• Shimin Hu, Zijun Y Xu-Monette, Alexander Tzankov, Tina Green, Lin Wu, Aarthi Balasubramanyam, Wei-min Liu, Carlo Visco, Yong Li, Roberto N Miranda, Santiago Montes-Moreno, Karen Dybkaer, April Chiu, Attilio Orazi, Youli Zu, Govind Bhagat, Kristy L Richards, Eric D Hsi, William W L Choi, Xiaoying Zhao, van KriekenJ HanJH, Qin Huang, Jooryung Huh, Weiyun Ai, Maurilio Ponzoni, Andrés J M Ferreri, Fan Zhou, Graham W Slack, Randy D Gascoyne, Meifeng Tu, Daina Variakojis, Weina Chen, Ronald S Go, Miguel A Piris, Michael B Møller, L Jeffrey Medeiros, and Ken H Young.
• Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
• Blood. 2013 May 16; 121 (20): 4021-31; quiz 4250.

AbstractDiffuse large B-cell lymphoma (DLBCL) is stratified into prognostically favorable germinal center B-cell (GCB)-like and unfavorable activated B-cell (ABC)-like subtypes based on gene expression signatures. In this study, we analyzed 893 de novo DLBCL patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). We show that MYC/BCL2 protein coexpression occurred significantly more commonly in the ABC subtype. Patients with the ABC or GCB subtype of DLBCL had similar prognoses with MYC/BCL2 coexpression and without MYC/BCL2 coexpression. Consistent with the notion that the prognostic difference between the 2 subtypes is attributable to MYC/BCL2 coexpression, there is no difference in gene expression signatures between the 2 subtypes in the absence of MYC/BCL2 coexpression. DLBCL with MYC/BCL2 coexpression demonstrated a signature of marked downregulation of genes encoding extracellular matrix proteins, those involving matrix deposition/remodeling and cell adhesion, and upregulation of proliferation-associated genes. We conclude that MYC/BCL2 coexpression in DLBCL is associated with an aggressive clinical course, is more common in the ABC subtype, and contributes to the overall inferior prognosis of patients with ABC-DLBCL. In conclusion, the data suggest that MYC/BCL2 coexpression, rather than cell-of-origin classification, is a better predictor of prognosis in patients with DLBCL treated with R-CHOP.

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