Adding MYC/BCL2 double expression to NCCN-IPI may not improve prognostic value to an acceptable level
Issued Date
2024-12-01
Resource Type
ISSN
2287979X
eISSN
22880011
Scopus ID
2-s2.0-85190807732
Journal Title
Blood Research
Volume
59
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Blood Research Vol.59 No.1 (2024)
Suggested Citation
Warnnissorn N., Kanitsap N., Niparuck P., Boonsakan P., Kulalert P., Limvorapitak W., Bhoopat L., Saengboon S., Suriyonplengsaeng C., Chantrathammachart P., Puavilai T., Chuncharunee S. Adding MYC/BCL2 double expression to NCCN-IPI may not improve prognostic value to an acceptable level. Blood Research Vol.59 No.1 (2024). doi:10.1007/s44313-024-00006-w Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98121
Title
Adding MYC/BCL2 double expression to NCCN-IPI may not improve prognostic value to an acceptable level
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Abstract
Background: MYC/BCL2 double expression (DE) is associated with poor prognosis in patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). This study aimed to determine whether the addition of DE to the National Comprehensive Cancer Network Internal Prognostic Index (NCCN-IPI) could improve the prediction of disease progression in patients with DLBCL treated with R-CHOP. Methods: This confirmatory prognostic factor study retrospectively recruited patients with newly diagnosed DLBCL between January 1, 2014, and January 31, 2018, at Ramathibodi Hospital (RA) and Thammasat University Hospital (TU). The follow-up period ended on July 1, 2022. Tumors expressing MYC ≥ 40% and BCL2 ≥ 50% were classified as DE. We calculated the hazard ratios (HR) for progression-free survival (PFS) from the date of diagnosis to refractory disease, relapse, or death. Discrimination of the 5-year prediction was based on Cox models using Harrell’s concordance index (c-index). Results: A total of 111 patients had DE (39%), NCCN-IPI (8%), and disease progression (46%). The NCCN-IPI adjusted HR of DE was 1.6 (95% confidence interval [CI]: 0.9–2.8; P = 0.117). The baseline NCCN-IPI c-index was 0.63. Adding DE to the NCCN-IPI slightly increased Harrell’s concordance index (c-index) to 0.66 (P = 0.119). Conclusions: Adding DE to the NCCN-IPI may not improve the prognostic value to an acceptable level in resource-limited settings. Multiple independent confirmatory studies from a large cohort of lymphoma registries have provided additional evidence for the clinical utility of DE.