Clinical Case Analysis Of Patients With Diffuse Large B-cell Lymphoma With Autoimmune Diseases

Objective:Diffuse Large B-cell Lymphoma(DLBCL)is clinically often characterized by painless,progressive enlargement of lymph nodes in the superficial region,which can invade organs outside the lymphatic system and appear as corresponding organs are invaded,destroyed,oppressed or obstructed,and about half of patients may also have systemic symptoms such as fever,night sweats,fatigue,weight loss.DLBCL is the most common pathological type of non-Hodgkin Lymphoma(NHL).At present,the incidence of DLBCL is gradually increasing.However,the cases of DLBCL with Autoimmune Diseases(ADs)are extremely rare in the clinic.Therefore,we report on 2 cases of DLBCL with ADs recently admitted to our hospital.And review the relevant literature to explore the characteristics of patients with non-Hodgkin's lymphoma combined with autoimmune diseases,to gain a deeper understanding of the relationship between DLBCL and ADs,to help the work of future clinicians.Methods:1.Two cases of DLBCL with autoimmune diseases were reported in our hospital.Case 1 was admitted with "Several knee joint swelling and pain for 8 years,fever with fatigue for 4 days".Case 2 was admitted to the hospital because of "Multiple joint pain for more than 10 years,the neck mass was found to be 4 days".They were completed the physical examination and related assistant examination after admission.Auxiliary examination: 1.Blood cell analysis,blood biochemistry,?2-microglobulin,rheumatism related indicators;2.Thoracic and abdominal CT,body surface and deep lymph node color Doppler;3.Lymph node pathological biopsy;4.Bone marrow cell morphology examination,bone marrow biopsy,bone marrow Flow cytometry,FISH detection(BCL-2,BCL-6,MYC).2.Retrieved cases about NHL and ADsreported in the CNKI and Wanfang database since 2000.Selected 107 cases with detailed informations,then combined with the above two cases,a total of 109 cases,to analyse and summarize t the patient's gender,the overlapping time of the two diseases,and their respective risk factors and outcomes of he types of NHL and ADs.Results:1.All the 2 patients were female,and the above-mentioned examinations were improved.The results showed that:Case 1 diagnosed as 1.Non-Hodgkin's lymphoma diffuse large B-cell lymphoma(non-germinal central,Ann Arbor stage: stage ? B,IPI: 4,high risk)Hemophagocytic syndrome 2.Rheumatoid arthritis.After chemotherapy with CHOPE R-CHOP regimen and related anti-rheumatoid arthritis treatment,rheumatoid arthritis was controlled and diffuse large B-cell lymphoma was partially relieved.Case 2 diagnosed as 1.Diffuse large B-cell lymphoma(non-germinal central,Ann Arbor stage: stage ? A,IPI: 4,high risk)2.Rheumatoid arthritis.After 4 cycles of R-CHOP chemotherapy and related anti-rheumatoid arthritis treatment,rheumatoid arthritis was controlled and diffuse large B-cell lymphoma was partially relieved.2.Literature ReviewOf the 109 cases,the male to female ratio was about 1:1,84 of whom started with ADs,mostly were Sjogren's syndrome,rheumatoid arthritis,systemic lupus erythematosus,autoimmune hemolytic anemia;Simultaneous diagnosis of ADs and NHL or NHL starters are less common,and NHL type is more common with DLBCL,and the time to superimpose the second type of disease is 0-41 years,and the prognosis was worse than that of normal NHL or ADs.Conclusion:1.Among the cases of NHL and ADs,the first time ADs are more common,the simultaneous diagnosis of ADs and NHL or the first NHL is rare,and DLBCL is more common in NHL types.2.Combined cell morphology,molecular biology,and biochemical markers to identify and identify DLBCL,and evaluate patients by risk stratification;it can improve the prognosis of DLBCL.3.Secondary NHL or secondary ADs,the reasons may be related to immune abnormalities,biological risk factors,therapeutic factors,etc.And disease specificity can trigger different ADs or NHL disease types.4.In patients with NHL or ADs,when there are symptoms that are inconsistent with their own diseases,such as lymphadenopathy,persistent high fever and other clinical features,it is necessary to pay attention to the differential diagnosis and be alert to the risk of other malignant diseases.5.For patients with NHL superimposed ADs,the treatment is still based on the treatment of NHL,supplemented by other effective treatments for ADs,following the principles of comprehensive treatment and individualized treatment.Patients with ADs combined with NHL have a worse prognosis than ordinary ADs or NHL in most situation,and should be diagnosed promptly and treated early.