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CLINICAL AND HEMATOLOGICAL ASPECTS OF INDOLENT NON-HODGKIN'S LYMPHOMAS
Buruaiana S.,
The State University of Medicine and Pharmacy "Nicolae Testemitanu", Doctor of medical sciences, associate professor
Gutan D.
The State University of Medicine and Pharmacy "Nicolae Testemitanu",
student
ABSTRACT
In the retrospective study, were analyzed the clinical and hematological aspects of 49 patients with indolent non-Hodgkin's lymphomas (NHL). The study demonstrated an increased incidence of indolent NHL in people older than 50 years, in men, along with the finding of generalized stages, mainly stage IV. In all the investigated cases, it was revealed a primary and secondary damage, mainly, of the lymph nodes, the disease being detected in the IV clinical stages with intoxication syndrome. Hematologically, patients showed leukocytosis, lymphocytosis and anemia. The medullogram detected the damage of the bone marrow, and in the case of bone marrow biopsy, the hypercellularity with diffuse or foci damage of the bone marrow was determined.
Keywords: indolent non-Hodgkin's lymphoma, lymph nodes, onset of disease.
Problem statement
NHL are a heterogeneous group of malignant tumors of lymphatic tissue, distinctive by etiology, morphology, immunophenotypic and genetic properties, clinical features and response to treatment [8].
The highest prevalence of NHL morbidity is assessed in people aged between 50-60 years. In the Republic of Moldova, the index of morbidity of NHL is 4.1 per 100.000 [8]. Globally, following the researches of the American Cancer Society, the incidence of NHL turned out to be 5.1 per 100.000, with a mortality rate of 2.5 per 100.000. According to Cancer Research UK, between 2016-2018, there is a prevalence of NHL in the male sex than in the female sex. Indolent NHL, is characterized by a generally slow evolution, being often asymptomatic, being detected, in many cases, already at the appearance of B-symptoms or extranodal damage. These types of NHL respond well to treatment, but there is an increased risk of relapse, and the healing is rarely achieved [1, 3, 11]. Small lymphocytic lymphoma (SLL) accounts for about 6% of NHL, predominating in men aged between 60-71 years, the white race [4]. Marginal zone lymphoma (MZL) comprises about 10-15% of all non-Hodgkin's lymphomas [7]. Follicular lymphoma (FL) is one of the most common types of indolent NHL, constituting approximately 2025% of all LNH with a prevalence in women in the range of 60-65 years [9, 10].
The aim of the study is the learning of the clinical and hematological aspects of indolent non-Hodgkin's lymphomas for the assessment of their peculiarities.
The objectives of the study: studying the clinical aspects of indolent NHL types, depending on age, gender, living environment; assessment of the onset of disease; stage; B-symptoms depending on the indolent NHL type; interpretation of hematological indices in peripheral blood and bone marrow depending on the type of indolent NHL.
Methodology and research methods
During the research carried out, have been studied the clinical and hematological aspects of 49 patients diagnosed with indolent NHL, aged between 27 years and 79 years, who were registered in the Diagnostic Advisory Center of the IMSP Oncological Institute in 2020. 63 outpatient cards of patients with confirmed morphological and immunohistochemical diagnosis have been examined. In the study were directly included 49 patients eligible for inclusion criteria. Sociodemographic, clinical and laboratory data of the patients were extracted from the outpatient cards.
Results of the research
Following the preparation of the patients research sheets, 3 types of indolent non-Hodgkin lymphomas were identified: SLL, FL and MZL. According to the results of our study, it was found a predominance of patients with SLL (40 patients-81.6%), compared to MZL
(6 patients-12.3%) and FL (3 patients-6.1%). Depending on the gender, indolent NHL development predominates in men (31 patients-63%) as opposed to women (18-37%). The results of our study demonstrate the development of SLL and MZL more frequently in men (67.5% and 66.6%, respectively), and FL only in women (100%). Independently of the indolent NHL type, the diagnosis was confirmed mainly in people aged between 51-60 and 61-70 years, followed by patients over 70 years of age and obviously less often at 18-30 years. In the study we determined that in women SLL developed more frequently at the age of 50-70 years, MZL - at the age of 51-60 and < 70 years, and FL - at the age of 61-70 years. In men SLL was confirmed more frequently at the age of more than 50 years, MZL - at the age of 51-60 years and there were no cases of FL.
