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Diffuse large B-cell lymphoma in Southeast Asian cohort: expression patterns of B-cell receptor (BCR) repertoire and its linkage with molecular subtypes and response to R-CHOP therapy
  1. Noraidah Masir1,
  2. Ariz Akhter2,
  3. Tariq M Roshan2,
  4. Chandramaya Sabrina Florence1,
  5. Faridah Abdul-Rahman1,
  6. Nor Rafeah Tumian3,
  7. Phang Kean-Chang1,
  8. Ghaleb Elyamany4,
  9. Meer-Taher Shabani-Rad2,
  10. Adnan Mansoor2
  1. 1 Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  2. 2 Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3 Internal Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Wilayah Persekutuan, Malaysia
  4. 4 Department of Central Military Laboratory and Blood Bank, Prince Sultan Riyadh Military Medical City, Riyadh, Saudi Arabia
  1. Correspondence to Dr Adnan Mansoor, Pathology and Laboratory Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada; adnan.mansoor{at}


Aims Heightened B-cell receptor (BCR) activity in diffuse large B-cell lymphoma (DLBCL) is well established, and a subset of patients with relapsed DLBCL can benefit from BCR-targeted therapies. Universal outreach of such emerging therapies mandates forming a global landscape of BCR molecular signalling in DLBCL, including Southeast Asia.

Methods 79 patients with DLBCL (nodal, 59% and extranodal, 41%) treated with rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) therapy were selected. Expression levels of BCR and linked signalling pathway molecules were inter-related with Lymph2Cx-based cell of origin (COO) types and overall survival (OS).

Results Activated B-cell (ABC) type DLBCL constituted 49% (39/79) compared with germinal centre B-cell (GCB) type DLBCL (29/79; 37%) and revealed poor prognosis (p=0.013). In ABC-DLBCL, high BTK expression exerted poor response to R-CHOP, while OS in ABC-DLBCL with low BTK expression was similar to GCB-DLBCL subtype (p=0.004). High LYN expression coupled with a poor OS for ABC-DLBCL as well as GCB-DLBCL subtypes (p=0.001). Furthermore, high coexpression of BTK/LYN (BTK high/LYN high) showed poor OS (p=0.019), which linked with upregulation of several genes associated with BCR repertoire and nuclear factor-kappa B pathway (p<0.01). In multivariate analysis, high BTK and LYN expression retained prognostic significance against established clinical predictive factors such as age, International Prognostic Index and COO (p<0.05).

Conclusions Our data provide a clear association between high BCR activity in DLBCL and response to therapy in a distinct population. Molecular data provided here will pave the pathway for the provision of promising novel-targeted therapies to patients with DLBCL in Southeast Asia.

  • cell biology
  • genetics
  • lymphoma

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  • Handling editor Mary Frances McMullin.

  • Contributors NM, AM and AA designed the study, collected the data, analysed the data, and drafted and edited the manuscript. TMR and M-TSR analysed the data, and reviewed and edited the manuscript. NMST, FA-R, PK-C, NMR and GE collected, compiled and analysed the data and materials.

  • Funding This study was funded by Dana Impak Perdana (DIP2012-10/3), University Kebangsaan Malaysia (NM and PKC). AA was supported by the Alberta Cancer Foundation (grant number 25999).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval In accordance with the Declaration of Helsinki, the institutional ethics committee approved this study (UKM1.5.3.5/244/DIP-2012-10/3).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.