A cytomorphological and immunohistochemical profile of aggressive B-cell lymphoma: High clinical impact of a cumulative immunohistochemical outcome predictor score

Abstract

We analyzed morphological and immunohisto-chemical features in 174 aggressive B-cell lymphomas of nodal and extranodal origin. Morphological features included presence or absence of a follicular component and cytologic criteria according to the Kiel classification, whereas immuno-histochemical studies included expression of CD10, BCL-2, BCL-6, IRF4/MUM1, HLA-DR, p53, Ki-67 and the assess-ment of plasmacytoid differentiation. Patients were treated with a CHOP-like regimen. While the presence or absence of either CD10, BCL-6 and IRF4/MUM1 reactivity or plasma-cytoid differentiation did not identify particular cytomorpho-logic or site-specific subtypes, we found that expression of CD10 and BCL-6, and a low reactivity for IRF4/MUM1 were favourable prognostic indicators. In contrast, BCL-2 expres-sion and presence of a monotypic cytoplasmic immunoglob-ulin expression was associated with an unfavourable prognosis in univariate analyses. Meta-analysis of these data resulted in the development of a cumulative immunohisto-chemical outcome predictor score (CIOPS) enabling the recognition of four distinct prognostic groups. Multivariate analysis proved this score to be independent of the interna-tional prognostic index. Such a cumulative immunohisto-chemical scoring approach might provide a valuable alternative in the recognition of defined risk types of aggressive B-cell lymphomas. © Springer-Verlag 2009.