Translocation t(14;18)/ IGH‐BCL2 in gastrointestinal follicular lymphoma

BACKGROUND: Chromosomal translocation t(14;18)(q32;q21) involving the immunoglobulin heavy chain gene ( IGH ) and the BCL2 gene (t[14;18][q32;q21]/ IGH‐BCL2 ) is present in 60% to 90% of nodal follicular lymphomas. To the authors' knowledge, the prevalence and clinical significance of this translocation have not been examined previously in gastrointestinal follicular lymphomas. METHODS: Clinicopathologic and molecular features were investigated in 48 patients who had gastrointestinal follicular lymphoma. The site of involvement was the duodenum in 54% of patients, the jejunum in 52%, the ileum in 52%, the stomach in 29%, and the colorectum in 15%. The presence of the t(14;18)/ IGH‐BCL2 translocation was detected by interphase fluorescence in situ hybridization. RESULTS: Treatment modalities included surgical resection (n = 16), rituximab plus chemotherapy (n = 13), rituximab alone (n = 6), antibiotics (n = 5), and watchful waiting (n = 8). Complete remission (CR) of lymphoma was achieved in 31 patients (65%). The overall survival and event‐free survival rates after 5 years were 93% and 68%, respectively. The t(14;18)/ IGH‐BCL2 was detected in 39 patients (81%). The involvement of multiple sites (69% vs 0%), manifestation of the lymphomatous polyposis type (72% vs 22%), and histologic grade 1 or 2 tumors (92% vs 56%) were more frequent in the t(14;18)‐positive group than in the negative group. In addition, the CR rate was lower in the t(14;18)‐positive group than in the negative group (56% vs 100%; P = .0179), and a trend was observed toward poorer event‐free survival in the positive group ( P = .089). CONCLUSIONS: The t(14;18)/ IGH‐BCL2 chromosomal translocation occurred frequently in gastrointestinal follicular lymphomas. The current results indicated that this translocation may be a predictor of an adverse clinical course. Cancer 2011. © 2010 American Cancer Society.