Preliminary Exploration Of Clinical Features And Prognosis Of Primary CD5 Positive Diffuse Large B Cell Lymphoma Patients

Objectives:The clinical features,treatment and outcome of primary CD5 positive diffuse large B cell lymphoma(DLBCL)patients were preliminarily analyzed.Methods:The clinical data of 17 patients with primary CD5 positive diffuse large B cell lymphoma diagnosed from the Second Affiliated Hospital of Kunming Medical University from July 2013 to May 2019 were retrospectively analyzed.Results:1.Clinical features:1.1Age:41?78,median age:60(?60:9 patients(52.94%),<60:8 patient(47.06%));1.2Gender:8 males(47.06%)and 9 females(52.94%);1.3Lymphadenectasis and extranodal invasion:17 patients suffered lymph gland and extranodal invasion;1.4Big-sized tumor:2 patients;1.5B symptoms:11 patients(64.71%);1.6Ann Arbor stage:Stage ???:3 patients,Stage ???:14 patients(82.35%);1.7IPI score:0 to 1 points in 3 cases,2 to 4 points in 14 cases.2.Laboratory characteristics:2.1 The routine blood examination:7 cases had abnormal blood routine(2 cases of patients with blood tests showed mild anemia)95?109g/L),2 cases of patients with blood tests showed moderate anamia(78?82g/L),2 cases of patients with blood tests showed leukopenia(3.1?3.67)×109/L,including lymphocytes also reduce(0.68×109/L),and 3 cases with total number of white blood cells to normal,also have lymphopenia(0.61?0.75)×109/L,1 cases of patients with routine blood tests showed thrombocytosis(632×109/L).1 cases of patients with routine blood tests showed thrombocytopenia(61 ×109/L)):2.2Bone marrow cytologic:6 cases had bone marrow cytologic abnormalities;2.3Lactate dehydrogenase:higher than normal in 11 cases(64.71%);2.4?-Hydroxybutyrate dehydrogenase:higher than normal in 7 cases(41.18%).3.Pathological and immunohistochemical testing results:3.1Immunohistochemical phenotypic classification:Non-GCB subtypes in 12 cases(70.59%),GCB subtypes in 5 cases;3.2Proliferation index of tumor cells:Ki-67 index?80%in 9 cases(52.94%);3.3Characteristic immunophenotype:All the 17 primary CD5 positive DLBCL patients were tested positive for CD20:there were 12 patients tested positive for BCL-2(70.59%),14 patients positive for MUM-1(82.35%),14 patients negative for CD10(82.35%),8 patients negative for BCL-6(47.06%),and 13 patients positive for C-MYC(76.47%),ten patients were found have double-protein-expression lymphomas of C-MYC and BCL-2 through IHC(58.82%);In situ hybridization:EBV(-).4.Cytogenetics and molecular biology:One patient was tested to have double-hit lymphomas of fractured C-MYC and BCL-6 through fluorescence in situ hybridization:one patient's result of karyotype analysis of bone marrow cells was "complex karyotype".5.Treatment and outcome:5.1 Treatment options:14 patients adopted CHOP based regimen(CHOP±R);2 patients were treated with R-EPOCH.Only one patient received HD-MTX protocol because of primary CNS disease.Rituximab was applied to 12 patients during treatment;5.2Outcome:5.2.1 Follow up:the median follow-up time was 8.5 months(0.5?38),with one patient lost to follow-up,eight patients died and eight survived.5.2.2Treatment response:One patient was discharged from hospital after refusing to continue treatment after treatment with HD-MTX regimen for 3 courses.The curative effect was evaluated as "SD" when he was discharged from hospital;15 patients were assessed after 4 courses of chemotherapy:CR(2 cases),PR(8 cases),SD(1 cases),PD(4 cases),ORR(66.67%);8 patients were assessed after 6 courses of chemotherapy:6 assessed as "PR",2 assessed as "PD";6 patients were assessed after 8 courses of chemotherapy:3 assessed as "CR",1 assessed as"SD",2 assessed as "PD".5.2.3Relapse:7 patients suffered relapse after treatment.Conclusions:1.The primary CD5 positive DLBCL has strong clinical invasiveness,and the patients are prone to extranodal invasion as well as affected bone marrow.The common clinical features include B symptoms,rise of LDH,unapparent rise of?-HBDH level,advanced stage in the first diagnosis(Stage ? or ?)and high IPI score.2.Primary CD5 positive DLBCL mostly belongs to Non-GCB subtype,which features a high Ki-67 index,usually tested positive for CD20 and C-MYC,BCL-2 and MUM-1,weakly positive or negative for CD 10 and mostly DPL.3.For primary CD5 positive DLBCL patients,the overall efficacy of the R-CHOP protocol is poor.Meanwhile,the patients are prone to relapse.Even if rituximab is applied in the course of treatment,the fatality rate is still high and the prognosis is poor.