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Wang X, He J, He H, Shuai Y, Wang L, Li Y, Huang Y, Yu K, Zhao M, Xie T, Li D. Myc rearrangement and concurrent high protein expression of C-Myc/Bcl2 carry an adverse prognosis in diffuse large B-cell lymphoma. Ann Diagn Pathol 2023; 66:152165. [PMID: 37348414 DOI: 10.1016/j.anndiagpath.2023.152165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous group of non-Hodgkin lymphoma, characterized by a variety of clinicopathological, histomorphological, immunophenotypic, and molecular genetic features. The subtype of DLBCL known as double-expressor lymphoma (DEL) is associated with an adverse prognosis when treated with R-CHOP. Our study aimed to investigate the clinicopathologic features of DEL and the prognostic roles of Myc rearrangement and C-Myc expression in DEL patients. PATIENTS AND METHODS We conducted a retrospective study of 145 patients who were identified through fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) testing. RESULTS We found that DEL patients were more likely to have a non-germinal center B-cell (GCB) subtype, stage III/IV disease, and a high International Prognostic Index (IPI) score. Our survival analysis indicated that Myc rearrangement and C-Myc expression were associated with poor prognosis. Although DEL patients with Myc rearrangement exhibited trends towards worse survival compared with patients without Myc rearrangement, the differences were not statistically significant (P = 0.4008). The median overall survival (OS) of DEL patients with ≥70 % C-Myc expression (DEL-C-Mychigh) was 5 months. In the DEL-C-Mychigh group, the non-GCB subtype showed nonsignificant trends towards poorer survival compared with the GCB subtype (P = 0.1042). CONCLUSION In conclusion, our study shows that a cut-off of ≥70 % for C-Myc expression in DEL patients can improve risk stratification, and suggests that more intensive treatment regimens may be necessary to improve survival in this high-risk population.
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Affiliation(s)
- Xingyu Wang
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Juan He
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hong He
- Department of Internal Medicine, The First Branch, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuhan Shuai
- Laboratory of Neuropsycholinguistics, Chongqing Medical University, Chongqing, China
| | - Lixin Wang
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanxin Li
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ying Huang
- Department of Pathology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Kuai Yu
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China; Department of Pathology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Min Zhao
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Tao Xie
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China; Department of Ultrasound, The Daxuecheng Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Dan Li
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China; Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China; Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
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Altered serum lipid levels are associated with prognosis of diffuse large B cell lymphoma and influenced by utility of rituximab. Ann Hematol 2023; 102:393-402. [PMID: 36670246 DOI: 10.1007/s00277-023-05092-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/31/2022] [Indexed: 01/22/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, and the prognosis of the disease varied. This research aims to investigate the impact of serum lipid level on the outcome of DLBCL patients and their interaction with rituximab (RTX). Data of newly diagnosed DLBCL in the third affiliated hospital of Soochow University were retrospectively collected. Baseline serum lipid levels, clinical data, and survival information were simultaneously recorded. Data of healthy controls were collected with age matching. Serum lipid levels significantly differed for the patients. All were transformed into categorical variables for the analysis of survival. During a median follow-up of 58 months, 32.8% patients died. Univariate analysis revealed all serum lipid indicators were associated with overall survival (OS); all except for total cholesterol (TC) and apolipoprotein B (apoB) showed significant impact on progression-free survival (PFS). Multivariable analysis confirmed the adverse effect of triglyceride (TG) on PFS (P = 0.013) and favorable impact of high-density lipoprotein (HDL) on OS (P = 0.003). For cases treated without RTX, apolipoprotein A (apoA) had independent favorable effect on both PFS (P = 0.004) and OS (P = 0.001). Comparably, for patients who received RTX, HDL showed remarkably predictive value of PFS (P = 0.011) and OS (P = 0.019). In conclusion, the abnormal serum lipids occurred throughout the course of DLBCL, and the associations of serum lipids and the prognosis of the disease were interfered by RTX. Trial registration: 2022()CL033; June 26, 2022, retrospectively registered.
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Chen H, Qin Y, Liu P, Yang J, Gui L, He X, Zhang C, Zhou S, Zhou L, Yang S, Shi Y. Genetic Profiling of Diffuse Large B-Cell Lymphoma: A Comparison Between Double-Expressor Lymphoma and Non-Double-Expressor Lymphoma. Mol Diagn Ther 2023; 27:75-86. [PMID: 36401148 DOI: 10.1007/s40291-022-00621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Data are limited regarding the genetic profiling of diffuse large B-cell lymphoma (DLBCL) with double expression of MYC and BCL2 proteins without underlying rearrangements (double-expressor lymphoma [DEL]). This study aimed to describe the genetic profiling and determine the prognostic significance in patients with DEL and in those with non-DEL. METHODS Capture-based targeted sequencing was performed on 244 patients with de novo DLBCL, not otherwise specified. Immunohistochemistry staining was performed for evaluating the MYC and BCL2 expression. RESULTS Among 244 patients, 46 patients had DEL, and 198 had non-DEL. KMT2D, CD58, EP300, PRDM1, TNFAIP3 and BCL2 gain or amplification (BCL2GA/AMP) were significantly more frequently altered in the DEL group. Alterations in the BCR/TLR (p = 0.021), B-cell development and differentiation (p = 0.004), and NF-κB (p = 0.034) pathways occurred more frequently in patients with DEL. Thirty-seven DEL patients and 132 non-DEL patients were included for survival analyses. DEL was not significantly associated with progression-free survival (PFS) (p = 0.60) and overall survival (OS) (p = 0.49). In DEL patients, after adjusting for the International Prognostic Index, BCL2 alteration (HR 2.516, 95% CI 1.027-6.161; p = 0.044) remained an independent predictor of inferior PFS. BCL2GA/AMP also predicted poor PFS, but with marginal statistical significance (HR 2.489, 95% CI 0.995-6.224; p = 0.051). CONCLUSION There was difference in profiling of altered genes and signaling pathways between the DEL group and the non-DEL group. The presence of DEL alone should not be considered as an adverse prognostic indicator, and BCL2 alteration could define a subset of patients with poor prognosis within DEL.
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Affiliation(s)
- Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yan Qin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Peng Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianliang Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xiaohui He
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Changgong Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Liqiang Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Clinicopathologic Features and Genomic Signature of De Novo CD5+ Diffuse Large B-Cell Lymphoma: A Multicenter Collaborative Study. Am J Surg Pathol 2022; 46:1533-1544. [PMID: 36006771 DOI: 10.1097/pas.0000000000001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
De novo CD5+ diffuse large B-cell lymphoma (DLBCL) has poor survival in the era of immunochemotherapy. Accurate gene-based typing and prognostic stratification can enhance the development of effective individualized treatments. Therefore, we conducted a multicenter retrospective study to evaluate the clinicopathologic characteristics, genomic profiles, and prognostic parameters of 61 patients with CD5+ DLBCL and 60 patients with CD5- DLBCL, with the goal of facilitating accurate prognostic stratification and potential individualized treatment strategies. Compared with patients with CD5- DLBCL, older age, advanced stage, higher incidence of central nervous system involvement, and MYC/BCL-2 and p53 overexpression were more prevalent in CD5+ DLBCL. Most patients with CD5+ DLBCL had lymph nodes with non-germinal center B-cell-like or activated B-cell-like subtype according to immunohistochemistry or Lymph2Cx assay. Next-generation sequencing showed that the proportion of MCD subtype (based on the co-occurrence of MYD88 and CD79B mutations) in the CD5+ DLBCL cohort was higher than that in the CD5- DLBCL cohort (54.2% vs. 13.0%, P=0.005). Compared with the CD5- cohort, CD5+ DLBCL patients showed poor 5-year overall survival (70.9% vs. 39.0%, P<0.001). Kaplan-Meier survival analysis indicated that cell of origin, MYC/BCL-2, p53, and BCL-6 expression did not have a prognostic impact on patients with CD5+ DLBCL. Multivariate analysis showed that age above 76 years, advanced stage, higher incidence of central nervous system involvement, and hypoalbuminemia were independent factors for poor prognosis in CD5+ DLBCL patients. In summary, CD5+ DLBCL displays poor prognosis, distinctive clinicopathologic characteristics and predominant genetic features of activated B-cell-like and MCD subtypes with worse survival outcome.
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Voorhees TJ, Epperla N. Identifying aggressive subsets within diffuse large B-cell lymphoma: implications for treatment approach. Expert Rev Anticancer Ther 2022; 22:523-533. [PMID: 35390262 DOI: 10.1080/14737140.2022.2064276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION While the majority of patients diagnosed with diffuse large B-cell lymphoma (DLBCL) can be cured with front-line chemoimmunotherapy, a subset of patients with high-risk disease remain challenging to treat. Identification of high-risk DLBCL is important as future therapy options are explored. AREAS COVERED We discuss the clinical, pathologic and molecular risk stratification in DLBCL and how these factors are incorporated into the decision making for the front-line therapy. EXPERT OPINION Clinical and pathological risk stratification has long been the standard for identifying likelihood of future disease progression and overall survival; however, these prediction models lack the granularity of individual patient pathology and response to therapy. Molecular subtypes defined through whole exome sequencing have independent prognostic significance. While identifying molecular drivers of aggressive disease has provided the opportunity to analyze novel therapy combinations with front-line chemoimmunotherapy, only modest benefit has been observed when targeting DLBCL subtypes. Combining clinical, pathologic, and molecular data will likely result in significant improvement in our ability to identify the most aggressive DLBCL subsets. Novel therapies and trial designs will continue to play an important role as we target these at-risk populations in the future.
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Affiliation(s)
- Timothy J Voorhees
- James Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, The Ohio State University
| | - Narendranath Epperla
- James Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology, The Ohio State University
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Weber T, Schmitz R. Molecular Subgroups of Diffuse Large B Cell Lymphoma: Biology and Implications for Clinical Practice. Curr Oncol Rep 2022; 24:13-21. [PMID: 35060000 PMCID: PMC8831345 DOI: 10.1007/s11912-021-01155-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 12/12/2022]
Abstract
Purpose of Review Genomic analyses have immensely advanced our conception of the heterogeneity of diffuse large B cell lymphoma (DLBCL), resulting in subgroups with distinct molecular profiles. In this review, we summarize our current knowledge of the biology of DLBCL complexity and discuss the potential implications for precision medicine. Recent Findings During the last two decades, gene expression profiling, copy number analysis, and high throughput sequencing enabled the identification of molecular subclasses of DLBCL that are biologically and clinically meaningful. The resulting classifications provided novel prospects of diagnosis, prognostication, and therapeutic strategies for this aggressive disease. Summary The molecular characterization of DLBCL offers unprecedented insights into the biology of these lymphomas that can guide precision medicine. The knowledge of the molecular setup of an individual DLBCL patients enables prognostication of patients and will be useful to stratify patients in clinical trials. Future direction should focus to implement the molecular classifications of DLBCL in the clinical practice to evaluate their significance and scope using real-world data.
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Xu-Monette ZY, Wei L, Fang X, Au Q, Nunns H, Nagy M, Tzankov A, Zhu F, Visco C, Bhagat G, Dybkaer K, Chiu A, Tam W, Zu Y, Hsi ED, Hagemeister FB, Sun X, Han X, Go H, Ponzoni M, Ferreri AJM, Møller MB, Parsons BM, van Krieken JH, Piris MA, Winter JN, Li Y, Xu B, Albitar M, You H, Young KH. Genetic Subtyping and Phenotypic Characterization of the Immune Microenvironment and MYC/BCL2 Double Expression Reveal Heterogeneity in Diffuse Large B-cell Lymphoma. Clin Cancer Res 2022; 28:972-983. [PMID: 34980601 DOI: 10.1158/1078-0432.ccr-21-2949] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/25/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is molecularly and clinically heterogeneous, and can be subtyped according to genetic alterations, cell-of-origin, or microenvironmental signatures using high-throughput genomic data at the DNA or RNA level. Although high-throughput proteomic profiling has not been available for DLBCL subtyping, MYC/BCL2 protein double expression (DE) is an established prognostic biomarker in DLBCL. The purpose of this study is to reveal the relative prognostic roles of DLBCL genetic, phenotypic, and microenvironmental biomarkers. EXPERIMENTAL DESIGN We performed targeted next-generation sequencing; IHC for MYC, BCL2, and FN1; and fluorescent multiplex IHC for microenvironmental markers in a large cohort of DLBCL. We performed correlative and prognostic analyses within and across DLBCL genetic subtypes and MYC/BCL2 double expressors. RESULTS We found that MYC/BCL2 double-high-expression (DhE) had significant adverse prognostic impact within the EZB genetic subtype and LymphGen-unclassified DLBCL cases but not within MCD and ST2 genetic subtypes. Conversely, KMT2D mutations significantly stratified DhE but not non-DhE DLBCL. T-cell infiltration showed favorable prognostic effects within BN2, MCD, and DhE but unfavorable effects within ST2 and LymphGen-unclassified cases. FN1 and PD-1-high expression had significant adverse prognostic effects within multiple DLBCL genetic/phenotypic subgroups. The prognostic effects of DhE and immune biomarkers within DLBCL genetic subtypes were independent although DhE and high Ki-67 were significantly associated with lower T-cell infiltration in LymphGen-unclassified cases. CONCLUSIONS Together, these results demonstrated independent and additive prognostic effects of phenotypic MYC/BCL2 and microenvironment biomarkers and genetic subtyping in DLBCL prognostication, important for improving DLBCL classification and identifying prognostic determinants and therapeutic targets.
