Low Serum Apolipoprotein A1 Levels Act As Negative A Prognosis Factor Of Diffuse Large B Cell Lymphoma

Background:Diffuse large B cell lymphoma(DLBCL)is the most common subtype of B-cell non-Hodgkin’s lymphoma,accounting for 30%–58%.In the era of rituximab,R-CHOP(R,rituximab;C,cyclophosphamide;H,doxorubicin;O,vincristine;P,prednisone)chemotherapy regimen significantly improved the therapeutic effect,but some patients still experience disease relapse or refractory to therapy.Identification of high-risk patients with recurrence as soon as possible and executing active treatment may improve the treatment effect.There are many factors affecting the prognosis of DLBCL,such as pathological classification,high-risk genes,treatment and so on.In recent years,many studies have observed that there is a correlation between lipids levels and the prognosis of DLBCL,but the relationship between lipids and tumor load and prognosis is not very clear.Moreover,serum lipids levels are easily affected by eating habits,region,gender and so on.Therefore,we were to investigate the correlation between serum lipids profile at diagnosis and DLBCL,and the prognostic value of lipids levels in DLBCL survival.Objective:The aim of this study was to explore the changes of serum lipids levels between post-chemotherapy and at diagnosis,the relationship between lipids and therapeutic effects and clinical features,and the prognostic value of lipids in DLBCL.Methods:We collected 105 patients with DLBCL,complete remission(CR)76 patients,Non-CR 29 patients,from October 1,2011 to January 16,2020 at the second affiliated Hospital of Nanchang University,with pretreatment and post-chemotherapy lipids including total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),Low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(APOA1),apolipoprotein B(APOB)and lipoprotein(a)(LP(a))were analyzed.105 healthy people act as control group,whose age and sex were similar to those of case in the Department of physical examination of the second affiliated Hospital of Nanchang University.Then,we analyzed the changes of serum lipids,the relationship between lipids and clinical features and the prognosis of DLBCL.Results:1.The levels of TC,TG,HDL-C,LDL-C,APOA1 and APOB in patients with DLBCL before chemotherapy were lower than those in healthy people and increased after chemotherapy.2.Patients who achieved CR exhibited a significantly increased TC,TG,LDL-C,APOA1 and APOB levels.However,no significant lipids alterations of LDL-C and APOB were observed in patients without CR.The level of APOA1 prior treatment in the Non-CR group was lower than that in CR patients.3.Decreased APOA1 levels in patients with initially diagnosed were related significantly with clinical features of advanced stage(III-IV),high IPI(3-5),elevated lactate dehydrogenase(LDH),B symptoms and extranodal sites(>1).4.Kaplan-Meier analysis showed that the low level of APOA1(≤0.96g/L)showed evidently worse overall survival(OS)in comparison with patients with a higher APOA1 levels(hazard ratio(HR)=0.307,95% confidence interval(CI):0.111-0.848,P=0.023).In multivariate analysis,the serum APOA1 level was an indicator for DLBCL(HR=0.331,95% CI: 0.119-0.925,P=0.035).Conclusions:The serum APOA1 levels at diagnosis may be related to tumor load.Low serum APOA1 levels were negatively correlated with the prognosis of DLBCL.