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Warnnissorn N, Kanitsap N, Niparuck P, Boonsakan P, Kulalert P, Limvorapitak W, Bhoopat L, Saengboon S, Suriyonplengsaeng C, Chantrathammachart P, Puavilai T, Chuncharunee S. Adding MYC/BCL2 double expression to NCCN-IPI may not improve prognostic value to an acceptable level. Blood Res 2024; 59:2. [PMID: 38485822 PMCID: PMC10903517 DOI: 10.1007/s44313-024-00006-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND MYC/BCL2 double expression (DE) is associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). This study aimed to determine whether the addition of DE to the National Comprehensive Cancer Network Internal Prognostic Index (NCCN-IPI) could improve the prediction of disease progression in patients with DLBCL treated with R-CHOP. METHODS This confirmatory prognostic factor study retrospectively recruited patients with newly diagnosed DLBCL between January 1, 2014, and January 31, 2018, at Ramathibodi Hospital (RA) and Thammasat University Hospital (TU). The follow-up period ended on July 1, 2022. Tumors expressing MYC ≥ 40% and BCL2 ≥ 50% were classified as DE. We calculated the hazard ratios (HR) for progression-free survival (PFS) from the date of diagnosis to refractory disease, relapse, or death. Discrimination of the 5-year prediction was based on Cox models using Harrell's concordance index (c-index). RESULTS A total of 111 patients had DE (39%), NCCN-IPI (8%), and disease progression (46%). The NCCN-IPI adjusted HR of DE was 1.6 (95% confidence interval [CI]: 0.9-2.8; P = 0.117). The baseline NCCN-IPI c-index was 0.63. Adding DE to the NCCN-IPI slightly increased Harrell's concordance index (c-index) to 0.66 (P = 0.119). CONCLUSIONS Adding DE to the NCCN-IPI may not improve the prognostic value to an acceptable level in resource-limited settings. Multiple independent confirmatory studies from a large cohort of lymphoma registries have provided additional evidence for the clinical utility of DE.
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Affiliation(s)
- Naree Warnnissorn
- Department of Pathology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | - Nonglak Kanitsap
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Wasithep Limvorapitak
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Lantarima Bhoopat
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Supawee Saengboon
- Division of Hematology, Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Pichika Chantrathammachart
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeraya Puavilai
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Boltežar L, Rožman S, Gašljević G, Grčar Kuzmanov B, Jezeršek Novaković B. Do Double-Expressor High-Grade B-Cell Lymphomas Really Need Intensified Treatment? A Report from the Real-Life Series of High-Grade B-Cell Lymphomas Treated with Different Therapeutic Protocols at the Institute of Oncology Ljubljana. Biomedicines 2024; 12:275. [PMID: 38397877 PMCID: PMC10886998 DOI: 10.3390/biomedicines12020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
High-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements are known for their aggressive clinical course and so are the ones with MYC and BCL2 protein overexpression. The optimal therapy for these lymphomas remains to be elucidated. A retrospective analysis of all diffuse large B-cell lymphomas and high-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements diagnosed between 2017 and 2021 at the Institute of Oncology Ljubljana, Slovenia, has been performed. Only patients with double-expressor lymphoma (DEL), double-hit lymphoma (DHL), or triple-hit lymphoma (THL) were included. Demographic and clinical parameters were assessed, as well as progression-free survival (PFS) and overall survival (OS). In total, 161 cases out of 309 (161/309; 52,1%) were classified as DEL. Sixteen patients had DHL, MYC/BCL2 rearrangement was observed in eleven patients, and MYC/BCL6 rearrangement was observed in five patients. Five patients were diagnosed with THL. Out of 154 patients (according to inclusion/exclusion criteria) included in further evaluation, one-hundred and thirty-five patients had double-expressor lymphoma (DEL), sixteen patients had DHL, and three patients had THL. In total, 169 patients were treated with R-CHOP, 10 with R-CHOP and intermediate-dose methotrexate, 19 with R-DA-EPOCH, and 16 with other regimens. The median follow-up was 22 months. The 5-year OS for the whole DEL group was 57.1% (95% CI 45.9-68.3%) and the 5-year PFS was 76.5% (95% CI 72.6-80.4%). The log-rank test disclosed no differences in survival between treatment groups (p = 0.712) while the high-risk international prognostic index (IPI) carried a significantly higher risk of death (HR 7.68, 95% CI 2.32-25.49, p = 0.001). The 5-year OS for DHL patients was 32.4% (95% CI 16.6-48.2%) while all three TH patients were deceased or lost to follow-up. Our analyses of real-life data disclose that the R-CHOP protocol with CNS prophylaxis is a successful and curative treatment for a substantial proportion of DEL patients.
