Cho Min-Chul, Chung Yousun, Jang Seongsoo, Park Chan-Jeoung, Chi Hyun-Sook, Huh Jooryung, Suh Cheolwon, Shim Hyoeun
Department of Laboratory Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital.
Institute of Health Sciences, Gyeonsang National University, Jinju.
Medicine (Baltimore). 2018 Nov;97(45):e13046. doi: 10.1097/MD.0000000000013046.
The prognostic significances of the germinal center B-cell-like (GCB) and non-germinal center B-cell-like (non-GCB) types of diffuse large B-cell lymphoma (DLBCL) have been reported to be different. We analyzed the effect of the cell of origin (COO) of bone marrow (BM) involvement in patients with DLBCL who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in a single institute.The subtype of BM involvement was evaluated in 633 patients who were diagnosed with primary DLBCL and had been treated with R-CHOP. BM trephine biopsies were analyzed, and immunohistochemical staining of CD20, CD79a, and CD3 was performed. Additional staining of CD10, Bcl-6, and MUM1 was performed to determine the COO based on a previously reported algorithm.BM involvement was present in 81 patients (12.8%). Among them, 30 patients (37.0%) had GCB-type BM involvement and 51 (63.0%) showed non-GCB-type involvement. Kaplan-Meier survival analysis showed that the non-GCB type had the worst progression-free survival (PFS) and overall survival (OS) (P <.001). In multivariate analysis controlled for the International Prognostic Index (IPI) score, non-GCB type was an independent predictor of PFS (P <.004) and OS (P =.042), whereas GCB type was not a prognostic factor independent of the IPI score.Further prognostication based on the COO of BM involvement is a useful indicator of PFS, independent of IPI score. Accurate staging based on the COO should be included in the examination of BM in DLBCL.
据报道，生发中心B细胞样（GCB）和非生发中心B细胞样（non-GCB）弥漫性大B细胞淋巴瘤（DLBCL）的预后意义有所不同。我们在一家机构分析了利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的DLBCL患者中，骨髓（BM）受累的细胞起源（COO）的影响。对633例诊断为原发性DLBCL并接受R-CHOP治疗的患者评估了BM受累的亚型。分析了骨髓环钻活检，并进行了CD20、CD79a和CD3的免疫组化染色。根据先前报道的算法，进行了CD10、Bcl-6和MUM1的额外染色以确定COO。81例患者（12.8%）存在BM受累。其中，30例患者（37.0%）为GCB型BM受累，51例（63.0%）为非GCB型受累。Kaplan-Meier生存分析显示，非GCB型的无进展生存期（PFS）和总生存期（OS）最差（P<0.001）。在对国际预后指数（IPI）评分进行校正的多变量分析中，非GCB型是PFS（P<0.004）和OS（P=0.042）的独立预测因素，而GCB型不是独立于IPI评分的预后因素。基于BM受累COO的进一步预后评估是PFS的有用指标，独立于IPI评分。基于COO的准确分期应纳入DLBCL的BM检查中。
