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Keppens C, Boone E, Gameiro P, Tack V, Moreau E, Hodges E, Evans P, Brüggemann M, Carter I, Lenze D, Sarasquete ME, Möbs M, Liu H, Dequeker EMC, Groenen PJTA. Evaluation of a worldwide EQA scheme for complex clonality analysis of clinical lymphoproliferative cases demonstrates a learning effect. Virchows Arch 2021; 479:365-376. [PMID: 33686511 PMCID: PMC8364525 DOI: 10.1007/s00428-021-03046-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/18/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
Clonality analysis of immunoglobulin (IG) or T-cell receptor (TR) gene rearrangements is routine practice to assist diagnosis of lymphoid malignancies. Participation in external quality assessment (EQA) aids laboratories in identifying systematic shortcomings. The aim of this study was to evaluate laboratories' improvement in IG/TR analysis and interpretation during five EQA rounds between 2014 and 2018. Each year, participants received a total of five cases for IG and five cases for TR testing. Paper-based cases were included for analysis of the final molecular conclusion that should be interpreted based on the integration of the individual PCR results. Wet cases were distributed for analysis of their routine protocol as well as evaluation of the final molecular conclusion. In total, 94.9% (506/533) of wet tests and 97.9% (829/847) of paper tests were correctly analyzed for IG, and 96.8% (507/524) wet tests and 93.2% (765/821) paper tests were correctly analyzed for TR. Analysis scores significantly improved when laboratories participated to more EQA rounds (p=0.001). Overall performance was significantly lower (p=0.008) for non-EuroClonality laboratories (95% for IG and 93% for TR) compared to EuroClonality laboratories (99% for IG and 97% for TR). The difference was not related to the EQA scheme year, anatomic origin of the sample, or final clinical diagnosis. This evaluation showed that repeated EQA participation helps to reduce performance differences between laboratories (EuroClonality versus non-EuroClonality) and between sample types (paper versus wet). The difficulties in interpreting oligoclonal cases highlighted the need for continued education by meetings and EQA schemes.
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Affiliation(s)
- Cleo Keppens
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35 block d, 1st floor, box 7001, 3000 Leuven, Belgium
| | - Elke Boone
- AZ Delta vzw - Laboratorium Moleculaire Diagnostiek, Deltalaan 1, 8800 Roeselare, Belgium
| | - Paula Gameiro
- Laboratory of Hemato-Oncology, Portuguese Institute of Oncology of Lisbon, Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
| | - Véronique Tack
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35 block d, 1st floor, box 7001, 3000 Leuven, Belgium
| | - Elisabeth Moreau
- AZ Delta vzw - Laboratorium Moleculaire Diagnostiek, Deltalaan 1, 8800 Roeselare, Belgium
| | - Elizabeth Hodges
- Precision Medicine Centre, Queen’s University Belfast, Health Science Building, 97 Lisburn Road, Belfast, BT9 7AE UK
| | - Paul Evans
- HMDS, Leeds Institute of Oncology, St. James University Hospital, Level 3 Bexley Wing Leeds, Leeds, LS9 7TF UK
| | - Monika Brüggemann
- Department of Hematology, University Hospital Schleswig-Holstein, Langer Segen 8-10, 24105 Kiel, Germany
| | - Ian Carter
- Molecular Diagnostics, Histopathology, Nottingham University Hospitals NHS Trust, City Campus, Hucknall Rd., Nottingham, NG5 1PB UK
| | - Dido Lenze
- Institut für Pathologie, Molekularpathologie, Charité –Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Maria Eugenia Sarasquete
- Laboratorio Biología Molecular, Servicio de Hematología, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Markus Möbs
- Institut für Pathologie, Molekularpathologie, Charité –Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Hongxiang Liu
- Molecular Malignancy Laboratory, Haematopathology and Oncology Diagnostic Service (HODS), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 234, Hills Road, Cambridge, CB2 0QQ UK
| | - Elisabeth M. C. Dequeker
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35 block d, 1st floor, box 7001, 3000 Leuven, Belgium
| | - Patricia J. T. A. Groenen
- Department of Pathology, Radboud University Medical Centre Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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He X, Xu P, Wang X, Jiang S, Gong D, Wu N. The association of gene rearrangement and lymphoma diagnosis: A prospective observational study. Medicine (Baltimore) 2020; 99:e20733. [PMID: 32541525 PMCID: PMC7302616 DOI: 10.1097/md.0000000000020733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION To investigate the gene rearrangement and mutation of lymphoma biomarkers including (Immunoglobulin H (IgH), Immunoglobulin kappa (IGK), Immunoglobulin lambda (IGL), and TCR) in the lymphoma diagnosis. METHODS AND ANALYSIS Paraffin tissue samples from 240 cases diagnosed as suspected lymphoma in the department of pathology, Deyang City People's Hospital from June 2020 to June 2021 will be enrolled. Deoxyribonucleic acid extraction and Polymerase Chain Reaction (PCR) amplification will be performed in these paraffin tissue samples. Immunoglobulin and T cell receptor (TCR) rearrangement will be analyzed by hetero-double chain gel electrophoresis and BioMed-2 standardized immunoglobulin gene rearrangement detection system. In this study protocol IGH gene rearrangement, IGK gene rearrangement, both IGH and IGL gene rearrangement, both IGH and IGK gene rearrangement, both IGK and IGL gene rearrangement, both IGH, IGK and IGL gene rearrangement, TCR gene rearrangement and positive Ig/TCR rearrangement will be analyzed. DISCUSSION In this study, we will use B and T cell lymphoma analysis focusing on IgH, IGK, IGL, and TCR gene rearrangement, so as to provide early guidance for the diagnosis of lymphoma. Second generation sequencing technology is helpful in the differential diagnosis of lymphoma. TRIAL REGISTRATION Chinese Clinical trial registry: ChiCTR2000032366.
