88 Egyptian Journal of Pathology 2018, Vol 38 No 1

Fig. 3

(a) Diffuse large B-cell lymphoma, not otherwise specified: hematoxylin and eosin (×200), (b) CD20, diffuse strong membranous positivity in
lymphoma cells (immunohistochemistry, × 200), (c) CD3: negativity in lymphoma cells with some positive small T cells (immunohistochemistry, × 100),
and (d) nuclear Ki-67 immunostaining low index in lymphoma cells, <90% (immunohistochemistry, × 100).

Since its introduction in 1993, IPI has been used as a
useful tool for categorizing patients with high-grade
NHL (The International Non-Hodgkin’s Lymphoma
Prognostic Factors Project, 1993). However, after the
introduction of immunotherapy, rituximab, to CHOP
regimen, a R-IPI was suggested in 2007, and it was more
predictive to patients’ outcome with higher reducibility
(Sehn et al., 2007).
In the present study, high R-IPI and bulky disease were
significantly correlated with high DHS. In addition, it was
a good predictor of shorter patients’ OS and PFS, similar to
the reports by previous studies (Kawamoto et al., 2016; Hu
et al., 2013; Green et al., 2012; Petrich et al., 2014). On the
contrary, the evaluated cohort response to R-CHOP as a
first-line of treatment failed to show significant correlation,
even though patients with low R-IPI had a tendency to
display better response in comparison with those with high
R-IPI group. Correspondingly, Kobayashi et al. (2012)
described a tendency of association between R-IPI and
response to R-CHOP as a first-line treatment, but also
without significant correlation. Yan et al. (2014) reported
insignificant relation between the R-IPI and patients’ OS
and PFS using R-CHOP as a frontline treatment, and they
proposed that MYC, BCL2 and BCL6 immunostaining
status of cases of DLBCL was more predictive of patients’
response to R-CHOP.
In the meantime, Abdelhamid et al. (2011) reported a
significant correlation between IPI of their DLBCL
cases and patients’ response to first-line treatment with
R-CHOP, but they correlated age-adjusted IPI rather
than R-IPI. Furthermore, they classified their cohort into
two major groups, one with CR and second one with all
other treatment responses (PR, stable disease and
disease progression), whereas in the present work, the
first-line treatment response was classified into three
groups: CR, PR, and disease progression. The rationale
for choosing this detailed classification of treatment
response is that, one of the main values of these
immunohistochemical markers (MYC, BCL2 and
BCL6) being investigated was to detect their role as
predictors of response to first-line treatment with
R-CHOP regimen.
In the current study, the double-expressor B-cell
lymphomas were detected in 25% of studied cohort
(four cases MYC + BCL2 + and two cases MYC + ,