CD20-negative de novo diffuse large B-cell lymphoma in HIV-negative patients: a matched case-control analysis in a single institution.

Abstract

HIV-negative, CD20-negative de novo diffuse large B-cell lymphoma (DLBCL) patients has rarely been reported. To elucidate the nature of this entity, we retrospectively reviewed the data of 1,456 consecutive de novo DLBCL patients who were treated at Sun Yat-Sen University Cancer Center between January 1999 and March 2011.
The pathologic characteristics of CD20-negative patients, clinical features, response to initial treatment, and outcomes of 28 patients with available clinical data (n = 21) were reviewed. Then, a matched case-control (1:3) analysis was performed to compare patients with CD20-negative and -positive DLBCL.
The median age of the 28 CD20-negative DLBCL patients was 48 years, with a male-female ratio of 20:8. Seventeen of 22 (77.3%) CD20-negative DLBCL cases were of the non-germinal centre B-cell (non-GCB) subtype. High Ki67 expression (≥ 80%), an index of cell proliferation, was demonstrated in 17 of 24 (70.8%) cases. Extranodal involvement (≥ 1 site) was observed in 76.2% of the patients. Following initial therapy, 9 of 21 (42.9%) cases achieved complete remission, 4 (19%) achieved partial remission, 1 (4.8%) had stable disease, and 7 (33.3%) had disease progression. The median overall survival was 23 months. The 3-year progression-free survival (PFS) and overall survival (OS) rates were 30.5% and 35%, respectively. A matched case-control analysis showed that patients with CD20-negative and -positive DLBCL did not exhibit a statistically significant difference with respect to the main clinical characteristics (except extranodal involvement), whereas the patients with CD20-positive DLBCL had a better survival outcome with 3-year PFS (P = 0.008) and OS (P = 0.008) rates of 52% and 74.1%, respectively.
This study suggests that HIV-negative, CD20-negative de novo DLBCL patients have a higher proportion of non-GCB subtype, a higher proliferation index, more frequent extranodal involvement, a poorer response, and a poorer prognosis to conventional treatment compared to patients with CD20-positive DLBCL. Further studies are warranted to investigate new target and optimal therapy of CD20-negative de novo DLBCL.

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RESEARCHOpen Access
CD20-negative de novo diffuse large B-cell
lymphoma in HIV-negative patients: A matched
case-control analysis in a single institution
Ya-Jun Li1,2†, Zhi-Ming Li1,2†, Hui-Lan Rao1,3, Yi Xia1,2, Hui-Qiang Huang1,2, Zhong-Jun Xia1,4, Su Li1,2,
Wen-Yu Li5and Wen-Qi Jiang1,2*
Abstract
Background: HIV-negative, CD20-negative de novo diffuse large B-cell lymphoma (DLBCL) patients has rarely been
reported. To elucidate the nature of this entity, we retrospectively reviewed the data of 1,456 consecutive de novo
DLBCL patients who were treated at Sun Yat-Sen University Cancer Center between January 1999 and March 2011.
Methods: The pathologic characteristics of CD20-negative patients, clinical features, response to initial treatment,
and outcomes of 28 patients with available clinical data (n=21) were reviewed. Then, a matched case-control (1:3)
analysis was performed to compare patients with CD20-negative and -positive DLBCL.
Results: The median age of the 28 CD20-negative DLBCL patients was 48 years, with a male-female ratio of 20:8.
Seventeen of 22 (77.3%) CD20-negative DLBCL cases were of the non-germinal centre B-cell (non-GCB) subtype.
