Potential Role of BCL2 and BCL6 Overexpression in Circulating Tumor Cells as Molecular Biomarkers in DLBCL After R-CHOP Therapy.

UNLABELLED: Diffuse large B-cell lymphoma (DLBCL) is the most prevalent non-Hodgkin lymphoma subtype. Although R-CHOP remains the standard first-line therapy, up to 30% of patients experience relapse or refractory disease. Currently, therapeutic monitoring relies on imaging, which is less sensitive than molecular techniques for detecting residual disease.

AIM: To evaluate BCL2 and BCL6 oncogene expression in Circulating Tumor Cells (CTCs) as potential molecular biomarkers for clinical outcomes in DLBCL patients after R-CHOP therapy.

METHODS

We analyzed BCL2 and BCL6 expression in CTCs from 42 patients post-R-CHOP using immunomagnetic enrichment of CD20+ cells followed by RT-qPCR.

RESULTS

Patients exhibited significantly higher BCL2 (p = 0.003) and BCL6 (p = 0.001) expression than healthy controls. Overexpression of BCL2 and BCL6 was observed in 16.7% and 19% of patients, respectively, with 9.5% showing co-expression. Normal BCL6 expression correlated with complete response (p = 0.004), and BCL6 demonstrated high discriminative ability for disease activity (AUC = 0.791, p = 0.008).

CONCLUSIONS

The presence of BCL2 and BCL6 in CTCs suggests that liquid biopsy serves as a robust, complementary tool to PET/CT for post-treatment monitoring. These findings support the utility of BCL6 as a biomarker for residual disease surveillance in DLBCL.