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Affiliation(s)
- Zijun Y Xu-Monette
- Hematopathology Division and Department of Pathology, Duke University Medical Center, Durham, North Carolina.
| | - Li Wei
- Hematopathology Division and Department of Pathology, Duke University Medical Center, Durham, North Carolina.,Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qingyan Au
- NeoGenomics Laboratories, Aliso Viejo, California
| | - Harry Nunns
- NeoGenomics Laboratories, Aliso Viejo, California
| | - Máté Nagy
- NeoGenomics Laboratories, Aliso Viejo, California
| | - Alexandar Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Feng Zhu
- Hematopathology Division and Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | | | - Govind Bhagat
- Columbia University Irving Medical Center and New York Presbyterian Hospital, New York, New York
| | | | | | - Wayne Tam
- Weill Medical College of Cornell University, New York, New York
| | - Youli Zu
- The Methodist Hospital, Houston, Texas
| | | | - Fredrick B Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiaoping Sun
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xin Han
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heounjeong Go
- Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of South Korea
| | | | | | | | | | - J Han van Krieken
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Miguel A Piris
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yong Li
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bing Xu
- The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Maher Albitar
- Genomic Testing Cooperative, LCA, Irvine, California
| | - Hua You
- Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Ken H Young
- Hematopathology Division and Department of Pathology, Duke University Medical Center, Durham, North Carolina. .,Duke Cancer Institute, Durham, North Carolina
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Kos IA, Thurner L, Bittenbring JT, Christofyllakis K, Kaddu-Mulindwa D. Advances in Lymphoma Molecular Diagnostics. Diagnostics (Basel) 2021; 11:diagnostics11122174. [PMID: 34943410 PMCID: PMC8699850 DOI: 10.3390/diagnostics11122174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Lymphomas encompass a diverse group of malignant lymphoid neoplasms. Over recent years much scientific effort has been undertaken to identify and understand molecular changes in lymphomas, resulting in a wide range of genetic alterations that have been reported across all types of lymphomas. As many of these changes are now incorporated into the World Health Organization’s defined criteria for the diagnostic evaluation of patients with lymphoid neoplasms, their accurate identification is crucial. Even if many alterations are not routinely evaluated in daily clinical practice, they may still have implications in risk stratification, treatment, prognosis or disease monitoring. Moreover, some alterations can be used for targeted treatment. Therefore, these advances in lymphoma molecular diagnostics in some cases have led to changes in treatment algorithms. Here, we give an overview of and discuss advances in molecular techniques in current clinical practice, as well as highlight some of them in a clinical context.
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Croci GA, Au-Yeung RKH, Reinke S, Staiger AM, Koch K, Oschlies I, Richter J, Poeschel V, Held G, Loeffler M, Trümper L, Rosenwald A, Ott G, Spang R, Altmann B, Ziepert M, Klapper W. SPARC-positive macrophages are the superior prognostic factor in the microenvironment of diffuse large B-cell lymphoma and independent of MYC rearrangement and double-/triple-hit status. Ann Oncol 2021; 32:1400-1409. [PMID: 34438040 DOI: 10.1016/j.annonc.2021.08.1991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with respect to outcome. Features of the tumor microenvironment (TME) are associated with prognosis when assessed by gene expression profiling. However, it is uncertain whether assessment of the microenvironment can add prognostic information to the most relevant and clinically well-established molecular subgroups when analyzed by immunohistochemistry (IHC). PATIENTS AND METHODS We carried out a histopathologic analysis of biomarkers related to TME in a very large cohort (n = 455) of DLBCL treated in prospective trials and correlated with clinicopathologic and molecular data, including chromosomal rearrangements and gene expression profiles for cell-of-origin and TME. RESULTS The content of PD1+, FoxP3+ and CD8+, as well as vessel density, was not associated with outcome. However, we found a low content of CD68+ macrophages to be associated with inferior progression-free survival (PFS) and overall survival (OS; P = 0.023 and 0.040, respectively) at both univariable and multivariable analyses, adjusted for the factors of the International Prognostic Index (IPI), MYC break and BCL2/MYC and BCL6/MYC double-hit status. The subgroup of PDL1+ macrophages was not associated with survival. Instead, secreted protein acidic and cysteine rich (SPARC)-positive macrophages were identified as the subtype of macrophages most associated with survival. SPARC-positive macrophages and stromal cells directly correlated with favorable PFS and OS (both, P[log rank] <0.001, P[trend] < 0.001). The association of SPARC with prognosis was independent of the factors of the IPI, MYC double-/triple-hit status, Bcl2/c-myc double expression, cell-of-origin subtype and a recently published gene expression signature [lymphoma-associated macrophage interaction signature (LAMIS)]. CONCLUSIONS SPARC expression in the TME detected by a single IHC staining with fair-to-good interobserver reproducibility is a powerful prognostic parameter. Thus SPARC expression is a strong candidate for risk assessment in DLBCL in daily practice.
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Affiliation(s)
- G A Croci
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - R K H Au-Yeung
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - S Reinke
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tübingen, Germany
| | - K Koch
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - I Oschlies
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Richter
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - V Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - G Held
- DSHNHL Studiensekretariat, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - M Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - L Trümper
- Department of Hematology and Oncology, Georg-August Universität, Göttingen, Germany
| | - A Rosenwald
- Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken (CCCMF), Würzburg, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tübingen, Germany
| | - R Spang
- Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - B Altmann
- DSHNHL Studiensekretariat, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - W Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Primary central nervous system lymphoma: status and advances in diagnosis, molecular pathogenesis, and treatment. Chin Med J (Engl) 2021; 133:1462-1469. [PMID: 32452898 PMCID: PMC7339152 DOI: 10.1097/cm9.0000000000000844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare group of extra-nodal non-Hodgkin lymphoma which is confined to the central nervous system or eyes. This article aims to present a brief profile of PCNSL diagnosis and treatment in immunocompetent patients. The authors retrieved information from the PubMed database up to September 2019. The annual incidence of PCNSL increased over the last four decades. The prognosis of PCNSL has improved mainly due to the introduction and wide-spread use of high-dose methotrexate, which is now the backbone of all first-line treatment polychemotherapy regimens. Gene expression profiling and next-generation sequencing analyses have revealed mutations that induce activation of nuclear factor-κB, B cell antigen receptor, and Janus kinases/signal transducer and activator of transcription proteins signal pathways. Some novel agents are investigated in the treatment of relapsed PCNSL including immunotherapy and targeted therapy. In particular, lenalidomide and ibrutinib have demonstrated durable efficiency. Treatment of PCNSL has evolved in the last 40 years and survival outcomes have improved in most patient groups, but there is still room to improve outcome by optimizing current chemotherapy and novel agents.
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11
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Outcomes of patients with limited-stage aggressive large B-cell lymphoma with high-risk cytogenetics. Blood Adv 2021; 4:253-262. [PMID: 31945157 DOI: 10.1182/bloodadvances.2019000875] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/23/2019] [Indexed: 01/08/2023] Open
Abstract
There is a paucity of data regarding outcomes and response to standard therapy in patients with limited-stage (LS) agressive B-cell lymphoma (LS-ABCL) who harbor MYC rearrangement (MYC-R) with or without BCL2 and/or BCL6 rearrangements. We conducted a multicenter retrospective study of MYC-R LS-ABCL patients who received either rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), or more intensive immunochemotherapy (IIC) plus or minus consolidative involved-field radiation therapy (IFRT). One hundred four patients from 15 academic centers were included. Forty four patients (42%) received R-CHOP, of whom 52% had IFRT. Sixty patients (58%) received IIC, of whom 40% had IFRT. Overall response rate was 91% (84% complete response [CR]; 7% partial response). Patients with double-hit lymphoma (DHL; n = 40) had a lower CR rate compared with patients with MYC-R only (75% vs 98%; P = .003). CR rate was higher in the IFRT vs no-IFRT group (98% vs 72%; P < .001). Median follow-up was 3.2 years; 2-year progression-free survival (PFS) and overal survival (OS) were 78% and 86% for the entire cohort, and 74% and 81% for the DHL patients, respectively. PFS and OS were similar across treatment groups (IFRT vs no IFRT, R-CHOP vs IIC) in the entire cohort and in DHL patients. Our data provide a historical benchmark for MYC-R LS-ABCL and LS-DHL patients and show that outcomes for this population may be better than previously recognized. There was no benefit of using IIC over R-CHOP in patients with MYC-R LS-ABCL and LS-DHL.
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12
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Frontzek F, Ziepert M, Nickelsen M, Altmann B, Glass B, Haenel M, Truemper L, Held G, Bentz M, Borchmann P, Dreyling M, Viardot A, Kroschinsky FP, Metzner B, Staiger AM, Horn H, Ott G, Rosenwald A, Loeffler M, Lenz G, Schmitz N. Rituximab plus high-dose chemotherapy (MegaCHOEP) or conventional chemotherapy (CHOEP-14) in young, high-risk patients with aggressive B-cell lymphoma: 10-year follow-up of a randomised, open-label, phase 3 trial. LANCET HAEMATOLOGY 2021; 8:e267-e277. [PMID: 33667420 DOI: 10.1016/s2352-3026(21)00022-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND R-MegaCHOEP was the first phase 3 study comparing high-dose chemotherapy plus rituximab followed by autologous haematopoietic stem-cell transplantation (HSCT) with conventional chemotherapy plus rituximab in first-line therapy for patients aged 60 years or younger with high-risk aggressive B-cell lymphoma. Little is known about the long-term outcomes of these patients. We aimed to evaluate the long-term efficacy and safety of conventional chemotherapy versus high-dose chemotherapy after 10 years of follow-up in the R-MegaCHOEP trial. METHODS In this open-label, randomised, phase 3 trial done across 61 centres in Germany, patients aged 18-60 years with newly diagnosed, high-risk (age-adjusted International Prognostic Index [IPI] 2 or 3) aggressive B-cell lymphoma were randomly assigned (1:1, using Pocock minimisation) to eight cycles of conventional chemotherapy (cyclosphosphamide, doxorubicin, vincristine, etoposide, and prednisolone) plus rituximab (R-CHOEP-14) or four cycles of high-dose chemotherapy plus rituximab followed by autologous HSCT (R-MegaCHOEP). The trial was unmasked. Patients were stratified by age-adjusted IPI factors, presence of bulky disease (tumour mass ≥7·5 cm diameter), and treatment centre. The primary endpoint was event-free survival, analysed here 10 years after randomisation. 10-year overall survival, progression-free survival, conditional survival, relapse patterns, secondary malignancies, and molecular characteristics were also analysed. All analyses were done on the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT00129090. FINDINGS Between March 3, 2003, and April 7, 2009, 275 patients were randomly assigned to R-CHOEP-14 (n=136) or R-MegaCHOEP (n=139). 130 patients in the R-CHOEP-14 group and 132 patients in the R-MegaCHOEP group were included in the intention-to-treat population. After a median follow-up of 9·3 years (IQR 5·1-11·1), 10-year event-free survival was 51% (95% CI 42-61) in the R-MegaCHOEP group and 57% (47-67) in the R-CHOEP-14 group (adjusted hazard ratio [HR] 1·3 [95% CI 0·9-1·8], p=0·23). 10-year progression-free survival was 59% (50-68) in the R-MegaCHOEP group and 60% (51-70) in the R-CHOEP-14 group (adjusted HR 1·1 [0·7-1·7], p=0·64). 10-year overall survival was 66% (57-76) in the R-MegaCHOEP group and 72% (63-81) in the R-CHOEP-14 group (adjusted HR 1·3 [0·8-2·1], p=0·26). Relapse occurred in 30 (16% [95% CI 11-22]) of 190 patients who had complete remission or unconfirmed complete remission; 17 (17%) of 100 patients in the R-CHOEP-14 group and 13 (14%) of 90 patients in the R-MegaCHOEP group. Seven (23%) of 30 patients had low-grade histology at relapse and had better outcomes compared with patients who relapsed with aggressive histologies. Lymphoma affected the CNS in 18 (28%) of 64 patients with treatment failure. 22 secondary malignancies were reported in the intention-to-treat population; in 12 (9%) of 127 patients in the R-CHOEP-14 group and ten (8%) of 126 patients in the R-MegaCHOEP group. INTERPRETATION Event-free survival and overall survival were similar between groups after 10 years of follow-up; outcomes were not improved in the R-MegaCHOEP group by high-dose chemotherapy and autologous HSCT. Patients who relapsed with aggressive histology showed a high incidence of CNS involvement and poor prognosis. For these patients, novel therapies are greatly warranted. FUNDING Deutsche Krebshilfe (German Cancer Aid).
