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 Prepublished online as a Blood First Edition Paper on March 20, 2003; DOI 10.1182/blood-2002-09-2822.

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2002-09-2822v1
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Blood, 1 July 2003, Vol. 102, No. 1, pp. 324-327

NEOPLASIA
Brief report

Very late relapse in diffuse large B-cell lymphoma represents clonally related disease and is marked by germinal center cell features

Daphne de Jong, Annuska M. Glas, Lucie Boerrigter, Marie-Christine Hermus, Otilia Dalesio, Els Willemse, Petra M. Nederlof, and Marie José Kersten

From the Department of Pathology, Biometrics and Medical Oncology, The Netherlands Cancer Institute; and the Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands.

Patients with diffuse large B-cell lymphoma (DLBCL) rarely show relapse after 4 years of complete remission (CR). In this study, we addressed the following questions: (1) Does late-relapsing DLBCL represent clonally related disease or a second malignancy; and (2) is there a characteristic biologic background? In 10 of 13 DLBCL patients with relapse after 4 to 17 years, a clonal relationship was established based on identical IgH-sequences and/or identical bcl2-IgH translocation. Most (77%) showed features of germinal center (GC) cells, as defined by expression of CD10, bcl-2, and bcl-6 protein and ongoing immunoglobulin heavy chain variable region (VH) hypermutation. A GC phenotype was seen in 8 (20%) of 38 control patients matched for age, stage, and (extra)nodal localization with relapse within 2.5 years (P = .005). In conclusion, we have found evidence that late-relapsing DLBCL represents truly clonally related disease episodes in most cases and that this clinical behavior may be related to the biologic features of GC cells. (Blood. 2003;102:324-327)


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