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Affiliation(s)
- Xiaoyan He
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Pei Xu
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Xianwei Wang
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Shuming Jiang
- Department of Pathology, Deyang People's Hospital, Deyang City
| | - Daoyin Gong
- Department of Pathology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Ning Wu
- Department of Pathology, Deyang People's Hospital, Deyang City
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Caltharp SA, Qayed M, Park SI. Atypical Marginal Zone Hyperplasia Is a Mimic for Lymphoma in Pediatric Transplant Recipients: Report of Two Patients. Pediatr Dev Pathol 2015; 18:416-21. [PMID: 25955878 DOI: 10.2350/15-01-1596-cr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Atypical marginal zone hyperplasia (AMZH) of mucosa-associated lymphoid tissue (MALT) closely resembles lymphoma in that it shows expansion of the marginal zones with prominent intraepithelial B lymphocytes, is immunoglobulin light-chain restricted, and may show aberrant CD43 expression. However, unlike lymphoma, it does not show rearrangement of the immunoglobulin heavy chain gene (immunoglobulin H [IgH]) by polymerase chain reaction (PCR), and it behaves in a benign fashion. We identified AMZH in 2 pediatric solid organ transplant recipients who presented with adenotonsillar hypertrophy. To date, the patients have experienced a self-limited course in the absence of treatment or reduction of immunosuppression. Atypical marginal zone hyperplasia is a pitfall for posttransplant lymphoproliferative disorder and MALT lymphoma in the pediatric solid organ transplant population. In transplant patients with a lambda-restricted B-cell clone and marginal zone hyperplasia in native MALT sites, PCR for IgH and IgK gene rearrangement is essential to prevent misdiagnosis.
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Affiliation(s)
- Shelley A Caltharp
- 1 Children's Healthcare of Atlanta, 1405 Clifton Road NE, Egleston Children's Hospital, Department of Pathology, First Floor, Tower One, Atlanta, GA 30322, USA
| | - Muna Qayed
- 2 AFLAC Cancer and Blood Disorders Center and Emory University, 2015 Upper Gate Dr NE, 4th Floor, Atlanta, GA 30322, USA
| | - Sunita I Park
- 1 Children's Healthcare of Atlanta, 1405 Clifton Road NE, Egleston Children's Hospital, Department of Pathology, First Floor, Tower One, Atlanta, GA 30322, USA
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Park IJ, Bena J, Cotta CV, Hsi ED, Jegalian AG, Rogers HJ, Tubbs RR, Wang L, Cook JR. Frequency, interobserver reproducibility and clinical significance of equivocal peaks in PCR clonality testing using Euroclonality/BIOMED-2 primers. J Clin Pathol 2014; 67:1093-8. [PMID: 25244911 DOI: 10.1136/jclinpath-2014-202454] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS PCR studies for lymphoid clonality are now widely employed, especially using Euroclonality/BIOMED-2 primers. Criteria for interpretation as a clonal result, however, have proven controversial. This study examines the frequency and clinical significance of equivocal amplification patterns and measures the interobserver reproducibility of clonality interpretations. METHODS At our institution, results of each primer set are first classified as clonal, non-clonal or abnormal (equivocal peak on polyclonal background). Final results for all primer sets are then collectively reported as positive (≥1 clonal result), negative (non-clonal results) or indeterminate (≥1 abnormal result) for a clonal population. Results of 274 consecutive clonality cases were reviewed, and the interobserver reproducibility of individual primer set reactions and final results was determined in a subset of 30 cases. RESULTS 44/161 (27%) B-cell and 50/163 (31%) T-cell cases contained at least one abnormal peak. Of these, 29 (64%) and 31 (62%), respectively, showed clonal results in another primer set. Interobserver reproducibility was excellent for most primer sets and for final interpretations, but only fair to good for IGK V-J and TCRB D-J1+2 primer sets. A definitive diagnosis of lymphoma was rendered in 93%, 20% and 6% of B-cell cases and 90%, 42%, and 14% of T-cell cases positive, indeterminate or negative for a clonal population, respectively. CONCLUSIONS Using a subjective approach, abnormal (equivocal) peaks are frequently observed in routine practice. However, most cases with abnormal peaks contain clonal rearrangements in other primer sets, facilitating overall interpretation of final results with excellent interobserver reproducibility.