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Affiliation(s)
- Lučka Boltežar
- Division of Medical Oncology, Institute of Oncology, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
- Medical Faculty, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Samo Rožman
- Pharmacy, Institute of Oncology, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
| | - Gorana Gašljević
- Department of Pathology, Institute of Oncology, Zaloška Cesta 2, 1000 Ljubljana, Slovenia; (G.G.); (B.G.K.)
| | - Biljana Grčar Kuzmanov
- Department of Pathology, Institute of Oncology, Zaloška Cesta 2, 1000 Ljubljana, Slovenia; (G.G.); (B.G.K.)
| | - Barbara Jezeršek Novaković
- Division of Medical Oncology, Institute of Oncology, Zaloška Cesta 2, 1000 Ljubljana, Slovenia;
- Medical Faculty, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
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3
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Abdelhamid TM, Gaber AA, Abdelfattah RM, Algamal DA, Hamdy O, Mohamed G. The significance of concurrent MYC and BCL2 expression in Egyptian patients with diffuse large B-cell NHL. Pathol Res Pract 2024; 253:154973. [PMID: 38101156 DOI: 10.1016/j.prp.2023.154973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
This study aimed to investigate the frequency of MYC/BCL2 co-expression using immunohistochemistry (IHC) in Egyptian patients with diffuse large B-cell lymphoma (DLBCL) and its impact on treatment outcomes, overall survival (OS), and disease-free survival (DFS). A total of 100 adult patients with newly diagnosed DLBCL were included in the study and treated with the R-CHOP regimen. The cases were classified into germinal center B-cell (GCB) and non-germinal center B-cell (non-GCB) subtypes based on IHC. Our results showed that a subset of the studied cases didn't achieve complete remission (CR) after chemotherapy (22%). Co-expression of MYC and BCL2 was observed in 20% of the cases, with most of them belonging to the non-GCB subtype. The CR rate was significantly lower in the double-expressor (DE) group (45%), while no significant difference was observed in CR between the GCB and non-GCB cases. The DE group was associated with advanced stage, extra-nodal involvement, and high-risk R-International Prognostic Index (R-IPI). Both the non-DE and GCB groups demonstrated better DFS, while the non-DE group only showed better OS. Both non-DE status and GCB subtype were identified as independent factors affecting DFS. In conclusion, the concurrent expression of MYC and BCL2 in DLBCL indicates an inferior outcome and lower chemotherapy response. The current chemotherapeutic strategy has not effectively improved the outcomes of this aggressive lymphoma subtype. Therefore, the identification of these patients is crucial for selecting appropriate treatment options.
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Affiliation(s)
- Thoraya M Abdelhamid
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ayman A Gaber
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Raafat M Abdelfattah
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Dina A Algamal
- Medical Oncology Department, Tanta Cancer Center, Tanta, Egypt
| | - Omar Hamdy
- Faculty of Engineering, Cairo University, Giza, Egypt
| | - Ghada Mohamed
- Department of Pathology, National Cancer Institute, Cairo University, Cairo, Egypt.
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Bobillo S, Wilson MR, Cwynarski K. Controversies in central nervous system prophylaxis of high-risk diffuse large B-cell lymphoma. Curr Opin Oncol 2023; 35:382-388. [PMID: 37551947 DOI: 10.1097/cco.0000000000000973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE OF REVIEW Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is an uncommon but devastating complication with an overall survival of less than 6 months. This article will review the recent updates on CNS prophylaxis including new potential advances in the identification of high-risk patients. RECENT FINDINGS The identification of patients at a high risk of CNS relapse is based on clinical and biological features has improved over recent years; however, the of different CNS prophylaxis strategies including intrathecal chemotherapy and high-dose methotrexate have been recently questioned in several large retrospective studies. The analysis of cell-free circulating tumor DNA (ctDNA) in the cerebrospinal fluid has been shown to identify patients with a high risk of CNS involvement and work is ongoing to identify how this can be used as a prognostic biomarker. SUMMARY Recent clinical retrospective data have questioned the effectiveness of intrathecal and high-dose methotrexate in the prevention of CNS relapse in high-risk DLBCL patients. The role of more sensitive methods to detect CNS involvement and the benefit of novel therapies in CNS relapse prevention are currently under evaluation.
