Diffuse Large Lymphoma Research Articles

Stem-Cell Transplantation Ineffective for Double-Hit Lymphoma

Patients with diffuse large B-cell lymphoma (DLBCL) carrying the chromosomal translocations CMYC plus BCL2 and/or BCL6 — so-called double-hit lymphoma

Estimation of the value of echocardiographic Tei index combined with serum high-sensitivity cardiac troponin T assay in early diagnosis of anthracycline-induced cardiotoxicity

Objective To investigate the value of echocardiographic Tei index combined with serum high-sensitivity cardiac troponin T(hs-cTnT) on monitoring cardiac toxicity associated with anthracycline chemotherapy drug in patients with diffuse large B-cell lymphoma(DLBCL). Methods PW-Tei index, TDI-Tei index of left/right ventricles and radionuclide cardiac measurement were acquired from 56 patients with DLBCL before, after the completion of 2-4 cycle(100-200 mg/m2) and 6-8 cycle(300-400 mg/m2) of the regimen, part of them received serum hs-cTnT detection at the same time. Cardiac toxicity event was defined as a relative reduction of radionuclide left ventricular ejection fraction(LVEF) of ≥10% during the regime or an absolute radionuclide LVEF≤50% after the complete chemotherapy. Results Compared with baseline, left ventricular PW-Tei index significantly increased after whole cures[(0.36±0.12) vs (0.44±0.13) vs (0.40±0.13), P=0.002]. After complete regimen, serum hs-cTnT level elevated significantly [(0.006±0.006)μg/L vs (0.012±0.007)μg/L vs (0.020±0.013)μg/L, P=0.001]. The sensitivity, specificity and area under ROC curve of early diagnosis of anthracycline-induced cardiotoxicity with elevated serum hs-cTnT in 2-4 cycle and increased left ventricular PW-Tei index in 6-8cycle detected together were 75%, 85%, 0.736 and 92%, 50%, 0.675, respectively(all P<0.05). Conclusions Echocardiographic PW-Tei index combined with serum hs-cTnT is a simple method and can be easily obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy. Key words: Echocrdiography; Tei index; Lymphoma, large B-cell, diffuse; High-sensitivity cardiac troponim T; Ventricular function; Anthracyclines

Progress in the application of rituximab in treating primary mediastinal B-cell lymphoma

Primary mediastinal large B-cell lymphoma (PMBCL) is morphologically similar to diffuse large B-cell lymphoma (DLBCL) and nodular sclerosis Hodgkin lymphoma. For most PMBCL patients, chemotherapy plus consolidation radiotherapy showed that the latter could improve PMBCL responsiveness and progression-free survival (PFS), and its combined use with chemotherapy demonstrated higher therapeutic efficacy. Recent clinical studies suggested that rituximab and anthracycline chemotherapy regimens could increase PMBCL treatment efficacy, reduce early treatment failure, enhance PFS and overall survival, and improve prognosis. Although rituximab combined with some high-intensity chemotherapy without radiotherapy have achieved good results, many studies still support the use of post-immunochemotherapy consolidation mediastinal radiotherapy. Based on the results of a few studies with a small sample size, patients who were assessed as complete metabolic remission by PET following high-intensity immunochemotherapy may omit consolidation radiotherapy. However, these results will need to be further confirmed by large-sample multicenter clinical trials. Consolidation radiotherapy is recommended for patients with poor prognostic factors or PET score>3. Key words: B-cell lymphoma/rituximab; B-cell lymphoma/radiotherapy; Prognosis

Value of 18F-FDG PET/CT in evaluation of curative effect and progression-free survival on lymphoma