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Affiliation(s)
- Il Joong Park
- Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Claudiu V Cotta
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Armin G Jegalian
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raymond R Tubbs
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - James R Cook
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Gazzola A, Mannu C, Rossi M, Laginestra MA, Sapienza MR, Fuligni F, Etebari M, Melle F, Sabattini E, Agostinelli C, Bacci F, Sagramoso Sacchetti CA, Pileri SA, Piccaluga PP. The evolution of clonality testing in the diagnosis and monitoring of hematological malignancies. Ther Adv Hematol 2014; 5:35-47. [PMID: 24688753 PMCID: PMC3949299 DOI: 10.1177/2040620713519729] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Currently, distinguishing between benign and malignant lymphoid proliferations is based on a combination of clinical characteristics, cyto/histomorphology, immunophenotype and the identification of well-defined chromosomal aberrations. However, such diagnoses remain challenging in 10-15% of cases of lymphoproliferative disorders, and clonality assessments are often required to confirm diagnostic suspicions. In recent years, the development of new techniques for clonality detection has allowed researchers to better characterize, classify and monitor hematological neoplasms. In the past, clonality was primarily studied by performing Southern blotting analyses to characterize rearrangements in segments of the IG and TCR genes. Currently, the most commonly used method in the clinical molecular diagnostic laboratory is polymerase chain reaction (PCR), which is an extremely sensitive technique for detecting nucleic acids. This technique is rapid, accurate, specific, and sensitive, and it can be used to analyze small biopsies as well as formalin-fixed paraffin-embedded samples. These advantages make PCR-based approaches the current gold standard for IG/TCR clonality testing. Since the completion of the first human genome sequence, there has been a rapid development of technologies to facilitate high-throughput sequencing of DNA. These techniques have been applied to the deep characterization and classification of various diseases, patient stratification, and the monitoring of minimal residual disease. Furthermore, these novel approaches have the potential to significantly improve the sensitivity and cost of clonality assays and post-treatment monitoring of B- and T-cell malignancies. However, more studies will be required to demonstrate the utility, sensitivity, and benefits of these methods in order to warrant their adoption into clinical practice. In this review, recent developments in clonality testing are examined with an emphasis on highly sensitive systems for improving diagnostic workups and minimal residual disease assessments.
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Affiliation(s)
- Anna Gazzola
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Claudia Mannu
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Maura Rossi
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Maria Antonella Laginestra
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Maria Rosaria Sapienza
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Fabio Fuligni
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Maryam Etebari
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Federica Melle
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Elena Sabattini
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Claudio Agostinelli
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Francesco Bacci
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Carlo Alberto Sagramoso Sacchetti
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Stefano Aldo Pileri
- Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Pier Paolo Piccaluga
- Molecular Pathology Laboratory, Department of Experimental, Diagnostic, and Specialty Medicine, Bologna University Medical School, Unit of Hematopathology, S. Orsola Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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EuroClonality/BIOMED-2 guidelines for interpretation and reporting of Ig/TCR clonality testing in suspected lymphoproliferations. Leukemia 2012; 26:2159-71. [PMID: 22918122 PMCID: PMC3469789 DOI: 10.1038/leu.2012.246] [Citation(s) in RCA: 336] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PCR-based immunoglobulin (Ig)/T-cell receptor (TCR) clonality testing in suspected lymphoproliferations has largely been standardized and has consequently become technically feasible in a routine diagnostic setting. Standardization of the pre-analytical and post-analytical phases is now essential to prevent misinterpretation and incorrect conclusions derived from clonality data. As clonality testing is not a quantitative assay, but rather concerns recognition of molecular patterns, guidelines for reliable interpretation and reporting are mandatory. Here, the EuroClonality (BIOMED-2) consortium summarizes important pre- and post-analytical aspects of clonality testing, provides guidelines for interpretation of clonality testing results, and presents a uniform way to report the results of the Ig/TCR assays. Starting from an immunobiological concept, two levels to report Ig/TCR profiles are discerned: the technical description of individual (multiplex) PCR reactions and the overall molecular conclusion for B and T cells. Collectively, the EuroClonality (BIOMED-2) guidelines and consensus reporting system should help to improve the general performance level of clonality assessment and interpretation, which will directly impact on routine clinical management (standardized best-practice) in patients with suspected lymphoproliferations.
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Bhat PV, Jakobiec FA, Papaliodis G, Sobrin L. Primary T-cell lymphoma of the retina and cerebellum: immunophenotypic and gene rearrangement confirmation. Am J Ophthalmol 2009; 148:350-60. [PMID: 19477711 DOI: 10.1016/j.ajo.2009.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 04/01/2009] [Accepted: 04/01/2009] [Indexed: 01/25/2023]
Abstract
PURPOSE To document fully the first credible primary T-cell lymphoma of the retina and central nervous system in a 71-year-old man. DESIGN Interventional, retrospective report. METHODS Critical analysis of clinical history and findings, which included bilateral vitreitis with anterior chamber reaction, creamy intraretinal infiltrates, and retinal detachment; complete blood counts and other blood studies (anti-neutrophil cytoplasmic antibody [ANCA], angiotensin-converting enzyme levels, and Lyme and fluorescent treponemal antibody absorption titers); magnetic resonance imaging (MRI) scanning of the brain with total body computed tomographic and positron emission tomographic scanning; interleukin (IL) level determinations (IL-10 and IL-6); cytologic and electron microscopic evaluations; immunophenotyping of cells; and polymerase chain reaction studies for viral deoxyribonucleic acid and ribonucleic acid, and immunoglobulin heavy-chain, and T-cell receptor (TCR) gene rearrangements. RESULTS The first vitreous specimen was diagnosed mistakenly as cytologically reactive and contained elevated levels of IL-10 and IL-6 in a ratio of 7 to 1. T cells predominated on immunophenotypic analysis. Computed tomographic and positron emission tomographic whole body scanning showed negative results for lymphoma. An MRI scan of the brain eventually revealed a cerebellar lesion. A retinal biopsy harbored cytologically atypical pleomorphic cells that were almost all immunophenotypically T cells; polymerase chain reaction studies demonstrated a clonal TCR gene rearrangement. T-cell lymphocytes in the biopsy specimen of the cerebellum had an identical clonal TCR gene rearrangement. CONCLUSIONS This case unequivocally establishes that primary retinal T-cell lymphoma accompanied by central nervous system involvement can occur. Elevation in the IL-10 to IL-6 ratio in the face of inconclusive or confusing vitreous cytologic and immunophenotypic findings (a predominance of "reactive T cells with some atypicality") should lead to gene rearrangement studies on biopsies of involved tissues for the detection of T-cell clonality.
