The Association of High-Sensitive C-reactive Protein with Clinical Parameters in Chronic Lymphocytic Leukemia and Diffuse Large B-Cell Lymphoma

Abstract Background: Chronic lymphocytic leukemia (CLL) is the most prevalent form of leukemia in the Western world, although it is less common in Asia. According to the annual report of cancer disease in Iraq in 2013, the incidence rate for all subtypes of leukemia in Iraq is 4.43 cases per 100,000, with CLL accounting for 5.34% of cases. Objective: The objective of this study was to assess the usefulness of high-sensitivity C-reactive protein (hsCRP) level against other clinical and laboratory parameters in both CLL and diffuse large B-cell lymphoma (DLBCL). We assessed the prognostic significance of pretreatment C-reactive protein (CRP) concentration in CLL and DLBCL patients. Patient and Methods: A hospital-based cohort study was conducted over the period of fifteen months from September 2019 to November 2020. This study was conducted in the hematology centers in Baghdad. We prospectively reviewed 30 patients with newly diagnosed CLL and 30 patients with DLBCL. hsCRP was estimated using immunoassay for both CLL and DLBCL patients. Results: The mean value of hsCRP for CLL was 5.47 ± 5.96 mg/L ranged from 0.3 to 28 and the mean value for DLBCL was 24.28 ± 24.59 mg/L ranged from (2.5 to 96). There was a significant statistical difference of pretreatment hsCRP between CLL and DLBCL patients ( P = 0.0001). There was no association between pretreatment hsCRP concentration and the presence of Binet stage B/C disease ( P = 0.081) and albumin concentration ( P = 0.893), there was moderate association with lactate dehydrogenase (LDH) concentration ( P = 0.046), whereas in DLBCL, there was no association between pretreatment high-sensitive CRP concentration and presence of advanced Ann Arbor stage of disease ( P = 0.064) and LDH concentration ( P = 0.136). An increased hsCRP concentration was significantly associated with the high IPI ( P = 0.009). Increased hsCRP concentration was not associated with poorer outcomes than those patients with low CRP concentration whereas in DLBCL, the elevated level of pretreatment hsCRP was significantly associated with poorer outcomes ( P = 0.064 and P = 0.001, respectively). Conclusion: Monitoring of hsCRP May not be valuable in CLL patients’ assessment or follow-up, however, if it get an increase, there may be other causes rather than the disease itself like coinfection or secondary malignancy. Unlike DLBCL where hsCRP is attributed to disease progression and advanced IPI scoring. Disease outcome had not found to be associated with hsCRP in CLL but the reverse in DLBCL with the significant association.