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PD-1 Expression in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) and Large B-cell Richter Transformation (DLBCL-RT): A Characteristic Feature of DLBCL-RT and Potential Surrogate Marker for Clonal Relatedness

He, Rong, MD*; Ding, Wei, MD, PhD; Viswanatha, David, S., MD*; Chen, Dong, MD, PhD*; Shi, Min, MD, PhD*; Van Dyke, Daniel, PhD; Tian, Shulan, PhD§; Dao, Linda, N., MD*; Parikh, Sameer, A., MBBS; Shanafelt, Tait, D., MD; Call, Timothy, G., MD; Ansell, Stephen, M., MD, PhD; Leis, Jose, F., MD, PhD; Mai, Ming, MS*; Hanson, Curtis, A., MD*; Rech, Karen, L., MD*

The American Journal of Surgical Pathology: July 2018 - Volume 42 - Issue 7 - p 843–854
doi: 10.1097/PAS.0000000000001077
Original Articles

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a low-grade B-cell neoplasm and ∼2% to 9% patients develop an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (Richter transformation, DLBCL-RT). Programmed death-1 (PD-1) pathway plays a crucial role in tumor host immunity evasion and its blockade has emerged as an effective anti-cancer immunotherapy. PD-L1 and PD-1 expression has shown predictive value in anti-PD cancer immunotherapy; however, it has not been well documented in CLL/SLL and DLBCL-RT. We evaluated PD-1 and PD-L1 expression by immunohistochemistry in 39 CLL/SLL, 15 DLBCL-RT, and 26 other DLBCL. In CLL/SLL, neoplastic B-cell PD-1 expression was weak and restricted to prolymphocytes/paraimmunoblasts within proliferation centers (PCs) and accentuated PCs of all sizes. Neoplastic B-cell PD-1 expression was highly prevalent and demonstrated increased intensity in DLBCL-RT, but in contrast was only rarely seen in other DLBCL (12/15 vs. 1/26; P<0.0001). An excellent correlation (90% concordance) was observed between neoplastic B-cell PD-1 immunohistochemistry positivity and molecularly defined CLL/SLL clonal relatedness in DLBCL-RT. PD-L1 expression was observed on the neoplastic B cells in rare DLBCL-RT and other DLBCL cases (1/15 vs. 1/26; P>0.05) as well as background histiocytes and dendritic cells. Overall survival of DLBCL-RT was significantly inferior to that of the other DLBCL (median, 16.9 vs. 106.1 mo; P=0.002). Our findings suggest a biological continuum from prolymphocytes/paraimmunoblasts in CLL/SLL PCs to the neoplastic B-cells in DLBCL-RT. The characteristic PD-1 expression in DLBCL-RT makes it a potential surrogate marker for determining clonal relatedness to CLL/SLL, which may have important prognostic and therapeutic implications.

Divisions of *Hematopathology


Laboratory Genetics and Genomics

§Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN

Division of Hematology, Mayo Clinic College of Medicine, Scottsdale, AZ

Conflicts of Interest and Source of Funding: W.D. has received research funding from Merck and is an advisory board member of Alexion. T.D.S. has received research support from Genentech, Celgene, Pharmacyclics, Jansen, GlaxoSmithKline, AbbVie, Hospira, and Cephalon. S.A.P. has received research funding from Pharmacyclics and also participated in advisory boards at Pharmacyclics and AstraZeneca. He was not personally compensated for both the research funding and the advisory boards. The remaining authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: Rong He, MD, Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN 55905 (e-mail:

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