Objective To evaluate the value of 18F-fluorodeoxyglucose (FDG) PET/CT in evaluation of curative effect and progression-free survival (PFS) for lymphoma patients. Methods The data of 85 lymphoma patients were retrospectively analyzed. Before and after 4-8 cycles standardized chemotherapy, the patients were evaluated with 18F-FDG PET/CT. The two-year PFS rate was compared. The value of 18F-FDG PET/CT in evaluation of curative effect and PFS for lymphoma patients received chemoradiotherapy was analyzed. Results The non Hodgkin lymphoma (NHL) was the common type, and the common pathogenic sites were head and neck lymph nodes, mediastinum and retroperitoneum. The majority of patients were accompanied with spleen enlargement and local lesions with high metabolism. The complete remission (CR) rate of Hodgkin lymphoma (HL) patients in PET/CT negative group was significantly higher than that in positive group (86.4% vs. 42.9%, P=0.038). The two-year PFS rates in PET/CT positive group and negative group were 42.9% and 81.8%, and the difference was statistically significant (χ2=7.70, P=0.006). Thirty-five NHL patients achieved CR, 13 achieved partial remission (PR), and 8 achieved stable disease (SD) or disease progression (PD). The two-year PFS rates in the CR group, PR group, SD or PD group were 89.7%, 65.3% and 19.4% respectively, and the difference was statistically significant (χ2=12.41, P=0.002). PET/CT imaging had a strong PFS predictive effect on T cell lymphoma (TCL) patients (χ2=13.85, P=0.001) and diffuse large B cell lymphoma (DLBCL) patients (χ2=13.51, P=0.001), and had no predictive effect on follicular lymphoma (FL) patients (χ2=4.63, P=0.099). Conclusion 18F-FDG PET/CT can evaluate the curative effect of lymphoma effectively and early predict prognosis, and has great guiding significance in choosing therapeutic schedule. Key words: Lymphoma; Fluorodeoxyglucose F18; Positron-emission tomography; Tomography, X-ray computed; Prognosis; Efficacy evaluation

A case of API2-MALT1-positive gastric MALT lymphoma with concomitant diffuse large B-cell lymphoma.

ABSTRACT API2-MALT1 translocation-positive gastric marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT) lymphoma is thought to transform to diffuse large B-cell lymphoma (DLBCL) rarely. A 69-year-old man presented with epigastralgia. Esophagogastroduodenoscopy showed multiple ulcerations in the stomach. Endoscopic biopsies revealed MALT lymphoma, with Helicobacter pylori infection. The patient underwent eradication therapy with no improvement, and was thereafter followed without additional therapy at his request. Twelve years after initial diagnosis, follow-up computed tomography (CT) showed multiple nodules in bilateral lungs, and a needle biopsy revealed MALT lymphoma, the same as in the stomach and API2-MALT1 translocation was found. Because he again refused additional therapy, follow-up was continued. 15 years after initial diagnosis, CT showed lymphadenopathy at the splenic hilum. At first we suspected disease progression of gastric MALT lymphoma, however a needle biopsy revealed DLBCL without API2-MALT1. Thus, the tumor at the splenic hilum was finally diagnosed as a de novo DLBCL as a second malignancy. Although treatment with rituximab given his age and his wishes was attempted, he died of DLBCL 15 years after the initial diagnosis. We experienced an API2-MALT1-positive gastric MALT lymphoma with concomitant DLBCL, not transformed to DLBCL over a 15-year clinical course.

Correlation between myc/bcl-2 co-expression and myc/p53 co-expression and prognosis of diffuse large B-cell lymphoma

