The Clinical Features And Prognosis Of Plasma Fibrinogen And D-dimer Level In Patients With Diffuse Large B-cell Lymphoma

Objectives:Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non-Hodgkin's lymphoma,and it is highly heterogeneous in clinical features and prognosis.Plasma fibrinogen and D-dimer level have been shown to be associated with tumor development and metastasis in a variety of solid tumors,which affect prognosis.However,there are very few studies on fibrinogen and D-dimer with lymphoma,especially DLBCL.Methods:This study retrospectively analyzed 511 cases of newly diagnosed DLBCL in Department of Hematology,the First Affiliated Hospital of Zhejiang University School of Medicine from January 1,2012 to December 31,2017.We collected their clinical features and overall survival.Results:The mean age of the 511 patients was 58.4 years old,and the median was 60 years old.The mean fibrinogen level was 3.42 g/l,and the median was 3.36 g/1(0.5 g/l-9.58 g/1).The mean D-dimer level was 1589.04ug/l,and the median was 804ug/l(11ug/l-54120ug/l).We found that patients with higher Ann Arbor stage(III-IV),B-symptoms(fever>38?,night sweats,or weight loss>10%of body weight in the last 6 months),high international prognostic index(IPI)scores(3-5),high C-reactive protein(CRP),and low albumin tended to have abnormal fibrinogen level(low fibrinogen group or high fibrinogen group)and higher D-dimer level.The overall 5-year overall survival(OS)rate was 65.6%.The 5-year OS rates of low fibrinogen group high fibrinogen group and high D-dimer group ware 59.5%,52.9%,and 52.8%,respectively,which were worse than the normal group.Ine the non-GCB subtype,patients with abnormal fibrinogen level tend to had worse prognosis.The high fibrinogen group had lower 5-year OS rate than the low group and normal group,no matter rituximab used or not.In the univariable analysis,we found age,Ann Arbor stage,B-symptoms,IPI score,fibrinogen,lactate dehydrogenase,Eastern cooperative oncology group(ECOG)score,CRP,albumin,rituximab,D-dimer were related with prognosis of DLBCL.In the multivariable analysis,age,IPI score,ECOG score,rituximab,and D-dimer were independent prognostic factors of DLBCL patients.Conclusion:This study suggests that plasma fibrinogen and D-dimer levels differ in patients with different clinical features of DLBCL.Abnormal fibrinogen level and high D-dimer are associated with poor prognosis.The influence of fibrinogen to prognosis is more observable in the patients with high D-dimer than with normal D-dimer.High D-dimer is an independent prognostic factor for DLBCL patients.