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Yao R, Schneider E. Detection of B- and T-cell-specific gene rearrangements in 13 cell lines and 50 clinical specimens using the BIOMED-2 and the original InVivoScribe primers. Leuk Lymphoma 2007; 48:837-40. [PMID: 17454651 DOI: 10.1080/10428190601187729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ramos JC, Ruiz P, Ratner L, Reis IM, Brites C, Pedroso C, Byrne GE, Toomey NL, Andela V, Harhaj EW, Lossos IS, Harrington WJ. IRF-4 and c-Rel expression in antiviral-resistant adult T-cell leukemia/lymphoma. Blood 2007; 109:3060-8. [PMID: 17138822 PMCID: PMC1852214 DOI: 10.1182/blood-2006-07-036368] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 11/11/2006] [Indexed: 01/08/2023] Open
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a generally fatal malignancy. Most ATLL patients fare poorly with conventional chemotherapy; however, antiviral therapy with zidovudine (AZT) and interferon alpha (IFN-alpha) has produced long-term clinical remissions. We studied primary ATLL tumors and identified molecular features linked to sensitivity and resistance to antiviral therapy. Enhanced expression of the proto-oncogene c-Rel was noted in 9 of 27 tumors. Resistant tumors exhibited c-Rel (6 of 10; 60%) more often than did sensitive variants (1 of 9; 11%). This finding was independent of the disease form. Elevated expression of the putative c-Rel target, interferon regulatory factor-4 (IRF-4), was observed in 10 (91%) of 11 nonresponders and in all tested patients with c-Rel+ tumors and occurred in the absence of the HTLV-1 oncoprotein Tax. In contrast, tumors in complete responders did not express c-Rel or IRF-4. Gene rearrangement studies demonstrated the persistence of circulating T-cell clones in long-term survivors maintained on antiviral therapy. The expression of nuclear c-Rel and IRF-4 occurs in the absence of Tax in primary ATLL and is associated with antiviral resistance. These molecular features may help guide treatment. AZT and IFN-alpha is a suppressive rather than a curative regimen, and patients in clinical remission should remain on maintenance therapy indefinitely.
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Affiliation(s)
- Juan Carlos Ramos
- Division of Hematology/Oncology, Department of Medicine, University of Miami Miller School of Medicine, FL 33136, USA
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Kuo FC, Hall D, Longtine JA. A novel method for interpretation of T-cell receptor gamma gene rearrangement assay by capillary gel electrophoresis based on normal distribution. J Mol Diagn 2007; 9:12-9. [PMID: 17251331 PMCID: PMC1867425 DOI: 10.2353/jmoldx.2007.060032] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
T-cell receptor gamma (TRG) gene rearrangement status is useful for the differential diagnosis of T-cell lesions. The BIOMED-2 protocol that uses two sets of Jgamma and four sets of Vgamma primers in a multiplex, two-tube reaction followed by capillary gel electrophoresis is emerging as a standard assay for this application. Here, we report a computer-aided method to evaluate the significance of a peak in this TRG clonality assay. A best-fit normal distribution (ND) curve and the chi(2) error for each peak are used to determine whether a peak is significantly taller than the background (cutoff for Vgamma(1-8) is 1). Eighty clinical samples that have been previously analyzed by a GC-clamped primer polymerase chain reaction/denaturing gradient gel electrophoresis assay were reanalyzed with the BIOMED-2 assay and scored by the ND method and four previously published methods: relative peak height (RPH), relative peak ratio (RPR), height ratio (HR), and peak height ratio (Rn). A greater than 90% concordance rate was observed between RPH and ND analysis, whereas RPR, Rn, and HR had a lower threshold to call a peak positive. The advantage of the ND method is that it is more objective, reproducible, and can be automated.
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Affiliation(s)
- Frank C Kuo
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Jabeen R, Payne D, Wiktorowicz J, Mohammad A, Petersen J. Capillary electrophoresis and the clinical laboratory. Electrophoresis 2006; 27:2413-38. [PMID: 16718719 DOI: 10.1002/elps.200500948] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Over the past 15 years, CE as an analytical tool has shown great promise in replacing many conventional clinical laboratory methods, such as electrophoresis and HPLC. CE's appeal was that it was fast, used very small amounts of sample and reagents, was extremely versatile, and was able to separate large and small analytes, whether neutral or charged. Because of this versatility, numerous methods have been developed for analytes that are of clinical interest. Other than molecular diagnostic and forensic laboratories CE has not been able to make a major impact in the United States. In contrast, in Europe and Japan an increasing number of clinical laboratories are using CE. Now that automated multicapillary instruments are commercially available along with cost-effective test kits, CE may yet be accepted as an instrument that will be routinely used in the clinical laboratories. This review will focus on areas where CE has the potential to have the greatest impact on the clinical laboratory. These include analyses of proteins found in serum and urine, hemoglobin (A1c and variants), carbohydrate-deficient transferrin, forensic and therapeutic drug screening, and molecular diagnostics.
