Retrospect And Analysis Of Elderly High-grade B-cell Lymphoma

Background: The 2016 revision of the WHO classification for lymphoma classification has a new category of lymphoma,which includes diffuse large B-cell lymphomas with "double-hit or triple-hit" and B-cell lymphomas whose morphological characteristics between diffuse large B-cell lymphomas and Burkitt's lymphoma called high-grade B-cell lymphoma(HGBL).The latter without "double-hits or triple-hit" are called high-grade B-cell lymphomas,not otherwise specified(HGBL,NOS).The diagnosis of such patients by IHC/FISH is of great significance.Treatment of HGBL-DH currently has no standard treatment.There is evidence for a superior progression-free survival(PFS)with intensive induction regimens in selected patients.However many HGBL-DH patients are elderly and/or frail,making them poor candidates for high-dose chemotherapy.Newer targeted therapies are increasingly clinically available,but their role in the treatment of HGBL-DH is not yet established.There are currently studies suggesting that these patients may benefit from intensive chemotherapy regimens.There are currently studies suggesting that such patients may benefit from intensive chemotherapy regimens,and that new regimens,new targeted drugs,and cell therapies could be considered for treatment when traditional drugs are ineffective.However,few data are available on the outcomes in elderly patients(aged > 65years)treated with these therapies.This article reviews the clinical data,the options of chemotherapy regimens,and the prognosis of 13 elderly patients with high-grade B-cell lymphoma,hoping to trigger reflections on treatment options for this particular group of patients.Objective:In this paper,we retrospectively analyzed the gender,age,genotyping,Performance Status,and IPI of elderly patients with high-grade B-cell lymphoma,and summarized the clinical features,treatment options and prognosis.Through analysis,we could further recognize and adopt a reasonable treatments for elderly high-grade B-cell lymphoma patients to improve the prognosis,and hope to provide reference for individualized treatment of this type of patients.Methods: The clinical data of 13 patients with high-grade B-cell lymphoma diagnosed in our hospital from January 2013 to January 2018 were retrospectively analyzed,including gender,age,genotyping,Performance Status,IPI score,chemotherapy regimen,drug toxicity and response to treatment.One typical case was reported,and reviewed related studies literature.Results:(1)Comparison of general data: Analysis of patients' general data,including gender,age,genotyping,Performance Status,IPI scores,etc.Of the 13 patients,7 were male(54%)and 6 were female(46%),and the median age was 75 years(range 65-86 years,Table1).In 13 patients,8 cases(62%)were Ann Arbor stage ?~IV,of which 1 case had central nervous system diseases.In addition,2(15%)patients had CNS.The median IPI score is 4points.(2)Comparison of treatment and prognosis: Among 13 patients,6 patients(46%)were c-Myc and Bcl-2 translocation,5 patients(38%)were c-Myc and Bcl-6 translocation,2patients(15%)were three-hit lymphomas.Patients were initially treated.5 of these patients received R-EPOCH(rituximab,etoposide,prednisolone,vincristine,cyclophosphamide,and adriamycin),4 patients received R-CHOP,and 1 patient received R-CODOX-M/IVAC,1patients received cyclophosphamide and rituximab,2 people gave up treatment(Table 2).4patients received central nervous system prophylaxis or were treated with drugs or systemic methotrexate.The median follow-up time for all patients was 24 months.For patients receiving R-EPOCH,the PFS rate was 40% at 24 months.For patients receiving R-CHOP,the PFS rate was 50% at 24 months.(3)Chemotoxicity included neutropenia,anemia,thrombocytopenia and infection.These chemotherapies were more common in the R-EPOCH group than other regimens(Table 4).One patient in the R-EPOCH group died of treatment-related causes.No treatment-related deaths occurred in the R-CHOP regimen.A total of 2 patients died of treatment(1 R-EPOCH and 1 R-CODOX-M/IVAC)and were secondary infections.Conclusion:1.Combined with cell morphology,immunology,FISH gene detection and diagnosis of HGBL,can better evaluate and treatment,improve the prognosis of HGBL.2.For elderly HGBL patients who are eligible for physical condition assessment,intensive treatment options may be considered.3.Through the literature review,for patients with conventional chemotherapy ineffective,could consider new drugs or cell therapy in order to improve the prognosis.