Chowdhury Sayan Mullick, Bhatta Subodh, Voorhees Timothy J, Annunzio Kaitlin, Bond David A, Sawalha Yazeed, Sigmund Audrey, Hanel Walter, Sehgal Lalit, Alinari Lapo, Baiocchi Robert, Maddocks Kami, Christian Beth, Jones Dan, Epperla Narendranath
Division of Hematology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH, USA.
Department of Pathology, The Ohio State University, Columbus, OH, USA.
J Hematol Oncol. 2025 Jan 5;18(1):4. doi: 10.1186/s13045-024-01658-y.
Diffuse large B-cell lymphoma (DLBCL), the most common B-cell non-Hodgkin lymphoma rarely presents with circulating lymphoma cells (CL) at diagnosis. Previous studies were limited by small sample size precluding robust analysis. Hence, we evaluated the prognostic relevance of CL cells in newly diagnosed DLBCL patients. Based on peripheral blood (PB) immunophenotyping, patients were grouped into CL + and CL-. CL was defined as detectable clonally restricted B-cells that matched the actual or expected B-cell immunophenotype of DLBCL. The primary endpoint was progression-free survival (PFS), and secondary endpoints included overall survival (OS) and diagnosis-to-treatment interval (DTI). Among the 1266 patients with DLBCL, 621 had PB flow at diagnosis, and after excluding patients not meeting eligibility criteria, 588 cases remained. Among these, 85 (15%) were CL + and 503 were CL- (85%). Patients in CL + group were younger (67 vs. 70 years, p = 0.03) with a higher proportion of non-bulky disease (85% vs. 56%, p < 0.0001), normal albumin (79% vs. 54%, p < 0.0001), and MYC/BCL2 and/or BCL6 rearrangements (18% vs. 7%, p = 0.003) compared to the CL - group. Patients with CL at diagnosis had significantly inferior PFS and OS compared with those without CL. After adjusting for factors associated with inferior PFS and OS in univariable analysis, presence of CL remained significantly associated with inferior PFS (HR = 2.04, 95%CI = 1.47-2.84, p < 0.0001) and OS (HR = 1.61, 95%CI = 1.1-2.36, p = 0.01), respectively. There was no significant difference in DTI between the two groups. Given the prognostic relevance associated with presence of CL, clinicians should consider checking PB flow at diagnosis in all newly diagnosed DLBCL patients.
弥漫性大B细胞淋巴瘤（DLBCL）是最常见的B细胞非霍奇金淋巴瘤，在诊断时很少出现循环淋巴瘤细胞（CL）。以往的研究因样本量小而受限，无法进行有力分析。因此，我们评估了新诊断的DLBCL患者中CL细胞的预后相关性。根据外周血（PB）免疫表型分析，患者被分为CL+组和CL-组。CL被定义为可检测到的克隆性受限B细胞，其与DLBCL的实际或预期B细胞免疫表型相匹配。主要终点是无进展生存期（PFS），次要终点包括总生存期（OS）和诊断至治疗间隔（DTI）。在1266例DLBCL患者中，621例在诊断时有PB流式检测结果，排除不符合入选标准的患者后，剩余588例。其中，85例（15%）为CL+，503例为CL-（85%）。与CL-组相比，CL+组患者更年轻（67岁对70岁，p = 0.03），非大包块疾病比例更高（85%对56%，p < 0.0001），白蛋白正常比例更高（79%对54%，p < 0.0001），MYC/BCL2和/或BCL6重排比例更高（18%对7%，p = 0.003）。诊断时存在CL的患者与无CL的患者相比，PFS和OS明显较差。在单变量分析中对与较差PFS和OS相关因素进行校正后，CL的存在仍分别与较差的PFS（HR = 2.04，95%CI = 1.47 - 2.84，p < 0.0001）和OS（HR = 1.61，95%CI = 1.1 - 2.36，p = 0.01）显著相关。两组之间的DTI无显著差异。鉴于CL存在与预后的相关性，临床医生应考虑在所有新诊断的DLBCL患者诊断时检查PB流式检测结果。