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Affiliation(s)
- Fabian Frontzek
- Department of Medicine A, Haematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics, and Epidemiology, University Leipzig, Leipzig, Germany
| | | | - Bettina Altmann
- Institute for Medical Informatics, Statistics, and Epidemiology, University Leipzig, Leipzig, Germany
| | - Bertram Glass
- Clinic for Haematology, Oncology, Tumour Immunology, and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Mathias Haenel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Lorenz Truemper
- Haematology and Medical Oncology, Georg August University, Göttingen, Germany
| | - Gerhard Held
- Department for Haematology and Oncology, Westpfalz-Klnikum Kaiserslautern, Kaiserslautern, Germany
| | - Martin Bentz
- Department of Internal Medicine III, Municipal Hospital of Karlsruhe, Karlsruhe, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Martin Dreyling
- Department of Medicine III, Ludwig Maximilians Universität Hospital, Munich, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | | | - Bernd Metzner
- Department of Internal Medicine, Oncology, and Haematology, University Hospital Klinikum Oldenburg, Oldenburg, Germany
| | - Annette M Staiger
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, University of Tübingen, Stuttgart, Germany; Department of Clinical Pathology, Robert Bosch Hospital, Stuttgart, Germany
| | - Heike Horn
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, University of Tübingen, Stuttgart, Germany; Department of Clinical Pathology, Robert Bosch Hospital, Stuttgart, Germany
| | - German Ott
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, University of Tübingen, Stuttgart, Germany; Department of Clinical Pathology, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Markus Loeffler
- Institute for Medical Informatics, Statistics, and Epidemiology, University Leipzig, Leipzig, Germany
| | - Georg Lenz
- Department of Medicine A, Haematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Norbert Schmitz
- Department of Medicine A, Haematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany.
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13
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Fan S, Zhao Z, Yu H, Wang L, Zheng C, Huang X, Yang Z, Xing M, Lu Q, Luo Y. Applying probability calibration to ensemble methods to predict 2-year mortality in patients with DLBCL. BMC Med Inform Decis Mak 2021; 21:14. [PMID: 33413321 PMCID: PMC7791789 DOI: 10.1186/s12911-020-01354-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/26/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Under the influences of chemotherapy regimens, clinical staging, immunologic expressions and other factors, the survival rates of patients with diffuse large B-cell lymphoma (DLBCL) are different. The accurate prediction of mortality hazards is key to precision medicine, which can help clinicians make optimal therapeutic decisions to extend the survival times of individual patients with DLBCL. Thus, we have developed a predictive model to predict the mortality hazard of DLBCL patients within 2 years of treatment. METHODS We evaluated 406 patients with DLBCL and collected 17 variables from each patient. The predictive variables were selected by the Cox model, the logistic model and the random forest algorithm. Five classifiers were chosen as the base models for ensemble learning: the naïve Bayes, logistic regression, random forest, support vector machine and feedforward neural network models. We first calibrated the biased outputs from the five base models by using probability calibration methods (including shape-restricted polynomial regression, Platt scaling and isotonic regression). Then, we aggregated the outputs from the various base models to predict the 2-year mortality of DLBCL patients by using three strategies (stacking, simple averaging and weighted averaging). Finally, we assessed model performance over 300 hold-out tests. RESULTS Gender, stage, IPI, KPS and rituximab were significant factors for predicting the deaths of DLBCL patients within 2 years of treatment. The stacking model that first calibrated the base model by shape-restricted polynomial regression performed best (AUC = 0.820, ECE = 8.983, MCE = 21.265) in all methods. In contrast, the performance of the stacking model without undergoing probability calibration is inferior (AUC = 0.806, ECE = 9.866, MCE = 24.850). In the simple averaging model and weighted averaging model, the prediction error of the ensemble model also decreased with probability calibration. CONCLUSIONS Among all the methods compared, the proposed model has the lowest prediction error when predicting the 2-year mortality of DLBCL patients. These promising results may indicate that our modeling strategy of applying probability calibration to ensemble learning is successful.
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Affiliation(s)
- Shuanglong Fan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Zhiqiang Zhao
- Department of Hematology, Shanxi Cancer Hospital, Taiyuan, China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Lei Wang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Chuchu Zheng
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xueqian Huang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Zhenhuan Yang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Meng Xing
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Qing Lu
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, USA.
| | - Yanhong Luo
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.
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14
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Hohloch K, Ziepert M, Truemper L, Buske C, Held G, Poeschel V, Chapuy B, Altmann B. Low serum albumin is an independent risk factor in elderly patients with aggressive B‐cell lymphoma: Results from prospective trials of the German High‐Grade Non‐Hodgkin's Lymphoma Study Group. ACTA ACUST UNITED AC 2020; 1:181-187. [PMID: 35847697 PMCID: PMC9175786 DOI: 10.1002/jha2.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
Serum albumin a well‐known risk factor predicting outcome in many solid tumors. We explore the role of low serum albumin (≤3.5 g/dL) as an independent risk factor in elderly patients with aggressive B‐cell lymphoma. Outcome of 429 patients treated with R‐CHOP‐14 in the RICOVER‐60 trial and available serum albumin were analyzed in this retrospective study. Of the 429 patients in the RICOVER‐60 trial, 137 (32%) had low and 292 (68%) had normal serum albumin levels (>3.5 g/dL). In the low albumin group, patients had significantly higher International Prognostic Index (IPI), bulky disease, extralymphatic involvement, and B‐symptoms. Event‐free survival (EFS) (P < .001), progression‐free survival (PFS) (P < .001), and overall survival (OS) (P < .001) were significantly inferior for patients with low compared to those with normal serum albumin. Multivariate analysis adjusted for IPI shows following Hazard ratios (HR) for low serum albumin: EFS (HR = 1.5; 95% confidance interval [CI] [1.1; 2.1], P = .009), PFS (HR = 1.7; 95% CI [1.2; 2.4], P = .001) and OS (HR = 1.6; 95% CI [1.1; 2.3], P = .006). Results were confirmed in 185 patients from the DENSE‐R‐CHOP‐14 and SMARTE‐R‐CHOP‐14 trials. In conclusion, low serum albumin is an independent risk factor in elderly patients with aggressive B‐cell lymphoma treated with R‐CHOP.
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Affiliation(s)
- Karin Hohloch
- Department of Hematology and OncologyKantonsspital Graubünden Chur Switzerland
- Department of Hematology and OncologyUniversity Medical CenterGeorg‐August University Göttingen Germany
| | - Marita Ziepert
- Statistics and EpidemiologyInstitute for Medical InformaticsUniversity of Leipzig Leipzig Germany
| | - Lorenz Truemper
- Department of Hematology and OncologyUniversity Medical CenterGeorg‐August University Göttingen Germany
| | - Christian Buske
- Comprehensive Cancer Center UlmInstitute of Experimental Cancer ResearchUniversity Hospital Ulm Ulm Germany
| | - Gerhard Held
- Department of Internal MedicineUniversity Hospital Saarland Homburg Germany
| | - Viola Poeschel
- Department of Internal MedicineUniversity Hospital Saarland Homburg Germany
| | - Bjoern Chapuy
- Department of Hematology and OncologyUniversity Medical CenterGeorg‐August University Göttingen Germany
| | - Bettina Altmann
- Statistics and EpidemiologyInstitute for Medical InformaticsUniversity of Leipzig Leipzig Germany
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15
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Akpa CA, Kleo K, Oker E, Tomaszewski N, Messerschmidt C, López C, Wagener R, Oehl-Huber K, Dettmer K, Schoeler A, Lenze D, Oefner PJ, Beule D, Siebert R, Capper D, Dimitrova L, Hummel M. Acquired resistance to DZNep-mediated apoptosis is associated with copy number gains of AHCY in a B-cell lymphoma model. BMC Cancer 2020; 20:427. [PMID: 32408898 PMCID: PMC7227222 DOI: 10.1186/s12885-020-06937-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/07/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enhancer of zeste homolog 2 (EZH2) is considered an important driver of tumor development and progression by its histone modifying capabilities. Inhibition of EZH2 activity is thought to be a potent treatment option for eligible cancer patients with an aberrant EZH2 expression profile, thus the indirect EZH2 inhibitor 3-Deazaneplanocin A (DZNep) is currently under evaluation for its clinical utility. Although DZNep blocks proliferation and induces apoptosis in different tumor types including lymphomas, acquired resistance to DZNep may limit its clinical application. METHODS To investigate possible mechanisms of acquired DZNep resistance in B-cell lymphomas, we generated a DZNep-resistant clone from a previously DZNep-sensitive B-cell lymphoma cell line by long-term treatment with increasing concentrations of DZNep (ranging from 200 to 2000 nM) and compared the molecular profiles of resistant and wild-type clones. This comparison was done using molecular techniques such as flow cytometry, copy number variation assay (OncoScan and TaqMan assays), fluorescence in situ hybridization, Western blot, immunohistochemistry and metabolomics analysis. RESULTS Whole exome sequencing did not indicate the acquisition of biologically meaningful single nucleotide variants. Analysis of copy number alterations, however, demonstrated among other acquired imbalances an amplification (about 30 times) of the S-adenosyl-L-homocysteine hydrolase (AHCY) gene in the resistant clone. AHCY is a direct target of DZNep and is critically involved in the biological methylation process, where it catalyzes the reversible hydrolysis of S-adenosyl-L-homocysteine to L-homocysteine and adenosine. The amplification of the AHCY gene is paralleled by strong overexpression of AHCY at both the transcriptional and protein level, and persists upon culturing the resistant clone in a DZNep-free medium. CONCLUSIONS This study reveals one possible molecular mechanism how B-cell lymphomas can acquire resistance to DZNep, and proposes AHCY as a potential biomarker for investigation during the administration of EZH2-targeted therapy with DZNep.
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Affiliation(s)
- Chidimma Agatha Akpa
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin School of Integrative Oncology, Charité - Medical University of Berlin, Berlin, Germany.
| | - Karsten Kleo
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Elisabeth Oker
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Nancy Tomaszewski
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Cristina López
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Rabea Wagener
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Kathrin Oehl-Huber
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Katja Dettmer
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Anne Schoeler
- Department of Neuropathology, Charité, Medical University of Berlin, corporate member of Free University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK); Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dido Lenze
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Peter J Oefner
- Berlin School of Integrative Oncology, Charité - Medical University of Berlin, Berlin, Germany
| | - Dieter Beule
- Berlin Institute of Health, Charité Core Unit Bioinformatics, Berlin, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - David Capper
- Berlin School of Integrative Oncology, Charité - Medical University of Berlin, Berlin, Germany
- Department of Neuropathology, Charité, Medical University of Berlin, corporate member of Free University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
- German Cancer Consortium (DKTK); Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lora Dimitrova
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Hummel
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin School of Integrative Oncology, Charité - Medical University of Berlin, Berlin, Germany
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16
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Kim YR, Yoon SO, Kim SJ, Cheong JW, Chung H, Lee JY, Jang JE, Kim Y, Yang WI, Min YH, Kim JS. Upfront autologous hematopoietic stem cell transplantation for high-risk patients with double-expressor diffuse large B cell lymphoma. Ann Hematol 2020; 99:2149-2157. [PMID: 32390113 DOI: 10.1007/s00277-020-04043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Although MYC and BCL2 co-expression in diffuse large B cell lymphoma (DLBCL) is associated with inferior prognosis, it remains uncertain whether upfront autologous hematopoietic stem cell transplantation (ASCT) is beneficial in this lymphoma. This study aimed to investigate whether ASCT consolidation could have a positive role for patients with MYC and BCL2 co-expression (double-expressor lymphoma, DEL). We retrospectively evaluated 67 DLBCL patients who underwent upfront ASCT following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. The 5-year overall survival (OS) and progression-free survival (PFS) were 82.3% and 79.2%, respectively. There were 23 (34.3%) patients with DEL and 51 (76.1%) patients with non-germinal center B cell (GCB) subtype. The 5-year OS and PFS of patients with DEL were not different from those with non-DEL (P = 0.429 and P = 0.614, respectively). No survival difference for OS and PFS was also observed between GCB and non-GCB subtypes (P = 0.950 and P = 0.901, respectively). The OS and PFS were comparable for patients with DEL and non-DEL and both GCB and non-GCB subtypes. In conclusion, MYC and BCL2 co-expression did not have a poor prognostic impact among high-risk patients with DLBCL treated with upfront ASCT regardless of molecular classification. This preliminary study suggested that the role of consolidative ASCT is needed to be evaluated in a prospective randomized clinical trial.