Objective To explore the relationship between myc/bcl-2 and myc/p53 co-expression and the prognosis of diffuse large B-cell lymphoma (DLBCL). Methods A total of 148 DLBCL cases with the follow-up data in Shanxi Cancer Hospital from January 2010 to October 2014 were selected. The expression of myc, bcl-2 and p53 protein in paraffin samples was detected by immunohistochemistry (IHC). Results The positive expression rate of myc, bcl-2 and p53 was 35.1 % (52/148), 60.1 % (89/148) and 24.3 % (36/148) respectively in 148 patients with DLBCL. There were 37 (25.0 %) cases of myc/bcl-2 co-expression, which were correlated with Hans classification (χ 2 = 4.749, P = 0.029), IPI score (χ 2 = 4.894, P = 0.027), bone marrow invasion (χ 2 = 4.751, P = 0.029), and efficacy evaluation (χ 2 = 9.14, P = 0.003). Myc/p53 co-expression was detected in 17 cases (11.5 %), which was associated with Hans classification (χ 2 = 5.349, P = 0.021) and LDH level (χ 2 = 11.1, P = 0.001). Univariate analysis revealed that myc [overall survival (OS): χ 2 = 6.044, P = 0.014; progression free survival (PFS): χ2 = 6.212, P = 0.013], bcl-2 (OS: χ2 = 5.812, P = 0.016; PFS: χ2 = 4.878, P = 0.027), p53 (OS: χ2 = 20.092, P < 0.000 1; PFS: χ2 = 18.492, P < 0.000 1), myc/bcl-2 co-expression (OS: χ 2 = 11.277, P = 0.001; PFS: χ2 = 9.024, P = 0.003) and myc/p53 co-expression (OS: χ2 = 21.150, P < 0.000 1; PFS: χ 2 = 18.655, P < 0.000 1) were the adverse prognostic factors. In addition, the survival rate of the co-expression group was lower than that of single expression group, and the survival rate of myc/p53 co-expression group was lower than that of myc/bcl-2 co-expression group. Multivariate analysis showed that among the six independent variables, including myc, bcl-2, p53, myc/bcl-2, myc/p53 and treatment regimen, p53 expression was an independent prognostic affecting factor of OS (95 % CI 0.172-0.763, P = 0.008) and PFS (95 % CI 0.172-0.773, P = 0.009). Conclusion Myc, bcl-2 and p53 are the poor prognostic factors in DLBCL. Myc/bcl-2 and myc/p53 co-expression have synergistic effect, indicating the poor prognosis. Key words: Lymphoma, large B-cell, diffuse; Gene, myc; Gene, bcl-2; Tumor suppressor protein p53; Prognosis

Expression of peripheral blood CD13+ CD4+ CD25hi regulatory T cells in patients with diffuse large B-cell lymphoma and its clinical significance

Objective To analyze the expression of peripheral blood CD13+ CD4+ CD25hi regulatory T cells (Treg cells) in patients with diffuse large B-cell lymphoma (DLBCL) and its clinical significance. Methods The expression of peripheral blood CD13+ CD4+ CD25hi Treg cells in 58 newly diagnosed patients with DLBCL and 30 healthy adults was detected by flow cytometry, and the relationship between its expression and the clinical indicators were analyzed statistically. Results The levels of peripheral blood CD13+ CD4+ CD25hi Treg cells in newly diagnosed DLBCL and healthy adults were different, with statistically significant difference [(36.37±11.89) % vs. (9.03±2.10) %, t = 7.168, P 0.05). Conclusion The levels of peripheral blood CD13+ CD4+ CD25hi Treg cells are higher in DLBCL patients, which has a close relationship between the expression of CD13+ CD4+ CD25hi Treg cells and clinical stage and prognosis. Key words: Lymphoma, large B-cell, diffuse; T lymphocytes, regulatory; Prognosis; Clinical stage

Progress of next generation sequencing in activated B-cell like diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL), being the most common lymphoma entity, accounting for 30 % - 40 % of newly diagnosed non-Hodgkin lymphomas, is a kind of highly heterogeneous lymphoma with different pathogenesis, clinical manifestations, morphological characteristics, the immune phenotype, molecular subgroup and clinical outcomes. Gene sequencing of DLBCL has redefined the genetic landscape of the disease by identifying recurrent single nucleotide variants, which provides more powerful evidence to support accurate diagnosis and targeted treatment in DLBCL molecular subtypes. Key words: Lymphoma, large B-cell, diffuse; Genes; Molecular targeted therapy

Progress of prognostic factors in diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is one of the most common progressive B-cell non-Hodgkin lymphoma affected by varieties of factors, which is featured by strong heterogeneity in clinic and prognosis. This review discusses the prognostic factors affecting DLBCL patients in both clinical and molecular biology characteristics according to domestic and abroad research progress. Key words: Lymphoma, large B-cell, diffuse; Prognosis