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Affiliation(s)
- Rukhsana Jabeen
- University of Texas Medical Branch--Pathology, Galveston, TX 77555-0551, USA
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Shaheen D, Elkader AA, Marouf S, Eltonbry Y, Elghaffar HA. Molecular immunoglobulin/T-cell receptor clonality diagnosis by gene scan in lymphoproliferative disorders. ACTA ACUST UNITED AC 2006; 11:77-86. [PMID: 16753846 DOI: 10.1080/10245330500469817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There remains significant controversy over the techniques used for clonal diagnosis of lymphoproliferative disorders because of questions regarding the sensitivity, specificity and throughput. This has stimulated us to explore the use of gene scan to determine clonality of Immunoglobulin (Ig)/T-cell receptor (TCR) (gamma gene rearrangement in a variety of morphologically, cytochemically, pathologically and immunophenotypically defined precursor B/T-ALL (12 patients), 5 patients with NHL, 10 patients with CLL and a group of reactive lymphocytosis as a reference group (10 subjects). Polymerase chain reaction (PCR) was done for IgH gene (FR3a, FR2b, LJH and JH primers) and for TCR gamma gene and the malignant clone was identified using gene scan (GS) analysis. In the ALL group, monoclonality was detected using GS and using IgH (FR2b) 75% had a clonal band, 63% with IgH (FR3a) and 88% with a combination of FR3a/FR2b. The results of TCR gamma monoclonality were 50% using primer mix I, 25% using primer mix II and 75% using a combination. In the CLL group, clonal IgH gene rearrangement was detected by FR2b in 80% of cases, while by FR3a clonal rearrangement was detected in 60%, the combination of FR2b and FR3a increased the detection rate to 90%. In B-cell NHL, the FR2b was clonally rearranged in 50% while FR3 was positive in 25%. In reactive lymphocytosis, all cases revealed polyclonal rearrangement with TCR gamma primers. The sensitivity and positive predictive value of GS was 100% and the specificity and negative predictive value was 86.6%. In conclusion, gene scanning provides a sensitive and specific method for detection of the malignant clone in PCR product in patients with lymphoproliferative disorders.
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Affiliation(s)
- Doaa Shaheen
- Mansoura University, Clinical Pathology Department, Hematology Unit, Mansoura Faculty of Medicine, Mansoura, Egypt
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Zhao XF, Sands AM, Ostrow PT, Halbiger R, Conway JT, Bagg A. Recurrence of Nodal Diffuse Large B-Cell Lymphoma as Intravascular Large B-Cell Lymphoma: Is an Intravascular Component at Initial Diagnosis Predictive? Arch Pathol Lab Med 2005; 129:391-4. [PMID: 15737037 DOI: 10.5858/2005-129-391-rondlb] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
We report a case of a 59-year-old man who first presented with a nodal diffuse large B-cell lymphoma that later relapsed as an intravascular large B-cell lymphoma. In the initial biopsy specimen, a few intranodal small vessels that contained large lymphoma cells were noted. After 8 months of multiagent chemotherapy, clinical remission was attained. Two years after the initial diagnosis of nodal diffuse large B-cell lymphoma, the patient presented with a rapid onset of multiorgan failure, which at autopsy was shown to be due to intravascular large B-cell lymphoma. Molecular genetic studies showed that these 2 lymphomas had immunoglobulin heavy-chain gene rearrangements that were of identical size, suggesting that they were derived from the same clone. To our knowledge, this is the first report of a nodal large B-cell lymphoma that relapsed as an intravascular large B-cell lymphoma. Although this report is of only a single case, the presence of a relatively inconspicuous intravascular component in an otherwise typical nodal large B-cell lymphoma may be predictive and could affect clinical decisions regarding diagnosis, monitoring, and prognosis of such lymphomas.
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Affiliation(s)
- Xian-Feng Zhao
- Department of Pathology and Laboratory Medicine, SUNY at Buffalo School of Medicine, Buffalo, NY, USA.
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14
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Xu D, Du J, Kamino H, Ratech H. Rapid diagnosis of clonal immunoglobulin heavy chain gene rearrangements in cutaneous B-cell lymphomas using the LightCycler-Polymerase Chain Reaction with DNA melting curve analysis. Am J Dermatopathol 2005; 26:385-9. [PMID: 15365370 DOI: 10.1097/00000372-200410000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We have recently developed a novel Immunoglobulin heavy chain gene rearrangement (IgH-R) assay that combines polymerase chain reaction (PCR) amplification and analysis in the same closed capillary tube using the LightCycler System. IgH-R can be identified by DNA melting curve analysis within 40 minutes after DNA preparation and amplification. To test the clinical utility of this new IgH-R assay for rapidly diagnosing cutaneous B-cell lymphomas, we prospectively analyzed 44 formalin-fixed, paraffin-embedded tissues suspected of B-cell malignant lymphoma: skin (n = 31), lymph node (n = 7), stomach (n = 3), spleen (n = 1), colon (n = 1), and soft tissue (n = 1). We detected IgH-R in 12 DNA samples, including 8 skin biopsies, with the following diagnoses: B-cell chronic lymphocytic leukemia (n = 4), extranodal marginal zone B-cell lymphoma (n = 4), diffuse large B-cell lymphoma (n = 2), Burkitt lymphoma (n = 1), and precursor B-lymphoblastic lymphoma (n = 1). DNA melting curve analysis, compared with polyacrylamide gel electrophoresis, achieved a sensitivity equal to 92.3% and a specificity equal to 100%. There was a single false negative result because DNA melting curve analysis could not detect less than 10.0% clonal B-cells. We conclude that this new, rapid PCR assay for detecting IgH-R based on DNA melting curve analysis can be clinically useful for confirming the initial diagnosis of B-cell malignant lymphoma.
