title: Immunohistochemical expression of CD23 and CD40 may identify prognostically favorable subgroups of diffuse large B-cell lymphoma: a Nordic Lymphoma Group Study.
abstract: OBJECTIVE
  In search for subgroups of diffuse large B-cell lymphoma (DLBCL) with different histogenetic origin and prognosis, as has been described by gene expression profiling, we examined tumor specimens from 125 patients with DLBCL, uniformly treated by either cyclophosphamideAdriamycin-vincristine-prednisone or methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin in a multicenter trial set by the Nordic Lymphoma Group 1989-1994.
  
  
  METHODS
  Bcl-6, CD10, and CD40 were chosen as markers for a germinal center phenotype, CD23 as a marker of pre/early germinal center origin, and CD138 as a marker for postgerminal center origin. In addition, expression of the apoptotic regulators bcl-2 and bax was analyzed. Immunohistochemical analysis was performed using the EnVision method.
  
  
  RESULTS
  CD10 was positive in 51%, bcl-6 in 97%, and CD138 only in 2% of the cases. No prognostic conclusions could be drawn from analysis of these factors. CD40 was positive in 76% of the cases. This group was associated with superior time to treatment failure (P = 0.027) and overall survival (OS; P = 0.0068). By Cox regression analysis, positivity for CD40 was shown to be a prognostic factor for OS, independent of International Prognostic Index. CD23 was positive in 16% of the cases (all CD5 negative and all CD40 positive). This group showed a strong tendency for better OS (P = 0.033). CD40 expression correlated with bax but not with bcl-2 expression.
  
  
  CONCLUSIONS
  CD23 and CD40 expression seems to be prognostically favorable in DLBCL. This may be secondary to a germinal center origin or attributable to increased apoptosis via induction of bax and/or enhanced T-cell interaction, resulting in improved autologous tumor response. Confirmatory studies are necessary.
authors.affiliation: Department of Oncology, Lund University Hospital, 221 85 Lund, Sweden. johan.linderoth@onk.lu.se
authors.forename: Johan
authors.initials: J
authors.lastname: Linderoth
authors.forename: Mats
authors.initials: M
authors.lastname: Jerkeman
authors.forename: Eva
authors.initials: E
authors.lastname: Cavallin-Ståhl
authors.forename: Stein
authors.initials: S
authors.lastname: Kvaløy
authors.forename: Emina
authors.initials: E
authors.lastname: Torlakovic
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D019013:CD40 Antigens / Q000097:blood*; D018572:Disease-Free Survival; D000939:Epitopes / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D016393:Lymphoma, B-Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D008562:Membrane Glycoproteins / Q000097:blood; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011509:Proteoglycans / Q000097:blood; D017455:Receptors, IgE / Q000097:blood*; D012189:Retrospective Studies; D016019:Survival Analysis; D053668:Syndecan-1; D053667:Syndecans
chemical_list: D015703:Antigens, CD; D014408:Biomarkers, Tumor; D019013:CD40 Antigens; D000939:Epitopes; D008562:Membrane Glycoproteins; D011509:Proteoglycans; D017455:Receptors, IgE; C508241:SDC1 protein, human; D053668:Syndecan-1; D053667:Syndecans