State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, China.
J Transl Med. 2012 May 3;10:84. doi: 10.1186/1479-5876-10-84.
HIV-negative, CD20-negative de novo diffuse large B-cell lymphoma (DLBCL) patients has rarely been reported. To elucidate the nature of this entity, we retrospectively reviewed the data of 1,456 consecutive de novo DLBCL patients who were treated at Sun Yat-Sen University Cancer Center between January 1999 and March 2011.
The pathologic characteristics of CD20-negative patients, clinical features, response to initial treatment, and outcomes of 28 patients with available clinical data (n = 21) were reviewed. Then, a matched case-control (1:3) analysis was performed to compare patients with CD20-negative and -positive DLBCL.
The median age of the 28 CD20-negative DLBCL patients was 48 years, with a male-female ratio of 20:8. Seventeen of 22 (77.3%) CD20-negative DLBCL cases were of the non-germinal centre B-cell (non-GCB) subtype. High Ki67 expression (≥ 80%), an index of cell proliferation, was demonstrated in 17 of 24 (70.8%) cases. Extranodal involvement (≥ 1 site) was observed in 76.2% of the patients. Following initial therapy, 9 of 21 (42.9%) cases achieved complete remission, 4 (19%) achieved partial remission, 1 (4.8%) had stable disease, and 7 (33.3%) had disease progression. The median overall survival was 23 months. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 30.5% and 35%, respectively. A matched case-control analysis showed that patients with CD20-negative and -positive DLBCL did not exhibit a statistically significant difference with respect to the main clinical characteristics (except extranodal involvement), whereas the patients with CD20-positive DLBCL had a better survival outcome with 3-year PFS (P = 0.008) and OS (P = 0.008) rates of 52% and 74.1%, respectively.
This study suggests that HIV-negative, CD20-negative de novo DLBCL patients have a higher proportion of non-GCB subtype, a higher proliferation index, more frequent extranodal involvement, a poorer response, and a poorer prognosis to conventional treatment compared to patients with CD20-positive DLBCL. Further studies are warranted to investigate new target and optimal therapy of CD20-negative de novo DLBCL.
HIV 阴性、CD20 阴性的初发性弥漫性大 B 细胞淋巴瘤（DLBCL）患者极为罕见。为了阐明该疾病实体的本质，我们回顾性分析了 1999 年 1 月至 2011 年 3 月在中山大学肿瘤防治中心接受治疗的 1456 例初发性 DLBCL 患者的数据。
我们复习了 28 例具有完整临床资料的 CD20 阴性患者（n = 21）的病理特征、临床特征、初始治疗反应和结局。然后，我们进行了匹配的病例对照（1:3）分析，以比较 CD20 阴性和阳性 DLBCL 患者。
28 例 CD20 阴性 DLBCL 患者的中位年龄为 48 岁，男女比例为 20:8。22 例 CD20 阴性 DLBCL 患者中，17 例（77.3%）为非生发中心 B 细胞（non-GCB）亚型。24 例中的 17 例（70.8%）高 Ki67 表达（≥80%），这是细胞增殖的指标。76.2%的患者有结外累及（≥1 个部位）。初始治疗后，21 例患者中，9 例（42.9%）达完全缓解，4 例（19%）达部分缓解，1 例（4.8%）病情稳定，7 例（33.3%）疾病进展。中位总生存期为 23 个月。3 年无进展生存率（PFS）和总生存率（OS）分别为 30.5%和 35%。匹配病例对照分析显示，CD20 阴性和阳性 DLBCL 患者的主要临床特征（除结外累及外）无统计学差异，而 CD20 阳性 DLBCL 患者的生存结局更好，3 年 PFS（P = 0.008）和 OS（P = 0.008）率分别为 52%和 74.1%。
本研究表明，与 CD20 阳性 DLBCL 患者相比，HIV 阴性、CD20 阴性的初发性 DLBCL 患者具有更高比例的 non-GCB 亚型、更高的增殖指数、更频繁的结外累及、较差的治疗反应和预后。需要进一步研究以探索 CD20 阴性初发性 DLBCL 的新靶点和最佳治疗方法。
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