Prognostic Significance of BCL-2 and BCL-6 Expression in MYC-positive DLBCL

Abstract

BackgroundDouble-expression lymphoma (DEL) is a rare subgroup of diffuse large B-cell lymphoma (DLBCL), which has coexpression of MYC and BCL-2. Coexpression of MYC and BCL-2 is considered a prognostic marker portending poor outcomes. However, the prognostic effect of BCL-2 and BCL-6 expression in DLBCL remains controversial. Materials and MethodsImmunohistochemical staining was performed to detect MYC, BCL-2 and BCL-6 expression in 212 patients with newly diagnosed DLBCL and assess the prognostic effects of BCL-2 and BCL-6 expression. The DLBCL patients were treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine [Oncovin], prednisone)–like regimens. ResultsRetrospective analysis revealed that BCL-2+ and BCL-2+/MYC+ were prognostic factors indicative of poor outcomes. Patients with BCL-2+ and/or MYC+ expression had a poorer prognosis than that of patients with BCL-2− and/or MYC− expression. Patients with BCL-2+/MYC− expression showed a trend toward poorer survival than those with BCL-2−/MYC+ expression, suggesting that BCL-2 plays a more important role than MYC. Also, patients with BCL-6−/MYC+ expression had poorer progression-free survival than those with BCL-6+/MYC+ expression. In addition, patients with BCL-2+/MYC+/BCL-6− expression had the worst prognosis, suggesting that BCL-6− is a prognostic factor for poor outcomes for MYC+ DLBCL patients. Altogether, our findings have shown that BCL-2 is an independent prognostic factor and possibly plays a more important role than MYC in MYC+ DLBCL patients. Furthermore, we found that BCL-6− expression could also be a prognostic factor portending poor outcomes for MYC+ DLBCL patients.