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Affiliation(s)
- Yu Ri Kim
- Division of Hematology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Och Yoon
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Soo-Jeong Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Haerim Chung
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jung Yeon Lee
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Ji Eun Jang
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Yundeok Kim
- Division of Hematology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo-Ick Yang
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoo Hong Min
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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17
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The clinicopathological and genetic features of ovarian diffuse large B-cell lymphoma. Pathology 2019; 52:206-212. [PMID: 31883669 DOI: 10.1016/j.pathol.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022]
Abstract
Ovarian lymphoma, whether a primary or secondary condition, is very rare. Little is known about its genetic aberrations. Here, we reviewed the clinical, morphological and immunohistochemical characteristics of nine ovarian diffuse large B-cell lymphoma (DLBCL) cases and performed fluorescence in situ hybridisation (FISH) analysis to detect MYC, BCL2 and BCL6 translocations. We also performed whole exome sequencing analysis to determine their genomic features compared with those of conventional extranodal DLBCL. The results showed that six of nine cases were bilateral and three cases were left-sided. Histologically, the tumour cells were homogeneous and a starry-sky pattern was very common in ovarian DLBCL (Burkitt-like). Immunohistochemically, most of the cases (7/9) were germinal centre B-cell-like (GCB) subtype, and dual expression of MYC and BCL2 was found in three cases of ovarian DLBCL. A double-hit (involving MYC and BCL6) phenotype was found in one case of ovarian DLBCL (GCB subtype). Sequencing analysis revealed that NOTCH4, NCOR2, BCL10 and CARD11 were frequently mutated both in ovarian DLBCL and conventional extranodal DLBCL. COL27A1, PRKCB, HLA-A, NOTCH3 and HDAC4 mutations were found only in ovarian DLBCL but not in conventional DLBCL, and NOTCH3 and HDAC4 mutations were only identified in the GCB subtype. Furthermore, several signalling pathways including the B-cell receptor, Epstein-Barr virus infection, HTLV-1 infection, Notch, PI3K-AKT and mTOR were found to be involved in ovarian DLBCL. Our results broaden the understanding of the clinicopathological and molecular characteristics of ovarian DLBCL and compare their genetic features to those of conventional extranodal DLBCL for the first time.
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Epperla N, Hamadani M, Reljic T, Kharfan‐Dabaja MA, Savani BN, Kumar A. Upfront autologous hematopoietic stem cell transplantation consolidation for patients with aggressive B‐cell lymphomas in first remission in the rituximab era: A systematic review and meta‐analysis. Cancer 2019; 125:4417-4425. [DOI: 10.1002/cncr.32464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/18/2019] [Indexed: 08/30/2023]
Affiliation(s)
- Narendranath Epperla
- Division of Hematology, Department of Medicine The James Cancer Hospital and Solove Research Institute, The Ohio State University Columbus Ohio
| | - Mehdi Hamadani
- Blood and Marrow Transplant (BMT) and Cellular Therapy Program Medical College of Wisconsin Milwaukee Wisconsin
| | - Tea Reljic
- Program for Comparative Effectiveness Research, Morsani College of Medicine University of South Florida Tampa Florida
| | - Mohamed A. Kharfan‐Dabaja
- Blood and Marrow Transplantation Program, Division of Hematology/Oncology Mayo Clinic Jacksonville Florida
| | - Bipin N. Savani
- Division of Hematology and Oncology, Department of Medicine Vanderbilt University Medical Center Nashville Tennessee
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, Morsani College of Medicine University of South Florida Tampa Florida
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19
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A novel lymphoma-associated macrophage interaction signature (LAMIS) provides robust risk prognostication in diffuse large B-cell lymphoma clinical trial cohorts of the DSHNHL. Leukemia 2019; 34:543-552. [PMID: 31530861 DOI: 10.1038/s41375-019-0573-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a disease with heterogeneous outcome. Stromal signatures have been correlated to survival in DLBCL. Their use, however, is hampered by the lack of assays for formalin-fixed paraffin-embedded material (FFPE). We constructed a lymphoma-associated macrophage interaction signature (LAMIS) interrogating features of the microenvironment using a NanoString assay applicable to FFPE. The clinical impact of the signature could be validated in a cohort of 466 patients enrolled in prospective clinical trials of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL). Patients with high expression of the signature (LAMIShigh) had shorter EFS, PFS, and OS. Multivariate analyses revealed independence from IPI factors in EFS (HR 1.7, 95% CI 1.2-2.4, p-value = 0.001), PFS (HR 1.8, 95% CI 1.2-2.5, p-value = 0.001) and OS (HR 1.8, 95% CI 1.3-2.7, p-value = 0.001). Multivariate analyses adjusted for the IPI factors showed the signature to be independent from COO, MYC rearrangements and double expresser status (DE). LAMIShigh and simultaneous DE status characterized a patient subgroup with dismal prognosis and early relapse. Our data underline the importance of the microenvironment in prognosis. Combined analysis of stromal features, the IPI and DE may provide a new rationale for targeted therapy.
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20
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Molecular characteristics of diffuse large B-cell lymphoma in the Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin lymphomas (PETAL) trial: correlation with interim PET and outcome. Blood Cancer J 2019; 9:67. [PMID: 31427567 PMCID: PMC6700149 DOI: 10.1038/s41408-019-0230-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 11/08/2022] Open
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21
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Akpa CA, Kleo K, Lenze D, Oker E, Dimitrova L, Hummel M. DZNep-mediated apoptosis in B-cell lymphoma is independent of the lymphoma type, EZH2 mutation status and MYC, BCL2 or BCL6 translocations. PLoS One 2019; 14:e0220681. [PMID: 31419226 PMCID: PMC6697340 DOI: 10.1371/journal.pone.0220681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/15/2019] [Indexed: 02/06/2023] Open
Abstract
Enhancer of zeste homolog 2 (EZH2) tri-methylates histone 3 at position lysine 27 (H3K27me3). Overexpression and gain-of-function mutations in EZH2 are regarded as oncogenic drivers in lymphoma and other malignancies due to the silencing of tumor suppressors and differentiation genes. EZH2 inhibition is sought to represent a good strategy for tumor therapy. In this study, we treated Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) cell lines with 3-deazaneplanocin—A (DZNep), an indirect EZH2 inhibitor which possesses anticancer properties both in-vitro and in-vivo. We aimed to address the impact of the lymphoma type, EZH2 mutation status, as well as MYC, BCL2 and BCL6 translocations on the sensitivity of the lymphoma cell lines to DZNep-mediated apoptosis. We show that DZNep inhibits proliferation and induces apoptosis of these cell lines independent of the type of lymphoma, the EZH2 mutation status and the MYC, BCL2 and BCL6 rearrangement status. Furthermore, DZNep induced a much stronger apoptosis in majority of these cell lines at a lower concentration, and within a shorter period when compared with EPZ-6438, a direct EZH2 inhibitor currently in phase II clinical trials. Apoptosis induction by DZNep was both concentration-dependent and time-dependent, and was associated with the inhibition of EZH2 and subsequent downregulation of H3K27me3 in DZNep-sensitive cell lines. Although EZH2, MYC, BCL2 and BCL6 are important prognostic biomarkers for lymphomas, our study shows that they poorly influence the sensitivity of lymphoma cell lines to DZNep-mediated apoptosis.
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Affiliation(s)
- Chidimma Agatha Akpa
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Berlin, Germany
- Berlin School of Integrative Oncology, Charité Medical University, Berlin, Berlin, Germany
- * E-mail:
| | - Karsten Kleo
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Berlin, Germany
| | - Dido Lenze
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Berlin, Germany
| | - Elisabeth Oker
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Berlin, Germany
| | - Lora Dimitrova
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Berlin, Germany
| | - Michael Hummel
- Department of Experimental Hematopathology, Institute of Pathology, Charité Medical University, Berlin, Berlin, Germany
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22
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Ott G, Klapper W, Feller AC, Hansmann ML, Möller P, Stein H, Rosenwald A, Fend F. [Revised version of the 4th edition of the WHO classification of malignant lymphomas : What is new?]. DER PATHOLOGE 2019; 40:157-168. [PMID: 30019203 DOI: 10.1007/s00292-018-0456-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
After 8 years, the WHO has now published the updated version of the 4th edition of the classification of hematopoietic and lymphoid tumors. This update provides a conceptual rewrite of existing entities as well as some new provisional entities and categories, particularly among the aggressive B‑cell lymphomas. Important new diagnostic categories include the high-grade B‑cell lymphomas, the large B‑cell lymphoma with IRF4 rearrangement, and the Burkitt-like lymphoma with 11q aberrations. Of particular importance, new concepts concerning the taxonomy and classification of early lymphoid lesions or precursor lesions are included, such as the in situ follicular neoplasia or the in situ mantle cell neoplasia. In addition, the concept of indolent lymphoproliferations, such as breast-implant-associated anaplastic large cell lymphoma and the indolent T‑cell lymphoproliferative disorder of the gastrointestinal tract, has been strengthened. Finally, diagnostic criteria for existing lymphoma entities have been refined.
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Affiliation(s)
- G Ott
- Abteilung für Klinische Pathologie, Robert-Bosch-Krankenhaus, und Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Auerbachstraße 110/112, 70376, Stuttgart, Deutschland.
| | - W Klapper
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A C Feller
- Hämatopathologie Lübeck, Lübeck, Deutschland
| | - M L Hansmann
- Senckenberg Institut für Pathologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - H Stein
- Pathodiagnostik Berlin, Berlin, Deutschland
| | - A Rosenwald
- Pathologisches Institut und Comprehensive Cancer Center Mainfranken, Universität Würzburg, Würzburg, Deutschland
| | - F Fend
- Institut für Pathologie und Neuropathologie, Eberhard-Karls-Universität, Tübingen, Deutschland
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23
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Scott DW, King RL, Staiger AM, Ben-Neriah S, Jiang A, Horn H, Mottok A, Farinha P, Slack GW, Ennishi D, Schmitz N, Pfreundschuh M, Nowakowski GS, Kahl BS, Connors JM, Gascoyne RD, Ott G, Macon WR, Rosenwald A. High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with diffuse large B-cell lymphoma morphology. Blood 2018; 131:2060-2064. [PMID: 29475959 PMCID: PMC6158813 DOI: 10.1182/blood-2017-12-820605] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/13/2018] [Indexed: 01/07/2023] Open
Abstract
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) is a newly defined entity in the latest World Health Organization Classification. Accurate diagnosis would appear to mandate fluorescence in situ hybridization (FISH) for all tumors with diffuse large B-cell lymphoma (DLBCL) morphology. We present the results of FISH, cell-of-origin, and immunohistochemistry (IHC) testing from 1228 DLBCL biopsies from 3 clinical trials and a population-based registry. HGBL-DH/TH made up 7.9% of the DLBCL, confined primarily to the germinal center B-cell-like (GCB; 13.3%) compared with activated B-cell-like (ABC; 1.7%) subtype (P < .001). HGBL-DH/TH with BCL2 rearrangement is a GCB phenomenon with no cases observed in 415 ABC DLBCL. A screening strategy restricting FISH testing to tumors of GCB subtype (by Lymph2Cx or Hans IHC) plus dual protein expression of MYC and BCL2 by IHC could limit testing to 11% to 14% of tumors, with a positive predictive value of 30% to 37%; however, this strategy would miss approximately one-quarter of tumors with HBGL-DH/TH with BCL2 rearrangement and one-third of all HGBL-DH/TH. These results provide accurate estimation of the proportion of HGBL-DH/TH among tumors with DLBCL morphology and allow determination of the impact of various methods available to screen DLBCL tumors for FISH testing.
