1
|
Soof CM, Spektor TM, Parikh SA, Slager SL, Rabe KG, Call TG, Kenderian SS, Ding W, Muchtar E, Ghermezi M, Kay NE, Berenson JR. Serum B-Cell Maturation Antigen is an Independent Prognostic Marker in Previously Untreated Chronic Lymphocytic Leukemia. Exp Hematol 2022; 111:32-40. [PMID: 35525334 DOI: 10.1016/j.exphem.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Abstract
B-cell maturation antigen (BCMA) is a cell membrane receptor expressed on mature B lymphocytes with elevated serum levels found among patients with B-cell malignancies, including chronic lymphocytic leukemia (CLL). Serum BCMA (sBCMA) levels were measured in 331 untreated, newly diagnosed CLL patients using an ELISA with a polyclonal anti-BCMA antibody. Elevated sBCMA was found among patients with CLL compared to age- and sex-matched healthy controls and those with more active CLL based on prognostic factors. The relationships between sBCMA, time to first treatment (TTFT), overall survival (OS) and multiple prognostic factors were compared using Mann Whitney and Kruskal-Wallis tests. The median sBCMA level in the CLL cohort (48.6 ng/mL) was significantly higher (p < 0.001) compared to age- and sex-matched healthy subjects (n = 100; 37.8 ng/mL). sBCMA correlated with TTFT (hazard ratio [HR] 2.9, 95% confidence interval [CI] 2.0-4.2, p < 0.001) and OS (HR 2.5, 95% CI 1.5-4.0, p < 0.001). Multiple models were utilized to test the predictive effects of sBCMA, sex, CLL-IPI and IPS-E on TTFT and OS. The addition of sBCMA to CLL-IPI and IPS-E improved their prognostic ability to predict TTFT and OS. Thus, serum BCMA is a new promising prognostic biomarker for CLL.
Collapse
Affiliation(s)
- Camilia M Soof
- OncoTracker Inc., West Hollywood, CA; Oncotherapeutics, West Hollywood, CA
| | | | | | - Susan L Slager
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Kari G Rabe
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - James R Berenson
- OncoTracker Inc., West Hollywood, CA; Oncotherapeutics, West Hollywood, CA; Institute for Myeloma and Bone Cancer Research, West Hollywood, CA.
| |
Collapse
|
2
|
Gamaleldin MA, Ghallab OM, Nadwan EA, Abo Elwafa RA. PD-1 and PD-L1 gene expressions and their association with Epstein-Barr virus infection in chronic lymphocytic leukemia. Clin Transl Oncol 2021; 23:2309-2322. [PMID: 34120295 DOI: 10.1007/s12094-021-02657-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The PD-1 (programmed cell death-1) receptor is expressed on the surface of activated T cells. Its ligand, programmed cell death ligand-1 (PD-L1), is expressed on the surface of dendritic cells or macrophages. The PD-1/PD-L1 interaction ensures prevention of autoimmunity by activating the immune system only when needed. In cancers, PD-L1 expressed on the tumour cells binds to PD-1 receptors on the activated T cells, leading to inhibition of the cytotoxic T cells and immunosuppression. PD-1/PD-L1 pathway is upregulated in EBV infection that is known to worsen the CLL prognosis. Therefore, we aimed to study the association between PD-1 and PD-L1 expressions, EBV status and the CLL prognosis. METHODS AND PATIENTS The study was conducted on 80 newly diagnosed CLL patients and 80 controls. We analyzed PD-1 and PD-L1 expressions and EBV-DNA load by real-time PCR. The cytogenetic abnormalities and expression of ZAP70 and CD38 were detected by FISH and Flow cytometry, respectively. RESULTS PD-1/PD-L1 expressions were significantly upregulated in CLL patients compared to controls. In addition, their mRNA levels were significantly higher in EBV( +) versus EBV( -) patients. High expression of PD-1/PD-L1 was associated with poor prognostic markers (RAI stages of CLL, del 17p13, ZAP70, and CD38 expression), failure of complete remission, shorter progression-free survival, and overall survival. CONCLUSION High expression of PD-1 and PD-L1, together with high EBD-DNA load were linked to worse prognosis in CLL. In addition, PD-1 and PD-L1 might represent suitable therapeutic targets for patients suffering from aggressive CLL.
