弥漫大B细胞淋巴瘤进展

New Prognostic Factor in DLBCL in 2013 ASH
Diffuse Large B Cell Lymphoma: Role Of MYC, BCL2, BCL6 Protein Expressions and Translocations
• 25 patients (38%) had a single protein expression; of which 14 patients had BCL2, 10 patients had BCL6 and 1 patient had MYC. • 24 patients (37%) were positive for both BCL2 and BCL6 coexpression; of which 5 patients had positive translocations by FISH. • 61 % (40/65) of the patients did not have FISH studies following immunohistochemistry.
New Prognostic Factor in DLBCL in 2013 ASH
Concurrent Expression Of MYC/BCL2 Protein In Newly Diagnosed DLBCL Is Not Associated With An Inferior Survival Following EPOCH-R Therapy
• R-IPI score is significant predictor and should be used for risk stratification of patients with aggressive B-cell lymphoma.
New Prognostic Factor in DLBCL in 2013 ASH
News About DLBCL in 2013 ASH
Dr. Junmin LI
The Validity of IPI in Rituximab Era
IPI In Selecting Patients With Diffuse Large B Cell Lymphoma in Rituximab Era
The Validity of IPI in Rituximab Era
IPI In Selecting Patients With Diffuse Large B Cell Lymphoma in Rituximab Era
• High-risk patients may be candidates for autologous transplantation as initial treatment, having in mind that in the rituximab era relapses occur very early in the first year and are difficult to be treated.
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• 81% (53/65) of patients had BCБайду номын сангаас2 expression (14 had translocation), 65% (42/65) had BCL6 expression (7 had translocation), and 24% (16/65) had MYC protein expression (12 had translocation).
• While several studies have now demonstrated that patients with MYCrearranged DLBCL have a worse outcome following treatment with CHOP -with or without rituximab - recent reports suggest that concurrent expression of MYC and BCL2 protein by immunohistochemistry (IHC), independent of a MYC rearrangement, is associated with an inferior clinical outcome following R-CHOP.
New Prognostic Factor in DLBCL in 2013 ASH
Diffuse Large B Cell Lymphoma: Role Of MYC, BCL2, BCL6 Protein Expressions and Translocations
• Conclusion: Diffuse large B cell lymphomas involving co-expression of MYC protein with BCL2 or BCL6 have a significantly lower survival rate compared to the patients with single protein expression of BCL2 or BCL6 as well as co-expression of BCL2 and BCL6. In addition to obtaining cytogenetic studies, we emphasize the need to conduct prospective clinical trials which can aim at the optimal treatment strategies for this subset of DLBCL patients expressing the MYC proto-oncogene with BCL2 and/or BCL6 proteins.
• The current study aims to identify patients with DLBCL for the presence of co-expression of proteins involving MYC with BCL2 and/or BCL6, corresponding translocations and their prognostic impact on response to therapy and overall survival.
Diffuse Large B Cell Lymphoma: Role Of MYC, BCL2, BCL6 Protein Expressions and Translocations
• Gene rearrangements and more recently protein expressions involving MYC, BCL2 or BCL6 have been shown to have major prognostic implications. Lymphomas with recurrent chromosomal breakpoints activating multiple oncogenes, (one being MYC), are often referred to as “Double hit” lymphomas (DHL).
• Having in mind that IPI is based on 5 clinical characteristics and it is constructed in the pre-rituximab is clear that R-IPI should be tested in rituximab era to provide any information of its validity. • The study retrospectively analyzed unselected population of 80 DLBCL patients. One with 0 to 2 factors as patients with low risk. Patients with more than 3 factors are considered as high risk. • There is statistically significant difference in overall survival between two groups with five –years overall survival 70% for low risk patients and 47% for high risk.
New Prognostic Factor in DLBCL in 2013 ASH
Diffuse Large B Cell Lymphoma: Role Of MYC, BCL2, BCL6 Protein Expressions and Translocations
• Data from 65 patients diagnosed between June 2001 and February 2012 were available for analysis. Positive MYC protein expression or translocation was found in 16 (24%) patients. • 7 patients had DHL with 5 patients having MYC/BCL2 translocations, 1 patient-MYC/BCL6 and 1 patient with MYC/BCL2/ BCL6 ( Triple hit) translocations. 9 patients had MYC protein expression with or without translocation with co-expression of either BCL2 or BCL6 protein.