High Ki67 expression (≥80%), an index of cell proliferation, was demonstrated in 17 of 24 (70.8%) cases. Extranodal
involvement (≥ 1 site) was observed in 76.2% of the patients. Following initial therapy, 9 of 21 (42.9%) cases
achieved complete remission, 4 (19%) achieved partial remission, 1 (4.8%) had stable disease, and 7 (33.3%) had
disease progression. The median overall survival was 23 months. The 3-year progression-free survival (PFS) and
overall survival (OS) rates were 30.5% and 35%, respectively. A matched case-control analysis showed that patients
with CD20-negative and -positive DLBCL did not exhibit a statistically significant difference with respect to the main
clinical characteristics (except extranodal involvement), whereas the patients with CD20-positive DLBCL had a better
survival outcome with 3-year PFS (P=0.008) and OS (P=0.008) rates of 52% and 74.1%, respectively.
Conclusions: This study suggests that HIV-negative, CD20-negative de novo DLBCL patients have a higher
proportion of non-GCB subtype, a higher proliferation index, more frequent extranodal involvement, a poorer
response, and a poorer prognosis to conventional treatment compared to patients with CD20-positive DLBCL.
Further studies are warranted to investigate new target and optimal therapy of CD20-negative de novo DLBCL.
Keywords: Diffuse large B-cell lymphoma, CD20-negative, Clinicopathologic features, HIV-negative
Background
Diffuse large B-cell lymphoma (DLBCL) is the most fre-
quent subtype of non-Hodgkin’s lymphoma (NHL) in
Western and Eastern countries, representing 30%-40% of
all non-Hodgkin’s lymphoma cases [1,2]. CD20 antigen is
a membrane-bound protein which plays a role in B-cell
activation, differentiation, and cell-cycle progression [3-5].
CD20 is an excellent pan-B-cell immunophenotypic
marker because CD20 is highly expressed on the surface
of 90%-95% of normal and neoplastic B lymphocytes;
CD20 is not expressed on immature B precursors and
plasma cells [6,7]. Recent studies have demonstrated that
CD20-negative DLBCL is frequently restricted to a few
variant subtypes of DLBCL with plasmablastic features
and terminal B-cell differentiation, including plasmablastic
lymphoma (PBL) of the oral mucosa type, PBL with plas-
macytic differentiation, primary effusion lymphoma (PEL),
* Correspondence: wqjiang@yahoo.com
†Equal contributors
1State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China
2Department of Medical Oncology, Sun Yat-Sen University Cancer Center,
Guangzhou 510060, China
Full list of author information is available at the end of the article
© 2012 Li et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
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Kaposi’s sarcoma-associated herpes virus (KSHV)-positive
solidlymphoma/extracavitary
DLBCL, and ALK-positive DLBCL [8-14]. Limited studies
with a large series of cases have focused on the clinical
and pathologic features of HIV-negative, CD20-negative
de novo DLBCL patients [9-14].
To shed light on the nature of the entity, we conducted
a matched case-control analysis to compare the clinico-
pathologic characteristics and clinical outcome of HIV-
negative, CD20-negative DLBCL and -positive DLBCL
patients at a single institution. This is the first matched
case-control analysis to investigate HIV-negative, CD20-
negative DLBCL patients.
PEL/HHV-8 associated
Materials and methods
Patient selection
We retrospectively reviewed the pathologic data of 1,456
consecutive patients with de novo DLBCL diagnosed by
experienced hematopathologists at Sun Yat-Sen University
Cancer Center between January 1999 and March 2011.
Twenty-eight patients were diagnosed as CD20-negative
DLBCL. Among these 28 patients, 21 patients received
treatment at Sun Yat-Sen University Cancer Center and
had available clinical information and follow-up data.
HIV infection test
All 21 patients with CD20-negative DLBCL were initially
screened for HIV infection status before initial therapy.
Blood samples were collected and tested for antibodies
to HIV-1 and -2 using a chromatographic qualitative
enzyme-linked immunosorbent assay (ELISA) test kit
(Atlas Link Biotech Co., Ltd., USA) according to the
manufacturer’s instruction. If samples were positive by
initial ELISA, the results were further confirmed by
Western blot.
Histologic review
All hematoxylin-eosin (HE) paraffin sections of the 28
patients were retrospectively reviewed by at least two
pathologists at Sun Yat-Sen University Cancer Center to
confirm the pathologic diagnosis of DLBCL according to
the criteria of the 2008 World Health Organization clas-
sification [15].
