Prognostic Value of Concurrent Expression of C‐MYC and BCL2 in Intravascular Large B‐Cell Lymphoma: A 10‐Year Retrospective Study
Paisarn Boonsakan, Wimolsiri Iamsumang, Pichika Chantrathammachart, Pamela Chayavichitsilp, Poonkiat Suchonwanit, Suthinee Rutnin
Abstract
Background . Intravascular large B‐cell lymphoma (IVLBCL) is a variant of extranodal diffuse large B‐cell lymphoma (DLBCL), characterized by the presence of a B‐lymphoma cell in the lumina of small blood vessels or capillaries. Due to its extremely variable clinical manifestations, IVLBCL typically results in a delayed diagnosis and poor disease prognosis. Skin biopsy, particularly random skin biopsy, has shown a potential role in the diagnosis of IVLBCL. However, information of clinicopathological features in patients with IVLBCL diagnosed by skin biopsy is limited. Objectives . To study the clinicopathological features in relation to immunohistochemical features and to identify prognostic factors in IVLBCL patients diagnosed by skin biopsy. Materials and Methods . Clinical characteristics; laboratory, histological, and immunohistochemical findings; and therapeutic response of all biopsy‐confirmed IVLBCL patients during the years 2008‐2017 were retrospectively reviewed. Results . The mean age was 67.4 (±9.8) years. Fever was the most common presenting symptom, accounting for 64.7%. Cutaneous and bone marrow involvement was found in 23.5% and 35.3% of patients, respectively. Patients receiving R‐CHOP showed more favorable therapeutic outcome. C‐MYC/BCL2 double expressors showed significantly higher incidence rate to mortality compared with nondouble expressors ( p = 0.042). One‐year and two‐year overall survival rates were 67.2% and 53.8%, respectively. Conclusions . Skin biopsy is an effective diagnostic method for IVLBCL. Concurrent expression of C‐MYC and BCL2 may be a useful prognostic indicator and should be performed in order to predict the prognosis in IVLBCL patients.