Experience of 243 cases in transperitoneal robotic-assisted laparoscopic surgery for adrenal diseases

Objective To summarize our experience in robotic-assisted laparoscopic surgery for adrenal diseases Methods The clinical data of 243 patients with adrenal tumor treated by robotic-assisted laparoscopic surgery from March 2010 to February 2017 were retrospectively reviewed. There were 99 men and 144 women. The mean age was 51.6 years (range, 19-84). Tumors located at left adrenal in 140 cases , right in 97 cases, and both sides in 6 cases. The average diameter was 3.32 cm (range, 0.8-12 cm). However, there were 41 cases whose tumor diameter were greater than 5 cm. Results There were 2 cases of conversion during operation, 1 case converted to open surgery and the other to the traditional laparoscope surgery. The mean operative time was 35 min (range, 20-130 min). Estimated blood loss was 80 ml (range, 20-1 200 ml). Blood transfusion was needed in 6 cases. The mean postoperative hospital stay was 5d (range, 3-20 d). The pathological diagnosis included 37 cases of pheochromocytoma, 149 cases of cortical adenoma, 3 cases of cortical carcinoma, 5 cases of metastatic tumor, 9 cases of adrenal myelolipoma, 3 cases of adrenal cyst, 2 cases of bronchogenic cyst, 25 cases of adrenal nodular hyperplasia, 2 cases of angiomyolipomas, 1 case of mature teratoma, 1case of diffuse large B-Cell lymphoma, 1 case of angioma, and 4 cases of neurofibromatosis. Conclusions Robotic-assisted laparoscopic adrenalectomy was safe and effective. Robotic-assisted laparoscopic surgery has the advantages over laparoscopic surgery in treatment of complicated adrenal tumor, such as large adrenal tumors, pheochromocytoma, bilateral adrenal diseases, overweight and obese patients with adrenal diseases. Key words: Adrenal tumor; Robotic; Laparoscopic; Adrenalectomy

Clinical characteristics and prognostic factor analysis of 61 children with non-Hodgkin′s lymphoma

Objective To investigate the clinical characteristics and prognostic factors of non-Hodgkin′s lymphoma. Methods Sixty-one cases of children with non-Hodgkin′s lymphoma in the Central Hospital of Nanyang City from January 2004 to December 2013 were retrospectively analyzed.The overall survival rate and survival rate without recurrence were analyzed by using Kaplan-Meier.And the prognostic factors were analyzed. Results Tumor type: Burkitt′s lymphoma 23 cases (37.7%), diffuse large B-cell lymphoma 7 cases (11.5%), B lymphoblastic lymphoma 5 cases (8.2%), B-cell lymphoma 2 cases (3.3%), gradient large T-cell lymphoma 14 cases (23.0%), T lymphoid lymphoma 8 cases (13.1%), and cutaneous T-cell lymphoma 2 cases (3.3%). Stages: stage Ⅰ 3 cases (4.9%), stage Ⅱ 8 cases (13.1%), stage Ⅲ 32 cases (52.4%), and stage Ⅳ 18 cases (29.5%). The 3-year overall survival rate of 61 children was 75.4% (46/61 cases), and 3-year survival rate without recurrence was 68.9% (42/61 cases). Univariate analysis showed that tumor stage (χ2=5.158, P<0.05), tumor size (χ2=9.173, P<0.05), bone marrow invasion (χ2=4.565, P<0.05), spleen invasion (χ2=5.306, P<0.05), and central nervous system invasion (χ2=5.220, P<0.05) could influence the prognosis of children. Conclusions The prognosis is different for non-Hodgkin′s lymphoma children with different pathology, and the tumor stage, tumor size, bone marrow invasion, spleen invasion and central nervous system invasion can significantly influence the prognosis.Children should be treated on the basis of comprehensive analysis of pathology, pathological stage, and prognostic factors. Key words: Non-Hodgkin′s lymphoma; Child; Clinical characteristic; Prognostic factor

