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Blood, 15 May 2004, Vol. 103, No. 10, pp. 3662-3668.
Prepublished online as a Blood First Edition Paper on January 15, 2004; DOI 10.1182/blood-2003-08-2726.


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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Bcl-2 protein expression is the strongest independent prognostic factor of survival in primary cutaneous large B-cell lymphomas

Florent Grange, Tony Petrella, Marie Beylot-Barry, Pascal Joly, Michel D'Incan, Michele Delaunay, Laurent Machet, Marie-Francoise Avril, Sophie Dalac, Philippe Bernard, Agnes Carlotti, Eric Esteve, Beatrice Vergier, Pierre Dechelotte, Elisabeth Cassagnau, Philippe Courville, Philippe Saiag, Liliane Laroche, Martine Bagot, and Janine Wechsler, for the French Study Group on Cutaneous Lymphomas

From the Department of Dermatology, Hôpital Pasteur, Colmar, France; the Centre de Pathologie and Department of Pathology, Hôpital du Bocage, Dijon, France; the Department of Dermatology, Hôpital Henri-Mondor, Créteil, France; the Department of Dermatology, Hôpital du Haut Lévêque, Pessac, France; the Department of Dermatology, Hôpital Charles Nicolle, Rouen, France; the Department of Dermatology, Hôtel Dieu, Clermont-Ferrand, France; the Department of Dermatology and Cancerology, Hôpital Pellegrin, Bordeaux, France; the Department of Dermatology, Hôpital Trousseau, Tours, France; the Department of Dermatology, Institut Gustave Roussy, Villejuif, France; the Department of Dermatology, Hôpital du Bocage, Dijon, France; the Department of Dermatology, Hôpital Robert Debré, Reims, France; the Department of Pathology, Hôpital Tarnier, Paris, France; the Department of Dermatology, Hôpital Porte Madeleine, Orléans, France; the Department of Pathology, Hôpital du Haut Lévêque, Pessac, France; the Department of Pathology, Hôtel Dieu, Clermont-Ferrand, France; the Department of Pathology, Hôtel-Dieu, Nantes, France; the Department of Pathology, Hôpital Charles Nicolle, Rouen, France; the Department of Dermatology, Hôpital Ambroise Paré, Boulogne, France; the Department of Dermatology, Hôpital Avicenne, Bobigny, France; and the Department of Pathology, Hôpital Henri-Mondor, Créteil, France.

Bcl-2 protein expression has been associated with poor prognosis in patients with noncutaneous diffuse large B-cell lymphomas. In primary cutaneous large B-cell lymphomas, the location on the leg, the round-cell morphology defined as the predominance of centroblasts and immunoblasts over large centrocytes, and multiple skin lesions were identified as adverse prognostic factors. The prognostic value of bcl-2 protein expression has not been studied in large series of patients. We evaluated 80 primary cutaneous large B-cell lymphomas collected by the French Study Group on Cutaneous Lymphomas. The prognostic value of age, sex, number of lesions, cutaneous extent, location, serum lactate dehydrogenase (LDH) level, B symptoms, morphology, and bcl-2 protein expression was studied. The overall 5-year specific survival rate was 65%. In univariate analysis, advanced age, multiple skin lesions (n = 48), location on the leg (n = 25), round-cell morphology (n = 32), and bcl-2 expression (n = 39) were significantly related to death from lymphoma. In multivariate analysis, bcl-2 expression (P = .0003), multiple skin lesions (P = .004), and age remained independent prognostic factors. The 5-year specific survival rates in bcl-2–positive and bcl-2–negative patients were 41% and 89%, respectively (P < .0001). A new prognostic classification of primary cutaneous B-cell lymphoma should be based primarily on bcl-2 protein expression rather than the location of skin lesions.


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