Rearrangement of the bcl-6 gene as a prognostic marker in diffuse large-cell lymphoma.

Rearrangement of the bcl-6 gene as a prognostic marker in diffuse large-cell lymphoma.
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bcl-6 基因重排作为弥漫性大细胞淋巴瘤的预后标志物。

DOI:
10.1056/nejm199407143310202
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发表时间:
1994
期刊:
The New England journal of medicine
影响因子:
--
通讯作者:
Rosenbaum,A
Rosenbaum,A
中科院分区:
--
文献类型:
--
作者:
Offit,K;LoCoco,F;Louie,DC;Parsa,NZ;Leung,D;Portlock,C;Ye,BH;Lista,F;Filippa,DA;Rosenbaum,A

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背景大约 40% 的非霍奇金淋巴瘤是具有大细胞成分 (DLLC) 的弥漫性淋巴瘤。目前的治疗可以使一半的 DLLC 患者得到长期缓解,但更强化的治疗有可能改善预后,特别是对于治疗失败高风险的患者。临床和细胞遗传学标记可以识别高风险或低风险的亚组。一种新的候选原癌基因 bcl-6 的重排是 DLLC 的一个可能的预后指标。方法我们进行了 Southern blot 杂交,以检测 102 名 B 细胞 DLLC 患者的淋巴瘤样本中的 bcl-6 和 bcl-2 基因重排。结果与患者的组织学特征、年龄、疾病分期、肿瘤部位和病变体积、血清乳酸脱氢酶水平以及治疗结果相关。结果重排bcl-6 23例,重排bcl-2 21例。 19 名 bcl-6 重排患者患有结外 DLLC,两名患有原发性脾淋巴瘤,只有一名患有骨髓受累。诊断后 36 个月,bcl-6 重排患者中疾病无进展的比例预计为 82%(95% 置信区间,66% 至 98%),而胚系 bcl-6 和 bcl-2 患者的无疾病进展比例为 56%(95% 置信区间,43% 至 70%),而生殖系 bcl-6 和 bcl-2 患者的无疾病进展比例为 31%(95% 置信区间,8% 至 53%)。重新排列 bcl-2。 bcl-6 基因的状态是多变量模型中生存和无疾病进展的独立预后标志物,并为已确定的预后标志增加了预测价值。结论 bcl-6 基因的重排与 DLLC 的良好临床结果相关,因此可以作为这种形式的恶性淋巴瘤患者的预后标志物。
BackgroundAbout 40 percent of non-Hodgkin's lymphomas are diffuse lymphomas with a large-cell component (DLLC). Current therapy can induce a long-term remission in half the patients with DLLC, but more intensive treatment has the potential to improve outcome, particularly in patients at high risk for treatment failure. Clinical and cytogenetic markers can identify subgroups at high or low risk. Rearrangement of a novel candidate proto-oncogene, bcl-6, is a possible prognostic indicator in DLLC.MethodsWe performed Southern blot hybridization to detect bcl-6 and bcl-2 gene rearrangement in samples of lymphoma from 102 patients with B-cell DLLC. The results were correlated with the patients' histologic features, age, disease stage, tumor sites and bulk of disease, serum lactate dehydrogenase level, and treatment outcome.ResultsRearranged bcl-6 was found in 23 cases, and rearranged bcl-2 in 21 cases. Nineteen of the patients with rearranged bcl-6 had extranodal DLLC, two had primary splenic lymphomas, and only one had bone marrow involvement. Thirty-six months after diagnosis, the proportion with freedom from progression of disease was projected to be 82 percent (95 percent confidence interval, 66 to 98 percent) among the patients with rearranged bcl-6, as compared with 56 percent (95 percent confidence interval, 43 to 70 percent) for the patients with germ-line bcl-6 and bcl-2 and 31 percent (95 percent confidence interval, 8 to 53 percent) for the patients with rearranged bcl-2. The status of the bcl-6 gene was an independent prognostic marker of survival and freedom from disease progression in a multivariate model and added predictive value to established prognostic signs.ConclusionsRearrangement of the bcl-6 gene correlated with a favorable clinical outcome in DLLC and may thus serve as a prognostic marker in patients with this form of malignant lymphoma.
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DOI: --
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