In the distribution of patients with indolent NHL, according to the living environment, we appreciated the predominance in 61% cases of patients from urban areas: SLL - 60%, MZL - 66% and FL in 100% cases.
The nodal onset (62.5%) prevailed over the ex-tranodal onset (37.5%) in cases of SLL. Damage to axillary lymph nodes prevailed from all nodal areas (48%). More rarely, the onset was detected in the inguinal (16%) and abdominal (12%) lymph nodes, followed by the cervical and submandibular ones (8% each, respectively), which were equally affected, and the supraclavicular, auricular lymph nodes - of 1 patient each (4% each). Spleen onset was detected in 13 patients (34.6%). Very rarely - in tonsil and soft tissues (of 1.45% each). In MZL the nodal onset prevailed in 66.6% cases, being more frequently appreciated in peripheral lymph nodes 3 patients (75%) and only in 1 patient (25%) the primary tumor outbreak was assessed in the abdominal lymph nodes. The stomach and spleen constituted extranodal onset. The nodal onset in the case of FL was appreciated in 66.6% at the level of the inguinal and abdominal lymph nodes. The spleen constituted the primary extranodal outbreak.
Independently of the indolent NHL type after determining the degree of dissemination of the malignant process, it was found the prevalence of advanced stages III and IV: in SLL - 92.5%, MZL - 83.3% and FL -100%. B-symptoms were present in SLL in 17 (53.1%) patients, in MZL - in 4 (80%) patients, and in FL in all patients.
The blood count changes were diverse: anemia, leukocytosis with lymphocytosis, leukopenia. In patients with SLL we found the predominance of first degree anemia - in 19 patients (79.1%), second degree -in 4 patients (16.6%), third degree - in 1 patient (4.3%). Metaplastic anemia prevailed (62.5%), followed by immune hemolytic anemia (20.8%) and iron-deficiency anemia (16.7%). Reticulocytosis and hyperbilirubinemia from the account of the indirect fraction, determined the presence of hemolysis. Leukocytosis in SLL was detected in 15 patients (37.5%). In patients with MZL in 50% cases anemia was confirmed. One patient developed reticulocytosis of 55%. Evaluation of blood count in patients with FL detected anemia in 66.6%.
The medullogram of patients with indolent NHL demonstrated lymphocyte variation between 22% and 94%. In the case of lymphocytosis in the sternal punctate, leukocytosis with lymphocytosis in the blood
count was also detected. Bone marrow biopsy detected hypercellularity, complete infiltration with lymphocytes, and in the case of FL - focal infiltration with lymphocytes.
Conclusions
1. SLL developed more frequently in patients over 50 years of age, MZL - in the age categories of 5160 years and older than 70 years, and FL - in patients aged between 61-70 years, in men (63%) in urban areas (61%).
2. The distribution of patients with indolent NHL according to the degree of dissemination revealed in 91.8% the generalized stages (III and IV), mainly stage IV-81,6% with the presence of B signs in 48.9% cases.
3. The nodal debut prevailed independently of the indolent NHL type: in SLL in 62.5%, in MZL -66.6%, in FL - 66.6%.
4. In the framework of damage to the bone marrow, the blood count demonstrated leukocytosis with lymphocytosis. The higher frequency of anemia was appreciated in the case of SLL and MZL.
5. The medullogram confirmed bone marrow involvement and hypercellularity with diffuse damage in SLL and MZL and the focal form damage in FL with the correlation of leukocytosis and lymphocytosis in the blood count.
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