The Prognostic Value of Morphology and Hans Classification in Diffuse Large B Cell Lymphoma

Objective: To investigate the prognostic value of morphology and Hans classification in diffuse large B cell lymphoma(DLBCL).Methods: We have analysed 249 patients who diagnosed with diffuse large B cell lymphoma in our hospital and Hangzhou Xixi hospital during Jan, 2006 to Dec, 2016. These patients have been classified into three group: immunoblastic variant(IB), centroblastic variant(CB), and others according to the cell morphology. And divided into GCB(germinal center B-cell-like) or non-GCB(non-germinal center B-cell-like) group by analysing the expression of CD10, BCL6 and MUM1 (GCB: CD10+、BCL6+-、MUM1^+-/CD10^-、BCL6⁺、MUM1^-; non-GCB: CD10^-、BCL6^-、MUM1^+-/CD10^-、BCL6⁺、MUM1⁺). Results: By univariate analysis, the clinical factors associated with general OS and EFS, included age, LDH level, IPI, IB, non-GCB, B-symptoms and rituximab. CB subtype had a significantly higher CR rate compared with patients with IB subtype (IB: 38.9% vs CB: 68.3%, P=0.02). IB subtype was the inferior prognosis factor with respect to both EFS and OS in the whole study. In multivariate analysis, IPI and IB were independent prognostic factors for OS and EFS. IB subtype predicted an inferior prognosis in EFS and OS with or without rituximab. The expression of BCL2 and BCL6 were relative to prognosis in R-CHOP but not in CHOP-only treated patients. Other markers (CD5, CD10, IRF4/MUM1, HLA-DR and Ki-67 proliferation index) didn't perform the significant prognosis value for DLBCL. When accepted rituximab, the GCB or non-GCB showed no differences in prognosis. While the non-GCB group predicted a poor prognosis when without using rituximab (EFS P=0.020; OS P=0.020). Multivariate Cox models showed no significant differences between GCB and non-GCB groups for OS and EFS. While the IB subtype had a significant poor prognosis in OS and EFS (P=0.001, P=0.002). When the analysis was restricted to DLBCL with CB morphology only, no prognostic value was observed in Hans classification. Conclusion: The subtype of immunoblast is a major risk factor in patients treated with CHOP or R-CHOP. There was a significant association between the Hans classification and the morphologic subclassification. Our researches have supplemented the data of the prognosis factor of DLBCL and demonstrated that the cytomorphologic diagnosis can be reproducibly.