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Affiliation(s)
- David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen, Germany
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Aixiang Jiang
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Vancouver, Canada
| | - Heike Horn
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen, Germany
| | - Anja Mottok
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
- Institute of Pathology, Würzburg University and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Pedro Farinha
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Daisuke Ennishi
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Norbert Schmitz
- Department of Medicine, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Michael Pfreundschuh
- Department of Medicine, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Grzegorz S Nowakowski
- Department of Internal Medicine I, Saarland University Medical School, Homburg/Saar, Germany
| | - Brad S Kahl
- Department of Oncology, Mayo Clinic, Rochester, MN; and
| | - Joseph M Connors
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andreas Rosenwald
- Institute of Pathology, Würzburg University and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
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24
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Klapper W, Fend F, Feller A, Hansmann ML, Möller P, Stein H, Rosenwald A, Ott G. [Aggressive B‑cell lymphomas : Recommendations from the German Panel of Reference Pathologists in the Competence Network on Malignant Lymphomas on diagnostic procedures according to the current WHO classification, update 2017]. DER PATHOLOGE 2018; 40:152-156. [PMID: 29666909 DOI: 10.1007/s00292-018-0440-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The update of the 4th edition of the WHO classification for hematopoietic neoplasms introduces changes in the field of mature aggressive B‑cell lymphomas that are relevant to diagnostic pathologists. In daily practice, the question arises of which analysis should be performed when diagnosing the most common lymphoma entity, diffuse large B‑cell lymphoma. We discuss the importance of the cell of origin, the analysis of MYC translocations, and the delineation of the new WHO entities of high-grade B‑cell lymphomas.
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Affiliation(s)
- W Klapper
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 14, 24105, Kiel, Deutschland.
| | - F Fend
- Institut für Pathologie und Neuropathologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - A Feller
- Hämatopathologie Lübeck, Lübeck, Deutschland
| | - M L Hansmann
- Dr. Senckenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - H Stein
- Pathodiagnostik Berlin, Berlin, Deutschland
| | - A Rosenwald
- Pathologisches Institut, Universität Würzburg, Comprehensive Cancer Center Mainfranken, Mainfranken, Deutschland
| | - G Ott
- Abteilung für Klinische Pathologie, Robert-Bosch-Krankenhaus, Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart, Deutschland
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25
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Shimono J, Miyoshi H, Kiyasu J, Kamimura T, Eto T, Miyagishima T, Nagafuji K, Seto M, Teshima T, Ohshima K. Clinicopathological analysis of polyploid diffuse large B-cell lymphoma. PLoS One 2018; 13:e0194525. [PMID: 29641580 PMCID: PMC5894967 DOI: 10.1371/journal.pone.0194525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/05/2018] [Indexed: 01/24/2023] Open
Abstract
Polyploid chromosomes are those with more than two sets of homologous chromosomes. Polyploid chromosomal abnormalities are observed in various malignant tumors. The prognosis in such cases is generally poor. However, there are no studies examining the prognosis of diffuse large B-cell lymphoma (DLBCL) with polyploid chromosomal abnormalities. Therefore, we statistically compared the clinicopathological features between polyploid DLBCL and DLBCL without polyploid abnormalities. Herein, 51 polyploid DLBCL and 53 control (without polyploid chromosomal abnormalities) cases were examined. G-banding method was employed to define polyploidy by cytogenetic analysis. Subsequently, flow cytometric immunophenotyping and immunohistochemical staining were performed. Polyploid DLBCL was defined as DLBCL with either near-tetraploid or greater number of chromosomes, as detected by the G-band. In a survival analysis, a significantly worse overall survival (OS) was observed for polyploid DLBCL (p = 0.04; p = 0.02 in cases who received R-CHOP regimens). In a multivariate analysis of OS, polyploid chromosomal abnormalities were an independent prognostic factor. Our results suggest that polyploid chromosomal abnormalities detected through G-band may represent a new poor prognostic factor for DLBCL.
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Affiliation(s)
- Joji Shimono
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan.,Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan
| | - Junichi Kiyasu
- Department of Hematology, Iizuka hospital, Iizuka, Japan
| | | | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | | | - Koji Nagafuji
- Department of Hematology, Kurume University, School of Medicine, Kurume, Japan
| | - Masao Seto
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan
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26
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Petrella T, Copie-Bergman C, Brière J, Delarue R, Jardin F, Ruminy P, Thieblemont C, Figeac M, Canioni D, Feugier P, Fabiani B, Leroy K, Parrens M, André M, Haioun C, Salles GA, Gaulard P, Tilly H, Jais JP, Molina TJ. BCL2 expression but not MYC and BCL2 coexpression predicts survival in elderly patients with diffuse large B-cell lymphoma independently of cell of origin in the phase 3 LNH03-6B trial. Ann Oncol 2018; 28:1042-1049. [PMID: 28327893 DOI: 10.1093/annonc/mdx022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Our aim was to evaluate whether the cell of origin (COO) as defined by the Hans algorithm and MYC/BCL2 coexpression, which are the two main biological risk factors in elderly patients treated with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone (R-CHOP), maintain their prognostic value in a large prospective clinical trial. Patients and methods We evaluated 285 paraffin-embedded samples from patients (60-80 years of age) enrolled in the Lymphoma Study Association trial LNH03-6B who were treated with R-CHOP. We correlated the COO defined by the transcriptome according to the Wright algorithm with that defined by the Hans algorithm in a subset of 62 tumors with available frozen tissue samples. Results The non-germinal center B-cell-like phenotype according to the Hans algorithm and BCL2 expression (but not MYC and BCL2 coexpression) predicted worse progression-free survival [hazard ratio (HR)=1.78, P = 0.003 and HR = 1.79, P = 0.003, respectively] and overall survival (HR = 1.85, P = 0.005 and HR = 1.67, P = 0.02, respectively) independently of the International Prognostic Index. The correlation between the Hans algorithm and the Wright algorithm was 91%, with an almost perfect concordance according to a kappa test (0.81). Conclusions Our results suggest that immunohistochemically defined COO remains a useful tool for predicting prognosis in diffuse large B-cell lymphoma when performed under optimized standardized conditions and that BCL2 expression may help to identify elderly patients at risk for relapse and who could potentially respond to anti-BCL2 targeted agents. In this prospective phase III trial, the coexpression of MYC and BCL2 does not appear to predict worse survival. Clinical trial Number NCT00144755.
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Affiliation(s)
| | - C Copie-Bergman
- Pathology, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil and IMRB, INSERM U955 Unité, Créteil
| | - J Brière
- Pathology, AP-HP, Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | - R Delarue
- Hematology, AP-HP, Necker Enfants-Malades, Paris
| | - F Jardin
- Hematology and UMR918, Centre Henri Becquerel, Université de Rouen, Rouen
| | - P Ruminy
- Hematology and UMR918, Centre Henri Becquerel, Université de Rouen, Rouen
| | - C Thieblemont
- Hemato-Oncology, AP-HP, Saint-Louis, Université Paris Diderot, Sorbonne Paris Cité and EA 7324, Paris Descartes, Sorbonne Paris Cité, Paris
| | - M Figeac
- Functional Genomic Platform, Cancer Research Institute, Lille
| | - D Canioni
- Pathology, AP-HP, Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | | | - B Fabiani
- Pathology, AP-HP, Saint-Antoine, Paris
| | - K Leroy
- Pathology, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil and IMRB, INSERM U955 Unité, Créteil
| | - M Parrens
- Pathology, CHU Bordeaux, Inserm U1053, Bordeaux, France
| | - M André
- Hematology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - C Haioun
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil
| | - G A Salles
- Haematology, Hospices Civils de Lyon, Université Claude Bernard, Pierre Bénite
| | - P Gaulard
- Pathology, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil and IMRB, INSERM U955 Unité, Créteil
| | - H Tilly
- Hematology and UMR918, Centre Henri Becquerel, Université de Rouen, Rouen
| | - J P Jais
- Biostatistics, AP-HP, Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | - T J Molina
- Pathology, AP-HP, Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris.,EA7324, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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27
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Schuhmacher B, Rengstl B, Döring C, Bein J, Newrzela S, Brunnberg U, Kvasnicka HM, Vornanen M, Küppers R, Hansmann ML, Hartmann S. A strong host response and lack of MYC expression are characteristic for diffuse large B cell lymphoma transformed from nodular lymphocyte predominant Hodgkin lymphoma. Oncotarget 2018; 7:72197-72210. [PMID: 27708232 PMCID: PMC5342154 DOI: 10.18632/oncotarget.12363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/19/2016] [Indexed: 12/29/2022] Open
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an indolent lymphoma, but can transform into diffuse large B cell lymphoma (DLBCL), showing a more aggressive clinical behavior. Little is known about these cases on the molecular level. Therefore, the aim of the present study was to characterize DLBCL transformed from NLPHL (LP-DLBCL) by gene expression profiling (GEP). GEP revealed an inflammatory signature pinpointing to a specific host response. In a coculture model resembling this host response, DEV tumor cells showed an impaired growth behavior. Mechanisms involved in the reduced tumor cell proliferation included a downregulation of MYC and its target genes. Lack of MYC expression was also confirmed in 12/16 LP-DLBCL by immunohistochemistry. Furthermore, CD274/PD-L1 was upregulated in DEV tumor cells after coculture with T cells or monocytes and its expression was validated in 12/19 cases of LP-DLBCL. Thereby, our data provide new insights into the pathogenesis of LP-DLBCL and an explanation for the relatively low tumor cell content. Moreover, the findings suggest that treatment of these patients with immune checkpoint inhibitors may enhance an already ongoing host response in these patients.
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Affiliation(s)
- Bianca Schuhmacher
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Benjamin Rengstl
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Claudia Döring
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Julia Bein
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Newrzela
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Uta Brunnberg
- Department of Internal Medicine 2, Hospital of the J. W. Goethe University, Frankfurt am Main, Germany
| | | | - Martine Vornanen
- Department of Pathology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Martin-Leo Hansmann
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
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28
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Ichiki A, Carreras J, Miyaoka M, Kikuti YY, Jibiki T, Tazume K, Watanabe S, Sasao T, Obayashi Y, Onizuka M, Ohmachi K, Yoshiba F, Shirasugi Y, Ogawa Y, Kawada H, Nakamura N, Ando K. Clinicopathological Analysis of 320 Cases of Diffuse Large B-cell Lymphoma Using the Hans Classifier. J Clin Exp Hematop 2018; 57:54-63. [PMID: 29021515 DOI: 10.3960/jslrt.17029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The estimation of clinical prognosis for diffuse large B-cell lymphoma (DLBCL) with a quick, cost-efficient method is necessary because of the clinical heterogeneity of this disease, which leads to death, relapsed or refractory disease in approximately 40% of patients. We analyzed 320 cases diagnosed from 2007 to 2013 treated with R-CHOP therapy at Tokai University Hospital and associated institutions. DLBCL was classified according to the cell-of-origin using the Hans algorithm [germinal center B-cell-like (GCB) vs non-GCB subtypes], and into 6 subgroups derived from combinations of CD10, BCL6 and MUM1 markers. The percentage of GCB and non-GCB (NGCB) subtypes was 35% and 65%, respectively. GCB-DLBCL was characterized by lower BCL2 immunohistochemical expression, extranodal sites <1, better therapeutic response, and favorable overall survival (OS) and progression free survival (PFS) (P<0.01). The most frequent subgroup was NGCB-1 (CD10-BCL6+MUM1+, 51%) followed by GCB-1 (CD10+BCL6+or-MUM1+, 21%), NGCB-2 (CD10-BCL6-MUM1+, 13%), GCB-2 (CD10+BCL6+or-MUM1-, 10%), GCB-3 (CD10-BCL6+MUM1-, 4%) and NGCB-3 (CD10-BCL6-MUM1-, 2%). In comparison with GCB-2 and GCB-3 (both MUM1-), the GCB-1 (MUM1+) was characterized by favorable PFS (5-year PFS 84% vs 65%, OR 0.368, P<0.05), independent of high LDH (associated with unfavorable PFS, OR 7.04, P<0.01) in the multivariate analysis. This predictive value of MUM1 was independent of CD10. Interestingly, triple-negative NGCB-3 tended to have a more favorable prognosis than the other NGCB subgroups. In conclusion, the Hans classifier is a valid method to evaluate the prognosis of DLBCL NOS. In the GCB subtypes, GCB subtypes, MUM1-positivity is associated with a more favorable outcome (PFS).