Collapse
Affiliation(s)
- M A Gamaleldin
- Clinical Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - O M Ghallab
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - E A Nadwan
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - R A Abo Elwafa
- Clinical Pathology Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| |
Collapse
|
3
|
Abo Elwafa R, Abd Elrahman A, Ghallab O. Long intergenic non-coding RNA-p21 is associated with poor prognosis in chronic lymphocytic leukemia. Clin Transl Oncol 2020; 23:92-99. [PMID: 32468342 DOI: 10.1007/s12094-020-02398-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/12/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Long non-coding RNAs (LncRNAs) are RNA transcripts longer than 200 nucleotides. They are new players in transcriptional regulation and cancer research. LincRNA-p21 is a p53-regulated lncRNA involved in the p53 transcriptional network. It has an important role in regulating cellular proliferation and apoptosis. Chronic lymphocytic leukemia is derived by a typical defect in apoptosis and characterized by clonal proliferation and accumulation of mature B cells. The aim of the present study was to assess the expression pattern of the lincRNA-p21 and investigate its potential role as a new prognostic marker in CLL. METHODS The study was conducted on 80 newly diagnosed CLL patients and 80 age- and sex-matched controls. The analysis of LincRNA-p21 and the p53 downstream proapoptotic target genes (MDM2, PUMA, BAX, and NOXA) was performed by real-time PCR. The cytogenetic abrasions and expression of ZAP70 and CD38 were detected by FISH and Flow cytometry, respectively. RESULTS LincRNA-p21 was significantly downregulated in CLL patients compared to controls. The downstream proapoptotic targets were significantly downregulated in CLL patients and positively correlated with lincRNA-p21. Low expression of lincRNA-p21 was associated with poor prognostic markers (advanced stages of CLL, del 17p13, ZAP70, and CD38 expression), failure of complete remission, shorter progression free survival, and overall survival. Low lincRNA-p21 expression was independently prognostic for shorter time to treatment. CONCLUSION Low expression of lincRNA-p21 demarcates a more aggressive form of CLL with poor prognosis. Therefore, it could be considered as a new prognostic marker to predict disease outcome in CLL.
Collapse
Affiliation(s)
- R Abo Elwafa
- Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - A Abd Elrahman
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - O Ghallab
- Internal Medicine Department (Hematology Unit), Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
4
|
Fang H, Reichard KK, Rabe KG, Hanson CA, Call TG, Ding W, Kenderian SS, Muchtar E, Schwager SM, Leis JF, Chanan-Khan AA, Slager SL, Braggio E, Smoley SA, Kay NE, Shanafelt TD, Van Dyke DL, Parikh SA. IGH translocations in chronic lymphocytic leukemia: Clinicopathologic features and clinical outcomes. Am J Hematol 2019; 94:338-345. [PMID: 30575108 DOI: 10.1002/ajh.25385] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 01/03/2023]
Abstract
The prevalence, clinicopathologic correlates, and outcomes of previously untreated chronic lymphocytic leukemia (CLL) patients with IGH-BCL2 and IGH-BCL3 translocations are not well known. Using the Mayo Clinic CLL database, we identified patients seen between March 1, 2002 and September 30, 2016 who had FISH testing performed within 3 years of CLL diagnosis. The prognostic profile, time to first therapy (TTT), and overall survival (OS) of patients with IGH-BCL2 and IGH-BCL3 translocation were compared to patients without these abnormalities (non-IGH group). Of 1684 patients who met the inclusion criteria, 38 (2.2%) had IGH-BCL2, and 16 (0.9%) had IGH-BCL3 translocation at diagnosis. Patients with IGH-BCL3 translocation were more likely to have high and very-high CLL-International Prognostic Index, compared to patients with IGH-BCL2 translocation and the non-IGH group. The 5-year probability of requiring therapy was significantly higher for IGH-BCL3 compared to IGH-BCL2 and non-IGH groups (84% vs 33% vs 29%, respectively, P < 0.0001). The 5-year OS was significantly shorter for IGH-BCL3 compared to IGH-BCL2 and non-IGH groups (45% vs 89% vs 86%, respectively, P < 0.0001). On multivariable analyses, IGH-BCL3 translocation was associated with a shorter TTT (hazard ratio [HR] = 2.7; P = 0.005) and shorter OS (HR = 5.5; P < 0.0001); IGH-BCL2 translocation did not impact TTT and OS. In conclusion, approximately 3% of all newly diagnosed CLL patients have either an IGH-BCL2 or IGH-BCL3 translocation. Patients with IGH-BCL3 translocations have a distinct prognostic profile and outcome. These results support the inclusion of an IGH probe during the routine evaluation of FISH abnormalities in newly diagnosed CLL.