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Affiliation(s)
- Sabela Bobillo
- Department of Haematology, Vall d'Hebron Institute of Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Matthew R Wilson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow
| | - Kate Cwynarski
- Department of Haematology, University College London Hospital, London, UK
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Sung HJ, Kim D, Yoon DH, Cho H, Huh J, Suh CW, Go H. Clinicopathologic and genetic features of the starry-sky pattern in double-expressor diffuse large B-cell lymphoma. Hum Pathol 2023; 139:106-116. [PMID: 37517597 DOI: 10.1016/j.humpath.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Double expressor lymphoma (DEL) is a subset of diffuse large B-cell lymphoma (DLBCL) characterized by the co-expression of MYC and BCL2 proteins with a poor prognosis. However, there are no standard criteria for evaluating the morphologic features of DEL. We aimed to analyze the prognostic value of the starry-sky pattern (SSP) and its correlation with clinicopathologic and genetic features in 153 DEL cases. The SSP was significantly associated with aggressive parameters, including c-MYC overexpression, CD5 expression, higher IPI, and age-adjusted IPI. In the univariate survival analyses, the presence of SSP was associated with unfavorable progression-free survival (PFS) (p = 0.040), and tended towards an adverse overall survival (OS) (p = 0.061). However, when c-MYC was overexpressed, SSP was significantly correlated with inferior OS (p = 0.019). In the multivariate survival analysis, SSP was also associated with poor PFS (p = 0.048). Additionally, next-generation sequencing data revealed SSP was significantly associated with the KMT2D mutation and had different genetic mutation profiles from non-SSP. In conclusion, SSP may represent morphologic characteristics of aggressiveness in DEL.
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Affiliation(s)
- Hyun-Jung Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Deokhoon Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Dok-Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Jooryung Huh
- Department of Pathology, Green Cross Laboratories, Yongin, Gyeonggi, 16924, South Korea
| | - Cheol-Won Suh
- Department of Pathology, Green Cross Laboratories, Yongin, Gyeonggi, 16924, South Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
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Koviazin AK, Filatova LV, Zyuzgin IS, Artemyeva AS, Poliatskin IL, Burda DS, Volchenkov SA, Elkhova SS, Semiglazova TY. The significance of upfront autologous stem cell transplantation for high-intermediate/high-risk stage IV diffuse large B-cell lymphoma. Cancer Rep (Hoboken) 2023; 6:e1786. [PMID: 36855295 PMCID: PMC10075296 DOI: 10.1002/cnr2.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/03/2022] [Accepted: 12/31/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common (30%-35%) type of B-cell lymphoma. Only about 60% of all newly diagnosed advanced-stage DLBCL can be completely treated with x6 R-CHOP. High-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation in the first remission (upfront auto-HSCT) can serve as an option to improve a prognosis in these patients. AIMS This trial aimed to improve prognosis in DLBCL by upfront auto-HSCT. METHODS AND RESULTS A group of 105 patients: DLBCL NOS, age 18-65, stage IV, IPI ≥2, CR/PR after x6 R-CHOP/DA-EPOCH-R from 2010 to 2019 at NMRC of Oncology named after N.N.Petrov of MoH of Russia was retrospectively analyzed. The HSCT group included patients with upfront HDCT followed by auto-HSCT (n = 35). The control group included patients with non-invasive follow-up after induction (n = 70). Primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS), response rate and relapse rate. The 3-year OS (p = .013) and 3-year PFS (p = .033) were significantly higher in the HSCT group. The 3-year OS was decreased by the occurrence of relapse (p ≤ .001) and weight loss (B-symptom) (p = .04). DEL was the negative prognostic factor for 3-year PFS in all patients (p = .001) and control group (p = .001). DA-EPOCH-R significantly increased the 3-year PFS (p = .041). CONCLUSION Upfront HDCT followed by auto-HSCT can increase 3-year OS and PFS and improve prognosis in DLBCL NOS, age 18-65, stage IV, IPI ≥2 patients.