Immunohistochemical studies
Immunohistochemical (IHC) analysis was performed
using a large pane of monoclonal and polyclonal anti-
bodies detecting CD20 (L26, 1:200), CD79a (1:50), CD45
(LCA,1:20), CD3 (1:200), CD5 (1:100), CD10 (1:50),
BCL-6 (1:10), MUM-1 (1:50), BCL-2 (1:80), Ki-67
(1:100), CD30 (1:20), CD38 (1:10), CD138 (1:50), UCHL-
1 (CD45RO,1:200), κ (1:300), λ (1:400), OCT-2 (1:500),
BOB-1 (1:500), CYCLIN D1 (1:50), ALK (1:10), CD43
(1:320), PAX-5, and Vs38c (P63,1:10) antigens (Dako,
Glostrup, Denmark). Sections (4 μm thick) were cut
from each paraffin block, deparaffinized, and incubated
at 121oC in citrate buffer (pH 6.0) for 10 min for antigen
retrieval. A routine immunohistochemistry method was
performed for immunostaining the above antigens, as
described previously [16]. For semi-quantitative evalu-
ation of immunostained sections, we used a cut-off value
of 10% to determine CD20 expression or absence accord-
ing to the following criteria: CD20-negative (immuno-
staining of 0-10% of tumor cells); and CD20-positive
(immunostaining of>10% of tumor cells). The cut-off
value we used in the present study for other proteins (ex-
cept Ki-67) was 30%, according to the following previously
published criteria: negative expression (immunostaining of
0-30% of tumor cells); and positive expression (immuno-
staining of>30% of tumor cells) [17]. A Ki-67≥80% was
consistent with a high proliferation index of lymphoma
cells. In all cases, the percentage of immunostained tumor
cells was consensually estimated by at least two patholo-
gists on a multi-headed microscope. To make sure the
results were as reliable as possible, loss of CD20 expres-
sion was confirmed by at least two experienced hemato-
pathologists in our center. Furthermore, the samples
without CD20 expression were re-immunostained for
CD20 to confirm the findings. Patients were sub-classified
into germinal centre B-cell-like (GCB) and non-GCB
groups based on the algorithm of Hans et al. [17].
In situ hybridization and fluorescence in situ hybridization
study
In situ hybridization (ISH) analysis for Epstein-Barr virus
(EBV)-encoded small RNAs (EBERs) was performed on
paraffin sections of lymphoma tissues with fluorescein-
conjuated peptide nucleic acid probes (Dako), according
to the manufacturer’s instructions. Fluorescent in situ
hybridization (FISH) analysis was performed to detect
the translocation of chromosomes in select cases.
Matched case-control study design
Patients who did not receive rituximab treatment during
the course of their disease were selected from the
remaining 1,428 CD20-positive patients with de novo
DLBCL diagnosed at Sun Yat-Sen University Cancer
Center between January 1999 and March 2011 to serve
as matched controls of patients with CD20-negative
DLBCL. Three control cases were matched to each study
patient with CD20-negative DLBCL. For the 21 CD20-
negative DLBCL with both pathologic and clinical data,
the matching criteria was as follows: a standard inter-
national prognosis index (IPI) score (age, Eastern Co-
operative Oncology Group PS, lactate dehydrogenase
[LDH] level, Ann Arbor stage, and number of extranodal
sites); gender (male or female); and age (±5 years). All of
the above three factors were fully matched between the
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study case and the three controls. For the remaining 7
CD20-neagtive DLBCL cases with only pathologic data,
the matching criteria was as follows: gender (male or
female); and age (the same age). Both factors were
matched between the case and the three controls. If
greater than three controls were matched with a case,
three were picked randomly.
This study was approved by the Institutional Review
Board of the National Cancer Institute, as well as the
Ethics Committee of Sun Yat-Sen University Cancer
Center. The study was conducted in accordance with the
Declaration of Helsinki and the institutional guidelines
of the local Ethics Committee.
