Expression and clinical value of programmed cell death-ligand 1(PD-L1)in diffuse large B cell lymphoma:a retrospective study

Background: The programmed cell death-1(PD-1)/programmed cell death-ligand 1(PD-L1) pathway inhibits the activation of T cells and plays a crucial role in the negative regulation of cellular and humoral immune responses.Diffuse large B-cell lymphoma(DLBCL) is the most common lymphoid malignancy in adults. In the present study, we aimed to detect the expression of PD-L1 in DLBCL and to analyze its relationship with prognosis.Methods: We reviewed medical records of 204 newly diagnosed DLBCL patients in Sun Yat-sen University Cancer Center between October 2005 and August 2012. The expression of PD-L1 in tumor tissues from these 204 patients was detected using immunohistochemical(IHC) assay. The expression of anaplastic lymphoma kinase(ALK), CD5,CD30, and C-Myc in tumor specimens from 109 patients was detected using IHC, and Epstein-Barr virus(EBV)-encoded RNAs(EBERs) were detected using fluorescence in situ hybridization. The Spearman method was used for correlation analysis. The Kaplan-Meier method with log-rank test was used for univariate analysis. Cox proportional hazards model was used for multivariate analysis.Results: Of the 204 patients, 100(49.0%) were PD-L1-positive in tumor cells and 44(21.6%) were PD-L1-positive in tumor microenvironment. PD-L1 expression in tumor cells and tumor microenvironment were more common in the non-germinal center B-cell-like(GCB) subtype than in the GCB subtype(P = 0.02 and P= 0.04). Patients with PD-L1 expression in tumor microenvironment were more likely to be resistant to first-line chemotherapy when compared with the patients without PD-L1 expression in tumor microenvironment(P = 0.03). PD-L1 expression in tumor microenvironment was negatively correlated with C-Myc expression(r =-0.20, P = 0.04). No correlations were detected between PD-L1 expression and the expression of ALK, CD5, and CD30 as well as EBERs. The 5-year overall survival(OS)rates were 50.0% and 67.3% in patients with and without PD-L1 expression in tumor cells(P = 0.02). PD-L1 expression in tumor cells was an independent risk predictor for OS(P < 0.01).Conclusions: PD-L1 expression is more common in the non-GCB subtype than in the GCB subtype. PD-L1 expression in tumor microenvironment has a negative correlation with C-Myc. PD-L1 positivity predicts short survival in DLBCL patients. For patients with PD-L1 expression, more strategy such as anti-PD-L1 antibody treatment should be recommended.

Hepatitis B virus reactivation and hepatitis in diffuse large B-cell lymphoma patients with resolved hepatitis B receiving rituximab-containing chemotherapy:risk factors and survival

Introduction:Hepatitis B virus(HBV) reactivation has been reported in B-cell lymphoma patients with resolved hepatitis B(hepatitis B surface antigen[HBsAg]-negative and hepatitis B core antibody[HBcAb]-positive).This study aimed to assess HBV reaaivation and hepatitis occurrence in diffuse large B-cell lymphoma(DLBCL) patients with resolved hepatitis B receiving rituximab-containing chemotherapy compared with HBsAg-negative/HBcAb-negative patients to identify risk factors for HBV reaaivation and hepatitis occurrence and to analyze whether HBV reaaivation and hepatitis affect the survival of DLBCL patients with resolved hepatitis B.Methods:We reviewed the clinical data of 278 patients with DLBCL treated with rituximab-containing therapy between January 2004 and May 2008 at Sun Yat-sen University Cancer Center,China.Prediaive faaors for HBV reaaivation,hepatitis development,and survival were examined by univariate analysis using the chi-square or Fisher's exact test and by multivariate analysis using the Cox regression model.Results:Among the 278 patients,165 were HBsAg-negative.Among these 165 patients,6(10.9%) of 55 HBcAb-positive(resolved HBV infeaion) patients experienced HBV reactivation compared with none(0%) of 110 HBcAb-negative patients(P=0.001).Patients with resolved hepatitis B had a higher hepatitis occurrence rate than HBsAg-negative/HBcAb-negative patients(21.8%vs.8.2%,P = 0.013).HBcAb positivity and elevated baseline alanine aminotransferase(ALT) levels were independent risk factors for hepatitis.Among the 55 patients with resolved hepatitis B,patients with elevated baseline serum ALT or aspartate aminotransferase(AST) levels were more likely to develop hepatitis than those with normal serum ALT or AST levels(P = 0.037,P = 0.005,respeaively).An elevated baseline AST level was an independent risk factor for hepatitis in these patients.Six patients with HBV reactivation recovered after immediate antiviral therapy,and chemotherapy was continued.HBcAb positivity,HBV reactivation,or hepatitis did not negatively affect the survival of DLBCL patients.Conclusions:DLBCL patients with resolved hepatitis B may have a higher risk of developing HBV reaaivation and hepatitis than HBsAg-negative/HBcAb-negative patients.Close monitoring and prompt antiviral therapy are required in these patients.

