Department of Experimental Hematology, Medical University of Lodz, Poland.
Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Poland.
Adv Clin Exp Med. 2024 Oct;33(10):1097-1104. doi: 10.17219/acem/174502.
Autoimmune cytopenias (ACs), including immune thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA) and autoimmune granulocytopenia, are rare complications observed in lymphoma patients. They may appear before, during or after lymphoma diagnosis, whether the patients had disease progression or not.
This study aims to correlate ACs with lymphoma type, disease course and prognosis. We performed a multicenter retrospective analysis of adult patients with malignant lymphoma and ACs coexistence diagnosed and treated in centers aligned with the Polish Lymphoma Research Group (PLRG).
The analysis covers the years 2016-2022 and included 51 patients comprised of 23 women and 28 men. Of these, 35 patients were diagnosed with AIHA, 15 patients with ITP and 1 patient with both AIHA and ITP.
The most common type of lymphoma was Hodgkin lymphoma (HL) (12 patients) and diffuse large B-cell lymphoma (DLBCL) (14 patients). At the time of diagnosis, 31 (61%) of patients had stage 4 of HL or DLBCL, according to Ann Arbor classification. In total, the response to treatment was evaluated in 50 patients, with 25 being in complete remission and 6 in partial remission. We observed that B cell symptoms (p = 0.036), bone marrow involvement (p = 0.073), splenomegaly (p = 0.025), and more than 2 lines of treatment were more common in AIHA compared to ITP patients. Conversely, eucopenia (p = 0.056) and ACs without lymphoma progression (p = 0.002) were more often diagnosed in ITP patients.
In the study group, relapsed and refractory disease was observed more often, and shorter overall survival (OS) was noted in patients with DLBCL. We found that AC is associated with a worse prognosis in comparison to the general population of lymphoma patients. There were no differences in response to AC therapy. To have more accurate data, a larger group, as part of a multicenter study, should be evaluated.
自身免疫性血细胞减少症（ACs），包括免疫性血小板减少症（ITP）、自身免疫性溶血性贫血（AIHA）和自身免疫性粒细胞减少症，是淋巴瘤患者中罕见的并发症。它们可能在淋巴瘤诊断之前、期间或之后出现，无论患者是否有疾病进展。
本研究旨在探讨 ACs 与淋巴瘤类型、疾病过程和预后的关系。我们对在与波兰淋巴瘤研究组（PLRG）相一致的中心诊断和治疗的恶性淋巴瘤合并 ACs 的成年患者进行了多中心回顾性分析。
分析涵盖了 2016 年至 2022 年，共纳入 51 例患者，其中 23 例为女性，28 例为男性。其中，35 例诊断为 AIHA，15 例诊断为 ITP，1 例同时诊断为 AIHA 和 ITP。
最常见的淋巴瘤类型为霍奇金淋巴瘤（HL）（12 例）和弥漫性大 B 细胞淋巴瘤（DLBCL）（14 例）。根据 Ann Arbor 分类，诊断时，31 例（61%）HL 或 DLBCL 患者处于 4 期。共有 50 例患者评估了治疗反应，其中 25 例完全缓解，6 例部分缓解。我们观察到，与 ITP 患者相比，AIHA 患者中 B 细胞症状更常见（p = 0.036）、骨髓受累（p = 0.073）、脾肿大（p = 0.025）和接受超过 2 线治疗（p = 0.036）。相反，ITP 患者中更常见的是白细胞正常（p = 0.056）和无淋巴瘤进展的 ACs（p = 0.002）。
在研究组中，观察到复发和难治性疾病更为常见，DLBCL 患者的总体生存（OS）更短。我们发现，与一般淋巴瘤患者相比，AC 与更差的预后相关。AC 治疗的反应没有差异。为了获得更准确的数据，应评估更大的患者组，作为多中心研究的一部分。
