Abstract
Background: Lymphoma is a malignant lymphoid cell tumors at varying stages of maturity and it is the most common hematological malignancy. Lymphoma is classified mainly into non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL). Cluster of Differentiation 47(CD47) is cell surface protein, expressed by approximately all cells in the body in addition to different tumor cell types such as lymphoma. It mediates immune homeostasis, cell proliferation, phagocytosis, migration and apoptosis.
Objectives: To evaluate the expression of CD47 in B-cells lymphoma in addition to study the relation of expression of CD47 with some clinicopathological parameters such as site , age and gender.
Methods: A retrospective and prospective case series study of 51 cases of B-cell lymphoma, which were collected from histopathological departments of governmental and private labs over six months extending from September 2024 to February 2025.Assessment of IHC expression of CD47 expression on B-cell lymphoma.
Results: A total of 51 patients, 53% were HL , while 47% were NHL. The age of the patients under 60 years was 45% while at 60 years and above 55%, 64.7% were nodal presentation and 35.3% were extranodal ,51% were males while 49% were females.64.71% were high CD47 expression while 35.29% were low CD47 expression group.
Conclusions: high CD47 expression was associated with female gender and younger age patients, however, long term follows up studies on larger sample is recommended.
References
- Rafea H, Al-Tae AK, Jawhar N. Diagnostic Yield of PAX5 in Lymphoma. Ann Coll Med Mosul. 2021;42(2):109–18. doi: 10.33899/mmed.2020.128737.1058.
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.doi: 10.3322/caac.21654.
- Ennishi D, Hsi ED, Steidl C, Scott DW. Toward a new molecular taxonomy of diffuse large B-cell lymphoma. Cancer Discov. 2020;10(9):1267–81. doi: 10.1158/2159-8290.cd-20-0174.
- Ansell SM. Hodgkin lymphoma: 2023 update on diagnosis, risk‐stratification, and management. Am.J.Hematol. 2022 Nov;97(11):1478-88. doi: 10.1002/ajh.26717.
- Kshatri JS, Satpathy P, Sharma S, Bhoi T, Mishra SP, Sahoo SS. Health research in the state of Odisha, India: a decadal bibliometric analysis (2011-2020). J Fam Med Prim Care. 2022 Jul 1;11(7):3771-6. doi: 10.4103/jfmpc.jfmpc_2192_21.
- Kundu R, Kal N, Singh A, Jagadeesh D. Global Incidence, Mortality and Risk Factors of Hodgkins and Non-Hodgkins Lymphoma 1990-2021: A Global Health Data Study. Blood. 2024 Nov 5;144:6360. doi:10.1182/blood-2024-212117.
- Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024 Jan;74(1):12-49. doi: 10.3322/caac.21820.
- de Charette M, Houot R. Hide or defend, the two strategies of lymphoma immune evasion: potential implications for immunotherapy. haematologica. 2018 Jul 13;103(8):1256 doi:10.3324/haematol.2017.186650.
- Ansell SM, et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin's lymphoma. N Engl J Med. 2015;372:311-319. doi:10.1056/NEJMoa1411087.
- Borgohain M, Krishnatreya K, Weingken CK, Das JK. Diagnostic Utility of Immunohistochemistry in Lymphoma Section. Int J Contemporary Med Res. 2017;4(12):6-9. ISSN (Online):2393-915×;(Print):2454-7379.
- Zuhair Z, Khattab KW. The Utility of CD10 and MUM1 Immunohistochemical Stains in Subtyping Diffuse Large B Cell Lymphoma. J Nat Sci Biol Med. 2024 Jan;15(1):51-7. doi:10.4103/jnsbm.JNSBM_15_1_6.
- Fahad LA, Al-Omar ZM, AL-Kheroo KN. Characterization of the FLT3 Mutation in Newly Diagnosed Patients with Acute Myeloid Leukemia. Al-Anbar Med J. 2024 Jun 1;20(1). doi:10.33091/amj.2024.144737.1447.
