Abstract
Gene expression and immunohistochemical profiling of diffuse large B-cell lymphoma (DLBCL) have revealed important prognostic subgroups: germinal center B-cell-like (GCB-like) DLBCL and activated B cell-like (ABC-like) DLBCL. Although few reports on high-risk DLBCL are available, the prognosis for the GCB-like subgroup has been shown to be better than that of the ABC-like subgroup. The role of Bcl-2 as a predictor of survival in DLBCL cases is unclear and its expression varies between the two subgroups of DLBCL. In this study, we analyzed the frequency and prognostic impact of Bcl-2 protein expression in high-risk DLBCL cases. Retrospective cohort study among DLBCL patients treated at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). The prognostic impact of the expression of the proteins CD10, Bcl-6, MUM1 (multiple myeloma oncogene-1) and Bcl-2 on high-risk DLBCL cases was evaluated by means of immunohistochemistry. Seventy-three patients aged 18-60 years were evaluated for all these markers. Twenty-four cases (32.9%) were GCB-like and 49 (67.1%) were ABC-like, with no difference regarding complete remission, disease-free survival or overall survival rates. Twenty-seven patients (37%) showed Bcl-2 expression, which was the only independent factor predicting a worse prognosis for overall survival according to multivariate analysis. Bcl-2 protein was expressed in 37% of the high-risk DLBCL patients, without any difference between the ABC-like DLBCL and GCB-like DLBCL cases.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is a clinically and biologically heterogeneous disease that accounts for 30-35% of non-Hodgkin lymphoma (NHL) cases
About 58% of these cases are of high-intermediate or high international prognostic index (IPI) risk and 30-50% are cured with conventional cyclophosphamide, doxorubicin, vincristine and prednisone-like (CHOP-like) regimens.[1,2]
The gene expression shown by deoxyribonucleic acid (DNA) microarrays and by immunohistochemical staining has revealed different DLBCL prognostic subgroups according to the gene expression of malignant cells.[3,4,5]
Summary
Diffuse large B-cell lymphoma (DLBCL) is a clinically and biologically heterogeneous disease that accounts for 30-35% of non-Hodgkin lymphoma (NHL) cases. The prognosis for DLBCL cases presenting Bcl-2 expression remains unclear, and there are few studies on this protein in high IPI risk groups alone.[8,9]
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