High proportion of anergic B cells in the bone marrow defined phenotypically by CD21(−/low)/CD38- expression predicts poor survival in diffuse large B cell lymphoma

• Main Authors: Sewa Rijal, Johanna Kok, Caitlin Coombes, Lillian Smyth, Jayde Hourigan, Sanjiv Jain, Dipti Talaulikar
• Format: Article
• Language: English
• Published: BMC 2020-11-01
• Series: BMC Cancer
• Subjects: Diffuse large B cell lymphoma; B cells; Prognosis; Microenvironment; Anergic
• Online Access: http://link.springer.com/article/10.1186/s12885-020-07525-6

Abstract Background Diffuse large B cell lymphoma (DLBCL) is the commonest lymphoma that is highly aggressive where one-third of the patients relapse despite effective treatment. Interaction between the lymphoma cells and the non-clonal immune cells within the bone marrow microenvironment is thought to play a critical role in the pathogenesis of DLBCL. Methods We used flow cytometry to characterize the proportion of B cell subpopulations in the bone marrow (N = 47) and peripheral blood (N = 54) of 75 DLBCL patients at diagnosis and study their impact on survival. Results Anergic B cells in the bone marrow (BM), characterized as having CD21(−/low)/CD38- expression, influenced survival with high numbers (defined as > 13.9%) being associated with significantly shorter overall survival (59.7 months vs 113.6 months, p = 0.0038). Interestingly, low numbers of anergic B cells in the BM (defined as ≤13.9%) was associated with germinal center B cell type of DLBCL (p = 0.0354) that is known to have superior rates of survival when compared to activated B cell type. Finally, Cox regression analysis in our cohort of patients established that the inferior prognosis of having high numbers of anergic B cells in the bone marrow was independent of the established Revised International Prognostic Index (R-IPI) score. Conclusions High proportion of anergic B cells in the BM characterized by CD21(−/low)/CD38- expression predicts poor survival outcomes in DLBCL.