Statistical methods
Progression-free survival (PFS) was defined as the inter-
val between the date of diagnosis and the date of first
relapse, progression, death, or last follow-up. Overall sur-
vival (OS) was defined from the day of diagnosis until
the time of death or last follow-up. The survival curve
was constructed by the Kaplan-Meier method, and com-
parisons between groups were made using the log-rank
test. The following clinicopathologic variables associated
with survival in common DLBCL were dichotomized to
facilitate univariate analysis for survival of HIV-negative,
CD20-negative de novo DLBCL patients, which were
compared using the Kaplan-Meier method and log-rank
test: age (>60 years vs. ≤ 60 years), Eastern Cooperative
Oncology Group (ECOG) performance status (PS; >1
vs. ≤ 1), stage (stage I/IIvs. stage III/IV), bulky (≥ 7 cm
vs. < 7 cm), serum LDH (normal vs. elevated), extrano-
dal involvement (≥ 2 vs. < 2), IPI (0-1 vs. 2-3), Ki-67
(≥ 80% vs. <80%), BCL-2 (positive vs. negative), mo-
lecular subtypes (GCB vs. non-GCB), response to initial
therapy (complete remission [CR]/partial remission [PR]
vs. stable disease [SD]/progressive disease [PD]).
The clinicopathologic variables of the two groups were
compared using a χ2test for categorical variables and the
Mann-Whitney test for continuous variables. A two-
tailed P-value <0.05 was considered to be statistically
significant. The statistical software package, SPSS 16.0
(SPSS, Inc., Chicago, IL, USA), was used for statistical
calculations.
Results
CD20-negative DLBCL patients
Clinical features and HIV test results
For all 28 cases, the median age was 48 years (range, 11-
83 years) and the male-to-female ratio was 20:8. Twenty-
one cases had complete clinical data and follow-up infor-
mation. The baseline clinical information is summarized
in Tables 1 and 2. All of the 21 cases were HIV-negative
and had no history of other lymphoproliferative disor-
ders, organ/hematopoietic stem cell transplantation, or
congenital immunodeficiencies. Twelve cases (57.1%)
had stage I/II disease, and 9 patients (42.9%) had stage
III/IV disease according to the Ann Arbor staging sys-
tem. B symptoms were present in 8 cases (38.1%). Bulky
disease (mass≥7 cm) was observed in 8 cases (38.1%).
The serum lactate dehydrogenase (LDH) level was ele-
vated in 7 cases (33.3%). Sixteen patients (76.2%) had
extranodal involvement (11 cases with 1 site, and 5 cases
with>1 site). Eleven patients (52.4%) had low Inter-
national Prognostic Index (IPI) scores (0-1 risk factor), 5
patients (23.8%) had low-intermediate IPI scores (2 risk
factors), the IPI score was 3 (3 risk factors) in 5 patients
(23.8%), and there were no patients with high-risk IPI
scores (4-5 risk factors). The bone marrow was involved
in 2 patients (9.5%). The PS was<2 in 18 patients
(85.7%).
