Evalution of prognostic importance of PUMA, P53 and BCL-2 in diffused large B cell lymphoma

Introduction: Lymphomas are neoplasms originating from lymphoid tissue. They may originate from any stage of lymphoid cell development. Prognosis depends on the subtype of lymphoma. Indolent lymphomas have a longer survival and are generally considered not to heal. Aggressive lymphomas progress faster, but recovery rates are higher. Diffuse large B cell lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin lymphoma (NHL) accounting for approximately 30 percent of NHL cases. Patients with DLBCL typically present with a rapidly enlarging symptomatic mass, most usually nodal enlargement in the neck or abdomen. Systemic 'B' symptoms (ie, fever, weightloss, drenching, night sweats) are observed in approximately 30 percent of patients. Bone marrow involvement and extranodal extramedullary disease are seen in upto 30 and 40 percent of cases, respectively. Apoptosis is programmed cell death. The mechanisms involved in this process, PUMA and P53, function by means of BCL2 andmainly provide the realization of apoptosis. PUMA may induce apoptosis with and without P53. Objectives: In this study, we aimed to evaluate whether BCL2, P53 and PUMA have an effect on overall survival and disease-free survival in DLBCL. If there is an association between PUMA, P53 and/or BCL2 on survival in lymph node samples from DLBCL patients, these parameters can be used as a prognostic indicator and/or a targeted therapy option. Materials and Methods: Immunohistochemical staining was applied to the paraffin-blocked lymph node biopsy sections of 46 patients who underwent diagnostic lymph node excision and were diagnosed with DLBCL. PUMA (cutoff 30%) and P53 (cutoff 50%) were evaluated as positive or negative. Results: In our study, a relationship was found between age and OS, and between extranodal involvement and OS and EFS. The positivity of p53 and PUMA alone or in combination with BCL2, BCL6 and MYC did not have any effect on survival. Considering the effect of IPI scoring on survival in P53 positive patients, it was seen that it was significant in terms of OS. When the relationship between IPI, R-IPI and NCCN-IPI and survival was evaluated in PUMA positive patients, no significant results were found. Conclusion: The significant result between IPI and survival times in P53 positive patients was thought to be related to the role of P53 in apoptosis. The reason why OS, EFS and PFS times of PUMA positive patients did not affect may be related to the limited number of patients in our study. İf the study with a sufficient number of patients obtain significant results the study of PUMA and P53 at the time of diagnosis can inform us about the overall survival of the patient. Keywords: Lymphoma, Diffuse large B cell lymphoma (DLBCL), PUMA, P53, BCL2, apoptosis, prognosis