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Affiliation(s)
- Aleksei K Koviazin
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Innovative Methods in Therapeutic Oncology and Rehabilitation, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Larisa V Filatova
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Innovative Methods in Therapeutic Oncology and Rehabilitation, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Oncology, Federal State Budgetary Educational Institution of Higher Education "North-Western State Medical University named after I.I. Mechnikov" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Ilia S Zyuzgin
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Anna S Artemyeva
- Laboratory of Tumor Morphology, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Ilia L Poliatskin
- Laboratory of Tumor Morphology, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Darya S Burda
- Laboratory of Tumor Morphology, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Stanislav A Volchenkov
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Svetlana S Elkhova
- Department of Hematology and Chemotherapy with Intensive Care Unit, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Tatiana Yu Semiglazova
- Department of Innovative Methods in Therapeutic Oncology and Rehabilitation, NMRC of Oncology n.a. N.N.Petrov of MoH of Russia, Federal State Budgetary Institution "Petrov National Medical Cancer Research Centre" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation.,Department of Oncology, Federal State Budgetary Educational Institution of Higher Education "North-Western State Medical University named after I.I. Mechnikov" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
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Baptista MJ, Tapia G, Muñoz‐Marmol A, Muncunill J, Garcia O, Montoto S, Gribben JG, Calaminici M, Martinez A, Veloza L, Martínez‐Trillos A, Aldamiz T, Menarguez J, Terol M, Ferrandez A, Alcoceba M, Briones J, González‐Barca E, Climent F, Muntañola A, Moraleda J, Provencio M, Abrisqueta P, Abella E, Colomo L, García‐Ballesteros C, Garcia‐Caro M, Sancho J, Ribera J, Mate J, Navarro J. Genetic and phenotypic characterisation of HIV-associated aggressive B-cell non-Hodgkin lymphomas, which do not occur specifically in this population: diagnostic and prognostic implications. Histopathology 2022; 81:826-840. [PMID: 36109172 PMCID: PMC9828544 DOI: 10.1111/his.14798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Abstract
The frequency of aggressive subtypes of B-cell non-Hodgkin lymphoma (B-NHL), such as high-grade B-cell lymphomas (HGBL) with MYC and BCL2 and/or BCL6 rearrangement (HGBL-DH/TH) or Burkitt-like lymphoma (BL) with 11q aberration, is not well known in the HIV setting. We aimed to characterise HIV-associated aggressive B-NHL according to the 2017 WHO criteria, and to identify genotypic and phenotypic features with prognostic impact. Seventy-five HIV-associated aggressive B-NHL were studied by immunohistochemistry (CD10, BCL2, BCL6, MUM1, MYC, and CD30), EBV-encoded RNAs (EBERs), and fluorescence in situ hybridisation (FISH) to evaluate the status of the MYC, BCL2, and BCL6 genes and chromosome 11q. The 2017 WHO classification criteria and the Hans algorithm, for the cell-of-origin classification of diffuse large B-cell lymphomas (DLBCL), were applied. In DLBCL cases, the frequencies of MYC and BCL6 rearrangements (14.9 and 27.7%, respectively) were similar to those described in HIV-negative patients, but BCL2 rearrangements were infrequent (4.3%). MYC expression was identified in 23.4% of DLBCL cases, and coexpression of MYC and BCL2 in 13.0%, which was associated with a worse prognosis. As for BL cases, the expression of MUM1 (30.4%) conferred a worse prognosis. Finally, the prevalence of HGBL-DH/TH and BL-like with 11q aberration are reported in the HIV setting. The phenotypic and genotypic characteristics of HIV-associated aggressive B-NHL are similar to those of the general population, except for the low frequency of BCL2 rearrangements in DLBCL. MYC and BCL2 coexpression in DLBCL, and MUM-1 expression in BL, have a negative prognostic impact on HIV-infected individuals.
