[Clinicopathological features in relapsed diffuse large B-cell lymphoma]

Objective: To study the clinical pathological features of patients with relapsed diffuse large B-celllymphoma (DLBCL) and to provide evidence for early clinical screening of recurrent cases. Methods: The clinical and pathological data of the 20 patients, who had relapsed DLBCL (relapsed group) and were admitted to the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2019, were included. Meanwhile, other 34 patients with DLBCL who had achieved complete response (CR) for 36 months or more (CR group) were used as controls.Statistical methods were used to retrospectively analyze the differences in general conditions, clinical characteristics, lab resultsand pathological features between the two groups. Results: Clinically, there were 6 males and 14 females with a median age of 55.5 (33-85) years in the relapsed group and 14 males and 20 females with a median age of 53 (15-89) years in the CR group. The relapsed and CR groups had significant difference in Ann Arbor stage (P=0.001), International Prognostic Index score (P=0.006), primary lesions (P=0.003), extranodal involvement (P=0.002), and hepatitis B viral infection (P=0.046), β2-MG level (P=0.029), LDH level (P=0.005) and CRP level (P=0.006), while the age (P=0.732), gender (P=0.416), ECOG score (P=0.248), B symptoms (P=0.511), the presence of hypoalbuminemia (P=0.279), anemia (P=0.983) and A/G(P=0.416) showed no statistical difference.Pathologically, compared with the CR group, the relapsed group was mostly non-GCB type (85% vs. 59%,P=0.048), with a higher CD5 positive rate (25% vs.3%,P=0.014) and a lower bcl-6　positive rate (60% vs. 88%,P=0.017), while the expression of Ki-67, CD10, bcl-2, MUM1, CD20 and PAX5 was not different between the two groups. Conclusion: Most of the patients with relapsed DLBCL are non-GCB type. The patients with CD5 positivity, stage III-IV, International Prognostic Index score 3-5, nodal origin, often involving>1 extranodal organ, abnormally elevated LDH, CRP and β2-MG level, and HBV infection are more likely to relapse.