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Jin Z, Miao Y, Zhang J, Zhang J, Wang C, Lu X, Miao Y, Sun M, Zhang Y, Zhuang Y, Ni H, Xu J, Zhuang W, Zhao M, Zhu J, Xu M, Lin G, Hua H, Xie X, Xu M, Jia T, Zhai L, Gu W, Shan Q, Wang Z, Shen Q, Zhang X, Li J, Shi W. The clinical significance and prognostic value of serum beta-2 microglobulin in adult lymphoma-associated hemophagocytic lymphohistiocytosis: a multicenter analysis of 326 patients. Ann Hematol 2024; 103:2257-2266. [PMID: 38270644 DOI: 10.1007/s00277-024-05631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
To investigate the prognostic impact of serum beta-2 microglobulin (B2M) in adult lymphoma-associated hemophagocytic lymphohistiocytosis (HLH). The clinical and laboratory characteristics of 326 adult patients in a multicenter cohort with lymphoma-associated HLH with available baseline serum B2M levels were retrospectively analyzed. A total of 326 cases were included in this study, and the median serum B2M level was 5.19 mg/L. The optimal cut-off of serum B2M was 8.73 mg/L, and the cases with serum B2M level >8.73 mg/L were older and had a more advanced stage, lower levels of platelets, albumin, and fibrinogen, and higher creatinine level. The serum B2M >8.73 mg/L, creatinine ≥133 μmol/L, fibrinogen ≤1.5 g/L, agranulocytosis (<0.5 × 109/L), severe thrombocytopenia (<50 × 109/L), and high Epstein-Barr virus DNA copy number were found to have independent prognostic values in all patients, and the serum B2M >8.73 mg/L was also an independent prognostic factor in patients with creatinine <133 μmol/L. Finally, a prognostic scoring system was established based on independent prognostic factors of all patients and categorized the patients into three groups with significant prognostic differences. This study confirmed that the serum B2M level can be an independent prognostic factor in lymphoma-associated HLH and established a prognostic scoring system to predict patients' survival.
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Affiliation(s)
- Ze Jin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Miao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Zhang
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, China
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
| | - Jing Zhang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
| | - Chunling Wang
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The First People's Hospital of Huai'an, Huai'an, China
| | - Xuzhang Lu
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Changzhou No.2 Hospital of Nanjing Medical University, Changzhou, China
| | - Yuqing Miao
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Yancheng First People's Hospital, Yancheng, China
| | - Miao Sun
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, Jingjiang, China
| | - Yunping Zhang
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, China
| | - Yun Zhuang
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Wu Xi People's Hospital, Wuxi, China
| | - Haiwen Ni
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jingyan Xu
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wanchuan Zhuang
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Min Zhao
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Wuhu Second People's Hospital, Wuhu, China
| | - Jianfeng Zhu
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, China
| | - Min Xu
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, China
| | - Guoqiang Lin
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, China
| | - Haiying Hua
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xiaoyan Xie
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Maozhong Xu
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China
| | - Tao Jia
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Lijia Zhai
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Weiying Gu
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qiurong Shan
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Shuyang Traditional Chinese Medicine Hospital, Shuyang, China
| | - Zhi Wang
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, Wuxi Second People's Hospital, Wuxi, China
| | - Qiudan Shen
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China
- Department of Hematology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaohui Zhang
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China.
- Department of Hematology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China.
| | - Wenyu Shi
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, China.
- Jiangsu Cooperative Lymphoma Group (JCLG) and Jiangsu Histiocytosis Association Lymphoma Group (JHA-LG), Nanjing, China.
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Zhang J, Qin S, Jin Z, Chen Q, Xing L, Qiu T, Xia Y, Liang J, Zhu H, Wang L, Fan L, Xu W, Li J, Miao Y. The Clinical Significance and Prognostic Role of Whole-Blood Epstein-Barr Virus DNA in Lymphoma-Associated Hemophagocytic Lymphohistiocytosis. J Clin Immunol 2023:10.1007/s10875-023-01493-9. [PMID: 37093406 DOI: 10.1007/s10875-023-01493-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To evaluate the role of circulating Epstein-Barr virus (EBV) DNA in lymphoma-associated hemophagocytic lymphohistiocytosis (HLH). METHODS We conducted a retrospective cohort study to explore the clinical and prognostic significance of EBV DNA in lymphoma-associated HLH. We included adult patients with combined diagnoses of lymphoma and HLH from January 2010 and November 2022 by retrieving the medical record system. RESULTS A total of 281 patients with lymphoma-associated HLH were identified. Elevated whole-blood EBV DNA was observed in 54.4% (153/281) of patients, and the median copy number was significantly higher in the T/NK-cell malignancies (199,500, interquartile range, 30,000-1,390,000) than that in the B-cell non-Hodgkin lymphoma (5520, interquartile range, 1240-28,400, P < 0.001). The optimum cutoff for predicting survival was 16,100 copies/mL. Compared to the patients with EBV DNA ≤ 16,100 copies/mL, those with EBV DNA > 16,100 copies/mL were younger and had more T/NK-cell malignancies, lower levels of neutrophils and fibrinogen, and higher levels of hemoglobin, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, and β2-microglobulin. A higher load of EBV DNA (> 16,100 copies/mL), thrombocytopenia (< 100 × 109/L), neutropenia (< 1 × 109/L), hypofibrinogenemia (≤ 1.5 g/L), and elevated levels of creatinine (> 133 μmol/L) were independent adverse predictors of 60-day overall survival and overall survival. A prognostic index based on EBV DNA and the other four factors was established to categorize the patients into four groups with significantly different outcomes. CONCLUSION Our study identified high EBV load as a risk factor for lymphoma-associated HLH and established a prognostic index to predict outcomes.
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Affiliation(s)
- Jing Zhang
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Shuchao Qin
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Ze Jin
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Qingqing Chen
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lingxiao Xing
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Tonglu Qiu
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yi Xia
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jinhua Liang
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Huayuan Zhu
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lei Fan
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Wei Xu
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Jianyong Li
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
| | - Yi Miao
- Department of Hematology, Pukou CLL Center, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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