“双表达”与“双打击”淋巴瘤临床特征、生存及预后因素分析

目的分析“双表达”与“双打击”淋巴瘤临床特征、疗效及预后因素。方法收集87例初诊弥漫大B细胞淋巴瘤石蜡切片,用免疫组织化学法(IHC)及荧光原位杂交技术(FISH)检测C-MYC、BCL-2及BCL-6蛋白表达、基因重排情况,分析DEL及DHL人群临床特征、疗效、生存及影响预后因素。结果87例DLBCL患者中,DEL占41.4%(36/87),DHL占2.3%(2/87)。DHL患者预后差,因病例数少,无法进一步预后分析。DEL人群预后差,接受一线R-CHOP方案化疗,DEL组ORR为56%,EFS为11个月,2年PFS为29%,而non-DEL组ORR为90%,EFS未达到,2年PFS为92%。LDH升高及MYC、BCL-2双表达为DLBCL独立预后不良因素。结论DLBCL患者中DEL发生率高,而DHL发生率低。DEL和DHL患者预后不良,强化方案未能改善其预后,新的治疗方案值得探索。

Clinical Characteristics and Survival Analysis in Double-expressor and Double-hitLymphoma

Objective To analyze the clinical characteristics,efficacy and prognostic factors of"double-expressor"and"double-hit"lymphoma.Methods 87 patients with primary DLBCL who were diagnosed were collected.The rearrangements and expressions of MYC,BCL-2,BCL-6 were detected by fluorescence in situ hybridization(FISH)and immunohistochemistry(IHC),respectively.The survival of patients was analyzed by the Kaplan-Meier and compared by log-rank test.The prognostic factors was analyzed by univariate and multivariate analysis.Results In 87 DLBCL patients,DEL cases were found in 36(41%)and DHL were found in 2(2.3%)cases.The outcome of the 2 DHL patients were poor,however,further prognostic analysis need carried out in a larger DHL sample.Receiving first-line standard R-CHOP chemotherapy,the DEL patients had an inferior outcome as compared to non-DEL patients.The ORR of the DEL group was 56%,EFS at 11 months,and PFS at 2 years was 29%,while the ORR of the non-DEL group was 90%,EFS not achieved,and PFS at 2 years was 92%.The co-expression of MYC and BCL-2 was an independent prognostic factor of DLBCLs.Conclusions DELs are more common than DHLs in DLBCL.Receiving standard chemotherapy,DELs have worse outcomes than other DLBCLs,but not as much aggressiveness as the DHLs.Co-expression of MYC and BCL-2 is an independent risk factor of DLBCLs survival.Therefore,new regimens need explored based on current standard chemotherapy in further study.