CD56-positive diffuse large B-cell lymphoma/leukemia with BCL6/MYC double-hit and multiple gene mutations: an indicator of poor prognosis?

J Int Med Res. 2020 May;48(5):300060520918087. doi: 10.1177/0300060520918087.

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common adult non-Hodgkin lymphoma (NHL) and is highly invasive, with a poor prognosis. The main clinical treatment for DLBCL involves chemotherapy or a combination of chemotherapy and targeted drugs. CD56 expression is considered as an indicator of poor prognosis in patients with acute myeloid leukemia and anaplastic large cell lymphoma; however, its role in DLBCL remains unclear. We report on a patient with CD56-positive DLBCL/leukemia with BCL6/MYC double-hit, and DDX3X, LRP1B, SIN3A, and GNA13 gene mutations (stage IVA, prognostic index aaIPI = 2 points). The patient was treated with cyclophosphamide and prednisone pre-chemotherapy plus R-Hyper-CVAD AB and DA-EPOCH regimens. Lumbar puncture combined with intrathecal injection was performed to prevent central nervous system infiltration during hospitalization, and complete remission was confirmed. We also reviewed the literature to clarify the relevance of the unique clinical features associated with this case.

Keywords: CD56-positive; Lymphoma; diffuse; double-hit lymphoma; large B-cell; prognosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Biopsy
  • Bone Marrow / pathology
  • Burkitt Lymphoma / diagnosis
  • CD56 Antigen / metabolism
  • Cyclophosphamide / therapeutic use
  • Diagnosis, Differential
  • Doxorubicin / therapeutic use
  • Etoposide / therapeutic use
  • Gene Rearrangement*
  • Genetic Heterogeneity
  • Genetic Testing
  • Humans
  • Lymphoma, Extranodal NK-T-Cell / diagnosis
  • Lymphoma, Large B-Cell, Diffuse / diagnosis*
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / genetics
  • Lymphoma, Large B-Cell, Diffuse / mortality
  • Male
  • Mutation
  • Prednisone / therapeutic use
  • Prognosis
  • Proto-Oncogene Proteins c-bcl-6 / genetics*
  • Proto-Oncogene Proteins c-myc / genetics*
  • Treatment Outcome
  • Vincristine / therapeutic use

Substances

  • BCL6 protein, human
  • CD56 Antigen
  • MYC protein, human
  • NCAM1 protein, human
  • Proto-Oncogene Proteins c-bcl-6
  • Proto-Oncogene Proteins c-myc
  • Vincristine
  • Etoposide
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • EPOCH protocol