Early Studies Show Biomarkers Can Be Useful in Determining Prognosis of Diffuse Large B-cell Lymphomas

Although Diffuse Large B-cell Lymphomas (DLBCL) is usually considered as a specific disease entity, the diversity in its clinical presentation, morphology, genetic and molecular alterations strongly suggest that these tumours represent a heterogeneous group of neoplasia rather than a single clinicopathological entity.

Clinical prognostic systems, including the International Prognostic Index (IPI), although useful in assessing overall prognosis, embrace patients with heterogeneous prognoses. It is likely that the prognostic assessment of patients with DLBCL might be improved by using biological features. Various biological markers such as bcl-2, bcl-6, p16, and Granzyme B, MHC-II, Ki-67 have been identified as potential prognostic factors in these tumours, with conflicting results among different studies.To determine the clinical significance and prognostic value of biological markers expressed in DLBCL, researchers retrospectively studied 26 patients diagnosed as de novo DLBCL at Chungnam National University Hospital from September 1992 to December 2000.Immunohistochemical studies were performed with CD10, bcl-6, IRF-4, bcl-2, p16, Granzyme B, and MHC-II, Ki-67 antibodies on archival pathology specimens. Two immunophenotypic patterns were distinguished according to the pattern of differentiation: germinal center (GC; CD10+/-/Bcl-6+/IRF-4 -) or post-germinal center (pGC; CD10+/-/bcl-6+/-/ IRF4+)type.The median age was 56 (range;37-69). 17 patients(65.4%) were male. 5 patients(19.2%) had ‘B’ symptoms. 11 patients(42.3%) had the elevated LDH level. 5 patients (19.2%) had bulky disease. Results of immunohistochemical study are as follows ; Granzyme 1+,17 patients(66.4%), 2+, 5 patients(19.2%), 3+, 4 patients(15.4%), MHC-II +, 23 patients(88.5%), Ki 67 greater than 60%, 17 patients(65.4%), bcl-2 +, 17 patients(65.4%), bcl-6 +, 20 patients(76.1%), CD10+, 5 patients(19.2%), IRF-4+, 8 patients(30.8%). After a median follow up duration of 48 months, the median survival time was 44 months with a range of 1-100+ months. 5-year overall survival rate was 32% by Kaplan-Meier method. The clinical factors affecting survival were serum LDH level, stage, B Symptom, bulky disease, stage at diagnosis. The only immunologic marker affecting survival was bcl-2. In patients with the same IPI scores, bcl-2 positive patients had lower survival.(p = 0.002 ) The germinal center like type had better survival than post-germinal center like type but had no statistical significance (p = 0.064 ).Researchers concluded immunohistochemical profiles of DLBCL maybe useful in predicting survival, especially bcl-2 expression. Germinal center type had better survival than post-Germinal center like type without statistical significance. Large scale study in more patients are warranted.If you would like more information on the HOTT congress please contact our office on (08) 9388 0344 or email us at adean@virtualcancercentre.com