Received: December 20, 2017 Revision received: December 21, 2017 Accepted after revision: February 1, 2018
BKK Med J 2018;14(1):16-22.
To study the prevalence of MYC/BCL2 double expression in diffuse large B-cell lymphomas (DLBCLs) and its prognostic value.
This is a retrospective observational study, which includes patients diagnosed with DLBCLs at King Chulalongkorn Memorial Hospital from 2013 to 2014. The slides were reviewed, and MYC and BCL2 immunostains were scored according to Revised WHO 2016 Classification. Clinical data were collected from medical records. Patients were divided into two groups: double expression (DE) and non-double expression (NDE). Survivals and hazard ratios (HR) were calculated.
Eighty-eight patients were included in the study and 40 (46%) had double expression. The mean age was 60±16 years old; 40.9% were male and 59.1% were female. Eight patients were excluded from the survival analysis due to incomplete clinical data. Of the remaining 80 patients, there were 34 (42.5%) DE and 46 (57.5%) NDE. Median overall survival time (OS) and median progression-free survival time (PFS) tended to be lower in the DE group but was not statistically significant (Log-rank test, p = 0.16). Multivariate analysis identified 4 confounders: sex, cell of origin (COO), risk group and addition of rituximab to the standard treatment. Adjusted HRs of the DE group were 1.21 (95%CI 0.63-2.31, p = 0.57) for OS and 1.20 (95%CI 0.63-2.30, p = 0.58) for PFS. In the germinal center subgroup (GCB) of DLBCL, patients with DE had HRs of 4.33 (95%CI 0.80-23.37, p = 0.08, significance level of p < 0.10) for OS and 4.61 (95%CI 0.80-23.37, p = 0.08) for PFS; but, these were not significant in the non-GCB subgroup.
MYC/BCL2 double expression (DE) is significantly associated with poorer prognosis than non-double expression (NDE) among DLBCLs with GCB phenotype. MYC/BCL2 double expression should be reported in the pathological diagnosis of DLBCLs.
MYC, BCL2, double expression, co-expression, diffuse large B-cell lymphoma, prognosis.
Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.