Clinical features and prognosis of 166 cases of MYC/BCL2 double-expression diffuse large B-cell lymphoma
10.3760/cma.j.issn.0253-2727.2022.09.010
- VernacularTitle:166例双表达弥漫大B细胞淋巴瘤临床特征与预后分析
- Author:
Shuhan TANG
1
;
Lei TIAN
;
Wei ZHAO
;
Jing WANG
;
Xiaoyan KE
Author Information
1. 北京大学第三医院血液内科，北京 100083
- Keywords:
Lymphoma, large B-cell, diffuse;
Clinical features;
Prognosis;
Gene, BCL2;
Double expression lymphoma
- From:
Chinese Journal of Hematology
2022;43(9):771-777
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical features and prognosis of MYC/BCL2 double-expression diffuse large B-cell lymphoma (DEL) .Methods:The clinical data, including clinical characteristics, survival, and prognostic factors, of 166 patients with DEL treated at Peking University Third Hospital from January 2016 to December 2020 were retrospectively analyzed.Results:A total of 410 patients with diffuse large B-cell lymphoma were collected, including 166 cases (40.5%) of DEL. There were 82 males and 84 females with a median age of 63.5 (21-95) years at diagnosis. A total of 110 patients (66.3%) were aged over 60 years at initial diagnosis, 106 patients (106/163, 65.0%) had elevated lactate dehydrogenase (LDH) at diagnosis, 74 patients (74/160, 46.2%) had β 2 microglobulin level over 3 mg/L at diagnosis, and 107 patients (107/163, 65.6%) had≥2 extranodal involvement. Sixty-five patients (65/166, 39.2%) had B symptoms, 131 patients (131/165, 79.4%) had stage Ⅲ and Ⅳ disease at initial diagnosis, 41 patients (41/161, 25.5%) had an International Prognostic Index (IPI) score of 0-2 at initial diagnosis, and 38 patients (38/161, 23.6%) had an IPI score of 3 at initial diagnosis. Eighty-two patients (82/161, 50.9%) had an IPI score of 4-5 at initial diagnosis. Nine (9/56, 16.1%) patients with DEL had MYD88 and CD79B mutations. Univariate analysis showed that age over 60 years ( P=0.004) , increased β 2 microglobulin level ( P=0.002) , and high IPI score ( P=0.003) were associated with poor overall survival (OS) . Increased β 2 microglobulin level ( P=0.031) , LDH level ( P=0.017) , stage Ⅲ-Ⅳ ( P=0.001) , high IPI score ( P=0.013) , immunohistochemical p53 mutation ( P=0.049) , and PIM1 mutation ( P=0.039) were associated with poor progression-free survival (PFS) . Multivariate analysis showed that IPI score of 4-5 was an independent risk factor for the prognosis of DEL ( HR=2.622, 95% CI 1.398-4.917, P=0.003) . Survival analysis showed that there was a significant difference in the PFS between patients with DEL and those without DEL (65.6% vs 75.1%, P=0.002) . However, there was no significant difference in the OS (81.8% vs 83.6%, P=0.226) . In patients with DEL, the overall response rate of R-EPOCH regimen was higher than that of RCHOP or RCHOP-like regimen (81.5% vs 63.4%, P=0.004) . Conclusion:DEL is a group of aggressive lymphomas with relatively poor PFS. The R-EPOCH regimen may improve the overall prognosis of patients.
