Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1 (5-Year IF – 2.0)
Journal Citation Indicator (JCI) (2023) – 0.4
Scopus CiteScore – 3.7 (CiteScore Tracker 3.8)
Index Copernicus  – 171.00; MNiSW – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 10, October, p. 1359–1365

doi: 10.17219/acem/109200

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

A large single-institution retrospective analysis of aggressive B-cell lymphomas according to the 2016/2017 WHO classification

Dorota Jesionek-Kupnicka1,A,B,C,D,F, Marcin Braun1,2,A,B,C,D,F, Tadeusz Robak3,E,F, Wojciech Kuncman1,E,F, Radzislaw Kordek1,E,F

1 Department of Pathology, Chair of Oncology, Medical University of Lodz, Poland

2 Postgraduate School of Molecular Medicine, Medical University of Warsaw, Poland

3 Department of Hematology, Medical University of Lodz, Poland

Abstract

Background. High-grade B-cell lymphomas (HGBLs) comprise a new entity in the revised 2016/2017 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. The diagnosis of HGBL encompasses histopathology and immunohistochemistry, with additional molecular examination of the BCL2/MYC or BCL6/MYC rearrangement status.
Objectives. The aim of the study was to summarize our experience in the histopathological and immunohistochemical diagnosis of patients with aggressive B-cell lymphomas according to the revised 2016/2017 WHO classifications.
Material and Methods. We reviewed our single-institution experience with accurate diagnoses of HGBL and diffuse large B-cell lymphoma (DLBCL) using the available histopathological and immunohistochemical tools. The timeframe was from January 1, 2017 to April 18, 2018.
Results. Out of 265 patients, 217 (81.9%) were diagnosed with DLBCL, 43 (16.2%) with HGBL/DLBCL and 5 (1.9%) with not otherwise specified HGBL (HGBL-NOS). Regarding concurrent expression of MYC and BCL2 and/or BCL6 (double expressors (DE) and triple expressors (TE)), more DE and TE cases were found in the HGBL/DLBCL group than in the DLBCL group (25.53% vs 8.47%, p < 0.001, for DE cases and 55.32% vs 6.21%, p < 0.001, for TE cases). All 48 (100.00%) of the HGBL-NOS and HGBL/DLBCL patients, and 26 (11.98%) of the DLBCL-DE/TE cases were recommended for molecular analysis.
Conclusion. Our findings show that a comprehensive histopathological and immunohistochemical examination may identify potential HGBL cases. This study emphasizes the need to introduce a suitable molecular examination for patients with HGBL morphology and/or double/triple expression of BCL2/BCL6/MYC proteins.

Key words

DLBCL, World Health Organization (WHO) 2016/2017 Classification Of Tumours Of Haematopoietic and Lymphoid Tissues, DLBCL/BL, HGBL, high grade B-cell lymphoma/diffuse large B-cell lymphoma

References (22)

