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Diffuse large B-cell lymphoma (DLBCL) patients with MYC/BCL2 double expression (DE) show poor prognosis and their clinical outcomes after R-CHOP therapy vary immensely. We investigated the prognostic value of DE in aggressive B-cell lymphoma patients ( n = 461), including those with DLBCL ( n = 417) and high-grade B-cell lymphoma (HGBL; n = 44), in a prospectively immunoprofiled cohort. DE was observed in 27.8% of DLBCLs and 43.2% of HGBLs ( P = 0.058). DE-DLBCL patients were older ( P = 0.040) and more frequently exhibited elevated serum LDH levels ( P = 0.002), higher international prognostic index (IPI; P = 0.042), non-germinal-center B-cell phenotype ( P &lt; 0.001), and poor response to therapy ( P = 0.042) compared to non-DE-DLBCL patients. In R-CHOP-treated DLBCL patients, DE status predicted poor PFS and OS independently of IPI ( P &lt; 0.001 for both). Additionally, in DE-DLBCL patients, older age (&gt;60 years; P = 0.017), involvement of ³2 extranodal sites ( P = 0.021), bone marrow involvement ( P = 0.001), high IPI ( P = 0.017), CD10 expression ( P = 0.006), poor performance status ( P = 0.028), and elevated LDH levels ( P &lt; 0.001) were significantly associated with poor OS. Notably, DE-DLBCL patients with normal LDH levels exhibited similar PFS and OS to those of patients with non-DE-DLBCL. Our findings suggest that MYC/BCL2 DE predicts poor prognosis in DLBCL. Risk stratification of DE-DLBCL patients based on LDH levels may guide clinical decision-making for DE-DLBCL patients.

cancers

Immunophenotypic Landscape and Prognosis of Diffuse Large B-Cell Lymphoma with MYC/BCL2 Double Expression: An Analysis of A Prospectively Immunoprofiled Cohort