Prognostic significance of t(14;18) and bcl-2 gene expression in follicular small cleaved cell lymphoma and diffuse large cell lymphoma

Objective: To evaluate whether there is an association between the presence of t(14;18) and bcl-2 gene expression, on one hand, and clinical presentation and outcome, on the other hand, in patients with follicular small cleaved cell lymphoma (FSCCL) and diffuse large cell lymphoma (DLCL), in light of conflicting reports concerning the prognostic significance of these parameters. Design: Retrospective cohort study and molecular analysis of archived tissue. Setting: Tertiary care hospital. Patients: Sixty-two patients with non-Hodgkin's lymphoma, of whom 33 (13 women and 20 men) had FSCCL and 29 (9 women and 20 men) had DLCL. Their ages ranged from 27 to 88 years. Interventions: Presence of t(14;18) was determined using Southern blot analysis or polymerase chain reaction or both. The level of bcl-2 gene expression was determined by immunohistological analysis using a monoclonal mouse anti-human antibody (DAKO-Bcl-2, 124). Outcome measures: Clinical stage of lymphoma at diagnosis and responsiveness to treatment, and the correlation between these clinical parameters and t(14;18) status and bcl-2 gene expression. Results: There was no clear association between t(14;18) status and prognosis for either FSCCL or DLCL. In contrast, high bcl-2 expression clearly predicted a generally poor prognosis in patients with FSCLL (p = 0.0146) and indicated resistance to treatment in those with DLCL (p = 0.0853). Conclusion: In non-Hodgkin's lymphoma, level of bcl-2 gene expression may represent a useful, independent prognostic indicator to identify high-risk patients and choose specific therapeutic approaches.