High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with diffuse large B-cell lymphoma morphology
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with diffuse large B-cell lymphoma morphology
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DOI：
10.1182/blood-2017-12-820605
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发表时间：
2018-05-03
期刊：
影响因子：
20.3
通讯作者：
Rosenwald, Andreas
中科院分区：
文献类型：
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作者：
Scott, David W.;King, Rebecca L.;Rosenwald, Andreas
伴有MYC和BCL 2和/或BCL 6重排的高度恶性B细胞淋巴瘤（HGBL-DH/TH）是最新世界卫生组织分类中新定义的实体。对于所有弥漫性大B细胞淋巴瘤（DLBCL）形态的肿瘤，准确的诊断似乎需要荧光原位杂交（FISH）。我们报告了来自3项临床试验和一项基于人群的登记研究的1228例DLBCL活检标本的FISH、cell-oforigin和免疫组化（IHC）检测结果。HGBL-DH/TH占DLBCL的7.9%，主要局限于生发中心B细胞样（GCB; 13.3%），而活化B细胞样（ABC; 1.7%）亚型（P <0.001）。HGBL-DH/TH伴BCL 2重排是一种GCB现象，在415例ABC DLBCL中未观察到病例。将FISH检测限制在GCB亚型肿瘤（通过Lymph 2Cx或Hans MHC）加上通过MHC检测MYC和BCL 2双蛋白表达的筛查策略可以将检测限制在11%至14%的肿瘤，阳性预测值为30%至37%;然而，这种策略会错过大约四分之一的伴有BCL 2重排的HBGL-DH/TH肿瘤和三分之一的所有HGBL-DH/TH肿瘤。这些结果提供了具有DLBCL形态的肿瘤中HGBL-DH/TH比例的准确估计，并允许确定可用于筛选DLBCL肿瘤用于FISH测试的各种方法的影响。
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) is a newly defined entity in the latest World Health Organization Classification. Accurate diagnosiswould appear to mandate fluorescence in situ hybridization (FISH) for all tumorswith diffuse large B-cell lymphoma (DLBCL) morphology. We present the results of FISH, cell-oforigin, and immunohistochemistry (IHC) testing from 1228 DLBCL biopsies from 3 clinical trials and a population-based registry. HGBL-DH/THmade up 7.9% of the DLBCL, confined primarily to the germinal center B-cell-like (GCB; 13.3%) compared with activated B-cell-like (ABC; 1.7%) subtype (P < .001). HGBL-DH/TH with BCL2 rearrangement is a GCB phenomenon with no cases observed in 415 ABC DLBCL. A screening strategy restricting FISH testing to tumors of GCB subtype (by Lymph2Cx or Hans IHC) plus dual protein expression of MYC and BCL2 by IHC could limit testing to 11% to 14% of tumors, with a positive predictive value of30% to 37%; however, this strategy would miss approximately one-quarter of tumors with HBGL-DH/TH with BCL2 rearrangement and one-third of all HGBL-DH/TH. These results provide accurate estimation of the proportion of HGBL-DH/TH among tumors with DLBCL morphology and allow determination of the impact of various methods available to screen DLBCL tumors for FISH testing.