RÉSUMÉ
Objective:To investigate the diagnosis and differential diagnosis methods of chronic mature small B-cell lymphoma involving the bone marrow and peripheral blood.Methods:The clinical data of 27 patients with mature small B-cell lymphoma involving the bone marrow and peripheral blood (seven subtypes phase IV) who received treatment in the Kunshan Third People's Hospital from February 2015 to June 2021 were retrospectively analyzed. The application value of different detection methods in the diagnosis of mature small B-cell lymphoma involving the bone marrow and peripheral blood was analyzed.Results:The majority of patients' peripheral blood was mainly characterized by an increase in the ratio or absolute value of lymphocytes. In terms of cell morphology, mature lymphocytes were mainly small to medium in size. A few bone marrow smears or peripheral blood smears show characteristic changes in cell morphology. Flow cytometry results showed that among the cohort of 15 patients presenting CD5 expression, 11 patients had chronic lymphocytic leukemia, 1 patient had mantle cell lymphoma, 1 patient had splenic diffuse red pulp small B-cell lymphoma, and 2 patients had B-cell chronic lymphoproliferative disorders (unclassified). Among 12 patients presenting no CD5 expression, 8 had Waldenstr?m's macroglobulinemia, 3 had splenic marginal zone lymphoma, and 1 had follicular lymphoma. Among the 2 patients presenting CD5-CD10 expression, 1 patient had follicular lymphoma, and 1 patient had Waldenstr?m's macroglobulinemia. One patient with splenic diffuse red pulp small B-cell lymphoma expressed CD5, CD11c, and CD103 in addition to pan-B-cell markers, while BRAF V600E mutation detection and immunohistochemical staining for tartrate-resistant acid phosphatase and annexin-1A showed negative expression.Conclusion:This type of lymphoproliferative disease is a general term for lymphoma that has various different molecular and biological characteristics. Its diagnosis and differential diagnosis need to comprehensively consider the clinical characteristics of the patient, relevant laboratory tests, cell morphology, flow cytometry detection results, reasonable use of fluorescence in situ hybridization, molecular biology, special chemistry, and bone marrow immunohistochemistry. In a few cases, diagnosis of the lymphoproliferative disease still relies on non-bone marrow involvement and tissue biopsy.
RÉSUMÉ
Objective@#To investigate the clinical features, treatment and prognosis of the patients with B-cell chronic lymphoproliferative disorders (B-CLPD).@*Methods@#The data of 40 patients with B-CLPD in the Third People's Hospital of Kunshan from September 2010 to June 2017 were retrospectively analyzed, including clinical features, laboratory inspections, immunophenotyping, genetics and molecules results, therapeutic regimens, evaluation of curative effect and disease outcome.@*Results@#There were 29 male and 11 female patients in 40 B-CLPD patients, with a median age of 71.5 years old (47-88 years old). The percentage of chronic lymphocytic leukemia (CLL) was 57.5% (23/40), monoclonal B lymphocytosis was 10.0% (4/40), Waldenstrom macroglobulinemia was 15.0% (6/40), marginal/splenic marginal zone lymphoma was 12.5% (5/40), and mantle cell lymphoma was 5.0% (2/40). The immunophenotyping of the whole patients had the expressions of CD19, and surface immunoglobulin light chain in cytomembrane of 37 patients had a restrictive expression. All CLL patients presented the expressions of CD5 and CD23, while the other types of B-CLPD expressed various level of CD20, CD22, CD10, CD5, FCM-7. Twenty-six patients received chemotherapies including purine analogue, anthracyclines, alkylating agents and hormone. The overall response rate (complete remission plus partial remission) was 69.2% (18/26). The complete remission rate was 15.4% (4/26), which only occurred in the cohort of CLL patients who received the regimen containing fludarabine. The median follow up time of 26 patients who received medical treatment was 42.8 months (0.5-82.0 months), not reaching the median survival time.@*Conclusions@#The clinical features of B-CLPD are various, which requires comprehensive analysis of clinical data, including medical history, laboratory findings, imageological examination, cell morphology, immunophenotyping, genetics as well as molecular biology. The choice of the treatment should take the individualized situation into consideration.