Prognostic impact of MYD88 mutation, proliferative index and cell origin in diffuse large B cell lymphoma

Abstract

BackgroundDiffuse large B-cell lymphoma, among non-Hodgkin lymphomas, is one of the most frequent subtypes. Clinical laboratory data and post-treatment outcomes are scarce in the Brazilian population.ObjectiveThe main objective of this retrospective study was to assess the impact of tumor markers, including the Myeloid differentiation primary response 88 (MYD88) mutation.MethodEighty-three patients were included and treated with R-CHOP or R-CHOP-like regimens.ResultsMedian age was 64-years old and 58% were female patients. The median follow-up was 42 months. The progression free survival (PFS) at this time was 63% and overall survival (OS), 66%. In the patients with tumors expressing Myc proto-oncogene protein (MYC) and B-cell lymphoma 2 (BCL2), assessed by immunohistochemistry (IHC), known as dual protein expressers, median post-progression survival was 31 (15–45) months. An increased proliferative index were associated with a high rate of progression (hazard ratio 2.31 [95% confidence interval [1.05–5.12]; p = 0.04). The cell of origin (COO), identified by IHC, was not able to predict PFS (p = 0.76). The MYD88 L265P mutation was present in 10.8% (9/83) of patients and did not show a prognostic correlation.ConclusionIn conclusion, the MYD88 mutation, although an important tool for diagnosis and a possible target drug, presented at a low frequency and was not a prognostic marker in this population.

The Incidence and Treatment Response of Double Expression of MYC and BCL2 in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis

“…IHC interpretation was performed by hematopathologists or other pathologists nearly three-quarters of the time (30/41, 73.2%). In brief, the study design was prospective in one study [59], retrospective in 22 [3,32,33,36,[38][39][40]42,[44][45][46][47][49][50][51]54,60,61,63,66,67,69], secondary analysis of primary clinical trials in six [37,41,48,53,57,58], and not-explained in 12 [19][20][21]34,35,43,52,55,56,62,65,68]. The number of patients per study ranged from 20 to 688, with median ages of 46-70 years.…”

“…Regarding cutoff values for MYC and BCL2 protein expression, 21 studies used >40% and >50% [20,[33][34][35]38,39,[41][42][43][44][45]47,49,[56][57][58]60,[62][63][64]69], 10 studies used >40% and >70% [3,19,48,50,51,53,54,[66][67][68], and two studies used >30% and >30% [55,65]. Six studies used other various criteria to define MYC and BCL2 protein expression [21,36,40,46,52,61]. Among the included studies, five evaluated only extra-nodal DLBCL (gastrointestinal, colorectal, and primary bone DLBCL) [38,44,55,59,65].…”