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Prepublished online as a Blood First Edition Paper on August 8, 2002; DOI 10.1182/blood-2002-04-1286.
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Blood, 1 January 2003, Vol. 101, No. 1, pp. 78-84
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Clinical impact of the differentiation profile assessed by
immunophenotyping in patients with diffuse large B-cell
lymphoma
Lluís Colomo,
Armando López-Guillermo,
María Perales,
Susana Rives,
Antonio Martínez,
Francesc Bosch,
Dolors Colomer,
Brunangelo Falini,
Emili Montserrat, and
Elías Campo
From the Departments of Pathology and Hematology,
Hospital Clínic, Institut de Recerca Biomèdica August Pi
i Sunyer, University of Barcelona, Barcelona, Spain; and
Institute of Hematology, Policlinico Monteluce, University of Perugia,
Italy.
To analyze the relationship between immunophenotyping profile and
main clinicopathological features and outcome in diffuse large B-cell
lymphoma (DLBCL), we studied 128 patients (59 men, 69 women; median age
65 years) consecutively diagnosed with de novo DLBCL in a single
institution. Cells from each patient were immunostained with
CD20, CD79a, CD5, CD10, bcl-6, MUM1, CD138, bcl-2, p53, p27,
and Ki-67 antibodies. Four immunophenotyping profiles were
distinguished according to the pattern of differentiation: germinal
center-CD10+ (GC-CD10+;
CD10+/Bcl-6+/MUM1 /CD138),
germinal center-CD10 (GC-CD10;
CD10/Bcl-6+/
MUM1/CD138), post-germinal center (pGC;
CD10/bcl-6±/
MUM1+/CD138), and plasmablastic
(CD10/bcl-6/MUM1+/CD138+).
Rearrangement of bcl-2 was studied by polymerase chain reaction (PCR) in 57 patients. Single-antigen expression was as follows: CD5, 2%; CD10, 21%; bcl-6, 72%; MUM1, 54%; CD138, 2%; bcl-2, 59%; p53, 28%; p27, 40%. Distribution according to differentiation profiles was as follows: GC-CD10+, 24 patients, GC-CD10-,
30 patients; pGC, 60 patients; plasmablastic, 2 patients; other
patterns, 12 patients. The pGC profile was associated with primary
nodal presentation and immunoblastic morphology, whereas
GC-CD10+ tumors showed disseminated disease, centroblastic
morphology, bcl-2 rearrangement, and lower Ki-67 proliferative index.
GC-CD10 patients more often presented with primary
extranodal origin, early stage, normal lactic acid dehydrogenase (LDH)
levels, and low or low/intermediate International Prognostic Index
(IPI) scores than the others. However, no significant difference was
found in terms of response or overall survival (OS) according to these profiles. Expression of bcl-2 was associated with advanced stage, high
or high-intermediate IPI, and poor OS. Expression of bcl-2 maintained
predictive value in multivariate analysis, with stage and LDH. In
conclusion, differentiation profile was associated with particular
clinicopathological features but was not essential to predicting
outcome in DLBCL patients.
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