86 Egyptian Journal of Pathology 2018, Vol 38 No 1

Table 1 Clinicopathological characteristics of studied cohort Fig. 1

Clinicopathologic variables n (%) R-IPI and Progression-Free Survival

1
Gender 0.9
Male 9 (37.5) 0.8

Disease Free Survival

Female 15 (62.5) 0.7

Proportion
Age (years) 0.6
Median (range) 46 (22-71) 0.5
Stage 0.4
Low 11 (45.8) 0.3 P=0.049
High 13 (54.2) 0.2
Lymphoma involvement 0.1
Nodal 15 (62.5) 0
0 4 8 12 16 20 24 28 32
Nodal & extranodal 9 (37.5)
LDH Time (Months)
Low 8 (33.3) Low R-IPI High R-IPI All cases
High 16 (66.7)
Performance Status R-IPI and Overall Survival
Low 18 (75.0) 1
High 6 (25.0) 0.9
0.8
IPI

Overall Survival
0.7

(Proportion)
Low 13 (54.2)
0.6
High 11 (45.8)
0.5
Bulky disease 0.4
No 18 (75.0) 0.3 P=0.035
Yes 6 (25.0) 0.2
Response to 1st line R-CHOP 0.1
CP 13 (54.2) 0
PR 8 (33.3) 0 4 8 12 16 20 24 28 32
Progression 3 (12.5) Time (Months)
Follow up (months) Low R-IPI High R-IPI All cases
Median (range) 10 (3-28)
Relapse Kaplan–Meier estimated curves of OS and PFS in the studied cohort,
No 21 (87.5) considering all patients as well as patients in high and low R-IPI groups.
Yes 3 (12.5) OS, overall survival; PFS, progression-free survival; R-IPI, revised
Status international prognostic index.
Dead 7 (29.2)
Alive 17 (70.8)
C myc
Negative 16 (66.7)
Positive 8 (33.3)
low Ki-67 index less than 90% (Fig. 3). Double expression,
Bcl2 high DHS, was detected in six (25%) cases, MYC + BCL2 +
Negative 12 (50.0) in four cases, and MYC + BCL6 + in two cases (Fig. 4).
Positive 12 (50.0)
Bcl6
Negative 14 (58.3)
Positive 10 (41.7)
Characteristics of double expressors
Ki67
< 90% 17 (70.8) The median age of patients with double-expressor B-cell
≥ 90% 7 (29.2) lymphomas was 57 years compared with only 41.5 years
DLBCL
Non-double expressor (Low DHS) 18 (75)
for the non-double expressor group (P = 0.008). They
Double expressor (High DHS) 6 (25) were associated with higher lactate dehydrogenase level
(P = 0.046) and higher R-IPI (P = 0.033), and showed
CR, complete response; DHS, double hit score; DLBCL, diffuse large B-cell
lymphoma; IPI, international prognostic index; LDH, lactate dehydrogenase; poorer response to R-CHOP chemotherapy, as none of
PR, partial response; R-CHOP, rituximab plus cyclophosphamide, doxorubicin, them developed CR (0/6). In addition, double-expressor
vincristine, and prednisone.
DLBCL cases were associated with high Ki-67 prolifera-
tion index at least 90% (P = 0.001) (Table 3). Double
expressors revealed an extremely statistically signifi-
Table 2 Correlation of revised international prognostic index score cantly association with shorter PFS and OS (P < 0.0001)
with clinicopathologic variables
(Fig. 5).
R-IPI [n (%)]

Clinicopathologic variables Low ≤ 2 High 3–5 P value

Sex
Patients’ outcomes
Male 5 (55.6) 4 (44.4) 0.916 The median duration of follow-up for patients was 10 months
Female 8 (53.3) 7 (46.7) (range: 3–28). Seventeen (62.5%) patients were alive without
DHS
Low 12 (66.7) 6 (33.3) 0.03* progression at last follow-up, and seven patients were dead.
High 1 (16.7) 5 (83.3) Using R-CHOP as frontline treatment, patients with high
Response to first line (CR) 9 (69.2) 4 (30.8) 0.271 R-IPI had median PFS and OS of 45.5 and 54.5%,
R-CHOP
PR 3 (37.5) 5 (62.5) respectively, whereas the figures for patients with low
Progression 1 (33.3) 2 (66.7) R-IPI were 76.9 and 84.6%, respectively, with statistical
Ki-67 (%)
< 90 11 (64.7) 6 (35.3) 0.106
significance. The outcomes for patients with DE lymphoma
≥ 90 2 (28.6) 5 (71.4) were dismal, where the median PFS and OS were 16.7 and
33.3%, respectively, compared with 77.8 and 83.3%,
CR, complete response; DHS, double-hit score; PR, partial response;
R-IPI, revised international prognostic index. respectively, for the non-double expressor group, with highly
*Statistically significant. significant difference (P < 0.0001) (Table 4).