Abstract
BCL2 overexpression has been reported to be associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL). However, currently there is no consensus on the evaluation of BCL2 expression and only the proportion of BCL2 positive cells are evaluated for the determination of BCL2 positivity. This study aimed to define BCL2 positivity by quantitative analysis integrating both the intensity and proportion of BCL2 expression. BCL2 expression of 332 patients (221 patients for the training set and 111 patients for the validation set) with newly diagnosed DLBCL who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) were analyzed using the tumor-specific automated quantitative analysis (AQUA) scoring method based on multiplex immunofluorescence. In the training set, high BCL2 AQUA score (N = 86, 38.9%) was significantly associated with poor prognosis (p = 0.01, HR 2.00; 95% CI [1.15–3.49]) independent of international prognostic index, cell of origin, and MYC expression. The poor prognostic impact of the high BCL2 AQUA score was validated in the validation set. AQUA scoring of BCL2 expression incorporating both the intensity and proportion of BCL2 positive cells was independently associated with survival outcomes of patients with primary DLBCL treated with R-CHOP.
Highlights
BCL2 overexpression has been reported to be associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL)
The survival outcome of DLBCL patients has improved with the addition of anti-CD20 monoclonal antibody rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)[2]
We investigated tumor-specific BCL2 expression with the automated quantitative analysis (AQUA) scoring system using the multiplex immunofluorescent (IF) imaging to assess the prognostic impact of quantitative BCL2 expression in patients with newly diagnosed DLBCL treated with R-CHOP
Summary
BCL2 overexpression has been reported to be associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL). High BCL2 AQUA score (N = 86, 38.9%) was significantly associated with poor prognosis (p = 0.01, HR 2.00; 95% CI [1.15–3.49]) independent of international prognostic index, cell of origin, and MYC expression. AQUA scoring of BCL2 expression incorporating both the intensity and proportion of BCL2 positive cells was independently associated with survival outcomes of patients with primary DLBCL treated with R-CHOP. A recent study reported that a semiquantitative BCL2 IHC scoring system incorporating both proportion and intensity had strong independent prognostic power in patients with DLBCL treated with R-CHOP25. We investigated tumor-specific BCL2 expression with the automated quantitative analysis (AQUA) scoring system using the multiplex immunofluorescent (IF) imaging to assess the prognostic impact of quantitative BCL2 expression in patients with newly diagnosed DLBCL treated with R-CHOP
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