Rijal, SewaKok, JohannaCoombes, CaitlinSmyth, LillianHourigan, JaydeJain, SanjivTalaulikar, Dipti2023-12-122023-12-121471-2407http://hdl.handle.net/1885/309833Background 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.The Canberra Hospital private trust fund.application/pdfen-AU© 2020 The authorshttp://creativecommons.org/licenses/by/4.0/Diffuse large B cell lymphomaB cellsPrognosisMicroenvironmentAnergic202010.1186/s12885-020-07525-62022-09-11Creative Commons Attribution licence