| Autor: |
Ichiki A; Department of Hematology and Oncology, Tokai University, School of Medicine., Carreras J; Department of Pathology, Tokai University, School of Medicine., Miyaoka M; Department of Pathology, Tokai University, School of Medicine., Kikuti YY; Department of Pathology, Tokai University, School of Medicine., Jibiki T; Department of Pathology, Atsugi-sato Hospital., Tazume K; Department of Pathology, Isehara Kyodo Hospital., Watanabe S; Department of Pathology, Ebina General Hospital., Sasao T; Department of Pathology, Ozawa Hospital., Obayashi Y; Department of Pathology, Red Cross Hadano Hospital., Onizuka M; Department of Hematology and Oncology, Tokai University, School of Medicine., Ohmachi K; Department of Hematology and Oncology, Tokai University, School of Medicine., Yoshiba F; Department of Hematology and Oncology, Tokai University, School of Medicine., Shirasugi Y; Department of Hematology and Oncology, Tokai University, School of Medicine., Ogawa Y; Department of Hematology and Oncology, Tokai University, School of Medicine., Kawada H; Department of Hematology and Oncology, Tokai University, School of Medicine., Nakamura N; Department of Pathology, Tokai University, School of Medicine., Ando K; Department of Hematology and Oncology, Tokai University, School of Medicine. |
| Abstrakt: |
The estimation of clinical prognosis for diffuse large B-cell lymphoma (DLBCL) with a quick, cost-efficient method is necessary because of the clinical heterogeneity of this disease, which leads to death, relapsed or refractory disease in approximately 40% of patients. We analyzed 320 cases diagnosed from 2007 to 2013 treated with R-CHOP therapy at Tokai University Hospital and associated institutions. DLBCL was classified according to the cell-of-origin using the Hans algorithm [germinal center B-cell-like (GCB) vs non-GCB subtypes], and into 6 subgroups derived from combinations of CD10, BCL6 and MUM1 markers. The percentage of GCB and non-GCB (NGCB) subtypes was 35% and 65%, respectively. GCB-DLBCL was characterized by lower BCL2 immunohistochemical expression, extranodal sites ＜1, better therapeutic response, and favorable overall survival (OS) and progression free survival (PFS) (P＜0.01). The most frequent subgroup was NGCB-1 (CD10 - BCL6 + MUM1 + , 51%) followed by GCB-1 (CD10 + BCL6 +or- MUM1 + , 21%), NGCB-2 (CD10 - BCL6 - MUM1 + , 13%), GCB-2 (CD10 + BCL6 +or- MUM1 - , 10%), GCB-3 (CD10 - BCL6 + MUM1 - , 4%) and NGCB-3 (CD10 - BCL6 - MUM1 - , 2%). In comparison with GCB-2 and GCB-3 (both MUM1 - ), the GCB-1 (MUM1 + ) was characterized by favorable PFS (5-year PFS 84% vs 65%, OR 0.368, P＜0.05), independent of high LDH (associated with unfavorable PFS, OR 7.04, P＜0.01) in the multivariate analysis. This predictive value of MUM1 was independent of CD10. Interestingly, triple-negative NGCB-3 tended to have a more favorable prognosis than the other NGCB subgroups. In conclusion, the Hans classifier is a valid method to evaluate the prognosis of DLBCL NOS. In the GCB subtypes, GCB subtypes, MUM1-positivity is associated with a more favorable outcome (PFS). |
