Clinicopathologic Significance of CD11c, CD16 and FOXP3 Expression in Diffuse Large B-Cell Lymphoma (DLBCL) Patients Receiving Rituximab, Cyclophosphamide, Anthracycline, Vincristine, and Prednisolone (R-CHOP) Combination Chemotherapy

The principal objective of this study was to determine whether the expressions of CD11c, CD16 and FOXP3 are predictive of clinical outcomes in diffuse large B-cell lymphoma (DLBCL) patients receiving treatment with rituximab, cyclophosphamide, anthracycline, vincristine, and prednisolone (R-CHOP) combination chemotherapy.

The study population consisted of 25 patients with DLBCL between January 2006 and December 2007. All the patients had been treated with R-CHOP combination chemotherapy. The R-CHOP regimen was as follows: 375 mg/m² rituximab, 750 mg/m² cyclophosphamide, 50 mg/m² anthracycline, 1. 4 mg/m²vincristine were intravenously administered on day 1, and prednisolone 100 mg was medicated on days 1 to 5. This regimen was repeated every three weeks. The expressions of CD11c, CD16 and FOXP3 of primary tumors were immunohistochemically evaluated.

The mean age of the patients was 58 years (range, 27–77 years), and the pilot study population included 11 (44%) females and 14 (56%) males. The stages of the patients were I, II, III, and IV in 4 (16%), 5 (20%), 7 (28%), and 9 (36%), respectively. 60% of the patients were categorized as the low (44%) or low-intermediate risk group (16%) according to the International Prognostic Index (IPI). After a median follow-up of 57months, 8 patients (32%) developed disease recurrence or death. The estimated 5-year Progression free survival (PFS) and Overall survival (OS) were 65% (Figure 1) and 74% (Figure 2), respectively. 8 (32%), 18 (72%), and 17 (68%) were positive for CD11c, CD16 and FOXP3 expression, respectively. Univariate analysis of CD11c, CD16, FOXP3 for PFS and OS are shown in Figures 3–5. We noted no significant correlation between immunostaining of CD11c, CD16, FOXP3, and PFS. Patients with a CD11c -expressing DLBCL had a significantly higher 5-year OS rate than those without (p=0. 033, Figure 3). We classified patients according to the risk group. Each one counted for 1 point; In CD11c and FOXP3 stain, positive was counted as 0, negative was 1. In CD16, positive was counted as 1, negative was 0- and they were summed. The points were separated into low risk (0–1) and high risk (2–3) groups (Figure 6). We could found significant differences of PFS (p=0. 015) and OS (p=0. 046) between two groups.

Even though this result was obtained from small number and retrospective data set, we can get a possibility of clinical significance of CD11c, CD16 and FOXP3 in DLBCL patients receiving R-CHOP therapy. Prospective large scale study is needed for confirming these promising our pilot study results.

No relevant conflicts of interest to declare.