Vovelle Jérémie, Row Céline, Larosa Fabrice, Guy Julien, Mihai Anca-Maria, Maynadié Marc, Barben Jérémy, Manckoundia Patrick
"Pôle Personnes Âgées", Hospital of Champmaillot, University Hospital, 21079 Dijon, France.
Department of Biological Hematology, University Hospital, 21079 Dijon, France.
J Clin Med. 2022 Mar 21;11(6):1748. doi: 10.3390/jcm11061748.
Lymphoid neoplasms are a heterogeneous group of lymphoid neoplastic diseases with multiple presentations, and varying prognoses. They are especially frequent in older patients (OPs) and the atypism of this frail elderly population can make the diagnostic process even more difficult. Blood lymphocyte immunophenotyping (BLI) is essential in rapid noninvasive diagnosis orientation and guides complementary investigations. To our knowledge, BLI prescription has never been evaluated in OPs. We hypothesized that, when there is a suspicion of lymphoid neoplasm in the geriatric population, a BLI is performed in view of various clinical or biological abnormalities. This study aimed to: (1) describe the characteristics of hospitalized OPs having undergone BLI for suspected lymphoid neoplasm, (2) identify the causes leading to BLI prescription, and (3) identify the most profitable criteria for BLI prescription. This was a descriptive retrospective study on 151 OPs aged ≥75 years who underwent BLI over a 2-year period. Regarding BLI prescriptions, eight had lymphocytosis, constituting the "lymphocytosis group" (LG+), while the 143 others had BLI prescribed for reasons other than lymphocytosis (LG-), mainly general weakness and anemia. In the LG-, we compared OPs with positive and negative BLI results. The criteria found to be profitable for BLI prescription were lymphadenopathy, splenomegaly, lymphocytosis, and thrombocytopenia. BLI identified circulating lymphoid neoplasms (positive BLI) in 21/151 OPs, mainly marginal zone lymphoma and chronic lymphocytic leukemia. In polymorbid OPs, as per our study population, the diagnostic and therapeutic complexity explained in part the sole use of indirect and minimally invasive diagnostic techniques such as BLI.
淋巴瘤是一组异质性的淋巴系统肿瘤性疾病，表现多样，预后各异。它们在老年患者中尤为常见，而这一脆弱老年人群的异型性会使诊断过程更加困难。血液淋巴细胞免疫表型分析（BLI）在快速无创诊断导向中至关重要，并指导补充检查。据我们所知，从未对老年患者的BLI处方进行过评估。我们假设，当老年人群疑似淋巴瘤时，鉴于各种临床或生物学异常情况会进行BLI检查。本研究旨在：（1）描述因疑似淋巴瘤接受BLI检查的住院老年患者的特征，（2）确定导致开具BLI处方的原因，以及（3）确定BLI处方最有益的标准。这是一项对151名年龄≥75岁、在两年期间接受BLI检查的老年患者进行的描述性回顾性研究。关于BLI处方，8例有淋巴细胞增多症，构成“淋巴细胞增多症组”（LG+），而其他143例因淋巴细胞增多症以外的原因开具BLI处方（LG-），主要是全身虚弱和贫血。在LG-组中，我们比较了BLI结果为阳性和阴性的老年患者。发现对BLI处方有益的标准是淋巴结病、脾肿大、淋巴细胞增多症和血小板减少症。BLI在151例老年患者中的21例中识别出循环淋巴瘤（BLI阳性），主要是边缘区淋巴瘤和慢性淋巴细胞白血病。在我们的研究人群中，在患有多种疾病的老年患者中，诊断和治疗的复杂性部分解释了仅使用BLI等间接和微创诊断技术的原因。