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Affiliation(s)
- Akifumi Ichiki
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | | | - Masashi Miyaoka
- Department of Pathology, Tokai University, School of Medicine
| | | | | | - Kei Tazume
- Department of Pathology, Isehara Kyodo Hospital
| | | | | | | | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | - Ken Ohmachi
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | - Fumiaki Yoshiba
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | - Yukari Shirasugi
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | - Yoshiaki Ogawa
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | - Hiroshi Kawada
- Department of Hematology and Oncology, Tokai University, School of Medicine
| | - Naoya Nakamura
- Department of Pathology, Tokai University, School of Medicine
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University, School of Medicine
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29
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Pfreundschuh M. Age and Sex in Non-Hodgkin Lymphoma Therapy: It's Not All Created Equal, or Is It? Am Soc Clin Oncol Educ Book 2017; 37:505-511. [PMID: 28561693 DOI: 10.1200/edbk_175447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Age is the most prominent factor for survival in all patients diagnosed with lymphoma, and male sex implies an increased and independent risk for a worse progression-free survival (PFS) and overall survival (OS) in most lymphomas, possibly with the exception of mantle cell lymphoma (MCL). The worse outcome for elderly patients is only partially explained by decreased tolerance to treatment regimens associated with the increasing number and severity of comorbidities. Little is known about specific differences in lymphoma biology with respect to age and sex, and this is changing only slowly despite the recent rise in interest about these issues. To better understand the differences and their underlying mechanisms, questions of age- and sex-specific outcomes, their correlation with pharmacokinetic data, and planned and received doses, must be addressed and reported in prospective clinical trials. Such studies must be accompanied by translational research that investigates biologic differences of lymphomas between old and young and male and female patients by addressing the microenvironment, cytogenetics including next-generation sequencing and systems biology of lymphomas, and correlation of these findings with treatment results. This knowledge will enable us to adjust lymphoma treatment to the necessities of more personalized medicine.
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Affiliation(s)
- Michael Pfreundschuh
- From the German High-Grade Non-Hodgkin Lymphoma Study Group, Internal Medicine I, Saarland University Medical School, Homburg, Germany
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30
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Pedersen MØ, Gang AO, Brown P, Pedersen M, Knudsen H, Nielsen SL, Poulsen T, Wirenfeldt Klausen T, Høgdall E, Nørgaard P. Real world data on young patients with high-risk diffuse large B-cell lymphoma treated with R-CHOP or R-CHOEP - MYC, BCL2 and BCL6 as prognostic biomarkers. PLoS One 2017; 12:e0186983. [PMID: 29088292 PMCID: PMC5663399 DOI: 10.1371/journal.pone.0186983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/11/2017] [Indexed: 01/01/2023] Open
Abstract
Background Double expression of MYC and BCL2 proteins (DE) and double-hit MYC+BCL2/BCL6 translocations (DH) were established as important biomarkers in patients with diffuse large B-cell lymphoma (DLBCL) by the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Whether this applies to the subgroup of young patients with high risk DLBCL is not known. We previously found that in a uniform retrospective population-based cohort of patients aged 18–60 years with high-risk DLBCL, the addition of etoposide to R-CHOP chemotherapy (R-CHOEP) resulted in improved survival mainly in patients with germinal center B-cell like (GCB) immunophenotype. The aim of this study was to investigate the prognostic and predictive value of DE and DH in this patient cohort. Methods Data on all young Danish patients diagnosed with de novo high-risk DLBCL 2004–2008 and treated with R-CHOP or R-CHOEP were obtained from the Danish Lymphoma database (n = 159). Tumor samples were available from 103 patients. MYC and BCL2 proteins were analyzed with quantitative immunohistochemistry (IHC) using different cut off values. MYC-, BCL2- and BCL6-translocations were examined with fluorescent in situ hybridization (FISH). Results DE with MYC>75% and BCL2>85% was an independent negative prognostic marker of progression free survival (PFS) in patients treated with R-CHOP but not R-CHOEP (p<0.001), also after exclusion of patients with DH. A predictive effect of DE for response (PFS) to R-CHOEP vs. R-CHOP was almost significant (p = 0.07). DH was not prognostic in this patient cohort. Conclusion In young patients with high-risk DLBCL, treatment with R-CHOEP may overcome the negative prognostic impact of DE observed in patients treated with R-CHOP.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Etoposide/administration & dosage
- Female
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Kaplan-Meier Estimate
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Male
- Middle Aged
- Prednisone/administration & dosage
- Prognosis
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-bcl-6/genetics
- Proto-Oncogene Proteins c-bcl-6/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
- Retrospective Studies
- Risk Factors
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
| | - Anne Ortved Gang
- Dept. of Hematology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Peter Brown
- Dept. of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Helle Knudsen
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Tim Poulsen
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Estrid Høgdall
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Peter Nørgaard
- Dept. of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
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31
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Romero M, Gapihan G, Castro-Vega LJ, Acevedo A, Wang L, Li ZW, El Bouchtaoui M, Di Benedetto M, Ratajczak P, Feugeas JP, Thieblemont C, Saavedra C, Janin A. Primary mediastinal large B-cell lymphoma: transcriptional regulation by miR-92a through FOXP1 targeting. Oncotarget 2017; 8:16243-16258. [PMID: 27806315 PMCID: PMC5369960 DOI: 10.18632/oncotarget.12988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Primary mediastinal large B-cell lymphoma (PMBL) shares pathological features with diffuse large B-cell lymphoma (DLBCL), and molecular features with classical Hodgkin lymphoma (cHL). The miR-17∼92 oncogenic cluster, located at chromosome 13q31, is a region that is amplified in DLBCL. Methods Here we compared the expression of each member of the miR-17∼92 oncogenic cluster in samples from 40 PMBL patients versus 20 DLBCL and 20 cHL patients, and studied the target genes linked to deregulated miRNA in PMBL. Results We found a higher level of miR-92a in PMBL than in DLBCL, but not in cHL. A combination of in silico prediction and transcriptomic analyses enabled us to identify FOXP1 as a main miR-92a target gene in PMBL, a result so far not established. This was confirmed by 3UTR, and RNA and protein expressions in transduced cell lines. In vivo studies using the transduced cell lines in mice enabled us to demonstrate a tumor suppressor effect of miR-92a and an oncogenic effect of FOXP1. A higher expression of miR-92a and the down-regulation of FOXP1 mRNA and protein expression were also found in human samples of PMBL, while miR-92a expression was low and FOXP1 was high in DLBCL. Conclusions We concluded to a post-transcriptional regulation by miR-92a through FOXP1 targeting in PMBL, with a clinico-pathological relevance for better characterisation of PMBL.
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Affiliation(s)
- Martha Romero
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,INSERM, U1165-Paris, Paris, France.,Hospital-Universitario-Fundación-Santa-Fe-de-Bogotá, Pathology-Department, Bogotá, Colombia
| | - Guillaume Gapihan
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,INSERM, U1165-Paris, Paris, France
| | | | - Andrés Acevedo
- Hospital-Universitario-Fundación-Santa-Fe-de-Bogotá, Pathology-Department, Bogotá, Colombia
| | - Li Wang
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,Pôle-Recherches Sino-Français en Science du Vivant Génomique, Molecular-Pathology, Shanghai, China
| | - Zhao Wei Li
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,Pôle-Recherches Sino-Français en Science du Vivant Génomique, Molecular-Pathology, Shanghai, China
| | - Morad El Bouchtaoui
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France
| | - Mélanie Di Benedetto
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France
| | - Philippe Ratajczak
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,INSERM, U1165-Paris, Paris, France
| | - Jean-Paul Feugeas
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,INSERM, U1137, Paris, France
| | | | - Carlos Saavedra
- Hospital-Universitario-Fundación-Santa-Fe-de-Bogotá, Pathology-Department, Bogotá, Colombia
| | - Anne Janin
- Université-Paris-Diderot, Sorbonne-Paris-Cité, Laboratoire de Pathologie, UMR-S-1165, Paris, France.,INSERM, U1165-Paris, Paris, France.,AP-HP-Hôpital Saint-Louis, Pathology-Department-Paris, Paris, France
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32
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Xiong J, Wang L, Fei XC, Jiang XF, Zheng Z, Zhao Y, Wang CF, Li B, Chen SJ, Janin A, Gale RP, Zhao WL. MYC is a positive regulator of choline metabolism and impedes mitophagy-dependent necroptosis in diffuse large B-cell lymphoma. Blood Cancer J 2017; 7:e0. [PMID: 28686226 PMCID: PMC5549253 DOI: 10.1038/bcj.2017.61] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023] Open
Abstract
The activation of oncogenes can reprogram tumor cell metabolism. Here, in diffuse large B-cell lymphoma (DLBCL), serum metabolomic analysis revealed that oncogenic MYC could induce aberrant choline metabolism by transcriptionally activating the key enzyme phosphate cytidylyltransferase 1 choline-α (PCYT1A). In B-lymphoma cells, as a consequence of PCYT1A upregulation, MYC impeded lymphoma cells undergo a mitophagy-dependent necroptosis. In DLBCL patients, overexpression of PCYT1A was in parallel with an increase in tumor MYC, as well as a decrease in serum choline metabolite phosphatidylcholine levels and an International Prognostic Index, indicating intermediate-high or high risk. Both in vitro and in vivo, lipid-lowering alkaloid berberine (BBR) exhibited an anti-lymphoma activity through inhibiting MYC-driven downstream PCYT1A expression and inducing mitophagy-dependent necroptosis. Collectively, PCYT1A was upregulated by MYC, which resulted in the induction of aberrant choline metabolism and the inhibition of B-lymphoma cell necroptosis. Referred as a biomarker for DLBCL progression, PCYT1A can be targeted by BBR, providing a potential lipid-modifying strategy in treating MYC-High lymphoma.
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Affiliation(s)
- J Xiong
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China
| | - L Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China
| | - X-C Fei
- Department of Pathology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X-F Jiang
- Department of Nuclear Medicine, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Z Zheng
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China
| | - Y Zhao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China
| | - C-F Wang
- Department of Pathology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - B Li
- Department of Nuclear Medicine, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - S-J Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China
| | - A Janin
- Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China.,Laboratory of Pathology, Paris Diderot University, U1165 Inserm, Paris, France
| | - R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - W-L Zhao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Pôle de Recherches Sino-Français en Science du Vivant et Génomique, Laboratory of Molecular Pathology, Shanghai Rui Jin Hospital, Shanghai, China
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33
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Strüßmann T, Fritsch K, Baumgarten A, Fietz T, Engelhardt M, Mertelsmann R, Ihorst G, Duyster J, Finke J, Marks R. Favourable outcomes of poor prognosis diffuse large B-cell lymphoma patients treated with dose-dense Rituximab, high-dose Methotrexate and six cycles of CHOP-14 compared to first-line autologous transplantation. Br J Haematol 2017. [PMID: 28643323 DOI: 10.1111/bjh.14802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The optimal therapeutic approach for young diffuse large B-cell lymphoma (DLBCL) patients with high-intermediate and high-risk age-adjusted international prognostic index (aaIPI) remains unknown. Hereby we report a 10-year single-centre study of 63 consecutively treated patients. To optimize outcome, two approaches were carried out: Cohort 1 patients received four cycles R-CHOP-21 (rituximab, cyclophosphamide, daunorubicin, vincristine, prednisolone over 21 days) followed by first-line high-dose chemotherapy with autologous stem-cell support (HDCT-ASCT), resulting in 2-year progression-free (PFS) and overall survival (OS) of 60·6% and 67·9%. 39·4% of those patients were not transplanted upfront, mainly due to early progressive disease (24·2%). Cohort 2 patients received an early intensified protocol of six cycles of CHOP-14 (cyclophosphamide, daunorubicin, vincristine, prednisolone over 14 days) with dose-dense rituximab and high-dose methotrexate resulting in promising overall response- (93·3%) and complete remission (90%) rates and sustained survival (2-year PFS and OS: 93·3%). In an intention-to-treat analysis, 2-year PFS (60·6% vs. 93·3%, hazard ratio [HR] 7·2, P = 0·009) and OS (69·7% vs. 93·3%, HR 4·95, P = 0·038) differed significantly, in favour of the early intensified protocol (Cohort 2). In a multivariate Cox-regression model, PFS (HR 8·12, 95% confidence interval [CI] 1·83-35·9, P = 0·006) and OS (HR 5·86, 95% CI 1·28-26·8, P = 0·02) remained superior for Cohort 2 when adjusted for aaIPI3 as the most important prognostic factor. Survival of young poor-prognosis DLBCL patients appears superior after early therapy intensification.