New risk factors and new tendency for central nervous system relapse in patients with diffuse large B-cell lymphoma:a retrospective study

Background: In patients with difuse large B?cell lymphoma(DLBCL), central nervous system(CNS) relapse is uncom?mon but is nearly always fatal. This study aimed to determine the risk factors for CNS relapse in DLBCL patients and to evaluate the eicacy of rituximab and intrathecal chemotherapy prophylaxis for CNS relapse reduction.Methods: A total of 511 patients with newly diagnosed DLBCL treated at the Sun Yat?sen University Cancer Center between January 2003 and December 2012 were included in the study. Among these patients, 376 received R?CHOP regimen(rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment, and 135 received CHOP regimen(cyclophosphamide, doxorubicin, vincristine, and prednisone) as primary treatment. Intrathe?cal chemotherapy prophylaxis(methotrexate plus cytarabine) was administered to those who were deemed at high risk for CNS relapse. In the entire cohort and in the R?CHOP set in particular, the Kaplan–Meier method coupled with the log?rank test was used for univariate analysis, and the Cox proportional hazards model was used for multivariate analysis. Diferences were evaluated using a two?tailed test, and P < 0.05 was considered signiicant.Results: At a median follow?up of 46 months, 25(4.9%) patients experienced CNS relapse. There was a trend of reduced occurrence of CNS relapse in patients treated with rituximab; the 3?year cumulative CNS relapse rates were 7.1% in CHOP group and 2.7% in R?CHOP group(P = 0.045). Intrathecal chemotherapy prophylaxis did not confer much beneit in terms of preventing CNS relapse. Bone involvement [hazard ratio(HR) = 4.21, 95% conidence interval(CI) 1.38–12.77], renal involvement(HR = 3.85, 95% CI 1.05–14.19), alkaline phosphatase(ALP) >110 U/L(HR = 3.59, 95% CI 1.25–10.34), serum albumin(ALB) <35 g/L(HR = 3.63, 95% CI 1.25–10.51), treatment with rituxi?mab(HR = 0.34, 95% CI 0.12–0.96), and a time to complete remission ≤ 108 days(HR = 0.22, 95% CI 0.06–0.78) were independent predictive factors for CNS relapse in the entire cohort. Bone involvement(HR = 4.44, 95% CI 1.08–18.35), bone marrow involvement(HR = 11.70, 95% CI 2.24–60.99), and renal involvement(HR = 10.83, 95% CI 2.27–51.65) were independent risk factors for CNS relapse in the R?CHOP set.Conclusions: In the present study, rituximab decreased the CNS relapse rate of DLBCL, whereas intrathecal chemo?therapy prophylaxis alone was not suicient for preventing CNS relapse. Serum levels of ALB and ALP, and the time to complete remission were new independent predictive factors for CNS relapse in the patients with DLBCL. In the patients received R?CHOP regimen, a trend of increased CNS relapse was found to be associated with extranodal lesions.

Clinical characteristics of the patients with Hodgkin's lymphoma involving extranodal sites

Differences between Hodgkin's lymphoma (HL) patients in China and Western countries are known to exist, but data on Chinese patients with HL are limited. It is not clear whether there are clinical and histological differences in patients with HL involving different extranodal sites. This is the first study to analyze Chinese patients with HL involving different extranodal sites. We selected 22 HL patients with extranodal involvement from more than 250 previously untreated HL patients. Most patients were young males, and 20 of the 22 patients had stage IV disease. The major pathologic types were nodular sclerosis classical HL (NSCHL) and mixed cellularity classical HL(MCCHL). At diagnosis, the most commonly involved extranodal sites were the liver and lung, followed by the bones. There was no significant association between the international prognostic score(IPS) and survival in patients with different extranodal sites. Our data showed the overall survival (OS) and disease-free survival (DFS) rates of low-risk group (IPS = 0-2) were relatively higher than those of high-risk group (IPS ≥ 3), but the IPS did not show predictive power for survival. Although HL with extranodal involvement is rare, it should be considered as a unique form of HL.

