Sahai Kavita, Gangadharan Vandana, Singh H P, Mani N S
Senior Advisor (Pathology), Base Hospital, Delhi Cantt-10.
Pathologist, Holovision Diagnostics, Port Blair.
Med J Armed Forces India. 2011 Jan;67(1):41-5. doi: 10.1016/S0377-1237(11)80010-9. Epub 2011 Jul 21.
Diffuse large B cell lymphomas (DLBCL) encompass a pathogenetically heterogeneous group of aggressive tumours that are rapidly fatal if untreated. Gene expression profiling studies have identified distinct molecular subtypes of DLBCL, one with an expression profile similar to normal germinal centre B cells (GCB subtype) and a second mimicking activated peripheral blood B cells (ABC subtype) having different prognostic significance allowing risk stratification of lymphoma patients and development of specific therapeutic strategies.
Twenty cases of DLBCL were included in the study and categorized into germinal centre and non germinal centre subtypes using the following antibody panel. CD10, Bcl-6, MUM1 and CD138. The germinal centre and non germinal centre subtypes were defined as under Germinal centre (DLBCL) CD10 + and/or Bcl-6 +, MUM1 -, CD138 - and Non germinal centre (DLBCL) CD10, Bcl-6 ±, MUM1 ±, CD138 ±.
In our study of twenty cases thirteen were germinal centre DLBCL while seven of the twenty cases were non germinal centre type of DLBCL. 75% of the nodal cases and 62.5% of extra nodal cases were germinal centre B cell type. Overall survival in the GCB and non GCB groups was 91% and 14% respectively and the difference was highly significant statistically.
This study validates the existence of prognostic subgroups of DLBCL in the Indian population.
弥漫性大B细胞淋巴瘤(DLBCL)是一组具有不同致病机制的侵袭性肿瘤,若不治疗会迅速致命。基因表达谱研究已鉴定出DLBCL的不同分子亚型,一种具有与正常生发中心B细胞相似的表达谱(生发中心B细胞亚型,GCB亚型),另一种则类似于活化的外周血B细胞(活化B细胞亚型,ABC亚型),这两种亚型具有不同的预后意义,有助于对淋巴瘤患者进行风险分层并制定特定的治疗策略。
本研究纳入了20例DLBCL病例,并使用以下抗体组合将其分为生发中心和非生发中心亚型。CD10、Bcl-6、MUM1和CD138。生发中心和非生发中心亚型的定义如下:生发中心(DLBCL):CD10 +和/或Bcl-6 +,MUM1 -,CD138 -;非生发中心(DLBCL):CD10、Bcl-6 ±,MUM1 ±,CD138 ±。
在我们的20例研究病例中,13例为生发中心型DLBCL,而20例中有7例为非生发中心型DLBCL。75%的淋巴结病例和62.5%的结外病例为生发中心B细胞型。GCB组和非GCB组的总生存率分别为91%和14%,差异具有高度统计学意义。
本研究证实了印度人群中DLBCL预后亚组的存在。