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Affiliation(s)
- Dongsheng Xu
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA
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15
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Snyder MJ, Stenzel TT, Buckley PJ, Lagoo AS, Rizzieri DA, Gasparetto C, Vredenburgh JJ, Chao NJ, Gong JZ. Posttransplant lymphoproliferative disorder following nonmyeloablative allogeneic stem cell transplantation. Am J Surg Pathol 2004; 28:794-800. [PMID: 15166672 DOI: 10.1097/01.pas.0000126052.88174.f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Posttransplantation lymphoproliferative disorder (PTLD) is a well-recognized complication of conventional bone marrow/stem cell and solid organ transplantation. However, not much is known about PTLD following the more recently introduced nonmyeloablative allogeneic stem cell transplantation (NMST). This study reports the findings from two cases of PTLD following NMST and compares them to the one previously reported case. The donor origin of the PTLD was determined using short tandem repeat analysis, and B- and T-cell clonalities were evaluated by polymerase chain reaction. Two cases of PTLD evolved in a total of 70 patients who have undergone NMST at our institution from 1999 to 2003. Both patients received conditioning with Fludarabine/Cytoxan/Campath 1H (alemtuzumab, anti-CD52 antibody) and T-cell-depleted donor cells with Campath-1H. Both PTLDs were EBV positive (by immunohistochemistry and in situ hybridization) with diffuse large B-cell lymphoma morphology. Our findings indicate the incidence of PTLD following NMST is 3% (2 of 70 patients from our institution and 1 of 30 from the previously reported case). All three PTLDs arose 6 to 7 months after NMST and were rapidly fatal. The pathology of the PTLD in all cases was donor origin, EBV positive, diffuse large B-cell lymphoma.
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MESH Headings
- Adult
- Alemtuzumab
- Antibodies/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/administration & dosage
- Antigens, CD/immunology
- Antigens, Neoplasm/immunology
- CD52 Antigen
- Female
- Glycoproteins/immunology
- Hematopoietic Stem Cell Transplantation/adverse effects
- Herpesvirus 4, Human/isolation & purification
- Humans
- In Situ Hybridization
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoproliferative Disorders/etiology
- Middle Aged
- Myelodysplastic Syndromes/therapy
- Polymerase Chain Reaction
- Tandem Repeat Sequences
- Transplantation Conditioning
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Affiliation(s)
- Matthew J Snyder
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
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16
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Gong JZ, Stenzel TT, Bennett ER, Lagoo AS, Dunphy CH, Moore JO, Rizzieri DA, Tepperberg JH, Papenhausen P, Buckley PJ. Burkitt lymphoma arising in organ transplant recipients: a clinicopathologic study of five cases. Am J Surg Pathol 2003; 27:818-27. [PMID: 12766587 DOI: 10.1097/00000478-200306000-00014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report five cases of Burkitt lymphoma arising in organ transplant recipients. There were four men and one woman with a mean age of 35 years. All were solid organ recipients with three renal, one liver, and one double lung transplantation. The time interval between organ transplantation and lymphoma averaged 4.5 years. Patients typically presented with high-stage disease with generalized lymphadenopathy and bone marrow involvement. Histology showed classic Burkitt lymphoma or atypical variant/Burkitt-like morphology. C-MYC rearrangement, including three cases with immunoglobulin heavy chain and two cases with lambda light chain, and Epstein-Barr virus were detected in all the cases. Additional chromosomal abnormalities were present in two of three cases and p53 mutation was found in one of three cases. Aberrant genotype and phenotype were frequently encountered, including minor monoclonal or oligoclonal T-cell populations and undetectable surface immunoglobulin light chain expression. Four patients received antilymphoma regimens, with combination chemotherapy (three patients) and/or Rituximab (three patients), in addition to reduction of immunosuppression. All four patients achieved complete remission. We conclude that posttransplant Burkitt lymphoma represents a characteristic clinicopathologic entity and occurs later after transplantation. Genotypic and phenotypic aberrations are often present. Rituximab may be an effective alternative to conventional combination chemotherapy in the treatment of a posttransplant Burkitt lymphoma.
