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Objective: To analyze the effects of highdose methotrexate (HD-MTX) and lenalidomide as central nervous system (CNS) prophylaxis strategies in patients with diffuse large B-cell lymphoma (DLBCL)., Methods: The data of DLBCL patients with high risk of CNS recurrence who were initially treated in Fujian Provincial Hospital and Fujian Cancer Hospital from January 2012 to June 2022 were analyzed retrospectively. The patients were divided into HD-MTX group and lenalidomide group according to different prophylaxis strategies. Each group was further divided into high-risk group and medium-risk group based on CNS-IPI score and/or testicular involvement. The CNS relapse-free survival (CRFS) rate, adverse effects, and the effects of different prophylaxis strategies on overall survival (OS) rate and progression-free survival (PFS) rate were evaluated in different groups and subgroups., Results: There were 200 patients enrolled in this study, 80 cases in lenalidomide group and 120 cases in HD-MTX group. According to the delivery timing of prophylactic HD-MTX, the patients in HD-MTX group were further divided into two groups: 80 cases at the end of induction chemotherapy and 40 cases during chemotherapy interval. At a median follow-up of 48(14-133) months, the 4-year CRFS rate, 4-year PFS rate, and 4-year OS rate of the HD-MTX group was 93.6%, 57.2%, and 68.8%, respectively, while that of the lenalidomide group was 90.4%, 69.4% and 75.6%. There were no significant differences in 4-year CRFS rate, 4-year PFS rate, and 4-year OS rate between HD-MTX group and lenalidomide group (all P >0.05), but lenalidomide group showed a trend of improvement in PFS. Further subgroup analysis showed that there was no significant difference in 4-year CRFS rate between high-risk patients of the two groups (91.7% vs 83.4%, P >0.05), while 4-year PFS rate showed difference (49.5% vs 64.2%, P <0.05). A total of 248 cycles were collected for adverse reaction analysis in the HD-MTX group, and 25 cycles occurred neutropenia accompanied with infection (10.1%), while in lenalidomide group 240 cycles were collected in which 20 cycles occurred neutropenia accompanied with infection (8.3%). Both the two groups had no treatment-related deaths., Conclusion: Compared with HD-MTX, lenalidomide combined with immunochemotherapy can prevent CNS relapse, at the same time, improve prognosis, which is a safe and well tolerated central prophylaxis strategy.

Objective: To investigate the predictive value of methyltransferase EZH2 expression level on the clinical efficacy and long-term prognosis of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL)., Methods: 161 patients with newly treated PGI-DLBCL in our hospital from August 2013 to July 2019 were selected. The expression level of EZH2 protein was detected by immunohistochemistry, and the short-term efficacy and long-term survival differences of patients with different levels of EZH2 were compared. The predictive values of EZH2 expression level on the short-term efficacy and long-term prognosis of PGI-DLBCL patients were analyzed by Log-rank test and COX risk proportional regression model. Chi-square test and Logistic regression analysis were used to analyze the influencing factors of EZH2 expression level., Results: The complete response (CR) and overal response(OR) rates of those with high EZH2 expression were significantly lower than those with low EZH2 expression (P<0.001). The median OS and PFS of EZH2 high-level and low-level expression group was 37, 31 months and 49, 42 months, respectively. The cumulative OS and PFS rates of the high-level expression group were significantly lower than those of the low-level expression group, and the differences were statistically significant (P<0.05). The high expression levels of H3K27me3, EZH2, BCL-2, BCL-6, c-MYC were closely related to the shortening of OS and PFS, while the high expression level of Ki-67 was closely related to the shortening of OS (P<0.05), of which the high expression levels of H3K27me3, EZH2, BCL-2, and BCL-6 were independent risk factors for shortening of OS and PFS. The expression level of EZH2 was positively correlated with the expression level of H3K27me3, BCL-6, c-MYC and Ki-67 (r=0.741, r=0.837, r=0.809, r=0.772), and the high expression levels of H3K27me3, BCL-6 and Ki-67 were independent factors influencing the high expression of EZH2., Conclusion: In patients with PGI-DLBCL, the high expression of EZH2 significantly reduces the short-term CR and OR rates, which is an independent risk factor for the shortening of long-term OS and PFS rates, and it is independently related to the high expression of H3K27me3 and BCL6.

Objective: To analyze the clinicopathological features and prognostic factors of patients with diffuse large B-cell lymphoma(DLBCL)., Methods: Ninety-four cases of DLBCL followed up were selected in Fujian Tumor Hospital. The immunohistochemistry method was used to detect the protein expressions of BCL-2 BCL-6, MYC, CD10 and MUM-1, the gene abnormalities of MYC and BCL-2 were analyzed by fluorescence in situ hybridization, and the clinical pathological features and the related factors affecting prognosis in the patients with DLBCL were analyzed., Results: The protein positive rates of BCL-2, BCL-6, MYC, CD10 and MUM-1 in 94 patients were 75.53% (71/94), 58.51% (55/94), 52.13% (49/94), 15.96% (15/94) and 34.04% (32/94) respectively. The detection rate of MYC gene abnormality was 20.93% (9/43) and the detection rate of BCL-2 gene abnormality was 44% (22/50); 2 kinds of gene abnormalities were of multiple copies, and 2 cases (2.13%) were abnormal in MYC and BCL-2 genes simultaneously. The median survival time of 3 years in 94 patients was 21.79 months (2-36 months), and the overall survival rates of 1 and 3 years were 82.98% and 64.89% respectively. Single factor analysis revealed that the high ECOG score (≥ 2), high international prognostic index (IPI) classification, positive expression of BCL-6 protein, and MYC and BCL-2 gene simultaneously abnormal were the risk factors influencing the prognosis (all P<0.05). COX regression analysis showed that IPI classification, ECOG score and treatment methods were independent factors influencing the prognosis (all P<0.05)., Conclusion: IPI classification, ECOG score and treatment methods have greater impacts on the prognosis of patients with DLBCL. Chemotherapy combined with radiotherapy or surgical treatment can significantly improve the prognosis of patients.