An imaging features of primary central nervous system lymphoma

Objective To explore the brain imaging features of primary central nervous system lymphoma (PCNSL). Methods A total of 32 patients with histologically confirmed PCNSL in Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Command form August 2010 to August 2016 were retrospectively analyzed for their CT and MR features. Results Fifty lesions were identified in this series of 32 patients including 18 cases (56%) with a single lesion and 14 cases (44%) with multiple lesions.PCNSLs were mostly located in the deep brain areas (76%, 38/50)such as the basal ganglia and corpus callosum, and less commonly shallow brain regions (24%, 12/50). Mild to moderate perilesional edema was seen in 38 out of 50 (76%) cases.On CT images, 44 (88%) lesions were isointense or mildly hyperintense, 6 (12%) lesions presented as mild hypointense, and 11 cases demonstrated significant enhancement with contrast. Most lesions(92%, 46/50)varied from hypointense to isointense on T1-weighted MRI and from isointense to hyperintense on T2-weighted images. Forty-five lesions (90%) presented as hyperintense on DWI.Contrast-enhanced MRI images showed obvious homogenous enhancement with various shapes such as lump-like, crack-like, butterfly-like, satellite-like, fist-like and indentation sign. Pathological studies confirmed 30 cases of diffuse large B-cell lymphoma and 2 cases of T-cell lymphoma. Conclusion Certain imagingand pathological features are associated with PCNSL, which would facilitate its diagnosis and differential diagnosis. Key words: Lymphoma; Central nervous system; Magnetic resonance imaging; Tomography, X-ray computed; Disease attributes

Diagnosis and treatment of primary hepatic lymphoma: report of one case

Primary hepatic lymphoma (PHL) is an extremely rare disease without any unified diagnostic criterion. The symptoms are usually nonspecific. Liver biopsy remains the most valuable tool for diagnosis of PHL. The predominant histology of PHL is diffuse large B-cell lymphoma. The therapeutic modalities are variable, including surgery, chemotherapy, radiotherapy, or combination of the various processes. This article described a 33-year-old man with diffuse large B-cell PHL who was treated at the Affiliated Cancer Hospital of Shanxi Medical University Blood Disease Diagnosis and Treatment Center in February 2014. The patient benefited from eight-cycle chemotherapy. At present, the patient is disease-free and undergoes regular follow-up. Key words: Primary hepatic lymphoma; Diagnosis; Treatment

Beyond international prognostic index: risk stratification in diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). Both the clinical behavior and the underlying biological process are very heterogeneous in DLBCL, suggesting the necessity of utilizing individualized and risk adapted therapy. The international prognostic index (IPI) has been widely used for risk evaluation in DLBCL. Although IPI could successfully differentiate DLBCL patients into four groups with different outcome in the era of conventional chemotherapy, the efficacy of the IPI has declined in the era of rituximab. Newer prognostic systems, including the revised IPI (R-IPI) and the enhanced IPI (NCCN-IPI), have shown superiority over the traditional IPI in predicting outcome in DLBCL patients treated with rituximab based therapy. Risk stratification system based solely on clinical factors is feasible in daily practice, but they can not necessarily reflect the underlying biological process, and it’s very hard to tailor targeted therapy based on solely clinical information. Over the past decade, numerous biomarkers were shown to be prognostic or predictive. However, incorporating biomarkers and clinical factors in one risk stratification system remains challenging.

