Clinical Characteristics And Immunophenotypes Of 231 Patients With B-cell Chronic Lymphoproliferative Disorders(B-CLPD)

ObjectB-cell chronic lymphoproliferative disorders(B-CLPD)is a group of mature B-cell clones proliferative tumor with similar morphology and indolent clinical progress,involving peripheral blood and bone.The purpose of this study was to investigate the clinical characteristics and immunophenotypes of B-CLPD patients and their values in differential diagnosis.MethodsThe clinical data of 231 patients diagnosed B-CLPDP in our Hospital’s hematology department from 01 January 2016 to 01 May 2019 were collected.Clinical features and immunophenotypes were recorded and analyzed by univariate assay.ROC assay was used for determining the cut-off value of immunophenotypes.Result1.Morbidity.We have anaylized 231 case of B-CLPD patients,including 159males(68.83%)and 72 females(31.17%),the ratio of M:F being 2.2:1,and the median age of them was 64 years(range:30-82 years).These patients were 123 CLL(53.2%),19 MCL(8.2%),14 LPL/WM(6.1%),13 MZL(5.6%),11 FL(4.8%),7HCL(3.0%),25 B-CLPD-U(10.8%)and 19 CD5+B-CLPD-U(8.2%),respectively,according to the diagnosis criteria.2.Clinical characteristics.(1)Hepatosplenomegaly and lymphadenopathy.HCL was the most common subtype(71.43%)with hepatosplenomegaly,followed by MCL(42.11%),FL(27.27%),LPL/WM(21.43%),CD5+B-CLPD-U(15.8%),MZL(15.38%),CLL(12.20%),CD5-B-CLPD-U(4%).The majority of the MCL patients presented with lymphadenopathy(84.9%),followed by FL(72.73%),CD5+B-CLPD-U(52.6%),CLL(50.41%),MZL(38.46%),LPL/WM(28.57%),CD5-B-CLPD-U(28.0%),HCL(0%).(2)Peripheral hemogram.The median leukocyte count of CLL was 25.12×10~9/L,median lymphocyte count was 18.22×10~9/L,median platelet count was 179×10~9/L and median hemoglobin count was 126g/L,all of them were higher than that in other B-CLPD.The median leukocyte count of HCL patients was 4.33×10~9/L,median lymphocyte count was 2.23×10~9/L,median platelet count was 61×10~9/L and median hemoglobin count was 119g/L,all of them were lower than that in others,except hemoglobin count.The lowest median hemoglobin count among all B-CLPDs was found in patients with LPL/WM with 92g/L.(3)LDH andβ2-MG.Among all the B-CLPD,only MCL had found abnormal expression of LDH,and LPL/WM had found increase expression ofβ2-MG(5.99mg/L).3.Immunophenotypes.(1)CLL.The positive expression of CD5,CD23,FMC7,s Ig M,CD79b,CD38 in CLL were 92.7%,90.2%,42.3%,57.4%,78.4%,17.9%,respectively,and in other B-CLPD were 38.9%,44.5%,82.5%,71.7%,96.1%,31.4%,respectively.There was a significant difference between the expression of CLL and other B-CLPD.Co-expression of CD5(>27.7%)and CD23(>28.4%)was a diagnostic indicator of CLL.Low positive expression of CD38 was also a potential diagnostic indicator of CLL.(2)MCL.The positive expression of CD5,CD23,FMC7,s Ig M were 73.7%,26.3%,94.4%,100%respectively in MCL and 100%,57.9%,47%,64.7%respectively in other CD5+B-CLPD.Co-expression of s Ig M(>77.30%)and FMC7(>24%)was an indicator to distinguish MCL and other CD5+B-CLPD.(3)Other B-CLPD.The high positive expression of CD19,CD20 and CD22 and the low positive expression of CD10 were found in other B-CLPD.The positive expression of immunophenotypes in LPL/WM and MZL was similar,except CD23.Conclusion1.The median age of 231 patients with B-CLPD was 64 years,with male dominant.CLL was the most common type(123 cases),followed by B-CLPD-U(34cases).2.In the newly diagnosed patients,HCL was the most common subtype with splenomegaly and cytopenia.Abnormal elevation of LDH and lymphadenopathy were more frequently found in MCL than other B-CLPD.The abnormal rate of leukocyte and lymphocyte has the trend of increasing in CLL.The most common clinical manifestation of LPL/WM were anemia and abnormal elevation ofβ2-MG.3.The expression rates of CD5、CD23、FMC7、s Ig M、CD79b、CD38 in CLL and other B-CLPD were significantly different.Coexpression of CD5(>27.7%)and CD23(>28.4%)was a diagnostic indicator in CLL.CD38 was also a potential diagnostic indicator in CLL.There are significant differences of immunophenotypes,including CD5、CD23、FMC7 and s Ig M,between MCL and CD5+B-CLPD.Co-expression of s Ig M(>77.30%)and FMC7(>24%)is the indicator to distinguish MCL and other CD5+B-CLPD.