Collapse
Affiliation(s)
- Hong Fang
- Division of Hematopathology; Mayo Clinic; Rochester Minnesota
| | | | - Kari G. Rabe
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | | | | | - Wei Ding
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Eli Muchtar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Jose F. Leis
- Division of Hematology and Oncology; Mayo Clinic; Phoenix Arizona
| | | | - Susan L. Slager
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - Esteban Braggio
- Division of Hematology and Oncology; Mayo Clinic; Phoenix Arizona
| | | | - Neil E. Kay
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | |
Collapse
|
5
|
Rahimi H, Sadeghian MH, Keramati MR, Jafarian AH, Shakeri S, Shams SF, Motamedi N, Sheikhi M, Ayatollahi H. Cytogenetic Abnormalities with Interphase FISH Method and Clinical Manifestation in Chronic Lymphocytic Leukemia Patients in North-East of Iran. Int J Hematol Oncol Stem Cell Res 2017; 11:217-224. [PMID: 28989588 PMCID: PMC5625472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Chronic lymphocytic leukemia (CLL) is one of the most prevalent adult leukemias. This malignancy is known by lymphocytosis for a duration of more than 3 months. In fact, it is a heterogeneous clinical disease with changeable progression. Chromosomal aberrations are significant parameters to predict result and survival rate and find treatment strategies for each patient. Cytogenetic methods are known as sensitive and relatively new procedures to detect abnormalities in genome. Materials and Methods: In order to identify CLL-related chromosomal abnormalities, 48 CLL patients included 38 Men and 10 Women with mean age of 58.25±36 were enrolled in this case series study.The survey was done at Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences. Interphase fluorescent in situ hybridization (I-FISH) was done on unstimulated peripheral blood or bone marrow samples, which were cultured in whole medium culture; it was used to detect chromosomal abnormalities such as 11q- , 13q14-, 17p- , 6q- and trisomy 12 in CLL patients. Results: Analysis demonstrated that 45.5% of CLL cases had chromosomal abnormalities; 13.63% haddel 17p, 40.90% had del 13q14 and 9.09% had del 11q. Statistical analysis of data revealed a significant relevancy between age variable and splenomegaly occurrence (P value<0.05). The younger the patients were, the less the splenomegaly occurrence. Conclusion: Laboratory findings were correlated with clinical data.
