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Blood, 15 June 2001, Vol. 97, No. 12, pp. 3713-3720
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
The Burkitt-like lymphomas: a Southwest Oncology Group study
delineating phenotypic, genotypic, and clinical features
Rita M. Braziel,
Daniel A. Arber,
Marilyn L. Slovak,
Margaret L. Gulley,
Catherine Spier,
Carl Kjeldsberg,
Joseph Unger,
Thomas P. Miller,
Raymond Tubbs,
Catherine Leith,
Richard I. Fisher, and
Thomas M. Grogan
From the Oregon Health Sciences University, Portland,
OR; City of Hope National Medical Center, Duarte, CA; University of
Texas Health Science Center and Audie Murphy Veterans Hospital, San
Antonio, TX; Southwest Oncology Group (SWOG) Central Lymphoma
Repository, University of Arizona, Tucson, AZ; University of Utah, Salt
Lake City, UT; SWOG Statistical Center, Seattle, WA; Cleveland Clinic,
Cleveland, OH; University of New Mexico, Albuquerque, NM; and the
Cancer Center, Loyola University Medical Center, Maywood, IL.
The Revised European-American Lymphoma classification gives
Burkitt-like lymphoma (BLL) provisional status, leaving unresolved the
differential diagnosis with Burkitt lymphoma (BL) and diffuse large
B-cell lymphoma (DLBCL). This study compared the biologic features of
adult BLL and DLBCL. The phenotypic distinction between BLL and DLBCL
was determined by immunohistochemical staining of frozen tissue from 13 patients with BLL and 55 patients with DLBCL by using an extensive
antibody panel including Ki-67, CD10, CD11a/lymphocyte function-associated antigen 1 (LFA-1), CD18/LFA-1 ,
CD58/LFA-3, and CD54/intercellular adhesion molecule, CD8 for
tumor-infiltrating cytotoxic T cells (T-TILs), CD44 homing receptor,
and p53 and Bcl-2 oncogenic proteins. Compared with DLBCL, BLL had a
higher proliferative rate (mean Ki-67, 88% versus 53%), greater
expression of CD10 and p53 antigens, and decreased expression of Bcl-2.
BLL cases had a consistent absence of one or more cell adhesion
molecules (92% versus 27%), low T-TIL numbers, and absence of CD44
homing receptor (92% versus 14%). The t(8;14) translocation was
identified in 80% of BLL cases, but no patients with BLL had the
t(14;18) translocation. In a 10-year analysis, median survival of
patients with BLL was 1.2 years, and that of patients with DLBCL was
2.5 years. Although the proportion of patients cured was similar in the
2 groups, BLL patients had an increased risk of early death. We
conclude that BLL can be recognized by its combined morphologic and
phenotypic features and that it represents a high-grade lymphoma much
closer to BL than DLBCL. Retention of the BLL category or inclusion of
BLL as a variant of BL is biologically and clinically more appropriate
than absorbing the category of BLL into DLBCL.
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