Abstract
To analyze the significance of different clinical factors for prognostic prediction in diffuse large B-cell lymphoma (DLBCL) patients. Two hundred and twenty-seven DLBCL patients were retrospectively reviewed. Patients were managed with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen or rituximab plus the CHOP (RCHOP) regimen. Lactate dehydrogenase (LDH), β2- microglobulin (β2-M), B symptoms, Ann Arbor stage and genetic subtypes were statistically relevant in predicting the prognosis of the overall survival (OS). In the CHOP group, the OS in patients with germinal center B-cell- like (GCB)(76.2%) was significantly higher than that of the non-GCB group (51.9%, P=0.032). With RCHOP management, there was no statistical difference in OS between the GCB (88.4%) and non-GCB groups (81.9%, P=0.288). Elevated LDH and β2-M levels, positive B symptoms, Ann Arbor stage III/IV, and primary nodal lymphoma indicate an unfavorable prognosis of DLBCL patients. Patients with GCB-like DLBCL have a better prognosis than those with non-GCB when treated with the CHOP regimen. The RCHOP treatment with the addition of rituximab can improve the prognosis of patients with DLBCL.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is defined by the World Health Organization (WHO) Classification as a heterogeneous entity, encompassing morphologic and genetic variants with variable clinical presentations and outcomes and it is the most common type of nonHodgkin’s lymphoma (NHL) in adults
Lactate dehydrogenase (LDH), β2microglobulin (β2-M), B symptoms, Ann Arbor stage and genetic subtypes were statistically relevant in predicting the prognosis of the overall survival (OS)
In Western countries, diffuse large B-cell lymphoma (DLBCL) accounts for about 31% of NHL cases and the percentage in Asia is over 40% (Alizadeh et al, 2000), with primary extra nodal NHL representing 25-40% of all non-Hodgkin’s cases (Krol et al, 2003)
Summary
Diffuse large B-cell lymphoma (DLBCL) is defined by the World Health Organization (WHO) Classification as a heterogeneous entity, encompassing morphologic and genetic variants with variable clinical presentations and outcomes and it is the most common type of nonHodgkin’s lymphoma (NHL) in adults. The development of a GeneChip technique provides an opportunity to take a genome-wide approach to predict the treatment outcome of diffuse large B-cell lymphoma (DLBCL) (Alizadeh et al, 2000; Shipp et al, 2002). Using cDNA or oligonucleotide microarrays, several studies showed that DLBCL can be subdivided into prognostically significant subgroups with germinal center B-cell-like (GCB), activated B-cell-like (ABC), and type 3 subgroups based on gene expression profiles, distinguished by expressing signatures of genes related to B-cell differentiation stages (Rosenwald et al, 2002; Poulsen et al, 2005). The latter two are inclusively named non-GCB subtype. In former decades, some features of the microarray technique, including its high cost, the need of specific sophisticated instrumentation, and highly trained personnel, limited its application for routine clinical prognostic analysis, but in recent years, the application of immunohistochemical methods in measuring genetic subtypes enables their detection as a routine clinical examination (Naz et al, 2011), making it a significant factor in predicting the prognosis in our daily clinical practice
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