伴有髓细胞瘤基因(MYC)和B细胞淋巴瘤2(BCL2)共表达的弥漫性大B细胞淋巴瘤患者的预后结果。
Prognostic outcomes of diffuse large B-cell lymphoma patients with myelocytomatosis oncogene (MYC) and B-cell lymphoma 2 (BCL2) co-expression.
作者信息
Kumjan Supanut, Satayasoontorn Kantang, Lawongsa Kasidid, Laoruangroj Chonlada
机构信息
Department of Hematology Medicine, Phramongkutklao Hospital, Bangkok, 10400, Thailand.
Department of Pathology, Phramongkutklao Hospital and College of Medicine, Bangkok, 10400, Thailand.
出版信息
J Hematop. 2025 Mar 18;18(1):8. doi: 10.1007/s12308-025-00623-z.
Double expressor lymphoma (DEL) refers to diffuse large B-cell lymphoma (DLBCL) cases characterized by the overexpression of both MYC and BCL2 proteins, as determined by immunohistochemistry (IHC), without requiring underlying genetic rearrangements. DEL is associated with more aggressive disease behavior and poorer prognosis. This study aimed to assess the impact of DEL on progression-free survival (PFS) and overall survival (OS) compared to non-DEL patients. We conducted a retrospective study at the Hospital, analyzing 177 patients diagnosed with DLBCL between March 2014 and March 2021. Patients were classified as DEL or non-DEL based on immunohistochemical analysis. Survival rates, clinical characteristics, and treatment responses were compared using Kaplan-Meier survival analysis, and multivariable Cox regression was performed to identify independent prognostic factors. Among 177 patients, 113 (63.8%) were DEL and 64 (36.2%) non-DEL. DEL patients had significantly worse outcomes, with a median follow-up of 39.4 months. The 3-year PFS (44.2% vs. 68.8%) and OS (54.9% vs. 81.3%) were significantly lower in DEL (PFS: p < 0.001; OS: p = 0.001). Median PFS in DEL was 19 months. Multivariable analysis confirmed DEL as an independent predictor of worse PFS (HR: 1.488, 95% CI: 1.091-2.03, p = 0.012) and OS (HR: 1.376, 95% CI: 1.011-1.873, p = 0.043). DEL status is strongly linked to poor survival in DLBCL, highlighting the need for targeted therapies beyond R-CHOP. Future research should explore personalized treatment strategies to improve outcomes in this high-risk group.
双表达淋巴瘤(DEL)是指通过免疫组织化学(IHC)测定,以MYC和BCL2蛋白均过表达为特征的弥漫性大B细胞淋巴瘤(DLBCL)病例,无需潜在的基因重排。DEL与更具侵袭性的疾病行为和更差的预后相关。本研究旨在评估与非DEL患者相比,DEL对无进展生存期(PFS)和总生存期(OS)的影响。我们在该医院进行了一项回顾性研究,分析了2014年3月至2021年3月期间诊断为DLBCL的177例患者。根据免疫组织化学分析将患者分为DEL或非DEL。使用Kaplan-Meier生存分析比较生存率、临床特征和治疗反应,并进行多变量Cox回归以确定独立的预后因素。在177例患者中,113例(63.8%)为DEL,64例(36.2%)为非DEL。DEL患者的结局明显更差,中位随访时间为39.4个月。DEL患者的3年PFS(44.2%对68.8%)和OS(54.9%对81.3%)显著更低(PFS:p<0.001;OS:p = 0.001)。DEL的中位PFS为19个月。多变量分析证实DEL是PFS更差(HR:1.488,95%CI:1.091-2.03,p = 0.012)和OS更差(HR:1.376,95%CI:1.011-1.873,p = 0.043)的独立预测因素。DEL状态与DLBCL的不良生存密切相关,凸显了R-CHOP以外的靶向治疗的必要性。未来的研究应探索个性化治疗策略,以改善这一高危群体的结局。