Open AccessPB1784 BCL‐2 EXPRESSION IS A GOOD PREDICTOR OF PROGNOSIS FOR PATIENTS WITH DIFFUSE LARGE B CELL LYMPHOMA
Author(s) -
Jandamnernpong W.,
Prayongratana K.,
Satayasoontorn K.,
Laoruangroj C.,
Leelasiri A.,
Prayoonwiwat W.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000565640.22736.aa
Subject(s) - medicine , rituximab , bcl6 , diffuse large b cell lymphoma , lymphoma , immunohistochemistry , oncology , regimen , chop , grading (engineering) , chemotherapy , b cell , immunology , antibody , germinal center , civil engineering , engineering
Background: Although diffuse large B cell lymphoma (DLBCL) is the most common subtype of lymphoma in all ethnic groups, it is highly heterogeneous in term of natural course of disease and treatment outcome. Previous studies indicated that patients with double expression of the MYC and BCL‐2 associated with a poorer response to treatment and long‐term survival. According to previous study indicated impact of MYC, but the impact for BCL‐2 expression on prognosis is still controversial. Aims: To evaluate BCL‐2 immunohistochemistry expression grading as a predictor of prognosis in DLBCL. Methods: Patients with de‐novo DLBCL and treated with chemotherapy (CMT) with/without rituximab were included. Primary mediastinum B cell lymphoma, CNS lymphoma and HIV patients were excluded. We designed a four‐grade BCL‐2 scoring criteria, from 0 to 3+, to evaluate immunohistochemistry grade by hematopathologists (Gr0 = negative; 1+ ≤ 50%; 2+ < 75%; 3+ ≥75%). The treatment options for these patients were CHOP or intensified regimen (EPOCH, DA‐EPOCH) ± rituximab. The intensified regimen was given in patients with double (BCL2+MYC+ or BCL6+MYC+) or triple expression. Progression‐free survival (PFS) and overall survival (OS) rates were analyzed in accordance with level of BCL2 expression. Results: One hundred patients were included to this study with a median follow‐up 22 months (range, 4‐48 months). BCL‐2, BCL‐6, and MYC expression were presence in 65%, 63%, and 73% of patients, respectively. Double expression and triple expression were detected in 36% and 32% of patients, respectively. The survival analyses showed that patients with BCL‐2 expression grade 0 had significant better outcome in PFS compared to other group (p‐value = 0.046); however, OS was not significant (p‐value = 0.207). Subgroup analysis showed that patients with both non‐GCB and BCL‐2 protein expression grade 0 had strongly significant better outcome in PFS (Figure 1). The analysis for impact of chemotherapy regimen on each subgroup showed that patients with BCL2 grade 0 received R‐intensified CMT had a better survival outcome compared to the other groups (p‐value = 0.048; Figure 2). Most of the patients with BCL2 grade 0 who received R‐intensified CMT were patients with double expression of BCL‐6 and MYC indicated that these patients respond well to intensified regimen. Summary/Conclusion: BCL‐2 expression was an independent prognostic factor in DLBCL and probably starts the cut‐point of ≥1+ to predict treatment outcome.