Document Detail

Poor outcome in patients with diffuse large B-cell lymphoma is associated with high percentage of bcl-2 and Ki 67-positive tumor cells.
MedLine Citation:
PMID:  19877554     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIM: Newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) tretaed with immunochemotherapy have durable remission and improved overall survival. It is important to identify high risk patients who may benefit from even more effective therapies. METHODS: In a group of 50 newly diagnosed patients with DLBCL, treated with CHOP/R-CHOP (cyclophosphemide doxorubicine, vincristine, prednisone with or without rituximab) regimen, we analyzed the prognostic value of the expression of Ki67 and bcl-2 at diagnosis as well as other standard clinical parameters: International Prognostic Index (IPI), bulky disease, extranodal distribution and lactat dehydrogenase (LDH). Significance was tested according to response rate and overall survival. RESULTS: Univariate survival analysis showed that high IPI had a statistically significant negative influence on overall and event free survival time (log rank, p < 0.01). The log rank test analysis signified that patients with a high proliferative fraction (Ki-67 > 60%) had a worse overall survival rate (OS5y) of 40% compared to those with low proliferation (Ki-67 < 60%) with OS5y of 80% (p < 0.01). There was a clear difference between bcl-2 positivity (treshold 50%) and the achievement of complete remission (66% vs 86% in patients with bcl-2 high and low levels respectively, p < 0.05). In survival analysis, patients with low bcl-2 expression had significantly higher OS5y - 68% compared to those with high bcl-2+ with OS5y 37% (p < 0.05). Multivariate analysis performed by Cox model revealed that IPI > 3, high Ki-67+, bcl-2 positivity had a significant independent prognostic value concerning overall survival (p < 0.05). CONCLUSION: An initial high IPI score associated with high Ki-67+ and bcl2+ could represent possible predictive factors of poor prognosis, which would help to identify a high risk subgroup of newly diagnosed DLBCL.
Maja Perunicić Jovanović; Ljubomir Jaković; Andrija Bogdanović; Olivera Marković; Vesna Cemerikić Martinović; Biljana Mihaljević
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Vojnosanitetski pregled. Military-medical and pharmaceutical review     Volume:  66     ISSN:  0042-8450     ISO Abbreviation:  Vojnosanit Pregl     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  21530700R     Medline TA:  Vojnosanit Pregl     Country:  Serbia    
Other Details:
Languages:  eng     Pagination:  738-43     Citation Subset:  IM    
Clinical Center of Serbia, Institute of Hematology, Belgrade, Serbia. pet.maj@sezampro.yu
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MeSH Terms
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Cyclophosphamide / therapeutic use
Doxorubicin / therapeutic use
Ki-67 Antigen / analysis*
Lymphoma, Large B-Cell, Diffuse / chemistry*,  drug therapy,  mortality
Middle Aged
Prednisone / therapeutic use
Proto-Oncogene Proteins c-bcl-2 / analysis*
Survival Rate
Tumor Markers, Biological / analysis
Vincristine / therapeutic use
Young Adult
Reg. No./Substance:
0/CHOP protocol; 0/Ki-67 Antigen; 0/Proto-Oncogene Proteins c-bcl-2; 0/Tumor Markers, Biological; 23214-92-8/Doxorubicin; 50-18-0/Cyclophosphamide; 53-03-2/Prednisone; 57-22-7/Vincristine

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