Abstract 5006

Diffuse large B-cell lymphoma (DLBCL) has an obvious heterogeneity for a set of morphological, immunological phenotype, genetics and clinical manifestations. We found some patients suffered in bone invovlement at early stage. However some patients are not even if many of primary lesions or at the advanced stage. Is this is a universal or accident phenomenon? Is there any regularity for the occurrence of bone invovlement? As we all know, CD44 is a important antigent in normal development of B cells, which express in post-germinal center. It has a negative contro with the expression of Bcl-6, and has a a positive control with Stat-3. CD44 is also a cell surface glycoprotein and the principle receptor for hyaluronan and have multiple splice forms, such as CD44H and CD44v6. In the immune system, CD44 is called a homing receptor. The goal of our study is to evaluate if using a panel of markers such as CD20, CD44H, CD44v6,Bcl-6, Mum-l and Stat3 by immunohistochemistry defines prognosis in patients with DLBCL. We expect to find out some effective indexes for prognosis and bone marrow involvement.

Materials and Methods

  1. There were 120 patients consecutively diagnosed with DLBCL between January 1998 - October 2008 in our Hospital. We set up follow-up data, analysis for clinical diagnosis and the efficacy of telephone follow-up of survival time and survival status.

  2. Review HE sections, immunohistochemical single-stains for CD20 ACD44H ACD446 ABcl-6 AStat3 and Mum-1 such the markers were perform on paraffin-embedded tissues.

  3. All of the results were analyzed by Spss13.0.

Results

1. Case imformation: There are male 67 cases (55.8%) and 53 cases (44.2%) of female in the 120 cases. The median age is 55 years. 77 cases of primary lymph nodes (60%) and 48 cases of primary lymph node outside (40%). The Median follow-up of 120 patient was17 months, range to 6-148 month

2. The percentage of expression for CD20, CD44H, CD44v6, Bcl-6, Stat3 and Mum-1 in the 120 cases studied were as follows: 95.0%, 66.0%, 55.8%,54.2%,41.7%,46.7%.

3. Survival for single factor and multi-factor analysis: The single factor survival analysis showed that Hans group, Bcl-6/Stat-3 group, chemotherapy ± Rituximab, age, systemic symptoms, LDH level, bone marrow involvement, IPI score, number of extranodal involvement, Bcl-6, CD44H, CD44v6 on the survival of patients with DLBCL influential. In the Cox multivariate analysis, only chemotherapy ± Rituximab, age, extranodal involvement and CD44v6 have a significant statistical significance on the survival of patients with DLBCL (P = 0.000, 0.001, 0.000 and 0.009 respectively).

4. The associativity with antigen expression and clinical factors. It showed that the expression of CD44H had a positive correlation with bone marrow involvement (P 0.022), and implied a poor effect (P 0.003). The expression of CD44v6 also had a negative correlation with effect (P 0.000) and had a positive correlation with bone marrow involvement (P 0.052). The expression of Bcl-6 had a negative correlation with age and extranodal involvement (P 0.025 A0.005);the expression of Stat-3 had a negative correlation with pathology stage (P 0.030); the expression of Mum-1 had a positive correlation with age and extranodal involvement (P 0.014 A0.023), but had a negative correlation with bone marrow involvement (P 0.028). The rest had no statistics, P>0.05.

5. The associativity with antigens expression. It showed that the expressions of CD44H and CD44v6 had a positive correlation (P 0.000); the expression of CD44v6 and Stat-3 also had a positive correlation (P 0.045); the expression of Bcl-6 with Stat-3, Mum-1 had a negative correlation (P 0.013 A0.000);the expression of Stat-3 and Mum-1 also had a positive correlation (P 0.007).

6. Bcl-6 (-) ACD44v6 (+) and Stat-3 (+) provide actively singal to choose rituximab for DLBCL patients.

Conclusions

  1. Bcl-6, Mum-1 and Stat-3 were the important index for typing in DLBCL.

  2. CD44H and CD44v6 implied bone marrow involvement, they could provide a help for prognosis.

  3. The results have shown that rituximab can improve the efficacy obviously

  4. Chems±Rituximab, Age, bone marrow involvement, IPI, extranodal involvement, pathology stage, LDH level are the main clinical factors, which affect the survival time.

ACKNOWLEDGMENTS. We thank Hilda Ye for helpes and discussions.

Disclosures

No relevant conflicts of interest to declare.

Topics:
diffuse large b-cell lymphoma, prognostic factors, bone marrow involvement, extranodal disease, rituximab, cd20 antigens, cd44 antigens, follow-up, homing-associated cell adhesion molecule, antigens

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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