The Expression Of Bcl-2, C-myc Protein And Its Affect To Prognosis In Relapsed DLBCL

Background and Purpose:Malignant lymphoma is a malignant tumor which originated in the lymph nodes or extranodal lymphoid tissues and organs, according to their clinical pathological features that Classificate into Hodgkin's lymphoma (Hodgkin's lymphoma, HL) and non-Hodgkin 's lymphoma (Non-Hodgkin's lymphoma, NHL). Diffuse large B-cell lymphoma (diffuse large B cell lymphoma, DLBCL) is the most common type of non-Hodgkin's lymphoma, Still have 50% of patients with diffuse large B-cell lymphoma recurrence by conventional therapy. DLBCL is a heterogeneous disease,the difference in clinical features, immune phenotype, therapy and so on. Double-hit lymphoma (DHL) is a class of B cell lymphoma which have the MYC gene rearrangement and an additional gene (Bcl-2, Bcl-6 or CCND1) translocation. The recent studies have shown that DHL patients with poor prognosis,the most common type of gene translocations is MYC/Bcl-2. While the use of immunohistochemistry to detect the Bcl-2/C-myc protein expression in lymphoma are called Bcl-2/MYC protein co-expression lymphoma. This study explored the expression of Bcl-2, C-myc protein and its affect to prognosis in relapsed DLBCL, which provide a reference for clinical practice in the diagnosis and treatment of DLBCL.Methods:322 cases of DLBCL patients which collected from January,2004 to October,2014 in Second Affiliated Hospital of Dalian Medical University, screened 30 cases of relapsed DLBCL patients, then retrospectively analyze the clinical characteristics of patients,which include gender, age, clinical stage, IPI score, LDH levels, B symptoms, extranodal involvement and so on, collected the survival data (DFS, OS). Application SP immunohistochemical method to assay C-myc, Bcl-2 protein expression in DLBCL,and use X2 test to analysis the single factor, use Kaplan-Meier analysis to survival analysis.Result:1.The analysis of clinical features:30 cases of DLBCL patients,14 cases (46.7%) males and 16 females (53.3%), male to female ratio is 1:1.15; age of onset is 31-80 years old, with the median age is 61 years old;The initial treatment Ann Arbor stage:3 cases of stage ?,5 cases of stage ?,16 cases of stage ?,6 cases of stage ?.8 cases with stage ? and ? (26.7%),22 cases with ?-? (73.3%);the serum LDH level is normal in 10 cases (33.3%), increased in 20 cases (66.7%);B symptoms in 16 cases (53.3%), no B symptoms in 14 cases (46.7%); the IPI score 0-1 points in 12 cases (40%), more than 2 points in 18 cases (60%); Primary disease in lymph nodes in 14 cases (46.7%),16 (53.3%) cases of extranodal; immunophenotype with germinal center origin in 13 patients (43.3%), the non germinal center origin in 17 cases (56.7%); with extranodal invasion in 12 cases (40%), no extranodal involvement in 18 cases (60%).In 30 cases of DLBCL patients, the immune group of Bcl-2 is positive in 21 patients (70%),9 cases of Bcl-2 negative (30%); 24 cases with C-myc positive (80%),6 cases of negative C-myc (20%). Bcl-2/C-myc co-expression patients are 18 cases (60%), non Bcl-2/C-myc co-expression patients are 12 cases (40%).2. Statistical analysis showed:There have no statistically significant differences between the onset age, gender, Ann Arbor stage, blood lactate dehydrogenase level, with or without B symptoms, IPI score, the primary site, with or without extranodal invasion with the expression of Bcl-2 protein, C-myc protein(P> 0.05). There have no correlation between Bcl-2 protein expression and C-myc protein expression (P=0.329).3. Survival analysis showed:The median DFS in Bcl-2 negative and positive groups are 22 months,7 months, the difference has statistically significant (P= 0.031); The median OS in Bcl-2 negative and positive groups are 49 months,28 months, the difference has no statistically significant (P=0.122); The median DFS in C-myc negative and positive groups are 18 months,13 months;The median OS in C-myc negative and positive groups are 44 months,35 months; the differences have no statistically significant (P=0.191,P=0.180); The median DFS in Bcl-2/C-myc protein co-expression group and non-co-expression group are 7 months,21 months; the difference has statistically significant (P=0.031); The average OS in Bcl-2/C-myc protein co-expression group and non-co-expression group are 24 months,49 months; the difference has no statistically significant (P=0.071).Conclusion:1. There has no correlation between the onset age, gender, Ann Arbor stage, blood lactate dehydrogenase level, with or without B symptoms, IPI score, the primary site, with or without extranodal invasion with the expression of Bcl-2 protein, C-myc protein.2.The DFS in Bcl-2 negative group is more than Bcl-2 positive group.There have on significant to patients with C-myc positive.3.There have no correlation between the expression of Bcl-2 protein and C-myc protein.4.The DFS in Bcl-2/C-myc protein co-expression group is inferior to in Bcl-2/C-myc non-co-expression group,have no difference in OS.