Figure 2.
Model assessing clinical risk according to MYC and BCL2 status in DLBCL. The body of literature supports a model whereby the risk of treatment failure is proportional to the degree of MYC and BCL2 protein expression, which in turn is determined by the mechanism of deregulation. Co-expression of MYC and BCL2 (in orange and red) occurs in 25% to 30% of patients. The 5% of patients with the worst clinical outcome (in red) have the highest expression of MYC generated from a translocation to the IG locus. The intermediate-risk patients (in orange) include those with HGBL-DH that express lower levels of MYC protein due to a non-IG MYC translocation and the DE-DLBCL that deregulate MYC and BCL2 from other mechanisms. The low-risk category (in blue) consists of all patients with non-DE-DLBCL, including HGBL-DH that are not dual expressors and DLBCL with a MYC translocation, but without BCL2 protein expression. Note that HGBL-DH has MYC translocations and BCL2 or BCL6 translocations, and DE-DLBCL expresses both MYC and BCL2 proteins.