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Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3152-3162
Clinical Relevance of BCL2, BCL6, and MYC Rearrangements in
Diffuse Large B-Cell Lymphoma
M.H.H. Kramer,
J. Hermans,
E. Wijburg,
K. Philippo,
E. Geelen,
J.H.J.M. van Krieken,
D. de Jong,
E. Maartense,
E. Schuuring, and
P.M. Kluin
From the Departments of Pathology and Medical Statistics, Leiden
University Medical Center, Leiden; Department of Pathology, The
Netherlands Cancer Institute, Amsterdam; Department of Internal
Medicine, Reinier de Graaf Gasthuis, Delft; and the Comprehensive
Cancer Center West, Leiden, The Netherlands.
Diffuse large B-cell lymphoma (DLCL) is characterized by a marked
degree of morphologic and clinical heterogeneity. We studied 156 patients with de novo DLCL for rearrangements of the BCL2, BCL6, and
MYC oncogenes by Southern blot analysis and BCL2 protein expression. We
related these data to the primary site of presentation, disease stage,
and other clinical risk factors. Structural alterations of BCL2, BCL6,
and MYC were detected in 25 of 156, 36 of 116, and 10 of 151 patients,
respectively. Three cases showed a combination of BCL2 and BCL6
rearrangements, and two cases had a combination of BCL6 and MYC
rearrangements. BCL2 rearrangement was found more often in extensive
(39%) and primary nodal (17%) lymphomas than in extranodal cases
(4%) (P = .003). BCL2 rearrangement was present in none of
40 patients with stage I disease, but in 22% of patients with stage II
to IV (P = .006). The presence of BCL2 rearrangements did
not significantly affect overall survival (OS) or disease-free survival
(DFS). In contrast, high BCL2 protein expression adversely affected
both OS (P = .008) and DFS (P = .01). BCL2
protein expression was poorly correlated with BCL2 rearrangement: only
52% of BCL2-rearranged lymphomas and 37% of BCL2-unrearranged cases
had high BCL2 protein expression. Rearrangement of BCL6 was found more
often in patients with extranodal (36%) and extensive (39%)
presentation versus primary nodal disease (28%). No significant
correlation was found with disease stage, lymphadenopathy, or bone
marrow involvement. DFS and OS were not influenced by BCL6
rearrangements. MYC rearrangements were found in 16% of primary
extranodal lymphomas, versus 2% of primary nodal cases
(P = .02). In particular, gastrointestinal (GI) lymphomas
(5 of 18 cases, 28%) were affected by MYC rearrangements. The distinct
biologic behavior of these extranodal lymphomas was reflected by a high
complete remission (CR) rate: 7 of 10 patients with MYC rearrangement
attained complete remission and 6 responders remained alive for more
than 4 years, resulting in a trend for better DFS
(P = .07). These data show the complex nature of molecular events in DLCL, which is a reflection of the morphologic and clinical heterogeneity of these lymphomas. However, thus far, these genetic rearrangements fail as prognostic markers.
© 1998 by The American Society of Hematology.

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