166例双表达弥漫大B细胞淋巴瘤临床特征与预后分析

OBJECTIVE: To investigate the clinical features and prognosis of MYC/BCL2 double-expression diffuse large B-cell lymphoma（DEL）. METHODS: The clinical data, including clinical characteristics, survival, and prognostic factors, of 166 patients with DEL treated at Peking University Third Hospital from January 2016 to December 2020 were retrospectively analyzed. RESULTS: A total of 410 patients with diffuse large B-cell lymphoma were collected, including 166 cases（40.5％）of DEL. There were 82 males and 84 females with a median age of 63.5（21–95）years at diagnosis. A total of 110 patients（66.3％）were aged over 60 years at initial diagnosis, 106 patients（106/163, 65.0％）had elevated lactate dehydrogenase（LDH）at diagnosis, 74 patients（74/160, 46.2％）had β(2) microglobulin level over 3 mg/L at diagnosis, and 107 patients（107/163, 65.6％）had≥2 extranodal involvement. Sixty-five patients（65/166, 39.2％）had B symptoms, 131 patients（131/165, 79.4％）had stage Ⅲ and Ⅳ disease at initial diagnosis, 41 patients（41/161, 25.5％）had an International Prognostic Index（IPI）score of 0–2 at initial diagnosis, and 38 patients（38/161, 23.6％）had an IPI score of 3 at initial diagnosis. Eighty-two patients（82/161, 50.9％）had an IPI score of 4–5 at initial diagnosis. Nine（9/56, 16.1％）patients with DEL had MYD88 and CD79B mutations. Univariate analysis showed that age over 60 years（P＝0.004）, increased β(2) microglobulin level（P＝0.002）, and high IPI score（P＝0.003）were associated with poor overall survival（OS）. Increased β(2) microglobulin level（P＝0.031）, LDH level（P＝0.017）, stage Ⅲ–Ⅳ（P＝0.001）, high IPI score（P＝0.013）, immunohistochemical p53 mutation（P＝0.049）, and PIM1 mutation（P＝0.039）were associated with poor progression-free survival（PFS）. Multivariate analysis showed that IPI score of 4–5 was an independent risk factor for the prognosis of DEL（HR＝2.622, 95％ CI 1.398–4.917, P＝0.003）. Survival analysis showed that there was a significant difference in the PFS between patients with DEL and those without DEL（65.6％ vs 75.1％, P＝0.002）. However, there was no significant difference in the OS（81.8％ vs 83.6％, P＝0.226）. In patients with DEL, the overall response rate of R-EPOCH regimen was higher than that of RCHOP or RCHOP-like regimen（81.5％ vs 63.4％, P＝0.004）. CONCLUSION: DEL is a group of aggressive lymphomas with relatively poor PFS. The R-EPOCH regimen may improve the overall prognosis of patients.