Role of radiotherapy in patients with stage I-II diffuse large B-cell lymphoma of waldeyer’s ring in remission after chemotherapy

Objective To investigate the impacts of adjuvant radiotherapy on the prognosis of patients with stage Ⅰ-Ⅱ diffuse large B cell lymphoma of Waldeyer’s ring (WR-DLBCL) who achieved complete remission (CR) after chemotherapy. Methods Clinical data were collected from 130 patients with stage Ⅰ-Ⅱ WR-DLBCL who were admitted to our hospital from 2005 and 2013. All the patients achieved CR after at least two cycles of cyclophosphamide, doxorubicin/epirubicin, vincristine, and prednisone (CHOP)-based chemotherapy or rituximab plus CHOP (R-CHOP)-based chemotherapy. In the 130 patients, 43 received R-CHOP (including 25 patients undergoing radiotherapy) and 87 CHOP (including 76 patients undergoing radiotherapy); 29 received chemotherapy alone and 101 chemoradiotherapy. The survival rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate and multivariate prognostic analyses were made by the log-rank test and the Cox model, respectively. Results In all patients, the 5-year sample size was 101. The univariate analysis showed that patients with an Eastern Cooperative Oncology Group (ECOG) score of 0 had significantly higher 5-year overall survival (OS) and disease-free survival (DFS) rates than those with an ECOG score of 1(95.6% vs. 80.1%, P=0.000; 95.7% vs. 75.4%, P=0.029). Patients treated with chemotherapy alone had significantly lower 5-year OS and DFS rates than those treated with chemoradiotherapy (77.1% vs. 91.7%, P=0.048; 77% vs. 87.4%, P=0.037). The multivariate analysis by the Cox model showed that ECOG score was a prognostic factor for both OS and DFS (P=0.047, 0.003). Adjuvant radiotherapy was related to improved DFS rather than OS (P=0.039, 0.133). Conclusions Stage Ⅰ-Ⅱ WR-DLBCL patients with low ECOG scores have better prognosis than those with high ECOG scores. Patients with CR after chemotherapy may benefit from adjuvant radiotherapy. The conclusions need to be further confirmed by prospective randomized controlled trials. Key words: Diffuse large B cell lymphoma/chemotherapy; Diffuse large B cell lymphoma/radiotherapy; Prognosis

A case of centrum diffuse large B-cell lymphoma with intracranial invading

A case of centrum diffuse large B-cell lymphoma with intracranial invading

Primary diffuse large B-cell lymphoma of central nervous system: clinical characteristics and prognostic analysis

Objective To investigate the clinical characteristics and prognosis of primary diffuse large B-cell lymphoma of central nervous system (PCNS DLBCL). Methods The data of 70 patients with PCNS DLBCL confirmed by pathology were retrospectively analyzed. Survival and prognostic analyses were further conducted in the 66 follow-up patients. Results Median age at diagnosis was 57 years old. The ratio of male and female was 1.3∶1. The time from having symptoms to seeking medical advice was less than 2 months in 54 (77.1%) patients. 44 (62.9%) patients had increased intracranial pressure, and 26 (37.1%) patients had limb weakness or hemiplegia symptoms. 37 (52.9%) patients were multiple lesions, 59 (84.3%) cases were supratentorial, and 46 (65.7%) cases showed involvement of deep-brain tissues. Among 66 follow-up patients 7 cases received supportive and palliative care, 27 cases received surgery, 6 cases received radiotherapy, 9 cases received chemotherapy alone, and 21 cases received radiotherapy in addition to chemotherapy. The median overall survival (OS) was 9 months (95% CI 1-16 months), and the 2-year survival rate was 36.1%. The median OSs of the supportive and palliative therapy group and the surgery group were 2 months and 3 months, respectively. The median OS of the chemotherapy, radiotherapy or combination group was 33 months (95%CI 22-43 months) and the 2-year OS rate was 56.9%. The Cox multivariate regression analysis showed that the involvement of deep-brain tissues (P=0.04) and not receiving radiotherapy or chemotherapy (P=0.00) were related to poor prognosis. Conclusions PCNS DLBCL is a highly aggressive and malignant tumor. Patients undergoing only surgery have poor effect and short survival. The patients with involvement of deep brain tissues have a poor prognosis. The chemotherapy, radiotherapy or combination of them may improve the prognosis. Key words: Central nervous system; Lymphoma, large B-cell, diffuse; Survival analysis; Prognosis