- Fadhil MS, Al-Nueimy WM, Lazim AF. Hodgkin's lymphoma. An immunohistochemical profile in northern Iraq. Saudi Med J. 2014 May;35(5):448-53. PMID: 24825804.
- Jameel ZZ, Khattab KW. BCL6 Immunohistochemical Expression In Diffuse Large B Cell Lymphoma. Ann Coll Med Mosul. 2024 Jun 1;46(1):43-0. doi:10.33899/mmed.2024.145600.1245.
- Eladl E, Tremblay-LeMay R, Rastgoo N, Musani R, Chen W, Liu A, et al. Role of CD47 in hematological malignancies. J Hematol Oncol. 2020 Dec;13:1-4. doi:10.1186/s13045-020-00930-1.
- Huang CY, Ye ZH, Huang MY, Lu JJ. Regulation of CD47 expression in cancer cells. Transl Oncol. 2020 Dec 1;13(12):100862. doi:10.1016/j.tranon.2020.100862.
- Yang H, Xun Y, You H. The landscape overview of CD47-based immunotherapy for hematological malignancies. Biomark Res. 2023 Feb 1;11(1):15. doi:10.1186/s40364-023-00456-x.
- Huang J, Liu F, Li C, Liang X, Li C, Liu Y, et al. Role of CD47 in tumor immunity: a potential target for combination therapy. Sci Rep. 2022 Jun 13;12(1):9803. doi:10.1038/s41598-022-13764-3.
- Zhao P, Xie L, Yu L, Wang P. Targeting CD47-SIRPα axis for Hodgkin and non-Hodgkin lymphoma immunotherapy. Genes Dis. 2024 Jan. doi:10.1016/j.gendis.2022.12.008.
- Qu T, Li B, Wang Y. Targeting CD47/SIRPα as a therapeutic strategy, where we are and where we are headed. Biomark Res. 2022;10:20. doi:10.1186/s40364-022-00373-5.
- Yang K, Xu J, Liu Q, Li J, Xi Y. Expression and significance of CD47, PD1 and PDL1 in T-cell acute lymphoblastic lymphoma/leukemia. Pathol Res Pract. 2019 Feb 1;215(2):265-71. doi:10.1016/j.prp.2018.11.007.
- Gholiha AR, Hollander P, Löf L, Glimelius I, Hedstrom G, Molin D, et al. Checkpoint CD47 expression in classical Hodgkin lymphoma. Br J Haematol. 2022 Jun;197(5):580-9. doi:10.1111/bjh.18137.
- Alizadeh AA, Aranda V, Bardelli A, Blanpain C, Bock C, Borowski C, et al. Toward understanding and exploiting tumor heterogeneity. Nat. Med. 2015 Aug;21(8):846-53. doi:org/10.1038/nm.3915.
- Aslani A, Morsali S, Mousavi SE, Choupani S, Yekta Z, Nejadghaderi SA. Adult Hodgkin lymphoma incidence trends in the United States from 2000 to 2020. Sci. Rep. 2024 Sep 3;14(1):20500.
- doi:10.1038/s41598-024-69975-3.
- Kumar V, Abbas A K & Aster J C. Robbins Basic Pathology . 2018 (10th ed., vol.12, p 463). Elsevier .
- Huang Y, Ma Y, Gao P, Yao Z. Targeting CD47: the achievements and concerns of current studies on cancer immunotherapy. J Thorac Dis. 2017 Feb;9(2):E168.
- doi:10.21037/jtd.2017.02.30.
- Velliquette RW, Aeschlimann J, Kirkegaard J, Shakarian G, Lomas‐Francis C, Westhoff CM. Monoclonal anti‐CD47 interference in red cell and platelet testing. Transfusion. 2019 Feb;59(2):730-7. doi:10.1111/trf.15033.
- Wiewiora M, Piecuch J, Sedek L, Mazur B, Sosada K. The effects of obesity on CD47 expression in erythrocytes. Cytometry B Clin Cytom. 2017 Nov;92(6):485-91. doi:10.1002/cyto.b.21232.