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Affiliation(s)
- Jerald Z Gong
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
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17
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Xu D, Du J, Schultz C, Ali A, Ratech H. Rapid and accurate detection of monoclonal immunoglobulin heavy chain gene rearrangement by DNA melting curve analysis in the LightCycler System. J Mol Diagn 2002; 4:216-22. [PMID: 12411589 PMCID: PMC1907354 DOI: 10.1016/s1525-1578(10)60706-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The detection of immunoglobulin heavy chain gene rearrangement (IgH-R) is a standard tool for distinguishing polyclonal from monoclonal B-cell populations. Current DNA-based polymerase chain reactions (PCR) strategies can diagnose monoclonal IgH-R either by measuring the length of the amplicon or by detecting gel mobility variations owing to sequence-dependent conformational changes. However, amplification and analysis remain sequential operations usually requiring manual transfer. We have developed a novel PCR strategy for detecting monoclonal IgH-R that monitors fluorescence of the specific double-stranded DNA binding dye SYBR Green I during melting curve analysis using the LightCycler System. We compared polyacrylamide gel electrophoresis (PAGE) versus melting curve analysis in 130 clinical DNA samples from formalin-fixed, paraffin-embedded (FFPE) tissues (mostly skin biopsies) of 128 patients. The identical FR3 primers were used to amplify the IgH variable region for both analytic techniques. We detected IgH-R in 24 DNA samples from FFPE tissue of 22 patients. Melting curve analysis, compared to PAGE, revealed no false negative and no false positive results, yielding both sensitivity and specificity equal to 100%. We also compared Southern blot analysis versus melting curve analysis in 23 clinical DNA samples from fresh-frozen lymph nodes of 23 patients. We detected IgH-R by melting curve analysis in 7 DNA samples from fresh-frozen lymph nodes. Melting curve analysis, compared to Southern blot analysis, revealed sensitivity equal to 58.3% (7 of 12) and specificity equal to 100% (11 of 11). We conclude that continuous fluorescence monitoring of PCR products with DNA melting curve analysis can rapidly and reproducibly distinguish polyclonal from monoclonal B-cell populations.
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Affiliation(s)
- Dongsheng Xu
- Department of Pathology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA
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18
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Yao R, Rich SA, Schneider E. Validation of Sixteen Leukemia and Lymphoma Cell Lines as Controls for Molecular Gene Rearrangement Assays. Clin Chem 2002. [DOI: 10.1093/clinchem/48.8.1344] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractBackground: Assays for rearrangement of the immunoglobulin, T-cell receptor, bcr/abl, and bcl-2 genes are valuable tools to aid in the diagnosis of leukemias and lymphomas and are now offered by many pathology laboratories. However, there is a lack of well-characterized and validated calibrators and positive controls for these assays. We therefore evaluated 16 readily available leukemia and lymphoma cell lines for their potential use as controls.Methods: DNA and RNA were isolated from each cell line and analyzed by Southern blot and PCR or reverse transcription-PCR (RT-PCR). Rearrangements in the IgJH, IgJκ, TcR-β or TcR-γ, bcr/abl, and bcl-2 genes were detected by commercially available probes and primers. Cell lineages were confirmed by immunophenotyping.Results: Immunoglobulin and T-cell receptor gene rearrangements were identified in five B- and three T-cell lines, respectively. Two cell lines tested positive for the bcr/abl gene, and one was positive for the bcl-2 gene rearrangement by Southern blot.Conclusions: The 16 cell lines studied can be used as positive controls in molecular detection assays for gene rearrangements. The parallel processing of these cell lines with clinical samples can serve to quality control the experimental procedures from the first step of DNA or RNA extraction to the final step of result analysis.
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Affiliation(s)
- Rong Yao
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12201
| | - Steven A Rich
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12201
| | - Erasmus Schneider
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY 12201
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19
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Greiner TC, Rubocki RJ. Effectiveness of capillary electrophoresis using fluorescent-labeled primers in detecting T-cell receptor gamma gene rearrangements. J Mol Diagn 2002; 4:137-43. [PMID: 12169674 PMCID: PMC1906981 DOI: 10.1016/s1525-1578(10)60694-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe the use of fluorescent-labeled primers to analyze T-cell receptor gamma gene rearrangements (TCR gamma GR) using capillary electrophoresis in the ABI Prism 310 Genetic Analyzer. We also compare the performance with denaturing gradient gel electrophoresis (DGGE). In a single multiplex polymerase chain reaction (PCR) we amplified TCR gamma GR with primers for all known groups of variable region genes, and joining region genes described in lymphoid neoplasms. Ten reactive samples, followed by five cell lines and 25 tumor samples with 41 individual TCR gamma GR (due to many biallelic rearrangements) previously identified by DGGE, were analyzed to validate the technique. The capillary electrophoresis protocol has 92% concordance for both TCR clonal status (23 of 25) and 95% concordance in the number of individual TCR gamma GR (38 of 41) identified by DGGE. The reproducible sensitivity for detecting TCR gamma GR diluted in reactive lymphoid DNA is 2% in clinical applications. Discrimination of predominant rearrangements requires a minimum ratio of two times the height of the normal distribution of polyclonal peaks. Capillary electrophoresis can provide results within 60 minutes for each specimen after PCR is complete. Capillary electrophoresis provides a faster result than sequence-based separation methods and gives an archival electronic record. Fluorescent labeling allows the identification of both the variable and joining gene segments used in a TCR gamma GR. The effectiveness of capillary electrophoresis is similar to DGGE.
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Affiliation(s)
- Timothy C Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska 68198-3135, USA.
