristics,pathological characteristics,clinical characteristics and the differences between BL and general BL are not completely clear.There are few reports on this type of BL in domestic and foreign literatures.Therefore,by collecting the clinical data of 17 BL patients with BMI from the first affiliated hospital of zhengzhou university,it provides reference for clinical workers in the diagnosis and treatment of BL patients with BMI.MethodsTo collect the detailed information of 17 clinical cases admitted to the first affiliated hospital of zhengzhou university from January 2014 to December 2019.Statistics,sort out some general information of patients with BMI with BL or general clinical data(gender,age,IPI score,B symptoms),inspection index,serum lactate dehydrogenase,white blood cells,platelets,hemoglobin,beta-2 microglobulin,bone marrow involvement parting,serum uric acid,IPI score),immunohistochemical results(c-myc,BCL-6,BCL-2,Ki-67,EBER,CD10,MUM-1),c-myc immunofluorescence test results and treatment method,spleen,ultrasound,and the data collected by statistical analysis is to sum up.To investigate the clinical characteristics,immunohistochemical characteristics and the significance of each index in the prognosis of patients with BL and BMI.Statistical processing:SPSS 21.0 software was used for statistical analysis of the samples,and kaplan-meier method was used for survival curve.COX regression model was used for multivariate analysis,and Logistic binary regression model was used for risk factor analysis.P<0.05 was considered statistically significant.Results1.among the 17 patients,11(65%)were male patients and 6(35%)were female patients.The median age of onset was 17 years old.Abdominal mass complaints accounted for 23.5%(4/17),fatigue complaints accounted for 23.5%(4/17),and neck mass complaints accounted for 17.6%.(3/17).Abdominal invasion(including intraperitoneal organ invasion and abdominal mass)was the main invasion site(8/17).IPI score:3 cases(18%)in the low-risk group,14 cases(72%)in the medium-risk group,and no high-risk group.Six patients developed symptoms of B(3 patients with fever,2 patients with night sweats,and 1 patient with weight loss).2.Classification of bone marrow invasion:6 cases were mild,4 cases were moderate,and 7 cases were severe.Bone marrow invasion type had no significant effect on haemoglobin reduction,thrombocytopenia and leukocyte abnormality(P=0.625,P=0.625,P=0.648).Splenic enlargement did not significantly affect the degree of bone marrow invasion(P=0.116).3.Among the 17 patients,6 were not tested for c-myc,and the remaining 11 were positive for MYC expression.Ten patients were not tested for EBER,and the remaining seven were all positive.In 10 cases,c-myc gene was not detected,and in the remaining 7 cases,c-myc gene was found to be broken in 5 cases,and multi-copy or multi-soma of chromosome 8 was found in 1 case.4.After 4 cycles of chemotherapy,1 patient reached Complete Remission(1/17),6 patients reached Partial Remission(6/17),3 patients reached Stable Disease(3/17),7 patients reached Progressive Disease(7/17),and the total response rate(including CR and PR)was 41.2%(7/17).5.Results of survival analysis:median survival time of 17 patients with BL and BMI was 9 months(95%CI,0.016-17.984),and 9 patients died.Bone marrow involvement parting,serum lactic dehydrogenase values,MUM-1 expression in OS in patients with statistically significant differences(P=0.012,P=0.015,P=0.012),while gender,age,symptoms,IPI score,beta-2 microglobulin,platelet count,white blood cell count,hemoglobin,blood uric acid value,splenomegaly,Ki-67 expression,the BCL-6,the BCL-2,CD 10 had no statistical difference in OS(P>0.05).Conclusion1.BL patients with BMI have a relatively short survival time,poor efficacy and poor prognosis.2.Patients with high degree of bone marrow invasion,high serum lactic dehydrogenase value and positive MUM-1 had worse prognosis.MUM-1 expression is an independent factor affecting prognosis.3.Bone marrow invasion type had no significant influence on peripheral blood image;There was no significant correlation between splenomegaly and bone marrow invasion.