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Affiliation(s)
- Maria Joao Baptista
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Ana‐María Muñoz‐Marmol
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Josep Muncunill
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Olga Garcia
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Silvia Montoto
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - John G Gribben
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - Maria Calaminici
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - Antonio Martinez
- Department of Pathology, Hospital Clinic, IDIBAPSUniversity of BarcelonaBarcelonaSpain
| | - Luis Veloza
- Department of Pathology, Hospital Clinic, IDIBAPSUniversity of BarcelonaBarcelonaSpain
| | | | - Teresa Aldamiz
- Department of Infectious DiseasesHospital Gregorio MarañónMadridSpain
| | | | - María‐José Terol
- Department of Hematology and OncologyHospital Clínic Universitari de ValènciaValenciaSpain
| | - Antonio Ferrandez
- Department of PathologyHospital Clínic Universitari de ValènciaValenciaSpain
| | - Miguel Alcoceba
- Department of HematologyHospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Centro de Investigación del Cáncer‐IBMCC (USAL‐CSIC)SalamancaSpain
| | - Javier Briones
- Department of Hematology, Hospital de la Santa Creu i Sant PauJosep Carreras Leukaemia Research Institute (IJC)BarcelonaSpain
| | - Eva González‐Barca
- Department of HematologyICO‐Hospital Duran i ReynalsL'Hospitalet de LlobregatSpain
| | - Fina Climent
- Department of PathologyHospital Universitari de Bellvitge‐IDIBELL, L'Hospitalet de LlobregatBadalonaSpain
| | - Ana Muntañola
- Department of Clinical HematologyHospital Universitari Mutua de TerrassaTerrassaSpain
| | - José‐María Moraleda
- Department of HematologyHospital Clinico Universitario Virgen de la ArrixacaMurciaSpain
| | - Mariano Provencio
- Department of Medical OncologyHospital Universitario Puerta De HierroMajadahondaSpain
| | - Pau Abrisqueta
- Department of HematologyHospital Vall d'HebrónBarcelonaSpain
| | | | - Lluis Colomo
- Department of PathologyHospital del MarBarcelonaSpain
| | | | | | - Juan‐Manuel Sancho
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Josep‐Maria Ribera
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - José‐Luis Mate
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - José‐Tomas Navarro
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
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8
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Tang SH, Tian L, Zhao W, Wang J, Ke XY. [Clinical features and prognosis of 166 cases of MYC/BCL2 double-expression diffuse large B-cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:771-777. [PMID: 36709172 PMCID: PMC9613496 DOI: 10.3760/cma.j.issn.0253-2727.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 01/30/2023]
Abstract
Objective: To investigate the clinical features and prognosis of MYC/BCL2 double-expression diffuse large B-cell lymphoma (DEL) . Methods: The clinical data, including clinical characteristics, survival, and prognostic factors, of 166 patients with DEL treated at Peking University Third Hospital from January 2016 to December 2020 were retrospectively analyzed. Results: A total of 410 patients with diffuse large B-cell lymphoma were collected, including 166 cases (40.5%) of DEL. There were 82 males and 84 females with a median age of 63.5 (21-95) years at diagnosis. A total of 110 patients (66.3%) were aged over 60 years at initial diagnosis, 106 patients (106/163, 65.0%) had elevated lactate dehydrogenase (LDH) at diagnosis, 74 patients (74/160, 46.2%) had β(2) microglobulin level over 3 mg/L at diagnosis, and 107 patients (107/163, 65.6%) had≥2 extranodal involvement. Sixty-five patients (65/166, 39.2%) had B symptoms, 131 patients (131/165, 79.4%) had stage Ⅲ and Ⅳ disease at initial diagnosis, 41 patients (41/161, 25.5%) had an International Prognostic Index (IPI) score of 0-2 at initial diagnosis, and 38 patients (38/161, 23.6%) had an IPI score of 3 at initial diagnosis. Eighty-two patients (82/161, 50.9%) had an IPI score of 4-5 at initial diagnosis. Nine (9/56, 16.1%) patients with DEL had MYD88 and CD79B mutations. Univariate analysis showed that age over 60 years (P=0.004) , increased β(2) microglobulin level (P=0.002) , and high IPI score (P=0.003) were associated with poor overall survival (OS) . Increased β(2) microglobulin level (P=0.031) , LDH level (P=0.017) , stage Ⅲ-Ⅳ (P=0.001) , high IPI score (P=0.013) , immunohistochemical p53 mutation (P=0.049) , and PIM1 mutation (P=0.039) were associated with poor progression-free survival (PFS) . Multivariate analysis showed that IPI score of 4-5 was an independent risk factor for the prognosis of DEL (HR=2.622, 95% CI 1.398-4.917, P=0.003) . Survival analysis showed that there was a significant difference in the PFS between patients with DEL and those without DEL (65.6% vs 75.1%, P=0.002) . However, there was no significant difference in the OS (81.8% vs 83.6%, P=0.226) . In patients with DEL, the overall response rate of R-EPOCH regimen was higher than that of RCHOP or RCHOP-like regimen (81.5% vs 63.4%, P=0.004) . Conclusion: DEL is a group of aggressive lymphomas with relatively poor PFS. The R-EPOCH regimen may improve the overall prognosis of patients.
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Affiliation(s)
- S H Tang
- Department of Hematology, Peking University Third Hospital, Beijing 100083, China
| | - L Tian
- Department of Hematology, Peking University Third Hospital, Beijing 100083, China
| | - W Zhao
- Department of Hematology, Peking University Third Hospital, Beijing 100083, China
| | - J Wang
- Department of Hematology, Peking University Third Hospital, Beijing 100083, China
| | - X Y Ke
- Department of Hematology, Peking University Third Hospital, Beijing 100083, China
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