Immunosuppression-Based Lymphoproliferative Disease Features and Parameters Affecting Survival

Aim: Lymphoid cell malignancies originate from the immune cells at various stages of differentiation, ranging from the slowest progressing ones to the most aggressive types. The immune deficiency-associated lymphomas are less frequently seen with worse prognoses, poor treatment responses, and high mortality rates than the primary lymphomas. In this study, we aim to evaluate the clinical and laboratory findings and to determine the survival rates, treatment responses, and the factors that may influence the mortality and survival rates in patients with immunodeficiency-associated lymphomas. Methods: The study included 15 patients with immunodeficiency-associated lymphomas and 49 patients with newly diagnosed primary lymphomas between January 2013 and January 2023. Patient characteristics, treatments, and mortality rates were retrospectively analyzed using data charts. Results: The remission and partial remission rates after the treatment were significantly lower in the patients with immunodeficiency-associated lymphomas [p=0.025; OR=5.6 (1.4-22, 95%CI)]. The IPI values of the primary lymphoma patients were significantly lower. Upon evaluating all patients in both groups collectively, a discernible trend indicated a deterioration in treatment responses correlating with escalating International Prognostic Index (IPI) values (p < 0.001). The levels of β-2 microglobulin were higher in the deceased patients (3.4±1.8mg/l vs 5.2±1.8mg/l; p<0.01). The EBV DNA positivity rates were significantly higher in the deceased patients in the patient group with immunodeficiency-based lymphomas (p<0.05). Mortalities were observed in 5 (10.2%) patients with primary lymphomas and in 7 (46.7%) patients with immunodeficiency-associated lymphomas at the end of the follow-up period (p<0.01; OR=7.7). The mean progression-free survival rate was 30.8±1.8. The mean progression-free survival rate of the patients with immunodeficiency-associated lymphomas was 22.4±4.2 months (14.1-90.6 95%CI), whereas, in the primary lymphoma patients, it was 32.2±1.5 months (29.1-35.3 95%CI), leading to a significant difference between the two groups (p=0.004). Conclusion: Our study demonstrated that immunodeficiency-associated lymphoma has a poorer prognosis, shorter survival rates, and higher mortality. In addition, IPI values, levels of β-2 microglobulin, and the outcomes of EBV serology tests are essential factors in determining this group of patients' prognoses and survival rates.