To Investigate The Clinical Features Of B-cell Lymphoma Patients With Abnormal Expression Of MYC,BCL-2 And/or BCL-6

Objectives:The clinical features,treatment,and outcome of B-cell lymphomas with abnormal expression of MYC,BCL-2,and/or BCL6 were preliminary analyzed.Methods:The clinical data of 10 patients with DLBCL with MYC,BCL-2,and/or BCL-6 protein abnormalities diagnosed from the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2017 were retrospectively analyzed.Results:1.Clinical features:1.1 Lymph node enlargement and extranodal involvement:In 10 patients,the majority of lymph nodes were involved,and it was easy to invade the extranodal tissues.Among them,there were 9 cases of lymphadenopathy.Extranodal involvement included:abdominal pelvic masses.In 6 cases,bone marrow involvement in 3 cases,central nervous system invasion in 3 cases,liver involvement in 2 cases,spleen involvement in 2 cases,other affected sites:thyroid,lung,pleura,lumbar spine,digestive tract,pancreas,adrenal gland,uterus,and vagina in each case 1.2 lactate dehydrogenase:higher than normal in 8 cases(247?1545 U/L);1.3 Ann Arbor stage:all belong to ??? period,including ? stage 7 cases,? stage 3 cases,including ? E phase 1 case;1.4 IPI score:2 to 4 points,including 4 points in 7 cases,3 points in 2 cases,and 2 points in 1 case.2.Pathological findings:2.1 Immunohistochemical phenotypic classification:Non-GCB subtypes in 6 cases,all non-HGBL,GCB subtypes in 4 cases,including 3 cases of HGBL,1 case of non-HGBL;2.2 proliferation index of tumor cells:Ki-67 index80%;2.3 characteristic immunophenotype:MYC,BCL-2 and/or BCL-6 protein expression.3.Molecular biology:Fluorescence in situ hybridization detection:MYC+/BCL-6+ gene rearrangement in 2 cases,MYC+/BCL-2+ gene rearrangement in 1 case.4.Treatment and outcome:4.1 Treatment options:4.1.1 One of the 7 non-HGBL patients was not treated,2 patients were treated with CHOP,and the other 4 patients were treated with R-CHOP protocol;4.1.2 3 patients with HGBL were treated with DA-EPOCH-R protocol;4.2 outcome:median follow-up time was 6 months(from April to September).4 course of chemotherapy assessment,9 patients were evaluated:CR(3 cases),PR(5 cases),PD(1 case);6 courses of chemotherapy assessment,5 patients were evaluated:CR(3 cases),PR(1 case),PD after PR(1 case).Ten patients except one patient were lost to follow-up,and the remaining patients all survived.Conclusions:1.DLBCL with MYC,BCL-2 and/or BCL-6 protein expression is clinically invasive,easy extranodal invasion,late stage,high IPI score,and HGBL is more aggressive,especially in bone marrow,central nervous system And LDH was significantly higher than normal and the prognosis was worse.2.HGBL patients were all GCB subtypes,but non-HGBL patients were mostly Non-GCB subtypes.3.The Ki-67 index of such lymphomas is high(?80%).4.When DLBCL with abnormal expression of MYC,BCL-2 and/or BCL-6 protein,FISH can be used to detect the rearrangement of MYC,BCL-2 and/or BCL-6 gene,to clarify the diagnosis of HGBL and to guide stratified treatment.