Prognostic values of interim and post-therapy ^(18)F-FDG PET/CT scanning in adult patients with Burkitt's lymphoma

Background:The prognostic values of interim and post-therapy fluorine-18-fluorodeoxyglucose(^(18)F-FDG) positron emission tomography(PET) and PET/computed tomography(CT) scanning have been confirmed in several subtypes of lymphoma.However,its prognostic value in Burkitt's lymphoma has not been clearly defined.The aim of the present study was to assess the prognostic value of PET/CT scanning during different treatment processes of Burkitt's lymphoma.Methods:A total of 29 adult patients with newly diagnosed Burkitt's lymphoma were retrospectively involved in this study;of them,23 patients underwent baseline PET/CT,15 patients underwent mid-therapy PET/CT after 1-4 cycles of chemotherapy,and 17 patients underwent post-therapy PET/CT after all planned first-line chemotherapy cycles.Mid-therapy and post-therapy PET/CT results(positive vs.negative) were visually interpreted according to the criteria of the International Harmonization Project.The reduction in the maximum standardizes uptake values(ASUVmax)of 25%,50%,and 75%were regarded as cutoff points.Overall survival(OS) and progression-free survival(PFS) were regarded as the major endpoints.Results:The median OS and PFS were 27.6 months(range 6.5-78.3 months) and 27.2 months(range 3.0-78.3 months),respectively.The median SUVmax of the baseline PET/CT was 18.3(range 1.6-35.9),whereas the median SUVmax of the mid-therapy and post-therapy PET/CT decreased to 4.0(range 0-17.6) and 3.0(range 0-14.5),respectively.The patients' Eastern Cooperative Oncology Group(ECOG) scores(<2 vs.≥2) were significantly associated with the baseline PET/CT SUVmax.The mid-therapy and post-therapy PET/CT results(positive vs.negative) showed no significant association with OS or PFS.The optimal cutoff ASUVmax from the baseline to the post-therapy PET/CT that could predict a change in OS in patients with Burkitt's lymphoma was 50%(P = 0.019).Conclusions:^(18)F-FDG uptake was intense in Burkitt's lymphoma,and there was a significant reduction in SUVmax during the interim and post-therapy PET/CT procedures.A ASUVmax of greater than 50%was a favorable cutoff point to predict the OS of Burkitt's lymphoma patients.

细胞程序性死亡配体-1(PD-L1)在弥漫大B细胞淋巴瘤中的表达及临床价值的回顾性研究

背景与目的细胞程序性死亡受体-1(programmed cell death-1,PD-1)/细胞程序性死亡配体-1(programmed cell death-ligand 1,PD-L1)通路会抑制T细胞的活化,在细胞和体液免疫应答的负调控中起关键作用。弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)是成年人中最为常见的淋巴样恶性肿瘤,本研究旨在检测DLBCL中PD-L1的表达,并分析其与预后的关系。方法回顾分析2005年10月至2012年8月204例在中山大学肿瘤防治中心新诊断为DLBCL的患者病历资料,采用免疫组织化学(immunohistochemical,IHC)法检测204例患者肿瘤组织中PD-L1的表达。应用IHC检测109例患者肿瘤组织中的间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)、CD5、CD30和C-Myc的表达,应用荧光原位杂交技术检测EB病毒(Epstein-Barr virus,EBV)编码RNAs(EBV-encoded RNAs,EBERs)的表达。应用Spearman方法进行相关分析,采用具有对数秩检验的Kaplan-Meier法进行单因素分析,采用Cox比例风险模型进行多因素分析。结果在选取的204例患者中,100例(49.0%)患者肿瘤细胞中PD-L1呈阳性,44例(21.6%)患者肿瘤微环境中PD-L1呈阳性。与生发中心B细胞样(germinal center B-cell-like,GCB)亚型相比,肿瘤细胞和肿瘤微环境中表达PD-L1在非生发中心B细胞样亚型中更为常见(P=0.02和P=0.04)。与肿瘤微环境中不表达PD-L1的患者相比,肿瘤微环境中PD-L1表达的患者更容易对一线化疗产生耐药性(P=0.03)。肿瘤微环境中PD-L1表达与C-Myc表达呈负相关(r=-0.20,P=0.04),而PD-L1表达与ALK、CD5、CD30和EBERs的表达无相关性。此外,肿瘤细胞中有PD-L1表达和无PD-L1表达的患者的5年总生存期(overall survival,OS)分别为50.0%和67.3%(P=0.02)。肿瘤细胞中的PD-L1表达是OS的独立风险预测因素(P<0.01)。结论PD-L1在非GCB亚型中的表达比在GCB亚型中更常见。肿瘤微环境中PD-L1的表达与C-Myc的表达呈负相关。PD-L1阳性预示DLBCL患者生存期短。因此对于PD-L1表达的患者,应推荐更多的治疗策略,如抗PD-L1抗体治疗。