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Blood, 1 April 2005, Vol. 105, No. 7, pp. 2916-2923.
Prepublished online as a Blood First Edition Paper on December 2, 2004; DOI 10.1182/blood-2004-07-2716.


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Submitted July 16, 2004
Accepted November 26, 2004

Immuno-histochemical profiling of caspase signaling pathways predicts clinical response to chemotherapy in primary nodal diffuse large B-cell lymphomas

Jettie J Muris, Saskia A Cillessen, Wim Vos, Inge S van Houdt, J A Kummer, J van Krieken, N M Jiwa, Patty M Jansen, Hanneke C Kluin-Nelemans, Gert J Ossenkoppele, Chad Gundy, Chris J Meijer, and Joost J Oudejans*

Department of Pathology, VU Medical Center, Amsterdam, The Netherlands
Department of Clinical Pathology, Utrecht Medical Center, Utrecht, The Netherlands
Department of Clinical Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Clinical Pathology, Medical Center Alkmaar, Alkmaar, The Netherlands
Department of Clinical Pathology, LUMC, Amsterdam, The Netherlands
Department of Hematology, University Hospital Groningen, Groningen, The Netherlands
Department of Haematology, VU Medical Center, Amsterdam, The Netherlands
Department of Clinical Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands

* Corresponding author; email: jj.oudejans{at}vumc.nl.

We investigated whether inhibition of caspase 8 and/or 9 apoptosis signaling pathways predicts clinical outcome in biopsy specimens of primary nodal diffuse large B-cell lymphomas (DLBCL). Expression levels of c-Flip and numbers of active caspase 3 positive lymphoma cells were used to determine the status of the caspase 8 mediated pathway. Expression levels of Bcl-2 and XIAP were used to determine the status of the caspase 9 mediated pathway. Expression of c-FLIP, XIAP and Bcl-2 and caspase 3 activity all provided prognostic information. According to these immuno-histochemical parameters, inhibition of either or both caspase signaling pathways was detected in all cases. Three groups were identified: one with a caspase 8 inhibition profile, one with a caspase 8 and 9 inhibition profile and one with a caspase 9 inhibition profile. A caspase 9 inhibition profile was strongly associated with poor response to chemotherapy and a usually fatal outcome, whereas a caspase 8 inhibition profile was associated with excellent clinical outcome. Thus, our data strongly suggest that inhibition of the caspase 9 and not the caspase 8 mediated pathway is a major cause for therapy resistance in patients with nodal DLBCL.


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