title: Prognostic impact of C-REL expression in diffuse large B-cell lymphoma.
abstract: Diffuse large B-cell lymphoma (DLBCL) with a germinal center B-cell (GCB) phenotype is believed to confer a better prognosis than DLBCL with an activated B-cell (ABC) phenotype. Previous studies have suggested that nuclear factor-kappaB (NF-kappaB) activation plays an important role in the ABC subtype of DLBCL, whereas c-REL amplification is associated with the GCB subtype. Using immunohistochemical techniques, we examined 68 newly diagnosed de novo DLBCL cases (median follow-up 44 months, range 1 to 142 months) for the expression of c-REL, BCL-6, CD10, and MUM1/IRF4. Forty-four (65%) cases demonstrated positive c-REL nuclear expression. In this cohort of patients, the GCB phenotype was associated with a better overall survival (OS) than the non-GCB phenotype (Kaplan-Meier survival (KMS) analysis, p = 0.016, Breslow-Gehan-Wilcoxon test). In general, c-REL nuclear expression did not correlate with GCB vs. non-GCB phenotype, International Prognostic Index score, or OS. However, cases with a GCB phenotype and negative nuclear c-REL demonstrated better OS than cases with a GCB phenotype and positive nuclear c-REL (KMS analysis, p = 0.045, Breslow-Gehan-Wilcoxon test), whereas in cases with non-GCB phenotype, the expression of c-REL did not significantly impact the prognosis. These results suggest that c-REL nuclear expression may be a prognostic factor in DLBCL and it may improve patient risk stratification in combination with GCB/non-GCB phenotyping.
authors: Pathology, The Methodist Hospital Research Institute, The Methodist Hospital, 6565 Fannin St MS-205, Houston, TX, 77030, USA.
authors: Choladda V
authors: CV
authors: Curry
authors: April A
authors: AA
authors: Ewton
authors: Randall J
authors: RJ
authors: Olsen
authors: Brent R
authors: BR
authors: Logan
authors: Hector A
authors: HA
authors: Preti
authors: Yao-Chang
authors: YC
authors: Liu
authors: Sherrie L
authors: SL
authors: Perkins
authors: Chung-Che
authors: CC
authors: Chang