Clinical research progress of B-cell lymphoma

In the 58th American Society of Hematology Annual Meeting, some clinical results on B-cell lymphoma were reported. This review will focus on the recent progress of diffuse large B-cell lymphoma and mantle cell lymphoma in this annual meeting. Key words: Lymphoma, B-cell; American Society of Hematology Annual Meeting

Clinical characteristics and prognosis of patients with acquired immune deficiency syndrome related lymphoma

Objective To explore the clinical characteristics, pathological features and prognostic factors of patients with acquired immune deficiency syndrome (AIDS) related lymphoma (ARL). Methods The clinical characteristics, treatment regimen and survival status were retrospectively analyzed. At a ratio of 1∶2, 106 general non-Hodgkin lymphoma (NHL) cases were included after matching for demography and clinical characteristics with 53 ARL patients. Chi-square test was used for statistical analysis. Overall survival was analyzed using Kaplan-Meier curves. Cox regression was used for multivariant analysis. Results The predominant pathologic type of ARL was diffuse large B cell lymphoma (60.4%, 32/53). B cell lymphoma accounted for 88.7% (47/53) and T cell lymphoma accounted for 11.3% (6/53). Patients in ARL group (62.3%, 33/53) had lower proportion of receiving radiotherapy or chemotherapy compared with patients in general NHL group (94.3%, 100/106) (χ2=26.58, P<0.05). ARL group had lower hepatitis B surface antigen (HBsAg) positivity rate compared with general NHL group (1.9% vs 26.4%, χ2=14.26, P<0.05). No other characteristic was found significantly different between these two groups. The survival time of ARL and general NHL patients was (6.0±1.3) months and (48.0±10.0) months, respectively (t=8.13, P<0.01). The 1- year, 2-year, 3-year and 5-year survival rates of ARL patients were 39.6%, 32.7%, 27.7% and 20.1%, respectively, while those of general NHL patients were 79.2%, 56.8%, 42.4% and 25.0%, respectively. Of the 33 ARL patients and 100 general NHL patients who received anti-NHL treatment, the 1-year survival rates were 60.6% and 83.0%, respectively (χ2=4.040, P=0.043), the 2-year survival rates were 53.5% and 60.5%, respectively (χ2=0.003, P=0.096), the 3-year survival rates were 48.1% and 45.9%, respectively (χ2=0.288, P=0.59), the 5-year survival rates were 39.1% and 27.5%, respectively (χ2=0.798, P=0.372). Multivariate analysis revealed that anti-NHL therapy and international prognostic index score were independent predictors for prognosis (both P<0.05). Conclusions Diffuse large B cell lymphoma is the predominant pathologic type of ARL. ARL patients has significantly lower survival rate compared with general NHL patients. Combination of anti-HIV therapy and anti-lymphoma therapy in individuals with ARL can prolong their survival time. Key words: Lymphoma, non-Hodgkin; Acquired immunodeficiency syndrome; Survival analysis

Novel mechanism of immune evasion in cancer via structural variations of the PD-L1 gene.

Cancer cells are thought to circumvent immune surveillance through PD-1/PD-L1 signaling. However, the genetic basis for PD-L1-PD-L1-mediated immune escape has not been completely understood, with the exception of elevated PD-L1 expression by gene amplification and the utilization of an ectopic promoter by translocation. Recently, we demonstrated a unique genetic mechanism of immune escape caused by structural variations (SVs) commonly disrupting the 3' part of the PD-L1 gene. These SVs invariably cause a marked elevation of aberrant PD-L1 transcripts that are stabilized by truncation of the 3'-untranslated region (UTR), and thereby widely affect multiple common cancer types, including adult T-cell leukemia/lymphoma (27%), diffuse large B-cell lymphoma (8%), and adenocarcinoma of the stomach (2%). All SVs invariably result in a prominent increase of aberrant PD-L1 transcripts commonly lacking an intact 3'-UTR, which most typically generate gene fusions with ectopic sequences including integrated viral genomes. In this review, the critical role of 3'-UTR disruption is briefly summarized.