Histologic and immunohistochemical features, and ISH and
FISH studies
We reviewed the pathologic data of 1,456 consecutive
patients with de novo DLBCL diagnosed at Sun Yat-Sen
University Cancer Center between January 1999 and
March 2011. Twenty-eight cases (1.9%) met the criteria
for CD20-negative DLBCL. Based on the IHC results
and microscopic morphologic characteristics, 2 of 28
patients were diagnosed as PBL, 3 patients were diag-
nosed as DLBCL with plasmacytic differentiation, and 5
patients were diagnosed as ALK-positive DLBCL accord-
ing to the WHO criteria. There were no patients diag-
nosed as PEL among the 28 cases. The microscopic
morphologic characteristics of 5 ALK-positive DLBCL
patients and 2 PBL patients were as follows: ALK-positive
DLBCL, the tumor showed a sinusoidal growth pattern
and was composed of monomorphic large immunoblast-
like cells with round pale nuclei containing large central
nuclei and abundant cytoplasm, with multinucleated neo-
plastic giant cells in 3 cases; PBL, the tumor showed a dif-
fuse and cohesive proliferation of cells resembling
immunoblasts and mitotic figures were observed in tumor
cells. For the remaining 21 conventional DLBCL cases,
typical morphology of the lymphoma cells was character-
ized by large lymphoid cells diffusely infiltrated lymph
nodes or other tissues. Most of the cells were centroblasts
and cells with plasmacytic differentiation were noted in
three cases. Centroblasts were medium-to-large lymphoid
cells with oval-to-round, vesicular nuclei containing fine
chromatin. There were two-to-four nuclear membrane-
bound nucleoli. The cytoplasm was usually scanty and
amphophilic-to-basophilic (Figure 1A).
The major immunophenotypic features are summar-
ized in Tables 3 and 4. All 28 patients were negative for
CD20. The immunophenotypes are listed as follows
(+/total): CD45, 26 of 27 (96.3%); CD79a, 23 of 26
(88.5%); BOB-1, 9 of 11 (81.8%); OCT-2, 9 of 12 (75%);
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Pax-5, 5 of 11 (45.5%); CD10, 5 of 22 (22.7%); BCL-6, 2
of 15 (13.3%); MUM-1, 16 of 21 (76.2%); BCL-2, 13 of 20
(65%); CD30, 9 of 25 (36%); CD38, 8 of 22 (36.4%);
CD138, 5 of 22 (22.7%); kappa, 5 of 11 (45.5%); lambda,
5 of 10 (50%); ALK, 5 of 24 (20.8%); CD43, 6 of 14
(42.9%); VS38c (P63), 6 of 15 (40%); CYCLIN D1, 0 of
12; CD5, 0 of 23; and CD23, 0 of 11. Of the T cell- or
NK/T cell-associated markers (CD3 and CD56, respect-
ively), 0 of 26 and 0 of 9 were positive in lymphoma
cells, respectively. Interestingly, the T cell-associated
antigen, UCHL-1(CD45RO), was positive in 3 of 23
(13%) cases. According to the Hans algorithm [17], 17 of
22 (77.3%) cases were categorized as non-GCB type,
while 5 of 22 (22.7%) cases were categorized as GCB
type. Ki-67 was immunolabelled as a high proliferation
index (≥ 80%) for lymphoma cells in 17 of 24 (70.8%)
cases (Figure 1K).
Only 1 of 21 cases (4.8%) tested for EBV infection had
positive signals in the nuclei of the lymphoma cells in
EBERs ISH. Both IgH-MALT-1/t (14; 18) and API-2-
MALT-1/t (11; 18) were negative in the one case tested
by FISH.