Collapse
Affiliation(s)
- Hossein Rahimi
- MD, Associate Professor of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hadi Sadeghian
- Msc, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Keramati
- Msc, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Jafarian
- Msc, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Shakeri
- MD, Associate Professor of Hematopathology, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyede Fatemeh Shams
- MD, Associate Professor of Hematopathology, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Motamedi
- MD, Associate Professor of Hematopathology, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sheikhi
- MD, Associate Professor of Hematopathology, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ayatollahi
- Msc, Cancer Molecular Pathology Research Center, Department of Hematology and Blood Bank, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
6
|
Herek TA, Cutucache CE. Using Murine Models to Investigate Tumor-Lymphoid Interactions: Spotlight on Chronic Lymphocytic Leukemia and Angioimmunoblastic T-Cell Lymphoma. Front Oncol 2017; 7:86. [PMID: 28512625 PMCID: PMC5411430 DOI: 10.3389/fonc.2017.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 04/18/2017] [Indexed: 12/15/2022] Open
Abstract
The role of the tumor microenvironment in leukemias and lymphomas is well established, yet the intricacies of how the malignant cells regulate and influence their non-malignant counterparts remain elusive. For example, chronic lymphocytic leukemia (CLL) is an expansion of malignant CD5+CD19+ B cells, yet the non-malignant T cells play just as large of a role in disease presentation and etiology. Herein, we review the dynamic tumor cell to lymphoid repertoire interactions found in two non-Hodgkin's lymphoma subtypes: CLL and angioimmunoblastic T-cell lymphoma. We aim to highlight the pivot work done in the murine models which recapitulate these diseases and explore the insights that can be gained from studying the immuno-oncological regulation of non-malignant lymphoid counterparts.
Collapse
Affiliation(s)
- Tyler A Herek
- Department of Biology, University of Nebraska at Omaha, Omaha, NE, USA
| | | |
Collapse
|
7
|
Identifying High-Risk Chronic Lymphocytic Leukemia: A Pathogenesis-Oriented Appraisal of Prognostic and Predictive Factors in Patients Treated with Chemotherapy with or without Immunotherapy. Mediterr J Hematol Infect Dis 2016; 8:e2016047. [PMID: 27872727 PMCID: PMC5111525 DOI: 10.4084/mjhid.2016.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 09/16/2016] [Indexed: 11/21/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) displays an extremely variable clinical behaviour. Accurate prognostication and prediction of response to treatment are important in an era of effective first-line regimens and novel molecules for high risk patients. Because a plethora of prognostic biomarkers were identified, but few of them were validated by multivariable analysis in comprehensive prospective studies, we applied in this survey stringent criteria to select papers from the literature in order to identify the most reproducible prognostic/predictive markers. Each biomarker was analysed in terms of reproducibility across the different studies with respect to its impact on time to first treatment (TTFT), progression free survival (PFS), overall survival (OS) and response to treatment. We were able to identify the following biomarkers as the most reliable in guiding risk stratification in the daily clinical practice: 17p-/TP53 mutations, IGHV unmutated configuration, short telomeres and 11q-. However, the method for measuring telomere length was not validated yet and 11q- was predictive of inferior OS only in those patients who did not receive FCR-like combinations. Stage and lymphocytosis were predictive of shorter TTFT and age, high serum thymidine kinase levels and poor performance status were predictive of shorter OS. Using our criteria no parameter was found to independently predict for inferior response to treatment.
Collapse
|
8
|
DE BRAEKELEER MARC, TOUS CORINE, GUÉGANIC NADIA, LE BRIS MARIEJOSÉE, BASINKO AUDREY, MOREL FRÉDÉRIC, DOUET-GUILBERT NATHALIE. Immunoglobulin gene translocations in chronic lymphocytic leukemia: A report of 35 patients and review of the literature. Mol Clin Oncol 2016; 4:682-694. [PMID: 27123263 PMCID: PMC4840758 DOI: 10.3892/mco.2016.793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) represents the most common hematological malignancy in Western countries, with a highly heterogeneous clinical course and prognosis. Translocations involving the immunoglobulin (IG) genes are regularly identified. From 2000 to 2014, we identified an IG gene translocation in 18 of the 396 patients investigated at diagnosis (4.6%) and in 17 of the 275 analyzed during follow-up (6.2%). A total of 4 patients in whom the IG translocation was identified at follow-up did not carry the translocation at diagnosis. The IG heavy locus (IGH) was involved in 27 translocations (77.1%), the IG κ locus (IGK) in 1 (2.9%) and the IG λ locus (IGL) in 7 (20.0%). The chromosome band partners of the IG translocations were 18q21 in 16 cases (45.7%), 11q13 and 19q13 in 4 cases each (11.4% each), 8q24 in 3 cases (8.6%), 7q21 in 2 cases (5.7%), whereas 6 other bands were involved once (2.9% each). At present, 35 partner chromosomal bands have been described, but the partner gene has solely been identified in 10 translocations. CLL associated with IG gene translocations is characterized by atypical cell morphology, including plasmacytoid characteristics, and the propensity of being enriched in prolymphocytes. The IG heavy chain variable region (IGHV) mutational status varies between translocations, those with unmutated IGHV presumably involving cells at an earlier stage of B-cell lineage. All the partner genes thus far identified are involved in the control of cell proliferation and/or apoptosis. The translocated partner gene becomes transcriptionally deregulated as a consequence of its transposition into the IG locus. With the exception of t(14;18)(q32;q21) and its variants, prognosis appears to be poor for the other translocations. Therefore, searching for translocations involving not only IGH, but also IGL and IGK, by banding and molecular cytogenetics is required. Furthermore, it is important to identify the partner gene to ensure the patients receive the optimal treatment.
