Clinical characteristics and prognosis analysis of B-cell chronic lymphoproliferative disorders unclassified / 白血病·淋巴瘤

ABSTRACT

Objective:To explore the clinical features and prognostic related factors of B-cell chronic lymphoproliferative disorders unclassified (B-CLPD-U).Methods:The clinical data of 39 patients diagnosed with B-CLPD-U in the First Affiliated Hospital of Harbin Medical University from January 2012 to January 2019 were retrospectively analyzed. Patients were regularly treated with COP regimen (30 cases) or fludarabine regimen (9 cases). The χ 2 test was used to analyze the relationship between the clinical characteristics and the efficacy of the patients. The Kaplan-Meier method was used for survival analysis and the log-rank test was used for single factor analysis. The Cox proportional hazard regression model was used for multivariate analysis, and the receiver operating characteristic (ROC) curve was used to analyze the value of platelet-to-lymphocyte ratio (PLR) in prognostic evaluation. Results:Among 39 patients, there were 24 males and 15 females, and the median age was 60 years old (37-78 years old). The international prognostic index (IPI) score was 0 to 2 in 19 cases (48.7%), and 3 to 5 in 20 cases (51.3%). The overall response rate (complete remission plus partial remission) rate (ORR) of the patients was 82.1% (32/39). The ORR of patients with normal lactate dehydrogenase (LDH) (≤ 245 U/L) was higher than that of patients with elevated LDH (> 245 U/L). The ORR of patients with Ann Arbor stage Ⅰ-Ⅱ was higher than that of patients with stage Ⅲ-Ⅳ, and the differences were statistically significant [95.5% (21/22) vs. 64.7% (11/17), 100.0% (15/15) vs. 70.8% (17/24), all P < 0.05]. At the end of the follow-up in October 2019, 31 cases (79.5%) survived and 8 cases (20.5%) died of 39 patients; the median overall survival(OS) time was 40.0 months (95% CI 36.0-55.2 months). Univariate analysis showed that patients with elevated LDH and age over 60 years had poor OS, and the difference was statistically significant (all P <0.05), while there were no statistically significant differences in OS between patients with gender, Ann Arbor staging, IPI score, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) score, anemia, B symptoms, COP-based chemotherapy or fludarabine-based chemotherapy, and different absolute lymphocyte (ALC) stratification (all P > 0.05). Multivariate analysis showed that LDH level ( HR = 0.411, 95% CI 0.172-0.981, P = 0.045) and age ( HR = 2.242, 95% CI 1.045-4.808, P = 0.038) were independent influencing factors of OS (both P < 0.05). The median PLR was 59.07 (1.18-276.26). ROC curve analysis showed that the area under the curve for PLR to predict OS was 0.565. Conclusion:B-CLPD-U is more common in middle-aged and elderly patients, and it is more commonly found in men than women. Elevated LDH and age over 60 years are independent risk factors for survival of patients with B-CLPD-U. The evaluation of sensitivity and specificity of the prognosis in B-CLPD-U patients by using PLR will be not that ideal.