Response and survival analysis
Twenty of 21 CD20-negative de novo DLBCL cases
received cyclophosphamide, doxorubicin, vincristine, and
Table 1 Clinical, treatment and survival characteristics of the 21 patients with CD20-negative diffuse large B-cell
lymphoma
Patient
NO. y/Sexstatusscoreinvolvementdisease
Age, HIVPS Site ofStageBulkySerum
LDH
IPI Therapy and response for
initial therapy
Out
come
Survival
(months)
168/M-1 LN IIBNo Normal1 CHOP×6+RT, ICE×4,CRAWD117
2 33/F-1 CervicalIA NoNormal0 CHOP×4, CR AND117
3 49/F-1 Maxillary sinus,
LN
IIB NoNormal0 CHOP×5, DHAP×4, CRDOD 11
4 11/M-2 Spinal canal,
Retroperitoneal
IIIBYes Normal3 Surgical resection+RT, CAV×2+
BFM-90×1, PD
DOD23
5 37/M-1Retroperitoneal,
LN, BM
IVBYesElevated2 CHOP×2,VAD×2,MEA×2, PRAND 90
6 56/M-1Stomach,
Retroperitoneal,
IIB NoNormal0 CHOP×6,ICE×2,DHAP×3,
GEMOX×7,Auto PBSCT, PR
DOD33
754/F-1Stomach IIBYes Normal0Gastrectomy, CHOP×6,ICE×2,
EPOCH×1,FC×1, PD
DOD13
873/M-1LNIANoElevated2 CHOP×2, PDDOD7
944/M-1LNIIIANoElevated2 CHOP×6,HD-MTX +Ara-C×1, PDDOD6
1041/M-2 Stomach, LNIIANoElevated1 CHOP×2, PD DOD3
1166/M-1 Stomach, LN IIBYesElevated2 EPOCH×6+RT, CRAND 27
12 22/M-1 Liver, lung,
LN, hip
IVBNoElevated3CHOP×1,DHAP×2, IMVP-16×4, PDDOD13
1355/M-1 LNIANo Normal0Bortezomib+EPOCH×4, RT, CR AND25
1419/F -1Stomach, LN IIAYes Normal0Gastrectomy, CHOP×6, CR AND 20
1567/M-1 Spleen, LNIIIANoElevated3CHOP×1, ICE×4,SDAWD19
1647/F-1Ileum, liver, LN,IVAYes Normal2Surgical resection, CHOP×1,
MAID×2,GEMOX×4,ESHAP×2, PD
DOD12
1727/M-1Mediastinum,
pleural
IIAYes Normal0Surgical resection, CHOP+IT×6, CR AND15
18 83/M-1Lung, rib, LNIVA NoNormal3CHOP×3, GEMOX×2, CRDOD7
1953/M-1Stomach, LNIIIA NoNormal1CHOPE×6,GIFOX×2,GND×2, CR AND9
2067/M -1LN IA No Normal1 RT,CHOP×2,Ara-C+DXM×1,
Ara-C+Paclitaxel×1, PR
AWD9
21 71/M-2Kidney, sternum,
vertebral, BM
IVA YesNormal3CHOP×2, ICE×2, PRDOD7
Note: -, negative; +, positive; PS, performance status; LN, lymph node; BM, bone marrow; LDH, lactate dehydrogenase; IPI, International Prognostic Index; RT,
radiotherapy; CAV, cyclophosphamide, doxorubicin, vincristine; VAD, vincristine, doxorubicin, dexamethasone; MEA, mitoxantrone, etoposide, cytarabine; GEMOX,
gemcitabine, oxaliplatin; GIFOX, gemcitabine, ifosfamide, oxaliplatin; GND, gemcitabine, vinorelbine, doxil; DXM, dexamethasone; MAID, mesna, doxorubicin,
ifosfamide, dacarbazine; PBSCT, peripheral blood stem cell transplant; IT, intrathecal; CR, complete remission; PR, partial remission; SD, stable disease; PD,
progressive disease; AWD, alive with disease; AND, alive with no evidence of disease; DOD, died of disease.
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prednisone (CHOP) or a CHOP-like regimen chemo-
therapy as first-line chemotherapy. Five cases received
radiotherapy pre- or post-chemotherapy. Five patients
underwent surgical resection as initial treatment. Only
one patient received autologous stem cell transplantation
(SCT) during the course of the disease. Following initial
therapy, 9 of 21 (42.9%) cases achieved CR, 4 (19%)
achieved PR, 1 (4.8%) had SD, and 7 (33.3%) had PD. By
the time of analysis, 11 patients (38.1%) had died; all of
the deaths were due to lymphoma. The median OS time
was 23 months. The estimated 3-year PFS and OS rates
were 30.5% and 35%, respectively (Table 5 and Figures
2A, B). Based on univariate analysis, 3 variables asso-
ciated with a longer OS included a PS≤1 (P=0.033),
extranodal involvement<2 sites (P=0.027), and a CR/
PR response to initial therapy (P=0.008); however, age
>60 years, advanced stage (stage III/IV), IPI score (≥ 2),
bulky disease (≥ 7 cm), elevated LDH, high Ki-67, non-
GCB subtype, and positive BCL-2 were not associated
with inferior survival (all P>0.05).