Collapse
Affiliation(s)
- MARC DE BRAEKELEER
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - CORINE TOUS
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - NADIA GUÉGANIC
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
| | - MARIE-JOSÉE LE BRIS
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - AUDREY BASINKO
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - FRÉDÉRIC MOREL
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| | - NATHALIE DOUET-GUILBERT
- Faculty of Medicine and Health Sciences, University of Brest, Brest, France
- National Institute of Health and Medical Research (INSERM U1078), Brest, France
- Department of Cytogenetics and Reproductive Biology, Morvan Hospital, Regional University Hospital Center of Brest (CHRU), Brest, France
| |
Collapse
|
9
|
Van Dyke DL, Werner L, Rassenti LZ, Neuberg D, Ghia E, Heerema NA, Dal Cin P, Dell Aquila M, Sreekantaiah C, Greaves AW, Kipps TJ, Kay NE. The Dohner fluorescence in situ hybridization prognostic classification of chronic lymphocytic leukaemia (CLL): the CLL Research Consortium experience. Br J Haematol 2016; 173:105-13. [PMID: 26848054 PMCID: PMC4963001 DOI: 10.1111/bjh.13933] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/19/2015] [Indexed: 12/23/2022]
Abstract
This study revisited the Dohner prognostic hierarchy in a cohort of 1585 well-documented patients with chronic lymphocytic leukaemia. The duration of both time to first treatment (TTFT) and overall survival (OS) were significantly longer than observed previously, and this is at least partly due to improved therapeutic options. Deletion 13q remains the most favourable prognostic group with median TTFT and OS from fluorescence in situ hybridization (FISH) testing of 72 months and >12 years, respectively. Deletion 11q had the poorest median TTFT (22 months) and 17p deletion the poorest median OS (5 years). The percentages of abnormal nuclei were significantly associated with differential TTFT for the trisomy 12, 13q and 17p deletion cohorts but not for the 11q deletion cohort. From the date of the first FISH study, patients with >85% 13q deletion nuclei had a notably shorter TTFT (24 months). Patients with ≤20% 17p deletion nuclei had longer median TTFT and OS from the date of the first FISH study (44 months and 11 years), and were more likely to be IGHV mutated.
