Achieving Bcl-2/IgH negativity in peripheral blood/bone marrow after therapy implies better prognosis for patients with follicular lymphoma

Czech version

Authors: D. Belada ¹; L. Smolej ¹; P. Štěpánková ¹; M. Beránek ²; D. Dvořáková ³; J. Bukač ⁴; J. Malý ¹
Authors‘ workplace: Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ¹; Ústav klinické biochemie a diagnostiky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Vladimír Palička, CSc. ²; Centrum molekulární biologie a genové terapie Interní hematoonkologické kliniky Lékařské fakulty MU a FN Brno, pracoviště Bohunice přednosta prof. MUDr. Jiří Vorlíček, CSc. ³; Ústav lékařské biofyziky Lékařské fakulty UK Hradec Králové, přednosta doc. Ing. Josef Hanuš, CSc. ⁴
Published in: Vnitř Lék 2007; 53(10): 1057-1063
Category: Original Contributions

Overview

Bcl-2/IgH rearrangement is a characteristic molecular rearrangement in patients with follicular lymphoma (FL), yet its prognostic significance is still unclear.

Objective:
Evaluation of the implications of achieving Bcl-2/IgH negativity for the prognosis of FL patients. Twenty seven patients (54 %) were receiving only chemotherapy (CHT), 23 patients (46 %) were receiving chemotherapy combined with monoclonal antibody anti/CD20, rituximab (R-CHT).

Results:
Molecular genetic remission was achieved in 7 out of 11 patients (64 %) after R-CHT, and only in 2 out of 14 patients (14 %) after CHT – this difference was statistically significant (p = 0.037). 4 weekly doses of rituximab were administered in a sequence to 17 out of 27 patients who had received only chemotherapy and failed to achieve complete remission. 12 out of 17 patients (71 %) on this therapy were Bcl-2/IgH positive prior to treatment. 7 out of 12 (58 %) patients were no longer Bcl-2/IgH positive in a check performed after one month; the remaining 2 out of 5 patients had a negative Bcl-2/IgH record for the interval of 3 months (1 patient) or 6 (1 patient) months, respectively. The following factors were associated with the achievement of Bcl-2/IgH negativity at any point during the treatment: age < 65 years (p = 0.02) and performance status 0 + 1 according to WHO at baseline (p = 0.02). Patients who were Bcl-2/IgH negative after treatment had a lower recurrence/progression risk rate than the Bcl-2/IgH positive group of patients, i.e. 27 % vs. 75 % (p = 0.03), and a higher chance for progression-free survival, i.e. 81 % vs. 38 % (p = 0.004), event-free survival, i.e. 74 % vs. 38 % (p = 0.01), and overall survival, i.e. 87 % vs. 74 % (p = 0.05) at 2 years.

Conclusion:
In our experience, achieving Bcl-2/IgH negativity after follicular lymphoma therapy implies a better prognosis.

Keywords:
Bcl-2/IgH – follicular lymphoma 2 minimum residual disease – rituximab – prognosis

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