探讨Double/Triple Hit淋巴瘤的流式免疫表型特征在疾病诊断及生存结局相关性中的应用

目的：本研究目的是确立二次或三次打击淋巴瘤(Double/Triple- Hit lymphoma,D/THL)流式免疫表型特征,研究与B淋巴细胞白血病(B-LBL)在免疫表型上的差异,并探讨流式免疫表型特征与D/THL生存结局的相关性。方法 采用多色FCI分析法对40例D/THL患者和25 B-LBL患者的样本的免疫表型进行检测和评价,并将流式免疫表型结果与基因亚型以及总体生存率进行统计学对比分析。结果 90%(36 / 40)的D/THL病例CD10表达呈阳性,近一半病例(48%,19 / 40)缺乏表面轻链。45%(18 / 40)的病例CD45表达呈弱阳性, 40%(16 /40)CD19表达呈弱阳性, 43%(17 / 40)CD20表达呈弱阳性。28%(11 / 40)显示伴随CD19和CD20的弱表达,38%(15 / 40)的CD19和CD20表达呈差异化表达(variable expression)。在不同基因亚型之间,除Dim CD45和 BCL2阳性发生率达有差异外(BCL2+/MYC+组Dim CD45发生率明显低于BCL2+/BCL6+/MYC+组(p=0.03)；BCL2+/MYC+组中bcl2阳性率为96%,而其它基因亚型组阳性率均为0%),其它表型发生率差异均无统计学意义。与B-LBL相比,B-LBL的CD45和CD20低表达发生率明显高于D / THL(c2 = 20.78、20.83,)；CD19和CD20同时弱表达在D / THL发生率稍多(28%D/ THL vs. 10% B-LBL),但差异无统计学意义(c2 = 2.31)。B-LBL的TdT阳性发生率明显高于D / THL(cc2= 30.74,)。对30例已经死亡患者进行了生存分析显示,不同基因型总体生存率无显著性差异(BCL2+ MYC+对BCL6+/MYC+,P=0.08；BCL2+MYC+对BCL2+/BCL6+/MYC+,P=0.13；BCL6+/MYC+对BCL2+/BCL6+/MYC+,P=1.0)；Dim CD45和Bcl2阳性预示着与较低的总体生存率(P = 0.01,0.015)相关。 结论D / THL流式免疫表型特征研究有助于D / THL鉴别诊断。对流式免疫表型与疾病结局的生存分析结果,将有利于临床对D／THL整体预后进行危险分层管理,以便能针对特定病人及时采取个体化治疗。

To expore Clinical value of Flow Cytometry immunophenotype in the diagnosis of Double/Triple- Hit lymphoma and Its Utility in D/THL survival outcome.

objector The aim of this study was to establish the flow cytometry immunophenotype (FCI) of D/THL, to study the difference in immunophenotype with B-LBL, and to investigate the correlation between flow cytometric features and D/THL survival outcome. Method The FCI features of 40 D/THL (24 BCL2+/MYC+, 8 BCL6+/MYC+, 8 BCL2+/BCL6+/MYC+) were evaluated, compared to 25 B-lymphoblastic leukemias (B-LBL), and correlated with overall survival. Results. Most (90%,36/40) D/THL were CD10+, 48% (19/40) lacked surface light chain, and a significant subset underexpressed CD45 (45%, 18 / 40), CD20 (43% ,17/40), and/or CD19 (40%,16 /40), which did not vary by genetic subgroup. Compared to B-LBL, D/THL less frequently underexpressed CD45 (c2 = 20.78) and CD20 (c2 = 20.83). Lower