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Subclassification of diffuse large B-cell lymphomas according to the Kiel
classification: distinction of centroblastic and immunoblastic lymphomas is
a significant prognostic risk factor
M Engelhard, G Brittinger, D Huhn, HH Gerhartz, P Meusers, W Siegert, E Thiel, W Wilmanns, U Aydemir, S Bierwolf, H Griesser, M Tiemann and K Lennert
Department of Medicine, Hematology, Universitatsklinikum Essen, Germany.
Among high-grade malignant non-Hodgkin's lymphomas the updated Kiel
classification identifies three major B-cell entities: centroblastic (CB),
B-immunoblastic (B-IB), and B-large cell anaplastic (Ki-1+) (now termed
anaplastic large cell [CD30+], [B-ALC]). The clinical prognostic relevance
of this distinction was evaluated in a randomized prospective treatment
trial (COP-BLAM/IMVP-16 regimen randomly combined +/- radiotherapy in
complete responders) conducted in adult (age 15 to 75) patients with Ann
Arbor stage II-IV disease (n = 219) diagnosed by optimal histomorphology
(Giemsa staining) and by immunohistochemistry. Overall survival was
significantly better in CB lymphoma as compared to B-IB (P = .0002) or
B-ALC (P = .046). Relapse-free survival was worse for B-IB (P = .0003) as
compared to CB lymphomas. The prognostic differences between CB and B-IB
were confirmed by multivariate analyses including the risk factors of the
International Index. Overall survival was significantly determined by
performance status (P = .0003), serum- LDH (P = .036), and B-IB histology
subtype (P = .036). Relapse-free survival was influenced by age (P = .007)
and histological subtype (P = .007). Thus, the diagnosis of the CB and B-IB
lymphomas by the histological criteria of the Kiel classification was
identified as an independent prognostic factor in diffuse large B-cell
lymphomas.
Volume 89,
Issue 7,
pp. 2291-2297,
04/01/1997
Copyright © 1997 by The American Society of Hematology
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