ABSTRACT
Objective:
To summarize the morphological characteristics of
diffuse large B-cell lymphoma (DLBCL)
cells and investigate the
prognosis value of the characteristics and the number of DLBCL
cells in
bone marrow.
Methods:
Retrospective study. We collected 79 cases newly diagnosed with DLBCL in the First Affiliated
Hospital of Zhengzhou
University from January 2020 to August 2022. 30 cases newly diagnosed without
bone marrow involvement were selected as controls, whose mean age 58 years (30-82 years). The DLBCL
cells were evaluated by the
bone marrow smear,
biopsy and
flow cytometry separetely.The
detection rate of DLBCL
cells in the
bone marrow was compared, to analyse the relationship between the morphological characteristics of DLBCL in the smear, clinical characteristics and
flow cytometry parameters, and the prognostic value of DLBCL detected in the
bone marrow smear and its quantity was analyzed.
Logistic regression was used to analyze the correlation between the
detection of DLBCL
cells in
bone marrow smears and the age, clinical stage, and the number of extraderules involved organs. Multivariate Cox regression was used to analyze the influence of DLBCL
cells detection and its number on the
prognosis of
patients.
Results:
(1) The positive rates of DLBCL
cells in
bone marrow biopsy,
bone marrow smear and
flow cytometry were 4.86%, 5.14% and 9.27% respectively. (2) The morphological characteristics of 79 cases in
bone marrow smears were described more than 2 times the volume of the
cell body of the
lymphocyte, the shape was different, round or quasi-round or irregular shape, can be seen
pseudopodia or protrusion; The volume of
cytoplasm was moderate,
vacuoles were visible, and a few perinuclear areas were visible. The nucleus were different in shape, round or quasi-round or irregularly shaped, with a majority of them having multiple nuclei and a few of them having delicate and loose
chromatin. Most nucleoli were medium or large obviously, with a majority of them having 1-2 nucleoli and a few having more than 3.Sergiosomes and hemophagocytosis were observed in some DLBCL cases,
tumor cell aggregation phenomenon was observed in a few DLBCL cases, occasionally pathological
mitosis.(3) DLBCL
cells in
bone marrow smear was positively related to the age of
patients, clinical stage and the number of extranodal organs involved(regression coefficient were 2.012, 2.754, 2.028, P<0.05);The volume of DLBCL
cells in
bone marrow smear was positively correlated with the ratio of CD4 and CD8(regression coefficient is 2.545, P<0.05);The
vacuoles in
cytoplasm and the pseudopod of
tumor were both negative relationship with the quantity of CD38 expressed on DLBCL
cells(regression coefficient was -2.465, -3.045, P<0.05); (4) DLBCL
cells in
bone marrow smear was an independent
risk factor for PFS and OS( RR=7.059, P<0.05); RR=5.409, P<0.05).
Conclusion:
The appearace of DLBCL
cells in
bone marrow smear with
prognosis, and could be used for clinical staging.