Matched case-control analysis
Clinical characteristics
As expected from the matching method, the two groups
of patients did not show any statistically significant dif-
ference in the main clinical characteristics (Table 2);
however, extranodal involvement (≥1 site) was more fre-
quent in CD20-negative DLBCL patients (76.2% vs.
44.4%, P=0.012).
Pathologic characteristics
The main pathologic characteristics of the two groups
are listed in Table 4. Compared with CD20-positive
DLBCL in the control group, the non-GCB subtype was
significantly more frequent in CD20-negative DLBCL
(34.4% vs. 77.3%, P=0.002). Similarly, the proportion of
CD20-negative DLBCL cases with Ki-67 expression≥
80% was significantly higher than the CD20-positive
DLBCL control group (70.8% vs. 27.7%, P<0.001). Inter-
estingly, CD30-positive expression was more frequent
in the CD20-negative DLBCL group (36% vs. 10.6%,
P=0.023). There was no significant difference in the rate
Table 2 Clinical characteristics of CD20-negative diffuse
large B-cell lymphoma and CD20-positive diffuse large B-
cell lymphoma patients
Total CD20-negative
DLBCL(n=21)
Age(years)
CD20-positive
DLBCL (n=63)
P
Median (range)51.5(9-83)53(11-83) 51(9-71)0.955
≤6056(66.7%)14(66.7%) 42(66.7)1
Sex
Male64(76.2%)16(76.2%) 48(76.2%)1
Female 20(23.8%) 5(23.8%)15(23.8%)
PS score
0-175(89.3%)18(85.7%) 57(90.5%)0.839
≥2 9(10.7%)3(14.3%)6(9.5%)
Stage
I-II49(58.3%)12(57.1%)37(58.7%)0.898
III-IV 35(41.7%)9(42.9%) 26(41.3%)
LDH
Normal50(59.5%)14(66.7%)36(57.1%)0.441
Elevated34(40.5%) 7(33.3%)27(42.9%)
Extranodal
sites
0-1 73(86.9%)16(76.2%)57(90.5%)0.191
≥211(13.1%)5(23.8%) 6(9.5%)
IPI
0-144(52.4%) 11(52.4%)33(52.4%)1
2-340(47.6%)10(47.6%) 30(47.6%)
Bulky
disease
Yes20(23.8%) 8(38.1%)12(19%) 0.076
No64(76.2%)13(61.9%) 51(81%)
BM involvement
Yes 2(2.4%)2(9.5%) 0(0)0.06
No82(97.6%)19(90.5%)63(100%)
B symptom
Present23(27.4%) 8(38.1%)15(23.8%) 0.204
Absent61(72.6%)13(61.9%)48(76.2%)
First-line
chemotherapy
CHOP or CHOP-like79(94%) 20(95.2%)59(93.7%)1
Other regimens5(6%) 1(4.8%) 4(6.3%)
Radiotherapy
Yes28(33.3%) 5(23.8%)23(36.5%) 0.285
No56(66.7%)16(76.2%)40(63.5%)
Surgery
Yes11(13.1%)5(23.8%) 6(9.5%)0.191
No73(86.9%)16(76.2%) 57(90.5%)
Table 2 Clinical characteristics of CD20-negative diffuse
large B-cell lymphoma and CD20-positive diffuse large B-
cell lymphoma patients (Continued)
Autologous SCT
Yes4(4.8%)1(4.8%)3(4.8%)1
No80(95.2%)20(95.2%)60(95.2%)
Follow-up
(months)
Median (range)41.5(2-121) 13(3-117)47(2-121)
PS, performance status; LDH, lactate dehydrogenase; IPI, international
prognosis index; BM, bone marrow; SCT, stem cell transplantation.
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