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Affiliation(s)
- Tim Strüßmann
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Kristina Fritsch
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Axel Baumgarten
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Thomas Fietz
- Community-based private haematology-oncology practice, Singen, Germany
| | - Monika Engelhardt
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Roland Mertelsmann
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Jürgen Finke
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - Reinhard Marks
- Department Haematology, Oncology & Stem Cell Transplantation, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
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34
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Abstract
These lymphomas, which occur in <10% of cases of diffuse large B-cell lymphoma, have been referred to as double-hit lymphomas (or triple-hit lymphomas if all 3 rearrangements are present). It is important to differentiate these lymphomas from the larger group of double-expressor lymphomas, which have increased expression of MYC and BCL-2 and/or BCL-6 by immunohistochemistry, by using variable cutoff percentages to define positivity. Patients with double-hit lymphomas have a poor prognosis when treated with standard chemoimmunotherapy and have increased risk of central nervous system involvement and progression. Double-hit lymphomas may arise as a consequence of the transformation of the underlying indolent lymphoma. There are no published prospective trials in double-hit lymphoma, however retrospective studies strongly suggest that aggressive induction regimens may confer a superior outcome. In this article, I review my approach to the evaluation and treatment of double-hit lymphoma, with an eye toward future clinical trials incorporating rational targeted agents into the therapeutic armamentarium.
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35
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Staiger AM, Ziepert M, Horn H, Scott DW, Barth TFE, Bernd HW, Feller AC, Klapper W, Szczepanowski M, Hummel M, Stein H, Lenze D, Hansmann ML, Hartmann S, Möller P, Cogliatti S, Lenz G, Trümper L, Löffler M, Schmitz N, Pfreundschuh M, Rosenwald A, Ott G. Clinical Impact of the Cell-of-Origin Classification and the MYC/ BCL2 Dual Expresser Status in Diffuse Large B-Cell Lymphoma Treated Within Prospective Clinical Trials of the German High-Grade Non-Hodgkin's Lymphoma Study Group. J Clin Oncol 2017; 35:2515-2526. [PMID: 28525305 DOI: 10.1200/jco.2016.70.3660] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To explore the prognostic impact and interdependence of the cell-of-origin (COO) classification, dual expression (DE) of MYC and BCL2 proteins, and MYC, BCL2, and BCL6 translocations in two prospectively randomized clinical trials of patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Overall, 452 formalin-fixed paraffin-embedded samples from two prospective, randomized DLBCL trials (RICOVER-60, prospective, randomized study for patients > 60 years, all IPI groups; and R-MegaCHOEP, prospective, randomized study for patients ≤ 60 years with age-adjusted IPI 2,3) of the German High-Grade Non-Hodgkin Lymphoma Study Group were analyzed with the Lymph2Cx assay for COO classification, with immunohistochemistry for MYC and BCL2, and with fluorescent in situ hybridization for MYC, BCL2, and BCL6 rearrangements. Results COO classification was successful in 414 of 452 samples. No significant differences with respect to COO (activated B-cell [ABC]-like DLBCL v germinal center B-cell [GCB]-like DLBCL) were observed in event-free survival, progression-free survival, and overall survival in patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the RICOVER-60 trial. Also, no differences with respect to COO were observed in multivariable analyses adjusted for International Prognostic Index factors in event-free survival (hazard ratio [HR] of ABC-like disease v GCB-like disease, 1.0; 95% CI, 0.6 to 1.6; P = .93), progression-free survival (HR, 1.1; 95% CI, 0.6 to 1.8; P = .82), and overall survival (HR, 1.0; 95% CI, 0.6 to 1.8; P = .96). Similar results were observed in the R-MegaCHOEP trial. In patients treated with R-CHOP, DE status was associated with significantly inferior survival compared with nonDE within the GCB, but not within the ABC subgroup. DE status was associated with significantly inferior outcome compared with patients with ABC-like DLBCL without DE (5-year PFS rate, 39% [95% CI,19% to 59%] v 68% [95% CI, 52% to 85%]; P = .03) and compared with patients with GCB-like DLBCL without DE. When data from patients with nonDE were analyzed separately, the outcome of patients in the ABC subgroup was inferior to that of patients in the GCB subgroup (5-year PFS rate, 68% [95% CI, 52% to 85%] v 85% [95% CI, 74% to 96%]; P = .04). Conclusion COO profiling in two prospective randomized DLBCL trials failed to identify prognostic subgroups, whereas dual expression of MYC and BCL2 was predictive of poor survival. Evaluation of prognostic or predictive biomarkers in the management of DLBCL, such as the COO, within prospective clinical trials will be important in the future.
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Affiliation(s)
- Annette M Staiger
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Marita Ziepert
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heike Horn
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - David W Scott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Thomas F E Barth
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heinz-Wolfram Bernd
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Alfred C Feller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Wolfram Klapper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Monika Szczepanowski
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Hummel
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Harald Stein
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Dido Lenze
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Martin-Leo Hansmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sylvia Hartmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Peter Möller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sergio Cogliatti
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Georg Lenz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Lorenz Trümper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Markus Löffler
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Norbert Schmitz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Pfreundschuh
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andreas Rosenwald
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - German Ott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
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Balagué O, Campo E. Refining the prognostic impact of the cell of origin in diffuse large B-cell lymphoma. Ann Oncol 2017; 28:918-920. [DOI: 10.1093/annonc/mdx133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Batlle-López A, González de Villambrosía S, Francisco M, Malatxeberria S, Sáez A, Montalban C, Sánchez L, Garcia J, González-Barca E, López-Hernández A, Ruiz-Marcellan MC, Mollejo M, Grande C, Richards KL, Hsi ED, Tzankov A, Visco C, Xu-Monette ZY, Cao X, Young KH, Piris MÁ, Conde E, Montes-Moreno S. Stratifying diffuse large B-cell lymphoma patients treated with chemoimmunotherapy: GCB/non-GCB by immunohistochemistry is still a robust and feasible marker. Oncotarget 2017; 7:18036-49. [PMID: 26910115 PMCID: PMC4951269 DOI: 10.18632/oncotarget.7495] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/02/2016] [Indexed: 12/15/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) is a heterogeneous group of aggressive lymphomas that can be classified into three molecular subtypes by gene expression profiling (GEP): GCB, ABC and unclassified. Immunohistochemistry-based cell of origin (COO) classification, as a surrogate for GEP, using three available immunohistochemical algorithms was evaluated in TMA-arranged tissue samples from 297 patients with de novo DLBCL treated by chemoimmunotherapy (R-CHOP and R-CHOP-like regimens). Additionally, the prognostic impacts of MYC, BCL2, IRF4 and BCL6 abnormalities detected by FISH, the relationship between the immunohistochemical COO classification and the immunohistochemical expression of MYC, BCL2 and pSTAT3 proteins and clinical data were evaluated. In our series, non-GCB DLBCL patients had significantly worse progression-free survival (PFS) and overall survival (OS), as calculated using the Choi, Visco-Young and Hans algorithms, indicating that any of these algorithms would be appropriate for identifying patients who require alternative therapies to R-CHOP. Whilst MYC abnormalities had no impact on clinical outcome in the non-GCB subtype, those patients with isolated MYC rearrangements and a GCB-DLBCL phenotype had worse PFS and therefore might benefit from novel treatment approaches.
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Affiliation(s)
- Ana Batlle-López
- Departments of Haematology and Pathology, Hospital Marques de Valdecilla, and IDIVAL, Santander, Spain
| | | | - Mazorra Francisco
- Departments of Haematology and Pathology, Hospital Marques de Valdecilla, and IDIVAL, Santander, Spain
| | - Sefora Malatxeberria
- Departments of Haematology and Pathology, Hospital Marques de Valdecilla, and IDIVAL, Santander, Spain
| | - Anabel Sáez
- Biobanco del Sistema Sanitario Público de Andalucía, Granada, Spain
| | | | - Lydia Sánchez
- Biotechnology Programme, Histology and Immunohistochemistry Core Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Juan Garcia
- Pathology, MD Anderson Cancer Center, Madrid, Spain
| | - Eva González-Barca
- Department of Haematology, Hospital de Bellvitge (ICOIRO), Barcelona, Spain
| | | | - M C Ruiz-Marcellan
- Departments of Pathology and Haematology, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Kristy L Richards
- Department of Hematology-Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Eric D Hsi
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Carlo Visco
- Department of Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Zijun Y Xu-Monette
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Cao
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ken H Young
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miguel Ángel Piris
- Departments of Haematology and Pathology, Hospital Marques de Valdecilla, and IDIVAL, Santander, Spain
| | - Eulogio Conde
- Departments of Haematology and Pathology, Hospital Marques de Valdecilla, and IDIVAL, Santander, Spain
| | - Santiago Montes-Moreno
- Departments of Haematology and Pathology, Hospital Marques de Valdecilla, and IDIVAL, Santander, Spain
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38
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Zhou X, Fang X, Jiang Y, Geng L, Li X, Li Y, Lu K, Li P, Lv X, Wang X. Klotho, an anti-aging gene, acts as a tumor suppressor and inhibitor of IGF-1R signaling in diffuse large B cell lymphoma. J Hematol Oncol 2017; 10:37. [PMID: 28153033 PMCID: PMC5288890 DOI: 10.1186/s13045-017-0391-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/03/2017] [Indexed: 01/13/2023] Open
Abstract
Background Klotho, is a transmembrane protein, performs as a circulating hormone and upstream modulator of the insulin-like growth factor-1 receptor (IGF-1R), fibroblast growth factor (FGF), and Wnt signaling pathways. These pathways are involved in the development and progression of B cell lymphoma. We aimed to explore the expression pattern and functional mechanism of Klotho in diffuse large B cell lymphoma (DLBCL). Methods Immunohistochemistry (IHC) and western blotting were performed to detect the expression level of Klotho in DLBCL patients and cell lines. Tumor suppressive effect of Klotho was determined by both in vitro and in vivo studies. Signaling pathway activity was assessed by western blotting. Results Remarkable lower expression levels of Klotho were observed in DLBCL patients and cell lines. Enforced expression of Klotho could significantly induce cell apoptosis and inhibit tumor growth in DLBCL. Upregulation of Klotho resulted in declined activation of IGF-1R signaling, accompanied with decreased phosphorylation of its downstream targets, including AKT and ERK1/2. Moreover, xenograft model treated with either Klotho overexpression vector or recombinant human Klotho administration presented restrained tumor growth and lower Ki67 staining. Conclusions Our findings establish that Klotho performs as a tumor suppressor and modulator of IGF-1R signaling in DLBCL. Targeting Klotho may provide novel strategies for future therapeutic intervention.
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Affiliation(s)
- Xiangxiang Zhou
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Yujie Jiang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Lingyun Geng
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Xinyu Li
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Ying Li
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Kang Lu
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Peipei Li
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Xiao Lv
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University, No.324, Jingwu Road, Jinan, Shandong, 250021, People's Republic of China. .,Shandong University School of Medicine, Jinan, Shandong, 250012, People's Republic of China.
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Shimono J, Miyoshi H, Seto M, Teshima T, Ohshima K. Clinical features of diffuse large B-cell lymphoma with polyploidy. Pathol Int 2016; 67:17-23. [PMID: 27868293 DOI: 10.1111/pin.12478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/13/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Abstract
Polyploidy, defined as more than two sets of homologous chromosomes, is found in a variety of malignant tumors and is thought to be related to disease pathogenesis. However, there have been no studies that have investigated polyploidy in diffuse large B-cell lymphoma (DLBCL). Here we reviewed clinicopathological features of 16 cases of DLBCL with polypoidy, which was defined as DLBCL with either near-tetraploid or greater number of chromosomes as detected by the G-band method. The frequency of polyploid DLBCL was 2.9 % (16/544), including 15 near-tetraploid and one near-pentaploid case. CD5, CD30 and EBER positive cases were 13 % (2/16), 13 % (2/16) and 6 % (1/16), respectively. Bcl2 positive cases were 75 % (12/16). The numbers of huge and multinucleated cells were higher in polyploid than in non-polyploid DLBCL (P = 0.0029 and P < 0.0001, respectively). Clinical features of polyploid DLBCL included reduced infiltration of extranodal sites (2/15, 13 %) and major lymph node infiltration. Of seven cases that received chemotherapy, six responded to treatment and survived. Our results suggest that polyploid DLBCL represents a clinicopathologically characteristic group of DLBCL. This knowledge can be useful for informing more personalized and targeted management of DLBCL patients.
