Prognostic significance of immunohistochemistry-based markers and algorithms in immunochemotherapy-treated diffuse large B cell lymphoma patients

AimsTo reassess the prognostic validity of immunohistochemical markers and algorithms identified in the CHOP era in immunochemotherapy-treated diffuse large B cell lymphoma patients. Methods and resultsThe prognostic significance of immunohistochemical markers (CD10, Bcl-6, Bcl-2, MUM1, Ki-67, CD5, GCET1, FoxP1, LMO2) and algorithms (Hans, Hans*, Muris, Choi, Choi*, Nyman, Visco-Young, Tally) was assessed using clinical diagnostic blocks taken from an unselected, population-based cohort of 190 patients treated with R-CHOP. Dichotomizing expression, low CD10 (<10%), low LMO2 (<70%) or high Bcl-2 (80%) predicted shorter overall survival (OS; P=0.033, P=0.010 and P=0.008, respectively). High Bcl-2 (80%), low Bcl-6 (<60%), low GCET1 (<20%) or low LMO2 (<70%) predicted shorter progression-free survival (PFS; P=0.001, P=0.048, P=0.045 and P=0.002, respectively). The Hans, Hans* and Muris classifiers predicted OS (P=0.022, P=0.037 and P=0.011) and PFS (P=0.021, P=0.020 and P=0.004). The Choi, Choi* and Tally were associated with PFS (P=0.049, P=0.009 and P=0.023). In multivariate analysis, the International Prognostic Index (IPI) was the only independent predictor of outcome (OS; HR: 2.60, P<0.001 and PFS; HR: 2.91, P<0.001). ConclusionsResults highlight the controversy surrounding immunohistochemistry-based algorithms in the R-CHOP era. The need for more robust markers, applicable to the clinic, for incorporation into improved prognostic systems is emphasized.