Immunohistochemical particularities as prognostic factors in diffuse large B-cell non-Hodgkin lymphoma

Abstract

Introduction. Diffuse Large B-Cell Lymphoma (DLBCL), the most common type of NonHodgkin Lymphoma (NHL) globally, is classified into two distinct biological categories based on the gene expression profile (GEP): the germinal center B-cell (GCB) subtype and the activated Bcell (ABC) or non-GCB subtype. Aim of study. Identification of Immunohistochemical Particularities as Prognostic Factors in Diffuse Large B-Cell Non-Hodgkin Lymphoma. Methods and materials. Data from medical scientific literature were examined, identified through Google Search and databases such as PubMed, Cochrane, Scopus, along with international clinical guidelines from NCCN and ESMO. Results. Studies have indicated that determining the cell of origin phenotype in DLBCL using gene expression profile (GEP) is significant for establishing the prognosis. Tumors with the GCB phenotype showed a better clinical course compared to those with the ABC/non-GCB phenotype. The classification into GCB and non-GCB subtypes, using the Hans algorithm, suggests a correlation between the expression of CD10 and BCL6 genes in DLBCL GCB and MUM1 in DLBCL non-GCB. In a study led by Patrascu A-M and his team (2017) on a sample of 601 patients, subjects with GCB type DLBCL exhibited a higher overall survival rate and progression-free survival compared to those with non-GCB DLBCL, although the prognosis may vary depending on the specific markers expressed within the same subtype. Studies using fluorescent in situ hybridization (FISH) reported that 7% to 10% of DLBCL cases harbored genetic translocations MYC, BLC2, and/or BCL6 and were termed “double-hit” lymphoma (DHL) or triple-hit lymphoma. More than 90% of patients with DHL present high-risk clinical features, such as leukocytosis, central nervous system (CNS) involvement, lactate dehydrogenase values three times above the upper limit, and an advanced disease stage. The presence of MYC rearrangements in combination with BCL2 and/or BCL6 has been described as a distinct entity with prognostic significance, presenting a poor long-term prognosis, refractoriness to therapy, and an increased risk of relapse. Conclusion. Research and studies emphasize the importance of evaluating the expression of MYC, BCL2, and BCL6 genetic rearrangements, through IHC and FISH, in patients recently diagnosed with DLBCL, for a more accurate assessment of disease progression, prognosis, and progressionfree survival. the gene expression profile (GEP): the germinal center B-ce ll (GCB) subtype and the activated Bcell (ABC) or non-GCB subtype. Aim of study. Identification of Immunohistochemical Particularities as Prognostic Factors in Diffuse Large B-Cell Non-Hodgkin Lymphoma. Methods and materials. Data from medical scientific literature were examined, identified through Google Search and databases such as PubMed, Cochrane, Scopus, along with international clinical guidelines from NCCN and ESMO. Results. Studies have indicated that determining the cell of origi n phenotype in DLBCL using gene expression profile (GEP) is significant for establishing th e prognosis. Tumors with the GCB phenotype showed a better clinical course compared to those wi th the ABC/non-GCB phenotype. The classification into GCB and non-GCB subtypes, using the Hans algorithm, suggests a correlation between the expression of CD10 and BCL6 genes i n DLBCL GCB and MUM1 in DLBCL non-GCB. In a study led by Patrascu A-M and his team ( 2017) on a sample of 601 patients, subjects with GCB type DLBCL exhibited a higher overall surviva l rate and progression-free survival compared to those with non-GCB DLBCL, although the pr ognosis may vary depending on the specific markers expressed within the same subtype . Studies using fluorescent in situ hybridization (FISH) reported that 7% to 10% of DLBCL cases harbored genetic translocations MYC, BLC2, and/or BCL6 and were termed “double-hit ” lymphoma (DHL) or triple-hit lymphoma. More than 90% of patients with DHL present high-r isk clinical features, such as leukocytosis, central nervous system (CNS) involvement, lac tate dehydrogenase values three times above the upper limit, and an advanced disease stage. The pres ence of MYC rearrangements in combination with BCL2 and/or BCL6 has been described as a dis tinct entity with prognostic significance, presenting a poor long-term prognosis, refract oriness to therapy, and an increased risk of relapse. Conclusion. Research and studies emphasize the importance of eval uating the expression of MYC, BCL2, and BCL6 genetic rearrangements, through IHC and FISH, in patients recently diagnosed with DLBCL, for a more accurate assessment of disease progression, prognosis, and progressionfree survival.