  1. Swerdlow S, Campo E, Harris N, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised 4th ed. Lyon, France: IARC Press; 2017.
  2. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375–2390. doi:10.1182/blood-2016-01-643569
  3. Sesques P, Johnson NA. Approach to the diagnosis and treatment of high-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements. Blood. 2017;129(3):280–288. doi:10.1182/blood-2016-02-636316
  4. Szumera-Ciećkiewicz A, Rymkiewicz G, Grygalewicz B, et al. Comprehensive histopathological diagnostics of aggressive B-cell lymphomas based on the updated criteria of the World Health Organization’s 2017 classification. Polish J Pathol. 2017;69(1):1–19. doi:10.5114/PJP.2018.75332
  5. Johnson NA, Slack GW, Savage KJ, et al. Concurrent expression of MYC and BCL2 in diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol. 2012;30(28):3452–3459. doi:10.1200/JCO.2011.41.0985
  6. Green TM, Young KH, Visco C, et al. Immunohistochemical double-hit score is a strong predictor of outcome in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol. 2012;30(28):3460–3467. doi:10.1200/JCO.2011.41.4342
  7. Hu S, Xu-Monette ZY, Tzankov A, et al. MYC/BCL2 protein coexpression contributes to the inferior survival of activated B-cell subtype of diffuse large B-cell lymphoma and demonstrates high-risk gene expression signatures: A report from the International DLBCL Rituximab-CHOP Consortium Program. Blood. 2013;121(20):4021–4031. doi:10.1182/blood-2012-10-460063
  8. Yan L-X, Liu Y-H, Luo D-L, et al. MYC expression in concert with BCL2 and BCL6 expression predicts outcome in Chinese patients with diffuse large B-cell lymphoma, not otherwise specified. PLoS One. 2014;9(8):e104068. doi:10.1371/journal.pone.0104068
  9. Horn H, Ziepert M, Becher C, et al; German High-Grade Non-Hodgkin Lymphoma Study Group. MYC status in concert with BCL2 and BCL6 expression predicts outcome in diffuse large B-cell lymphoma. Blood. 2013;121(12):2253–2263. doi:10.1182/blood-2012-06-435842
  10. Perry AM, Alvarado-Bernal Y, Laurini JA, et al. MYC and BCL2 protein expression predicts survival in patients with diffuse large B-cell lymphoma treated with rituximab. Br J Haematol. 2014;165(3):382–391. doi:10.1111/bjh.12763
  11. Macpherson N, Lesack D, Klasa R, et al. Small noncleaved, non-Burkitt’s (Burkitt-like) lymphoma: Cytogenetics predict outcome and reflect clinical presentation. J Clin Oncol. 1999;17(5):1559–1567. doi:10.1200/JCO.1999.17.5.1558
  12. Hans CP, Weisenburger DD, Greiner TC, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood. 2004;103(1):275–282. doi:10.1182/blood-2003-05-1545
  13. Cheah CY, Oki Y, Westin JR, Turturro F. A clinician’s guide to double hit lymphomas. Br J Haematol. 2015;168(6):784–795. doi:10.1111/bjh.13276
  14. Pedersen MØ, Gang AO, Brown P, et al. Real world data on young patients with high-risk diffuse large B-cell lymphoma treated with R-CHOP or R-CHOEP – MYC, BCL2 and BCL6 as prognostic biomarkers. PLoS One. 2017;12(10):e0186983. doi:10.1371/journal.pone.0186983
  15. Scott DW, King RL, Staiger AM, et al. High grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with diffuse large B-cell lymphoma morphology. Blood. 2018;(131):2060–2064. doi:10.1182/blood-2017-12-820605
  16. Li S, Young KH, Medeiros LJ. Diffuse large B-cell lymphoma. Patho­logy. 2018;50(1):74–87. doi:10.1016/j.pathol.2017.09.006
  17. Howlett C, Snedecor SJ, Landsburg DJ, et al. Front-line, dose-escalated immunochemotherapy is associated with a significant progression-free survival advantage in patients with double-hit lymphomas: A systematic review and meta-analysis. Br J Haematol. 2015;170(4):504–514. doi:10.1111/bjh.13463
  18. Petrich AM, Gandhi M, Jovanovic B, et al. Impact of induction regimen and stem cell transplantation on outcomes in double-hit lymphoma: A multicenter retrospective analysis. Blood. 2014;124(15):2354–2361. doi:10.1182/blood-2014-05-578963
  19. Johnson NA, Savage KJ, Ludkovski O, et al. Lymphomas with concurrent BCL2 and MYC translocations: The critical factors associated with survival. Blood. 2009;114(11):2273–2279. doi:10.1182/blood-2009-03-212191
  20. Puvvada SD, Stiff PJ, Leblanc M, et al. Outcomes of MYC-associated lymphomas after R-CHOP with and without consolidative autologous stem cell transplant: Subset analysis of randomized trial intergroup SWOG S9704. Br J Haematol. 2016;174(5):686–691. doi:10.1111/bjh.14100
  21. Staiger AM, Ziepert M, Horn H, et al; German High-Grade Lymphoma Study Group. Clinical impact of the cell-of-origin classification and the MYC/BCL2 dual expresser status in diffuse large B-cell lymphoma treated within prospective clinical trials of the German High-Grade non-Hodgkin’s Lymphoma Study Group. J Clin Oncol. 2017;35(22):2515–2526. doi:10.1200/JCO.2016.70.3660
  22. Rosenthal A, Younes A. High grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6: Double hit and triple hit lymphomas and double expressing lymphoma. Blood Rev. 2017;31(2):37–42. doi:10.1016/j.blre.2016.09.004