366 Published by Bali Medical Journal | Bali Medical Journal 2021; 10(1): 366-372 | doi: 10.15562/bmj.v10i1.2188 ORIGINAL ARTICLE ABSTRACT Prognostic signifcance of double expressor lymphoma subtype in patient with difuse large B-cell lymphoma Hermawan Istiadi 1* , Udadi Sadhana 1 , Dik Puspasari 2 , Ika Pawitra Miranti 1 , Vega Karlowee 1 , Devia Eka Listiana 2 , Awal Prasetyo 1 Background: DLBCL is the most common type of non-Hodgkin lymphoma in Asia and Indonesia. DLBCL, based on cell of origin is divided into germinal center B-cell-like (GCB) and non-GCB subtypes. 20% of patients have a molecular profle double expressor lymphoma (DEL), which has a worse prognosis. The study aims to determine the relationship between DEL subtypes and cell of origin subtypes with clinical stage and 3-year overall survival of double large B-cell lymphoma (DLBCL) patients in Kariadi General Hospital Semarang. Methods: This study sample was 36 DLBCL patients in Kariadi General Hospital from January to September 2017. The data collection including age of diagnosis, location, stage, cell of origin subtype, DEL subtype and 3-year overall survival. Data analysis using chi-square test and Kaplan Meier curve. Results: DLBCL DEL subtype patients were signifcantly associated with advanced-stage (p: 0.028). DLBCL non-GCB subtype and DEL subtype patients had a 3-year overall survival that was signifcantly worse than GCB subtype and non-DEL subtypes (p: 0.026 and p: 0.006, respectively), with a 3-year survival rate of non-GCB subtypes was 38.9% and DEL subtypes were 33.3%. DLBCL patients with advanced stages also have a 3-year overall survival signifcantly worse than the early stage (p: 0.000), with a 3-year survival rate of 14.3%. Conclusion: DLBCL non-GCB subtype patients, DEL subtypes and advanced stages have a lower 3-year overall survival rate and thus have a worse prognosis. Keywords: double expressor lymphoma, DLBLC, survival. Cite This Article: Istiadi, H., Sadhana, U., Puspasari, D., Miranti, I.P., Karlowee, V., Listiana, D.E., Prasetyo, A. 2021. Prognostic signifcance of double expressor lymphoma subtype in patient with difuse large B-cell lymphoma. Bali Medical Journal 10(1): 366-372. DOI: 10.15562/bmj.v10i1.2188 1 Anatomical Pathology Department, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia. 2 Anatomical Pathology Laboratory, Kariadi General Hospital, Indonesia. *Corresponding author: Hermawan Istiadi; Anatomical Pathology Department, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia; hermawanistiadi@fk.undip.ac.id Received: 2021-01-15 Accepted: 2021-04-20 Published: 2021-04-30 366 Published by Bali Medical Journal Bali Medical Journal (Bali MedJ) 2021, Volume 10, Number 1: 366-372 P-ISSN.2089-1180, E-ISSN: 2302-2914 Open access: www.balimedicaljournal.org INTRODUCTION Lymphoma is a malignant disease that arose from lymphocytes in lymphoid tissue, divided into two main groups: Hodgkin’s lymphoma and non-Hodgkin’s lymphoma (NHL). More than 85% of lymphoma in the world is NHL and more than 90% of NHL in the world arose from mature B cells. In Indonesia, NHL is the seventh rank most common cancers. 1,2 Te most common type of mature B cell NHL types in Asia, including in Indonesia, is Difuse Large B-Cell Lymphoma (DLBCL). Nearly 90% of all aggressive B cell type NHL in adults is DLBCL. DLBCL has the highest mortality rate among B cell NHL types and about 64% of DLBCL patients are mostly found in stage III and IV. 1,2,3 Histologically, DLBCL has difuse distribution of large malignant lymphoid cells expressing B cell markers (CD20, CD79a, CD19, CD22 and PAX5) and has high Ki-67 proliferation index. 2,3,4 DLBCL can be classifed into 2 subtypes, based on the molecular profle of the cell of origin (Hans’s criteria): Germinal Center B-cell- like (GCB) and Activated B-Cell-like (ABC) or non-Germinal Center B-cell-like (non-GCB), using immunohistochemistry (IHC) examination for CD10, BCL6 and MUM1. 2,5,6 Generally the GCB subtype DLBCL has better prognosis and overall survival than the non-GCB subtype. 2,6,7 Some DLBCL patients also have genetic changes in the BCL2 and myelocytomatosis (MYC) genes. Translocation of the MYC gene provides a worse prognosis in DLBCL patients treated with R-CHOP. Approximately 20% of DLBCL patients had a double expressor lymphoma (DEL) molecular profle, with high MYC and BCL2 protein expression. DEL type DLBCL is reported to have more aggressive clinical course and lower response to R-CHOP therapy. 8–12 Data on lymphoid tissue malignancy cases in Indonesia have not been well published, and most DLBCL patients in Indonesia were not been diagnosed completely until its subtypes to support immunotherapy and predict prognosis. Tis study observed the prevalence of DLBCL and its subtypes, based on the cell origin and DEL subtype. Tis study’s objective was to determine association between DEL subtypes and cell of origin subtypes with clinical profle and overall survival of DLBCL patients at Dr. Kariadi