- Kiliçarslan A, Kurt Çevik G, Doğan M, AKSOY ALTINBOĞA AY, Ceran F, BAKANAY ÖZTÜRK ŞM, et al. Does CD47 expression have prognostic significance in classical Hodgkin lymphoma?. Turk J Med Sci. 2025;55(1):203-8. doi:10.55730/1300-0144.5958.
- López-Pereira B, Fernández-Velasco AA, Fernández-Vega I, Corte-Torres D, Quirós C, Villegas JA, et al. Expression of CD47 antigen in Reed–Sternberg cells as a new potential biomarker for classical Hodgkin lymphoma. Clin Transl Oncol. 2020 May;22:782-5.doi:10.1007/s12094-019-02171-2.
- Cho J, Yoon SE, Kim SJ, Ko YH, Kim WS. CD47 overexpression is common in intestinal non-GCB type diffuse large B-cell lymphoma and associated with 18q21 gain. Blood Adv. 2022 Dec 27;6(24):6120-30.
- doi:10.1182/bloodadvances.2021006305.
- Kazama R, Miyoshi H, Takeuchi M, Miyawaki K, Nakashima K, Yoshida N, et al. Combination of CD47 and signal‐regulatory protein‐α constituting the “don’t eat me signal” is a prognostic factor in diffuse large B‐cell lymphoma. Cancer Sci. 2020 Jul;111(7):2608-19. doi:10.1111/cas.14437.
- Sun H, Xue L, Guo Y, Du J, Nan K, Li M. Global, regional and national burden of non-Hodgkin lymphoma from 1990 to 2017: estimates from global burden of disease study in 2017. Ann Med. 2022 Dec 31;54(1):633-45. doi:10.1080/07853890.2022.2039957.
- Muhealdeen DN, Shwan A, Yaqo RT, Hassan HA, Muhammed BO, Ali RM, et al. Epstein-Barr virus and Burkitt’s lymphoma. Associations in Iraqi Kurdistan and twenty-two countries assessed in the International Incidence of Childhood Cancer. Infect Agents Cancer. 2022 Jul 27;17(1):39. doi:10.1186/s13027-022-00452-0.
- Testi AM, Al-Jadiry MF, Moleti ML, Uccini S, Al-Darraij AF, Al-Saeed RM, et al. Hodgkin Lymphoma in children: a 16-year experience at the Children’s Welfare Teaching Hospital of Baghdad, Iraq. Mediterr J Hematol Infect Dis. 2024 Jul 1;16(1):e2024053. doi:10.4084/mjhid.2024.053.
- Cook KL, Soto-Pantoja DR. “UPRegulation” of CD47 by the endoplasmic reticulum stress pathway controls anti-tumor immune responses. Biomark Res. 2017 Dec;5:1-6. doi:10.1186/s40364-017-0105-8.
- Huang D, Berglund M, Damdimopoulos A, Antonson P, Lindskog C, Enblad G, Amini RM, Okret S. Sex-and Female Age-Dependent Differences in Gene Expression in Diffuse Large B-Cell Lymphoma—Possible Estrogen Effects. Cancers. 2023 Feb 17;15(4):1298. doi:10.3390/cancers15041298.
- Starr JS, Jiang L, Li Z, Qiu Y, Menke DM, Tun HW. CD47 and osteopontin expression in diffuse large B-cell lymphoma with nodal and intravascular involvement. Clin Lymphoma Myeloma Leuk. 2013 Oct 1;13(5):597-601. doi:10.1016/j.clml.2013.05.001.
- Chao MP, Tang C, Pachynski RK, Chin R, Majeti R, Weissman IL. Extranodal dissemination of non-Hodgkin lymphoma requires CD47 and is inhibited by anti-CD47 antibody therapy. Blood. 2011 Nov 3;118(18):4890-901.doi:10.1182/blood-2011-02-338020.
- Monabati A, Safaei A, Noori S, Mokhtari M, Vahedi A. Subtype distribution of lymphomas in South of Iran, analysis of 1085 cases based on World Health Organization classification. Ann Hematol. 2016;95(4):613-618. doi:10.1007/s00277-016-2590-5.
