Expression of bcl-2 in Classical Hodgkin's Lymphoma: An Independent Predictor of Poor Outcome

Although most classical Hodgkin's lymphoma (CHL) patients are cured, a significant minority fails primary therapy and may die as a result of their disease. Age, stage, and other basic clinical and laboratory parameters, which comprise the International Prognostic Score (IPS), are used at diagno...

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Bibliographic Details
Published in:	Journal of clinical oncology Vol. 23; no. 16; pp. 3773 - 3779
Main Authors:	SUP, Stephen J, ALEMAHY, Carlos A, POHLMAN, Brad, ELSON, Paul, MALHI, Serena, THAKKAR, Snehal, STEINIE, Roxanne, HSI, Eric D
Format:	Journal Article
Language:	English
Published:	Baltimore, MD American Society of Clinical Oncology 01-06-2005 Lippincott Williams & Wilkins
Subjects:	Biological and medical sciences Biomarkers, Tumor - metabolism Cell Cycle Proteins - metabolism Cyclin-Dependent Kinase Inhibitor p21 Female Gene Expression Regulation, Neoplastic Hematologic and hematopoietic diseases Hodgkin Disease - metabolism Hodgkin Disease - pathology Humans Immunoenzyme Techniques Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Male Medical sciences Microarray Analysis Middle Aged Neoplasm Staging Predictive Value of Tests Prognosis Proto-Oncogene Proteins c-bcl-2 - metabolism Survival Rate Tumor Suppressor Protein p53 - metabolism Tumors Cancerology Prognosis Lymphoproliferative syndrome C-Onc gene Hodgkin disease Malignant hemopathy Predictive factor Lymphoma Protooncogene
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Summary:	Although most classical Hodgkin's lymphoma (CHL) patients are cured, a significant minority fails primary therapy and may die as a result of their disease. Age, stage, and other basic clinical and laboratory parameters, which comprise the International Prognostic Score (IPS), are used at diagnosis to predict outcome. To date, there is no consensus on biologic markers that add value to these parameters. We evaluated 107 CHL patients for bcl-2, p53, and p21 expression by immunohistochemistry using tissue microarrays and correlated the results with outcome. The median follow-up of the 79 surviving patients was 6.8 years. Univariate analysis showed that age > or = 45 years, stage III or IV, and IPS > or = 3 were associated with a poor failure-free survival (FFS) and overall survival (OS). bcl-2 was expressed in 26% of patients and was associated with poor FFS and a trend for OS. p53 expression in combination with lack of p21 expression was not associated with outcome. Multivariate analysis showed that three factors were independently associated with both FFS and OS: age > or = 45 years, stage III or IV, and bcl-2 expression. Using these three parameters, a scoring system was devised that stratified patients into three risk groups (with zero, one, or two to three of these risk factors) and a progressively worse FFS and OS (P < .001). Expression of bcl-2 in CHL is a useful, independent prognostic marker and can be used in association with clinical parameters to identify newly diagnosed patients with a good, intermediate, or poor prognosis.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.2005.04.358