PROGNOSTIC-SIGNIFICANCE OF T(14-18) AND BCL-2 GENE-EXPRESSION IN FOLLICULAR SMALL CLEAVED CELL LYMPHOMA AND DIFFUSE LARGE-CELL LYMPHOMA

Objective: To evaluate whether there is an association between the pre sence of t(14;18) and bcl-2 gene expression, on one hand, and clinical presentation and outcome, on the other hand, in patients with follicu lar small cleaved cell lymphoma (FSCCL) and diffuse large cell lymphom a (DLCL), in light of conflicting reports concerning the prognostic si gnificance of these parameters. Design: Retrospective cohort study and molecular analysis of archived tissue. Setting: Tertiary care hospita l. Patients: Sixty-two patients with non-Hodgkin's lymphoma, of whom 3 3 (13 women and 20 men) had FSCCL and 29 (9 women and 20 men) had DLCL . Their ages ranged from 27 to 88 years. Interventions: Presence of t( 14;18) was determined using Southern blot analysis or polymerase chain reaction or both. The level of bcl-2 gene expression was determined b y immunohistological analysis using a monoclonal mouse anti-human anti body (DAKO-Bcl-2, 124). Outcome measures: Clinical stage of lymphoma a t diagnosis and responsiveness to treatment, and the correlation betwe en these clinical parameters and t(14;18) status and bcl-2 gene expres sion. Results: There was no clear association between t(14;18) status and prognosis for either FSCCL or DLCL. In contrast, high bcl-2 expres sion clearly predicted a generally poor prognosis in patients with FSC LL (p = 0.0146) and indicated resistance to treatment in those with DL CL (p = 0.0853). Conclusion: In non-Hodgkin's lymphoma, level of bcl-2 gene expression may represent a useful, independent prognostic indica tor to identify high-risk patients and choose specific therapeutic app roaches.