Collapse
MESH Headings
- Chromosome Deletion
- Chromosomes, Human/genetics
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Survival Rate
Collapse
Affiliation(s)
- Daniel L. Van Dyke
- Departments of Laboratory Medicine and Pathology and Internal MedicineMayo ClinicRochesterMNUSA
| | - Lillian Werner
- Biostatistics and Computational BiologyDana‐Farber Cancer InstituteBostonMAUSA
| | - Laura Z. Rassenti
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Donna Neuberg
- Biostatistics and Computational BiologyDana‐Farber Cancer InstituteBostonMAUSA
| | - Emanuella Ghia
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Nyla A. Heerema
- Department of PathologyThe Ohio State UniversityColumbusOHUSA
| | - Paola Dal Cin
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Marie Dell Aquila
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | | | - Andrew W. Greaves
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Thomas J. Kipps
- Moores University of California San Diego Cancer CenterLa JollaCAUSA
| | - Neil E. Kay
- Departments of Laboratory Medicine and Pathology and Internal MedicineMayo ClinicRochesterMNUSA
| |
Collapse
|
10
|
Rose-Zerilli MJJ, Gibson J, Wang J, Tapper W, Davis Z, Parker H, Larrayoz M, McCarthy H, Walewska R, Forster J, Gardiner A, Steele AJ, Chelala C, Ennis S, Collins A, Oakes CC, Oscier DG, Strefford JC. Longitudinal copy number, whole exome and targeted deep sequencing of 'good risk' IGHV-mutated CLL patients with progressive disease. Leukemia 2016; 30:1301-10. [PMID: 26847028 PMCID: PMC4861248 DOI: 10.1038/leu.2016.10] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 02/08/2023]
Abstract
The biological features of IGHV-M chronic lymphocytic leukemia responsible for disease progression are still poorly understood. We undertook a longitudinal study close to diagnosis, pre-treatment and post relapse in 13 patients presenting with cMBL or Stage A disease and good-risk biomarkers (IGHV-M genes, no del(17p) or del(11q) and low CD38 expression) who nevertheless developed progressive disease, of whom 10 have required therapy. Using cytogenetics, fluorescence in situ hybridisation, genome-wide DNA methylation and copy number analysis together with whole exome, targeted deep- and Sanger sequencing at diagnosis, we identified mutations in established chronic lymphocytic leukemia driver genes in nine patients (69%), non-coding mutations (PAX5 enhancer region) in three patients and genomic complexity in two patients. Branching evolutionary trajectories predominated (n=9/13), revealing intra-tumoural epi- and genetic heterogeneity and sub-clonal competition before therapy. Of the patients subsequently requiring treatment, two had sub-clonal TP53 mutations that would not be detected by standard methodologies, three qualified for the very-low-risk category defined by integrated mutational and cytogenetic analysis and yet had established or putative driver mutations and one patient developed progressive, therapy-refractory disease associated with the emergence of an IGHV-U clone. These data suggest that extended genomic and immunogenetic screening may have clinical utility in patients with apparent good-risk disease.
Collapse
Affiliation(s)
- M J J Rose-Zerilli
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Gibson
- Centre for Biological Sciences, Faculty of Natural and Environmental Studies, University of Southampton, Southampton, UK
| | - J Wang
- Bioinformatics Unit, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - W Tapper
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Z Davis
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - H Parker
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - M Larrayoz
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H McCarthy
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - R Walewska
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - J Forster
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Gardiner
- Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - A J Steele
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C Chelala
- Bioinformatics Unit, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - S Ennis
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Collins
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C C Oakes
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, USA
| | - D G Oscier
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - J C Strefford
- Academic Unit of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
11
|
De Braekeleer M, Le Bris MJ, Basinko A, Morel F, Douet-Guilbert N. Incidence of chromosomal anomalies detected by interphase FISH in chronic lymphoid leukemia. Int J Hematol Oncol 2015. [DOI: 10.2217/ijh.15.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims & methods: We used interphase FISH to determine the incidence of chromosomal changes in 638 B-cell chronic lymphocytic leukemia patients. Results: Chromosomal abnormalities were found in some 75% of the patients. Del(13)(q14) was present in 57.3 and 57% of patients at diagnosis and during follow-up, respectively. It was followed by trisomy 12 (19 and 19.8% at diagnosis and during follow-up, respectively), del(11)(q22) (9.1 and 14.3% at diagnosis and during follow-up, respectively) and del(17)(p13) (2.8 and 12.4% at diagnosis and during follow-up, respectively). Discussion & conclusion: Our results correlate with those obtained in 55 studies reported in the literature. Trisomy 12 and del(13)(q14) are present in high proportions at diagnosis and are not enriched during progression, to the contrary of del(11)(q22) and del(17)(p13) that are markers of evolution.