- Aladily TN, Khreisat W, Ashukhaibi O, Alkhatib SM, Annab H, Tarawneh MS, et al. The epidemiology of lymphoma in Jordan: A nationwide population study of 4189 cases according to World Health Organization classification system .Hematol Oncol Stem Cell Ther. 2021 Oct 1;14(4):336-42.doi:10.1016/j.hemonc.2020.10.002.
- Chao MP, Alizadeh AA, Tang C, Myklebust JH, Varghese B, Gill S, et al. Anti-CD47 antibody synergizes with rituximab to promote phagocytosis and eradicate non-Hodgkin lymphoma. Cell. 2010 Sep 3;142(5):699-713. doi:10.1016/j.cell.2010.07.044.
- Ahmed HA, Raslan WF, Deifalla AH, Fathallah MD. CD163 is a predictive biomarker for prognosis of classical Hodgkin's lymphoma in Saudi patients. Mol Clin Oncol. 2019 Jul;11(1):67-76. doi:10.3892/mco.2019.1850.
- Salati M, Cesaretti M, Macchia M, El Mistiri M, Federico M. Epidemiological overview of Hodgkin lymphoma across the mediterranean basin. Mediterr J Hematol Infect Dis. 2014 Jul 1;6(1):e2014048. doi:10.4084/mjhid.2014.048.
- Shen YG, Ji MM, Yi HM, Shen R, Fu D, Cheng S, et al.CD47 overexpression is related to tumour‐associated macrophage infiltration and diffuse large B‐cell lymphoma progression. Clin Transl Med. 2024 Jan 9;14(1):e1532.doi:10.1002/ctm2.1532.
- Bouwstra R, He Y, de Boer J, Kooistra H, Cendrowicz E, Fehrmann RS, et al. CD47 expression defines efficacy of rituximab with CHOP in non–germinal center B-cell (non-GCB) diffuse large B-cell lymphoma patients (DLBCL), but not in GCB DLBCL. Cancer Immunol Res. 2019 Oct 1;7(10):1663-71.doi:10.1158/2326-6066.cir-18-0781.
- Lee WY, Perry AM, Azcutia V, Herrera AF, Skrabek P, Jackson R, et al. Upregulation of CD47 Expression in De Novo Diffuse Large B-Cell Lymphoma Is More Frequent in Activated B-Cell Type. Blood. 2021 Nov 23;138(Supplement 1):3507-.doi:10.32388/9m8mla.
- Gholamin S, Mitra SS, Feroze AH, Liu J, Kahn SA, Zhang M, et al. Disrupting the CD47-SIRPα anti-phagocytic axis by a humanized anti-CD47 antibody is an efficacious treatment for malignant pediatric brain tumors. Sci Transl Med. 2017 Mar 15;9(381):eaaf2968. doi:10.1126/scitranslmed.aaf2968.
- Advani R, Flinn I, Popplewell L, Forero A, Bartlett NL, Ghosh N, et al. CD47 blockade by Hu5F9-G4 and rituximab in non-Hodgkin’s lymphoma. N Engl J Med. 2018 Nov 1;379(18):1711-21. doi:10.1056/NEJMoa1807315.
- Yu J, Li S, Chen D, Liu D, Guo H, Yang C, et al. SIRPα-Fc fusion protein IMM01 exhibits dual anti-tumor activities by targeting CD47/SIRPα signal pathway via blocking the “don’t eat me” signal and activating the “eat me” signal. J Hematol Oncol. 2022 Nov 16;15(1):167. doi: 10.1186/s13045-022-01385-2.
- Sikic BI, Lakhani N, Patnaik A, Shah SA, Chandana SR, Rasco D, et al. First-in-human, first-in-class phase I trial of the anti-CD47 antibody Hu5F9-G4 in patients with advanced cancers. J Clin Oncol. 2019 Apr 20;37(12):946-53.doi: 10.1200/JCO.18.02018.



