Prognostic Factors In Diffuse Large B Cell Lymphoma, A Preliminary Study

Purpose: The goal of the current study is to evaluate if using a panel of markers such as CD 10, CD30, CD 138, Bcl-6 and Mum1/IRF4 by immunohistochemistry defines prognosis in patients with diffuse large B-cell lymphoma (DLBCL).Materials and Methods : There were 73 patients consecutively diagnosed with diffuse large B-cell lymphoma (DLBCL) between February 2000 and October 2006 in Cancer Hospital. Immunohistochemical stains for the above markers were performed on paraffin-embedded tissues. All of the patients were followed up, and the results were analyzed by Spss 13.0.Results :1. The Median follow-up of 73 patients was 14 months (range, 1-106months), and in surviving patients it was 17 months (range, 5-106 months). The 1-year, 2-year, 3-year, 4-year, 5-year overall survival (OS) was 61.64%, 39.73%, 27.40%, 21.92%, 13.70%, respectively.2. The overall frequencies of expression for CD10, CD30, CD138, Bcl-6 and Mum1/IRF4 in the 73 cases studied were as follows: 17 of 73 (23.29%), 21 of 73 (28.77%), 11 of 73 (15.07%), 26 of 73 (35.62%) and 55 of 73(78.34%).3. When the patients were subdivided according to the two different methods of Hans and Chang, 19 patients (26.03%) were subclassified as GCB (CD10+ or CD10-/Bcl-6+/Mum-1-) and 54 (73.97%) as non-GC (CD10-/ Bcl-6+/Mum-1+orCD10-/ Bcl-6-), and there is no difference between the two groups in survival rate (p=0.959). Using the four groups classification, 5 patients (6.85%) were subclassified as pattern A which group expresses GCB markers only, 29 (39.73%) as B (positive GCB and activation markers) and C (activation markers only) separately, and 10 (13.70%) as D (all negative). Among the four patterns, pattern C showed a better survival rate, pattern D had a significantly lower survival rate, and pattern D is between the two groups.4. The univariate analysis demonstrated that age, therapy, the expression of Bcl-6 and Mum-1 were significant prognosis factors, with p values of 0.003, 0.000, 0.028 and 0.01. Moreover, CD138 (p=0.210) and abnormal serum lactate dehydrogenase (LDH, p=0.217) level may play an important role as a poor prognostic marker.Conclusions: Morphology, immunophenotyping and genetics are heterogeneous among DLBCLs. Immunohistochemical analysis on paraffin-embedded tissues is more readily available than gene expression profiling by cDNA microarray and may provide similar prognostic information. In the present study, age, therapy, the expression of Bcl-6 and Mum-1 were associated with particular clinicopathologic features and outcome, which were favourable prognostic factors. CD 138 and abnormal serum lactate dehydrogenase level may play an important role as a poor prognostic marker.