Collapse
Affiliation(s)
- Marc De Braekeleer
- Laboratoire d'Histologie, Embryologie et Cytogénétique, Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078, Brest, France
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Morvan, CHRU Brest, Brest, France
| | - Marie-Josée Le Bris
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Morvan, CHRU Brest, Brest, France
| | - Audrey Basinko
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078, Brest, France
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Morvan, CHRU Brest, Brest, France
| | - Frédéric Morel
- Laboratoire d'Histologie, Embryologie et Cytogénétique, Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078, Brest, France
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Morvan, CHRU Brest, Brest, France
| | - Nathalie Douet-Guilbert
- Laboratoire d'Histologie, Embryologie et Cytogénétique, Faculté de Médecine et des Sciences de la Santé, Université de Brest, Brest, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1078, Brest, France
- Service de Cytogénétique et Biologie de la Reproduction, Hôpital Morvan, CHRU Brest, Brest, France
| |
Collapse
|
12
|
Davids MS, Vartanov A, Werner L, Neuberg D, Dal Cin P, Brown JR. Controversial fluorescencein situhybridization cytogenetic abnormalities in chronic lymphocytic leukaemia: new insights from a large cohort. Br J Haematol 2015; 170:694-703. [DOI: 10.1111/bjh.13498] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/24/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Matthew S. Davids
- Department of Medical Oncology; Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | - Alexander Vartanov
- Department of Medical Oncology; Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | - Lillian Werner
- Biostatistics and Computational Biology; Dana-Farber Cancer Institute; Boston MA USA
| | - Donna Neuberg
- Biostatistics and Computational Biology; Dana-Farber Cancer Institute; Boston MA USA
| | - Paola Dal Cin
- Department of Pathology; Brigham & Women's Hospital; Boston MA USA
| | - Jennifer R. Brown
- Department of Medical Oncology; Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
| |
Collapse
|
13
|
Gerrie AS, Huang SJT, Bruyere H, Dalal C, Hrynchak M, Karsan A, Ramadan KM, Smith AC, Tyson C, Toze CL, Gillan TL. Population-based characterization of the genetic landscape of chronic lymphocytic leukemia patients referred for cytogenetic testing in British Columbia, Canada: the role of provincial laboratory standardization. Cancer Genet 2014; 207:316-25. [PMID: 25441686 DOI: 10.1016/j.cancergen.2014.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 08/14/2014] [Accepted: 08/21/2014] [Indexed: 01/23/2023]
Abstract
Detection of recurrent chromosome abnormalities by fluorescence in situ hybridization (FISH) is an essential component of care in chronic lymphocytic leukemia (CLL) patients. In the province of British Columbia (BC), Canada, population 4.6 million, CLL patients receive uniform evaluation and therapy with FISH testing performed in three jurisdictions. The aims of this study were to (i) validate CLL-FISH testing among the BC cytogenetic laboratories to ensure standardization of results and (ii) characterize population-level CLL-FISH abnormalities by pooling provincial data. From 2004 to 2011, 585 consecutive patients underwent pretreatment CLL-FISH testing at laboratory A (50.1%), laboratory B (32.3%), or laboratory C (17.6%). For validation purposes, 26 CLL-FISH abnormalities were tested by each laboratory's protocol, with 91% result concordance. Discordant results involved percent abnormalities at or near cutoff values; therefore, a 10% universal cutoff was established when pooling results. Applying the universal cutoff to the provincial cohort, CLL-FISH abnormalities were detected in 74.9%: 54.9% 13q-, 18.8% +12, 8.5% 11q-, and 7.7% 17p-. In this large population-based cohort of patients referred for CLL-FISH testing, frequencies of abnormalities detected by FISH analysis were highly consistent with those reported in single-institution and clinical trial populations. Provinces or districts that work together to care for CLL patients can effectively pool data with appropriate laboratory validation to ensure standardization of results.
