Clinical features and immunophenotypes of double-hit diffuse large B-cell lymphoma

Abstract

Double-hit (DH) genetics induces a reduction in the complete remission (CR) and, consequently, in poor overall survival (OS) in diffuse large B-cell lymphoma (DLBCL) patients. Unfortunately, DH identification is time-consuming. Here, we retrospectively reviewed 92 newly diagnosed DLBCL patients and stratified them into the DH (n = 14) and non-DH groups (n = 78). The clinical features and treatment outcomes were compared between the two groups, and clinical parameters were employed to predict DH genetics. The results revealed that the DH group had a higher percentage of bulky disease than the non-DH group (64.3% vs. 28.2%; p = 0.013). More patients in the DH group tested positive for double expresser (DE) (50.0% vs. 21.8%; p = 0.044). Conversely, the CR rates in these groups were not significantly different (50.0% vs. 60.3%; p = 0.672). The three-year OS rates of patients with and without DH were 28.6% and 49.7%, respectively (p = 0.008). Importantly, DH genetics (HR: 6.19; 95% CI: 1.59–24.07; p = 0.009), advance stage (HR: 9.24; 95% CI: 1.34–63.63; p = 0.024), and a high uric acid level (HR: 1.24; 95% CI: 1.00–1.54; p = 0.046) were correlated with a high mortality rate. Furthermore, by combining DE and the bulky disease, a specificity of 89.7% for DH prediction was achieved. In summary, DH genetics, not DE immunopositivity, is a poor prognostic factor for newly diagnosed DLBCL. A combination of bulky disease and a positive DE immunophenotype could facilitate DH genetics prediction in newly diagnosed DLBCL patients.

A Differential Diagnosis of Unusual Gastric Ulcer

“…This patient’s final diagnosis was HIV-related diffuse large B cell lymphoma (DLBCL). Endoscopic findings of gastric DLBCL have various presentations, such as nodular, polypoid, ulcerofungating, ulceroinfiltrative, erosive, diffuse infiltrating, thickened fold-like, and mixed types [ 1 , 2 , 3 , 4 ]. This patient had developed multiple elevated central ulceration lesions, and the peripheral elevated portion had a heaped-up margin.…”