Prognostic evaluation of immunohistochemical profiles in diffuse large B-cell lymphoma: a Chinese study

Abstract

Diffuse large B-cell lymphoma (DLBCL) has been classified into different prognostic subgroups using immunohistochemistry in Western populations. However, the applicability in Chinese patients of these subgroups was unclear. We collected 116 specimens and performed immunohistochemical staining for CD10, BCL-6, MUM1, CD138, and CD5, and the results were classified into subgroups according to 3 different algorithms. We then analyzed the subgroups' correlation to patient survival. Expression of CD10 and BCL-6 predicted favorable 5-year OS (70 and 62.5%, respectively) and PFS (64.3 and 61.5%, respectively) rates. In contrast, the expression of MUM1 predicted unfavorable 5-year OS (23.1%) and PFS (17.9%) rates and was also independent of other markers. All algorithms led to useful subclassifications. Using Hans' algorithm based on CD10, BCL-6, and MUM1, the non-germinal center (GC) subgroup (66.4%) had worse 5-year OS (29.8%) and PFS (26.7%) rates than did the GC subgroup. Likewise, using Muris' algorithm based on CD10 and MUM1, fewer non-GC cases (27%) showed poorer OS (20.3%) and PFS (16.2%) rates than did GC cases, an effect that was independent of both the International Prognostic Index, a clinical indicator, and treatment. It identified a subgroup with a high-risk of death and seemed to be applicable in our series. In conclusion, these algorithms can be used effectively in Chinese patients with DLBCL.

MYC Expression in Concert with BCL2 and BCL6 Expression Predicts Outcome in Chinese Patients with Diffuse Large B-Cell Lymphoma, Not Otherwise Specified

“…Furthermore, non-GCB was not an independent survival predictor for DLBCL patients treated with CHOP, indicating that such algorithm was not a stable survival predictor for DLBCL especially for R-CHOP-treated patients. Consistent with previous reports [10], [12], [36], [37], Chinese patients with DLBCL in our series had a much lower incidence of GCB subtype compared with those reported on Western populations [23], [37], [38]. These data support the notion that immunophenotypic subgroups in DLBCL vary according to the geographic factor.…”

Bcl‐2 and BLIMP‐1 expression predict worse prognosis in gastric diffuse large B cell lymphoma (DLCBL) while other markers for nodal DLBCL are not useful

“…Despite the stomach being the most common extranodal site for DLBCL, 16 only two studies have been published concerning immunohistochemical prognostic markers in gastric DLBCL. On the one hand, as described in nodal DLBCLs, 7–10,12 Chen et al. , 21 analysing 32 gastric DLBCL cases, observed a better prognosis for GCB‐type patients, and Ponzoni et al.…”

“… 8 developed another algorithm based upon Bcl‐2, CD10 and MUM1 and found an even higher difference in overall survival (OS) when comparing the two groups. In addition to these algorithms, several groups have studied the prognostic importance of the levels of expression of individual proteins using immunohistochemistry 3,9–22 . CD10 and Bcl‐6 expression has been related to longer survival, MUM‐1, Bcl‐2 and BLIMP‐1 expression to poorer outcome, and Gcet1 has been proposed as a GC marker and may be able to identify cases with different clinical courses.…”

The Hans algorithm failed to predict outcome in patients with diffuse large B-cell lymphoma treated with rituximab

“…This algorithm was based on the immunohistochemical expression of CD 10, bcl-6 and MUM 1 proteins. Over the years, a number of papers have been published, some of which confirm the prognostic division according to Hans [8,[10][11][12][13] while others failed to find statistically significant differences between these two groups [14][15][16][17][18].…”