Ann Lab Med 2020; 40(5): 361-369  https://doi.org/10.3343/alm.2020.40.5.361
Diagnostic Approach for Double-Hit and Triple-Hit Lymphoma Based on Immunophenotypic and Cytogenetic Characteristics of Bone Marrow Specimens
Heyjin Kim, M.D.1, Hee-Jin Kim, M.D., Ph.D.2, and Sun-Hee Kim, M.D., Ph.D.2
1Department of Laboratory Medicine, Korea Cancer Center Hospital, Seoul, Korea; 2Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding author: Sun-Hee Kim, M.D., Ph.D.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu,
Seoul 06351, Korea
Tel.: +82-2-3410-2704
Fax: +82-2-3410-2719
E-mail: sunnyhk@skku.edu
Received: October 21, 2019; Revised: December 16, 2019; Accepted: March 13, 2020; Published online: September 1, 2020.
© Korean Society for Laboratory Medicine. All rights reserved.

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Abstract
Background: High-grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6 (BCL2/BCL6), also known as double-hit lymphoma (DHL) and/or triple-hit lymphoma (THL), is a new entity of B-cell lymphoma in the 2017 WHO Classification. We retrospectively investigated D/THL and their clinico-laboratory features among cases of large B-cell lymphoma involving the bone marrow (BM), including diffuse large B-cell lymphoma, Burkitt lymphoma, and B-cell lymphomas with medium to large lymphoid cells, by additional FISH analysis of BM aspirates.
Methods: A total of 111 patients diagnosed with aggressive B-cell lymphomas or B-cell lymphoma involving the BM with medium to large-sized malignant lymphocytes were reviewed from January 2000 to January 2018. Patients with available BM aspirates were evaluated by immunophenotyping by flow cytometry, chromosome, and FISH analysis for MYC and/or BCL2/BCL6 rearrangements.
Results: In total, 23/111 (20.7%) showed MYC rearrangement, and eight (7.2%) were reclassified as D/THL on BM after FISH analysis for MYC and BCL2/BCL6. The detection of CD5(-)/CD10(+) based on flow cytometry was strongly associated with D/THL. A complex karyotype with aberrations related to regions in MYC and BCL2/BCL6 was significantly associated with D/THL. When the MYC FISH results of 28 BM aspirates and formalin-fixed paraffin-embedded tissue specimens were compared, 14% were discrepant.
Conclusions: Immunophenotypic and cytogenetic characteristics facilitate the diagnosis of D/THL in the cases with BM-involving aggressive B-cell lymphomas.
Keywords: Double-hit lymphoma, Triple-hit lymphoma, Diffuse large B-cell lymphoma, Burkitt lymphoma, Aggressive B-cell lymphoma, MYC, BCL2, BCL6



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