Pathological Characteristics Of Bone Marrow In Non-Hodgkin's Lymphoma Patients With Myelofibrosis And Their Relationship With Clinical Relevance

Objective: Non-Hodgkin's lymphoma(non-Hodgkin's lymphoma,NHL)is a group of lymphoproliferative diseases with great heterogeneity,most of which are characterized by lymph node and / or extramedullary lymphoid tissue involvement.With the development of non-Hodgkin's lymphoma,bone marrow invasion gradually appeared.At present,there are few studies at home and abroad on whether secondary myelofibrosis(MF)affects the prognosis of non-Hodgkin's lymphoma.The purpose of this study is to investigate the pathological features of bone marrow and their effects on clinical relevance in patients with myelofibrosis(MF)and non-Hodgkin's lymphoma(NHL).Methods: The clinical data of 215 patients with non-Hodgkin's lymphoma including 96 patients with secondary myelofibrosis are analyzed retrospectively in the Affiliated Hospital Of Qingdao University from June 2016 to June 2018.According to the European grading standard of myelofibrosis,the patients are divided into patients with and without myelofibrosis,and the pathological characteristics of bone marrow are observed.The remission rate of 6 treatment cycles,the degree of myelosuppression after chemotherapy,the overall survival rate(OS)and the progression-free survival rate(PFS)are compared between patients with and without myelofibrosis.The lymphoma is classified according to the classification criteria of WHO in 2019,and the Ann Arbor stage is adopted in clinical staging.All statistics are analyzed by SPSS17.0,staging and myelosuppression are compared by rank sum test,chi-square test is used for rate comparison,life table method is used for survival rate,Log-rank test is used for univariate survival analysis,and COX regression survival analysis is used for multivariate analysis.There's statistical significance(P < 0.05).Results:The secondary myelofibrosis could be observed in any stage and pathological types of non-Hodgkin's lymphoma.26 cases(34.7%,26/75)of stage I and II are secondary myelofibrosis,while 70 cases(50%,70/140)of stage ? and ?.Stage ? and ? are more likely to be secondary myelofibrosis than those in stage? and ?(Z=-2.548,P < 0.05).The degree of myelofibrosis in patients with secondary myelofibrosis are mainly MF-1 grade(81.2%)and MF-2 grade(16.7%).Splenomegaly symptoms accounted for 28.1%(27/96)of non-Hodgkin's lymphoma patients with secondary myelofibrosis,while that accounted for 9.2%(11/119)of non-Hodgkin's lymphoma patients without secondary myelofibrosis.The incidence of grade 4 myelosuppression in patients with non-Hodgkin's lymphoma with secondary myelofibrosis reaches as high as 76%(73/96)after chemotherapy,while the incidence of non-Hodgkin's lymphoma without myelofibrosis is only 59.7%(71 / 119).The complete remission rates of non-Hodgkin's lymphoma patients with and without secondary myelofibrosis for 6 cycles are 34.4%(33/96)and 31.1%(37/119)respectively.The progression-free survival and overall survival rates of non-Hodgkin's lymphoma patients with secondary myelofibrosis at 1?2?3 years are 83%,68%,55% and 86%,85% and 60% respectively.The disease-free and overall survival rates of non-Hodgkin's lymphoma patients without secondary myelofibrosis at 1?2?3 years are 94%,81%,81% and 96%,95%,and 95% respectively.COX regression survival analysis shows that the progression-free survival rate and overall survival rate of patients with non-Hodgkin's lymphoma with myelofibrosis are lower than those without myelofibrosis(P<0.05).Kaplan-Meier analysis indicates that the disease-free survival rate and overall survival rate of patients with NK/T cell-derived lymphoma are lower than those of patients with B-cell-derived lymphoma(P <0.05).Conclusion: 1.Compared with patients without secondary myelofibrosis,there are more symptoms of splenomegaly in patients with non-Hodgkins lymphoma with secondary myelofibrosis.Splenomegaly should exclude whether non-Hodgkin's lymphoma is assosiated with myelofibrosis.2.All stages and pathological types of non-Hodgkin's lymphoma can be associated with myelofibrosis.The later the stage,the more likely to be associated with myelofibrosis,which may be related to the involvement of bone marrow in the advanced stage of lymphoma or the secreetion of certain cytokines during the growth of lymphoma cells.3.The degree of fibrosis in patients with non-Hodgkin's lymphoma with myelofibrosis was mild,and the condition of bone marrow hyperplasia is better than that of primary bone marrow fibrosis.4.Myelofibrosis is a risk factor for the prognosis of patients with non-Hodgkin's lymphoma.Secondary myelofibrosis can shorten the overall survival rate(OS)and progression-free survival rate(PFS)of patients with non-Hodgkin's lymphoma,which may be related to early death caused by severe myelosuppression after chemotherapy,and the reduction or the postponement of chemotherapy.