Collapse
Affiliation(s)
- Alina S Gerrie
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Steven J T Huang
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada; Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Helene Bruyere
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Chinmay Dalal
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Monica Hrynchak
- Cytogenetics Laboratory, Royal Columbian Hospital, New Westminster, Canada
| | - Aly Karsan
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Khaled M Ramadan
- Division of Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Adam C Smith
- Cancer Genetics Laboratory, Pathology and Laboratory Medicine, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada; Instituto de Pesquisa Pelé Pequeno Princípe, Curitiba, Brazil
| | - Christine Tyson
- Cytogenetics Laboratory, Royal Columbian Hospital, New Westminster, Canada
| | - Cynthia L Toze
- Leukemia/BMT Program of BC, Vancouver General Hospital and British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Tanya L Gillan
- Pathology and Laboratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
14
|
Cutucache CE. Tumor-induced host immunosuppression: Special focus on CLL. Int Immunopharmacol 2013; 17:35-41. [DOI: 10.1016/j.intimp.2013.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/16/2013] [Accepted: 05/23/2013] [Indexed: 10/26/2022]
|
15
|
Evolution and impact of subclonal mutations in chronic lymphocytic leukemia. Cell 2013; 152:714-26. [PMID: 23415222 DOI: 10.1016/j.cell.2013.01.019] [Citation(s) in RCA: 1060] [Impact Index Per Article: 96.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/15/2012] [Accepted: 01/06/2013] [Indexed: 02/06/2023]
Abstract
Clonal evolution is a key feature of cancer progression and relapse. We studied intratumoral heterogeneity in 149 chronic lymphocytic leukemia (CLL) cases by integrating whole-exome sequence and copy number to measure the fraction of cancer cells harboring each somatic mutation. We identified driver mutations as predominantly clonal (e.g., MYD88, trisomy 12, and del(13q)) or subclonal (e.g., SF3B1 and TP53), corresponding to earlier and later events in CLL evolution. We sampled leukemia cells from 18 patients at two time points. Ten of twelve CLL cases treated with chemotherapy (but only one of six without treatment) underwent clonal evolution, predominantly involving subclones with driver mutations (e.g., SF3B1 and TP53) that expanded over time. Furthermore, presence of a subclonal driver mutation was an independent risk factor for rapid disease progression. Our study thus uncovers patterns of clonal evolution in CLL, providing insights into its stepwise transformation, and links the presence of subclones with adverse clinical outcomes.
Collapse
|
16
|
Mian M, Rinaldi A, Mensah AA, Rossi D, Ladetto M, Forconi F, Marasca R, Uhr M, Stussi G, Kwee I, Cavalli F, Gaidano G, Zucca E, Bertoni F. Large genomic aberrations detected by SNP array are independent prognosticators of a shorter time to first treatment in chronic lymphocytic leukemia patients with normal FISH. Ann Oncol 2013; 24:1378-84. [PMID: 23372049 DOI: 10.1093/annonc/mds646] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Genomic complexity can predict the clinical course of patients affected by chronic lymphocytic leukemia (CLL) with a normal FISH. However, large studies are still lacking. Here, we analyzed a large series of CLL patients and also carried out the so far largest comparison of FISH versus single-nucleotide polymorphism (SNP) array in this disease. PATIENTS AND METHODS SNP-array data were derived from a previously reported dataset. RESULTS Seventy-seven of 329 CLL patients (23%) presented with a normal FISH. At least one large (>5 Mb) genomic aberration was detected by SNP array in 17 of 77 patients (22%); this finding significantly affected TTT. There was no correlation with the presence of TP53 mutations. In multivariate analysis, including age, Binet stage, IGHV genes mutational status and large genomic lesion, the latter three factors emerged as independent prognosticators. The concordance between FISH and SNP array varied between 84 and 97%, depending on the specific genomic locus investigated. CONCLUSIONS SNP array detected additional large genomic aberrations not covered by the standard FISH panel predicting the outcome of CLL patients.
Collapse
Affiliation(s)
- M Mian
- Lymphoma and Genomics Research Program, IOR Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Rigolin GM, Cuneo A. Cytogenetics in myelodysplastic syndromes: Old methods, new clues. Leuk Res 2012; 36:806-7. [DOI: 10.1016/j.leukres.2012.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 03/28/2012] [Accepted: 03/31/2012] [Indexed: 11/25/2022]
|