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. 2014 Dec;30(4):269-74.
doi: 10.1007/s12288-014-0346-8. Epub 2014 Apr 2.

Switching to BCL-6 Negativity in Relapsed Diffuse Large B Cell Lymphoma Correlated with More Aggressive Disease Course

Milena Todorović  1 , Bela Balint  2 , Bosko Andjelic  3 , Ziv Radisavljevic  4 , Biljana Mihaljevic  1
Affiliations

Switching to BCL-6 Negativity in Relapsed Diffuse Large B Cell Lymphoma Correlated with More Aggressive Disease Course

Milena Todorović et al. Indian J Hematol Blood Transfus. 2014 Dec.

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most frequent, complex and heterogeneous lymphoma of adulthood. Heterogeneity is expressed at clinical, genetic, and molecular levels. It is known that BCL-6 expression is a favorable prognostic factor in DLBCL. However, the underlying mechanisms of BCL-6 expression in DLBCL relapse are not yet elucidated. Here, we present so far undescribed clinical phenomenon of switching BCL-6(+) protein expression into BCL-6(-) expression in 19 of 41 relapsed DLBCL patients. The switch in relapsed DLBCL was associated with more aggressive clinical course of the disease. Bone marrow infiltration and high IPI risk were more often present in BCL-6(-) patients. Significantly increased biochemical parameters, such as LDH, beta-2 macroglobulin, CRP, and ferritin have been found, as well as significantly decreased serum Fe, TIBC, and hemoglobin. A Ki-67 proliferation marker was considerably high in relapsed DLBCL, but without significant differences between BCL-6(+) and BCL-6(-) groups of patients. Thus, switching of the positive into negative BCL-6 expression during DLBCL relapse could be used as a prognostic factor and a valuable criterion for treatment decision.

Keywords: BCL6 switching; DLBCL; Prognosis; Relapse.

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Figures

Fig. 1
Fig. 1
The immunohistochemical staining for BCL-6 expression in tumor tissue. a Positive; b negative
Fig. 2
Fig. 2
Biochemical changes in relapsed DLBCL. a Levels of the LDH; b levels of the CRP and beta 2 microglobulin of BCL-6+ and switched into BCL-6− patients in relapsed DLBCL
Fig. 3
Fig. 3
Markers of relapsed DLBCL. a Levels of the ferritin, b levels of the Fe and TIBC of BCL-6+ and switched into BCL-6− patients in relapsed DLBCL
Fig. 4
Fig. 4
Parameters of the anemia and tumor lysis syndrome. a Levels of the uric acid; b levels of the hemoglobin, MCV, and hematocrit (Ht) of BCL-6+ and switched into BCL-6− patients in relapsed DLBCL
Fig. 5
Fig. 5
Survival functions according to BCL-6 status in relapse. a Time to first relapse after the initial diagnosis (TTR1); b event free survival after the first relapse (EFSr); c overall survival since the first diagnosis (OS)
See this image and copyright information in PMC

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