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20
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Crisi GM, Emanuel JR, Johnson C, Crotty P, Costa J, Tallini G. Semireannealing, single-stranded conformational polymorphism: a novel and effective tool for the diagnosis of T-cell clonality. DIAGNOSTIC MOLECULAR PATHOLOGY : THE AMERICAN JOURNAL OF SURGICAL PATHOLOGY, PART B 2002; 11:67-74. [PMID: 12045709 DOI: 10.1097/00019606-200206000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Single-stranded conformational polymorphism (SSCP) is often used for the diagnosis of T-cell clonality in lymphoproliferative disorders. We introduce a semireannealing SSCP (SR-SSCP) protocol that is rapid, reproducible, and effective. By denaturing and reannealing the polymerase chain reaction (PCR) product before high-resolution polyacrylamide gel electrophoresis, it is possible to generate a diagnostic fingerprint for each case with clonal T-cell receptor-gamma (TCR-gamma) gene rearrangement detected after PCR with TCR-gamma specific consensus primers. Discrete and distinct denatured single-stranded DNA band profiles characterize the rearranged TCR-gamma clones. In the same gel, the clone size may be estimated in the reannealed double-stranded PCR DNA and can be assessed down to the 2% clonal T-cell population level. Eighty-four cases, including 37 T-cell neoplasms, 29 B-cell neoplasms, and 18 reactive lymph node samples were analyzed by SR-SSCP. Clonal TCR-gamma rearrangement was diagnosed in 32 out of 37 T-cell neoplasms but in none of the B-cell tumors or reactive lymph node samples corresponding to sensitivity and specificity of 86.5% and 100%, respectively. We compare the results of SR-SSCP to those obtained by capillary electrophoresis and direct sequence analysis with 100% correlation. This novel method is applicable to any system for identification and quantitation of microheterogeneity in PCR products.
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MESH Headings
- Base Sequence
- Clone Cells/pathology
- DNA, Neoplasm/analysis
- Electrophoresis, Capillary/methods
- Electrophoresis, Polyacrylamide Gel
- Gene Rearrangement
- Humans
- Lymph Nodes/pathology
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/pathology
- Molecular Sequence Data
- Nucleic Acid Conformation
- Polymerase Chain Reaction/methods
- Polymorphism, Single-Stranded Conformational
- Pseudolymphoma/genetics
- Pseudolymphoma/pathology
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Sequence Alignment
- Sequence Analysis, DNA
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Affiliation(s)
- Giovanna Maria Crisi
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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21
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Meier VS, Rufle A, Gudat F. Simultaneous evaluation of T- and B-cell clonality, t(11;14) and t(14;18), in a single reaction by a four-color multiplex polymerase chain reaction assay and automated high-resolution fragment analysis: a method for the rapid molecular diagnosis of lymphoproliferative disorders applicable to fresh frozen and formalin-fixed, paraffin-embedded tissues, blood, and bone marrow aspirates. THE AMERICAN JOURNAL OF PATHOLOGY 2001; 159:2031-43. [PMID: 11733354 PMCID: PMC1850583 DOI: 10.1016/s0002-9440(10)63055-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Current polymerase chain reaction (PCR) methods for the molecular diagnosis of B- and T-cell lymphomas by determination of clonality of immunoglobulin heavy chain (IgH) and T-cell receptor-gamma rearrangements and by detection of the chromosomal translocations t(14;18) and t(11;14), require several laborious and costly PCR assays for each of these diagnostic tests. We have developed a multiplex PCR assay for the simultaneous determination of B- and T-cell clonality and the detection of the chromosomal translocations t(14;18) and t(11;14) in a single reaction, using four-color fluorescence and automated high-resolution fragment analysis. The 26 primers combined in the multiplex PCR correspond to the sequences of >90% of the 69 variables and 6 join IgH genes and 100% of the T-cell receptor-gamma variables and join genes that could participate in the respective rearrangements. In addition, they detect the major and the minor breakpoint regions of the t(14;18) and the major breakpoint region of the t(11;14), and amplify the beta-globin gene as an internal control. The specificity of the multiplex PCR was confirmed by analysis of 39 T-cell lymphomas and 58 B-cell lymphomas, including 11 mantle cell lymphomas bearing the t(11;14) and 25 follicular lymphomas bearing the t(14;18), with known rearrangements and/or translocations. Fifteen samples of reactive lymphadenitis remained negative.
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MESH Headings
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Base Sequence
- Biopsy, Needle
- Bone Marrow/pathology
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Clone Cells
- DNA/chemistry
- DNA/genetics
- Fixatives
- Formaldehyde
- Frozen Sections
- Gene Rearrangement
- Genes, T-Cell Receptor gamma/genetics
- Humans
- Immunoglobulin Heavy Chains/genetics
- Jurkat Cells
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/pathology
- Lymphoproliferative Disorders/blood
- Lymphoproliferative Disorders/diagnosis
- Lymphoproliferative Disorders/genetics
- Molecular Sequence Data
- Paraffin Embedding
- Polymerase Chain Reaction/methods
- Sequence Analysis, DNA
- Sequence Homology, Nucleic Acid
- T-Lymphocytes/metabolism
- T-Lymphocytes/pathology
- Tissue Fixation
- Translocation, Genetic
- Tumor Cells, Cultured
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Affiliation(s)
- V S Meier
- Institute for Pathology, University of Basel, Basel, Switzerland.
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