Analysis Of Clinical Features Of Rheumatic Immune Disease Related Lymphoma

Objectives:The purpose of this study is to investigate the clinical characteristics,types of lymphoma patients with rheumatic immune disease related lymphoma,in order to determine whether they are related,and provide a better choice for such patients.Methods:We collected complete case information of initial treatment lymphoma patients who were hospitalized from January 2010 to December 2017.Data collection includes following terms: age,gender,major clinical manifestations,interval between rheumatic immune disease and lymphoma,smoking history,concomitant disease,the relevant auxiliary examination results,first visit department,treatment process,survival time and other relevant clinical data.Excle software was used to record medical record data and establish database.This study focused on the analysis of the first part,first department,clinical manifestations,type of rheumatic immunity,lymphoma types,related auxiliary examination results,treatment and lifetime of patients with rheumatic immune disease complicated with lymphoma,at the same time cases of lymphoma patients who were not associated with rheumatoid disease were set as control group.Based on the above data,the age,gender,lymphoma types,related auxiliary examination results and lifetime were compared between the two groups of patients,and the number of cases of rheumatoid arthritis,Sjogren's syndrome,and systemic lupus erythematosus hospitalized in the same period was counted as well.SPSS 22.0 statistical software was used to process the data,and the data of counting were expressed as percentage,the data of measurement were expressed as mean value plus or minus standard deviation.F test,x2 test,and bilateral P test were used for comparison.Statistical significance was obtained when P<0.05.Kaplan-Meier method and Log Rank test were used for survival curve comparison.Results:1.From January 2010 to December 2017,a total of 796 lymphoma patients were hospitalized.Among them,765 lymphoma patients who did not have rheumatic immune disease ranged in age from 14 to 93 years.The median age was 67;480 cases were men?62.7%?,285 women?37.3%?,male to female ratio was 1.68:1.66 Hodgkin lymphoma?HL?patients accounted for 8.6%,699 non-Hodgkin lymphoma?NHL?patients accounted for 91.4%.The proportion of diffuse large B-cell lymphoma?DLBCL?was the highest,accounted for approximately 44.5%?311/699?,followed by follicular lymphoma?FL?8.8%?61/699?,mucosa-associated lymphoid tissue with B-cell lymphoma?MALT?5.6%?39/699?,mantle cell lymphoma?MCL?3.7%?26/699?,NK/T cell lymphoma 3.1%?22/699?,and the others were rare lymphomas subtypes.2.There were 31 patients with rheumatoid immune disease complicated with lymphoma,accounting for 3.9%?31/796?of the cases with lymphoma.Among these cases,the oldest was 80 years old,the youngest was 36 years old,and the median age was 62.Every 10 years old group,14 patients?61.5%?aged 61 to 70 years old had the highest incidence in the age group.There were 4 males and 27 females.The male to female ratio was 1:6.8.The types of rheumatoid immune diseases complicated with lymphoma were as follows: DLBCL accounted for 41.93%?13/31?;MALT accounted for 38.70%?12/31?;FL accounted for 6.46%?2/31?;NK/T cell lymphoma,angioimmunoblastic T cell lymphoma,lymphoplasmacytic lymphoma,and T-B double-clone lymphoma each accounted for 3.23%?1/31?.3.Among these 31 patients with rheumatic immune disease complicated with lymphoma,there were 5 types of rheumatic immune diseases,15 cases suffered Sjogren's syndrome?SS?,accounting for 48.39%;12 Cases suffered rheumatoid arthritis?RA?,accounting for 38.71%;1 case suffered SS overlapping RA,accounting for 3.23%;1 case suffered systemic lupus erythematosus?SLE?,accounting for 3.23%;1 case suffered Behcet's disease,accounting for 3.23%;1 case suffered dermatomyositis,accounting for3.23%.In the same period,a total of 512 SS patients,760 RA patients,and 346 SLE patients were hospitalized,the incidence of lymphomas in the three diseases was respectively1.58%,2.93%,and 0.28%.4.Among these 31 patients with rheumatic immune disease complicated with lymphoma,10 patients were diagnosed with rheumatoid immune disease and lymphoma at the same time,and 21 patients were diagnosed with lymphoma after diagnosis of rheumatic immune disease?1 to 55 years?.5.The first clinical manifestations of 31 cases with rheumatoid immune disease complicated with lymphoma were: parotid gland enlargement?11 cases?,lymphadenopathy?10 cases?and fever?5 cases?;10 cases were diagnosed in department of stomatology,accounting for 32.26%;followed by the department of hematology accounted for 21.6%,and the rest were found in otolaryngology,rheumatism,respiratory,skin,general,parenteral,hand microsurgery,oncology,and ophthalmology department.6.In the lymphoma group,146 cases complicated with anemia accounted for 19.08%,134 cases complicated with ESR increasing accounted for 17.52%,277 cases complicated with ?₂ microglobulin increasing accounted for 36.21%,258 cases complicated with LDH increasing accounted for 33.73%,and 9 cases complicated with Ig M increasing accounted for 1.18%.Among 31 patients with rheumatoid immune disease complicated with lymphoma,14 patients had anemia accounted for 45.2%;23 patients had rapid ESR,accounted for 74.19%;25 patients had increased ?₂ microglobulin accounted for 80.65%;11patients had increased LDH accounted for 35.5%;4 patients had decreased Ig M accounted for 12.9%;ESR increased,?₂ microglobulin increased,hemoglobin and immunoglobulin Ig M decreased,compared two group,the difference was statistically significant?P <0.05?;LDH increasing between the two groups showed no statistics difference.7.The treatment of 31 patients with rheumatic immune disease complicated with lymphoma were radiotherapy in one patient,combined chemotherapy in the remaining 18 patients,and no chemotherapy in 3 patients?DLBCL and 9 MALT?.The follow-up period ended at 2017.12.30.Seven patients with rheumatic immune disease complicated with lymphoma died during follow-up.Five patients were lost in follow-up period.The remaining 19 patients survived?1-84 months?and the median survival time did not reach.Conclusions:1.There were more men than women in lymphoma.The most common lymphoma subtype was DLBCL,followed by FL.Rheumatoid immune disease complicated lymphoma was more common in female patients,with DLBCL accounting for the highest ratio,followed by MALT.2.Patients with rheumatoid immune disease and lymphoma of the hospitalized lymphoma patients in the same period was 3.9%,accounting for the same time hospitalized SS,RA,and SLE the percentage were 3.93%,1.58%,and 0.28%.Rheumatoid immune disease complicated by lymphoma can occur in many types of rheumatoid immune diseases,the most common with SS,followed by RA.3.Patients with rheumatoid immune disease have lymphadenopathy swelling of the parotid glands,and fever during the course of the disease,should be alert to lymphoma.4.Rheumatoid immune disease complicated by lymphoma is a special group of lymphomas,and it is necessary to emphasize the treatment of rheumatoid immune pathogens in order to improve the immune disorders and improve the therapeutic effect of lymphoma.