t（14；18）和myc基因重排双阳性弥漫性大B细胞淋巴瘤的临床特征和预后  

Clinical characteristics and prognosis of concurrent positive t （14;18） and myc gene rearrangement in diffuse large B cell lymphoma

作　　者：张宏伟[1] 陈振文[2] 王列样[1] 贺建霞[1] 郑玉萍[1] 韩维娥[1] 杨斌[1] 王艳丽[1] 赵志强[1] 白敏[1] 苏丽萍[1] 

机构地区：[1]山西省肿瘤医院血液科,太原030013 [2]山西医科大学汾阳学院病理教研室,汾阳032200

出　　处：《中华肿瘤杂志》2016年第3期206-210,共5页Chinese Journal of Oncology

摘　　要：目的探讨弥漫性大B细胞淋巴瘤（DLBCL）中t（14；18）、myc基因重排的发生情况以及t（14；18）、myc基因重排双阳性的二次打击淋巴瘤（DHL）的临床特征和预后。方法采用荧光原位杂交技术检测106例DLBCL患者肿瘤组织中t（14；18）和myc基因重排的发生情况，采用免疫组化染色检测myc蛋白和bcl-2蛋白的表达情况，分析t（14；18）、myc基因重排双阳性DHL的临床特征和预后以及影响DLBCL患者预后的因素。结果106例DLBCL患者中，t（14；18）阳性27例（25．5％），myc基因重排阳性13例（12．3％），DHL7例。t（14；18）与myc基因重排相关（P=0．019）。7例DHL患者的发病年龄为52-84岁，2例患者的国际预后指数（IPI）评分为3分，4例为4分，1例为5分；美国东部肿瘤协作组（ECOG）评分均为3分；4例患者发病时累及骨髓，合并白血病。7例DHL患者的生存时间为0．5～6个月，中位生存时间为4个月。单因素分析结果显示，有无B症状、AnnArbor分期、ECOG评分、血清乳酸脱氢酶水平、IPI评分、免疫分型、bcl-2蛋白表达、myc蛋白表达、myc基因重排与DLBCL患者的预后有关（均P〈0．05）。多因素分析结果显示，ECOG评分、bcl-2蛋白表达、myc蛋白表达、myc基因重排以及免疫分型均为影响DLBCL患者预后的独立因素（均P〈0．05），其中myc基因重排的预测意义最强（OR=4．337，P〈0．001）。结论DHL的发病率较低，其诊断主要根据基因检测，t（14；18）与myc基因重排可能协同导致其发病；DHL具有明显的侵袭性，预后较差。Objective To study the incidence of positive t（14;18） and myc gene rearrangement, and the clinical features and prognosis of concurrent positive t （14; 18） and myc gene rearrangement ＂double-hit lymphoma＂ （DHL） in diffuse large B cell lymphoma. Methods The positive t （14; 18） and myc gene rearrangement in 106 cases of DLBCL were analyzed using interphase fluorescent in situ hybridization （FISH） technique. The expression of mye and bcl-2 proteins was determined by immunohistochemistry. The relationship of positive t （14; 18） and mye gene rearrangement with clinical features, pathogenesis and prognosis for the patients was analyzed. SPSS 16.0 software was used for statistical analysis. Results Among the 106 cases, there were 27 （25.5%） eases with positive t（14;18） and 13 （12.3%） cases with myc gene rearrangement, and 7 cases （6.6%） of DLBCL with concurrent t（ 14; 18） -positive and myc gene rearrangement. A relationship was observed between positive t （14; 18） and myc gene rearrangement （P= 0.019）. The follow-up data showed that the 7 DHL patients were in age of 52-84 years, the International Prognostic Index （IPI） scores were 3 in two cases, 4 in four cases and 5 in one case, and the ECOG scores were 3 in all the 7 cases. Four patients had bone marrow involvement and were combined with leukemia. The survival time ranged from O. 5 to 6 months, with a median survival of 4 months. The univariate analysis showed that B symptom, Ann Arbor stage, ECOG score, LDH level, IPI score, immunophenotype, bcl-2 protein expression, mye protein expression, and myc gene rearrangement were all associated with poor prognosis （P〈0.05 for all）. The multivariate analysis using a COX proportional hazard model confirmed that ECOG score, bcl-2 protein expression, myc protein expression, myc gene rearrangement, and immunophenotype were independent prognostic factors affecting survival （P〈0. 05 for all）, among them, the myc gene rearrangement was the strongest prognostic

关 键 词：淋巴瘤 t(14 18) myc重排 DHL 预后 

分 类 号：R733.1[医药卫生—肿瘤]