DETERMINATION OF IMMUNOPHENOTYPIC DIFFERENTIATION PROFILES, APOPTOSIS AND PROLIFERATION STATUS IN INDONESIAN DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS

YOSINTA SNAK, Prijono Tirtoprodjo, MD, ; Nungki Anggorowati, MD, Ph.D.

2017 | Tesis-Spesialis | SP ILMU PATOLOGI ANATOMI

Diffuse large B-cell lymphoma (DLBCL) mempunyai 2 (dua) profil imunofenotip utama yaitu, Germinal Center B-cell-like (GCB) dan non-GCB. Kedua profil imunofenotip tersebut mempunyai perilaku yang berbeda dan mempengaruhi harapan hidup pasien. Tujuan dari penelitian ini adalah untuk meneliti frekuensi GCB dan non-GCB pada pasien DLBCL di Indonesia. Ekspresi index apoptosis (IA) dan index proliferasi (IP) pada kedua imunofenotip DLBCL juga diteliti. GCB dan non-GCB ditentukan dengan pemeriksaan immunohistochemistry (IHC) menggunakan algoritme Hans yang melibatkan CD10, BCL6 dan MUM1. IP ditentukan dengan IHC menggunakan Ki67 sedangkan IA menggunakan TUNEL. Selama 3.5 tahun periode penelitian ini, telah teridentifikasi 98 kasus DLBCL. GCB ditemukan pada 31 kasus (31.6%) dan non-GCB pada 67 kasus (68.4%). Jenis kelamin menunjukkan pria lebih dominan (54 kasus, 55.1%) dengan insiden lokasi lesi tertinggi pada ekstranodal (57 kasus, 58.2%). IA dan IP secara signifikan lebih tinggi pada GCB (p<0.001 dengan tes Mann-Whitney). Tes koefisien korelasi Spearman menunjukkan ekspresi IP berkorelasi positif dengan IA (r=-0.673, p<0.001). Seluruh hasil tersebut mengindikasikan bahwa imunofenotip non-GCB lebih tinggi dibandingkan GCB pada pasien DLBCL di Indonesia. GCB secara signifikan berhubungan dengan tingginya IP dan IA. IP juga mempunyai korelasi positif dengan IA.

Diffuse Large B-cell Lymphoma (DLBCL) has two major immunophenotypic differentiation profiles, germinal center B-cell-like (GCB) and non-GCB. They have different behavior and affect patients survival. The aim of this study was to investigate the frequency of GCB and non-GCB in Indonesian DLBCL patients. The expression of apoptotic index (AI) and proliferation index (PI) in those two immunophenotypic differentiations of DLBCL were also investigated. GCB and non-GCB were determined by immunohistochemistry using Hans Algorithm with CD10, BCL6 and MUM1. PI was determined by immunohistochemistry using Ki67 and the TUNEL method was used to determine AI. During a study period of 3.5 years, a total of 98 cases of DLBCL were identified. GCB was found in 31 cases (31.6%) and non-GCB was determined in 67 cases (68.4%). Gender showed slightly male predominance (54 cases, 55.1%) with higher incidence in extra-nodal (57 cases, 58.2%). The AI and PI were significantly higher in GCB (p<0.001 in the Mann-Whitney test). The Spearman correlation coefficient test showed the expression of PI was positively correlated with AI (r=-0.673, p<0.001). The above findings indicate that non-GCB immunophenotypic profile is higher than GCB in Indonesian DLBCL patients. GCB significantly related to the higher PI and AI. PI also had significantly positive correlation with AI.

Kata Kunci : diffuse large B-cell lymphomas, imunofenotip, diferensiasi, apoptosis, proliferasi, diffuse large B-cell lymphomas, immunophenotypic, differentiation, apoptosis, proliferation.