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Affiliation(s)
- Joji Shimono
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan.,Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan
| | - Masao Seto
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University, School of Medicine, Kurume, Japan
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High-dose chemotherapy followed by autologous transplantation may overcome the poor prognosis of diffuse large B-cell lymphoma patients with MYC/BCL2 co-expression. Blood Cancer J 2016; 6:e491. [PMID: 27813532 PMCID: PMC5148062 DOI: 10.1038/bcj.2016.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of mature B-cell lymphoma. While the majority of patients are cured with immunochemotherapy incorporating the anti-CD20 monoclonal antibody rituximab (R-CHOP), relapsed and refractory patients still have a dismal prognosis. DLBCL subtypes including an aggressive activated B-cell-like (ABC) and a more favorable prognosis germinal center-like (GCB) DLBCL have been identified by gene expression profiling and are characterized by distinct genetic abnormalities and oncogenic pathways. This identification of novel molecular targets is now enabling clinical trials to evaluate more effective personalized approaches to DLBCL therapy. The forkhead transcription factor FOXP1 is highly expressed in the ABC-DLBCL gene signature and has been extensively studied within the context of DLBCL for more than a decade. Here, we review the significance of FOXP1 in the pathogenesis of DLBCL, summarizing data supporting its utility as a prognostic and subtyping marker, its targeting by genetic aberrations, the importance of specific isoforms, and emerging data demonstrating a functional role in lymphoma biology. FOXP1 is one of the critical transcription factors whose deregulated expression makes important contributions to DLBCL pathogenesis. Thus, FOXP1 warrants further study as a potential theranostic in ABC-DLBCL.
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Affiliation(s)
- Duncan M Gascoyne
- a Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine , University of Oxford , Oxford , UK
| | - Alison H Banham
- a Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine , University of Oxford , Oxford , UK
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with considerable heterogeneity reflected in the 2008 World Health Organization classification. In recent years, genome-wide assessment of genetic and epigenetic alterations has shed light upon distinct molecular subsets linked to dysregulation of specific genes or pathways. Besides fostering our knowledge regarding the molecular complexity of DLBCL types, these studies have unraveled previously unappreciated genetic lesions, which may be exploited for prognostic and therapeutic purposes. Following the last World Health Organization classification, we have witnessed the emergence of new variants of specific DLBCL entities, such as CD30 DLBCL, human immunodeficiency virus-related and age-related variants of plasmablastic lymphoma, and EBV DLBCL arising in young patients. In this review, we will present an update on the clinical, pathologic, and molecular features of DLBCL incorporating recently gained information with respect to their pathobiology and prognosis. We will emphasize the distinctive features of newly described or emerging variants and highlight advances in our understanding of entities presenting a diagnostic challenge, such as T-cell/histiocyte-rich large B-cell lmphoma and unclassifiable large B-cell lymphomas. Furthermore, we will discuss recent advances in the genomic characterization of DLBCL, as they may relate to prognostication and tailored therapeutic intervention. The information presented in this review derives from English language publications appearing in PubMed throughout December 2015. For a complete outline of this paper, please visit: http://links.lww.com/PAP/A12.
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Koch K, Hoster E, Ziepert M, Unterhalt M, Ott G, Rosenwald A, Hansmann M, Bernd W, Stein H, Pöschel V, Dreyling M, Trümper L, Löffler M, Schmitz N, Hiddemann W, Pfreundschuh M, Klapper W. Clinical, pathological and genetic features of follicular lymphoma grade 3A: a joint analysis of the German low-grade and high-grade lymphoma study groups GLSG and DSHNHL. Ann Oncol 2016; 27:1323-9. [DOI: 10.1093/annonc/mdw185] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/22/2016] [Indexed: 11/14/2022] Open
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Abstract
High-grade B-cell lymphomas (HGBCLs) are a heterogeneous group of neoplasms that include subsets of diffuse large B-cell lymphoma, Burkitt lymphoma, and lymphomas with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Morphologically indistinguishable HGBCLs may demonstrate variable clinical courses and responses to therapy. The morphologic evaluation and classification of these neoplasms must be followed by further genetic and immunophenotypic work-up. These additional diagnostic modalities lead to a comprehensive stratification of HGBCL that determines the prognosis and optimal therapy. This article reviews the well-established and emerging biomarkers that are most relevant to the clinical management of HGBCL.
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MESH Headings
- Biomarkers, Tumor/metabolism
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/pathology
- Gene Rearrangement
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Grading
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
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Affiliation(s)
- Amir Behdad
- Division of Hematopathology, Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, 251 East Huron, Feinberg 7-210, Chicago, IL 60611, USA.
| | - Nathanael G Bailey
- Division of Hematopathology, Department of Pathology, University of Michigan, 5242 Med Sci I, 1301 Catherine Street, Ann Arbor, MI 48109, USA
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Schiefer AI, Kornauth C, Simonitsch-Klupp I, Skrabs C, Masel EK, Streubel B, Vanura K, Walter K, Migschitz B, Stoiber D, Sexl V, Raderer M, Chott A, da Silva MG, Cabecadas J, Müllauer L, Jäger U, Porpaczy E. Impact of Single or Combined Genomic Alterations of TP53, MYC, and BCL2 on Survival of Patients With Diffuse Large B-Cell Lymphomas: A Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e2388. [PMID: 26717387 PMCID: PMC5291628 DOI: 10.1097/md.0000000000002388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
MYC and BCL2 translocations as well as TP53 deletion/mutation are known risk factors in diffuse large B-cell lymphoma (DLBCL) but their interplay is not well understood.In this retrospective cohort study, we evaluated the combined prognostic impact of TP53 deletion and mutation status, MYC and BCL2 genomic breaks in tumor samples of 101 DLBCL patients. The cohort included 53 cases with MYC rearrangements (MYC+).TP53 deletions/mutations (TP53+) were found in 32 of 101 lymphomas and were equally distributed between MYC+ and MYC- cases (35.8% vs. 27.1%). TP53+ lymphomas had lower responses to treatment than TP53- (complete remission 34.4% vs. 60.9%; P = 0.01). TP53 alteration was the dominant independent prognostic factor in multivariate analysis (P = 0.01). Overall survival (OS) varied considerably between subgroups with different genomic alterations: Patients with sole MYC translocation, and interestingly, with triple MYC+/BCL2+/TP53+ aberration had favorable outcomes (median OS not reached) similar to patients without genomic alterations (median OS 65 months). In contrast, patients with MYC+/BCL2+/TP53- double-hit lymphomas (DHL) (28 months), MYC+/BCL2-/TP53+ lymphomas (10 months) or sole TP53 mutation/deletion (12 months) had a poor median OS. Our findings demonstrate differences in OS of DLBCL patients depending on absence or presence of single or combined genetic alterations of MYC, BCL2, and TP53. Cooccurrence of TP53 and BCL2 aberrations ameliorated the poor prognostic impact of single TP53+ or BCL2+ in MYC positive patients.This pilot study generates evidence for the complex interplay between the alterations of genetic pathways in DLBCL, which goes beyond the concept of DHL. The variable survival of DLBCL patients dependent on single or combined alterations in the TP53, MYC, and BCL2 genes indicates the need for comprehensive genomic diagnosis.
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Affiliation(s)
- Ana-Iris Schiefer
- From the Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria (A-IS, CK, IS-K, BS, KW, BM, LM); Division of Hematology and Hemostaseology, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (CS, KV, UJ, EP); Division of Palliative Care, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (EKM); Institute of Pharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria (DS); Ludwig Boltzmann Institute for Cancer Research, Vienna, Austria (DS); Institute of Pharmacology and Toxicology, Department of Biomedical Sciences, Veterinary University of Vienna, Vienna, Austria (VS); Division of Oncology, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria (MR); Institute of Pathology and Bacteriology, Wilhelminenspital, Vienna, Austria (AC); Portuguese Institute of Oncology, Haematology Unit, Lisbon, Portugal (MGdS); and Portuguese Institute of Anatomical Pathology, Lisbon, Portugal (JC)
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Clinical features, tumor biology, and prognosis associated with MYC rearrangement and Myc overexpression in diffuse large B-cell lymphoma patients treated with rituximab-CHOP. Mod Pathol 2015; 28:1555-73. [PMID: 26541272 DOI: 10.1038/modpathol.2015.118] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/16/2015] [Accepted: 08/29/2015] [Indexed: 12/19/2022]
Abstract
MYC dysregulation, including MYC gene rearrangement and Myc protein overexpression, is of increasing clinical importance in diffuse large B-cell lymphoma (DLBCL). However, the roles of MYC and the relative importance of rearrangement vs overexpression remain to be refined. Gaining knowledge about the tumor biology associated with MYC dysregulation is important to understand the roles of MYC and MYC-associated biology in lymphomagenesis. In this study, we determined MYC rearrangement status (n=344) and Myc expression (n=535) in a well-characterized DLBCL cohort, individually assessed the clinical and pathobiological features of patients with MYC rearrangement and Myc protein overexpression, and analyzed the prognosis and gene expression profiling signatures associated with these MYC abnormalities in germinal center B-cell-like and activated B-cell-like DLBCL. Our results showed that the prognostic importance of MYC rearrangement vs Myc overexpression is significantly different in germinal center B-cell-like vs activated B-cell-like DLBCL. In germinal center B-cell-like DLBCL, MYC-rearranged germinal center B-cell-like DLBCL patients with Myc overexpression significantly contributed to the clinical, biological, and prognostic characteristics of the overall Myc-overexpressing germinal center B-cell-like DLBCL group. In contrast, in activated B-cell-like DLBCL, the occurrence, clinical and biological features, and prognosis of Myc overexpression were independent of MYC rearrangement. High Myc levels and Myc-independent mechanisms, either tumor cell intrinsic or related to tumor microenvironment, conferred significantly worse survival to MYC-rearranged germinal center B-cell-like DLBCL patients, even among Myc(high)Bcl-2(high) DLBCL patients. This study provides new insight into the tumor biology and prognostic effects associated with MYC dysregulation and suggest that detection of both MYC translocations and evaluation of Myc and Bcl-2 expression is necessary to predict the prognosis of DLBCL patients.
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Landsburg DJ, Petrich AM, Abramson JS, Sohani AR, Press O, Cassaday R, Chavez JC, Song K, Zelenetz AD, Gandhi M, Shah N, Fenske TS, Jaso J, Medeiros LJ, Yang DT, Nabhan C. Impact of oncogene rearrangement patterns on outcomes in patients with double-hit non-Hodgkin lymphoma. Cancer 2015; 122:559-64. [PMID: 26565895 DOI: 10.1002/cncr.29781] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Double-hit lymphomas (DHLs) are collectively defined as B-cell non-Hodgkin lymphomas harboring rearrangements of MYC as well as B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6). To the authors' knowledge, the impact of specific oncogene rearrangements on outcomes of patients with DHL who are treated with immunochemotherapy has not been previously described. METHODS The authors identified patients whose diagnostic tissue specimens underwent metaphase karyotyping or fluorescence in situ hybridization for MYC as well as both BCL2 and BCL6 rearrangements. Cohorts were defined by the presence (+) or absence (-) of rearrangements: MYC+/BCL2+/BCL6- (BCL2-DHL), MYC+/BCL2-/BCL6+ (BCL6-DHL), and MYC+/BCL2+/BCL6+ (triple-hit lymphoma; THL). RESULTS A total of 117 patients were included in the current analysis (76 BCL2-DHL patients, 16 BCL6-DHL patients, and 25 THL patients). Compared with patients with BCL2-DHL, those with BCL6-DHL were more likely to be classified as having a non-germinal center cell of origin, presented with extranodal disease, and appeared to achieve higher rates of complete response despite receiving intensive induction therapy less frequently. However, patients with BCL6-DHL experienced a shorter median overall survival if achieving an initial complete response compared with patients with BCL2-DHL. Patients with THL experienced survival outcomes similar to those of patients with BCL2-DHL. CONCLUSIONS Recognition of the specific oncogene rearrangements may be of prognostic value and potentially guide future therapeutic strategies for patients with DHL.
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Affiliation(s)
- Daniel J Landsburg
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Petrich
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Oliver Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Kevin Song
- Leukemia/BMT Program of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew D Zelenetz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mitul Gandhi
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.,Virginia Cancer Specialists, Fairfax, Virginia
| | - Namrata Shah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jesse Jaso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David T Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Chadi Nabhan
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
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Sarkozy C, Traverse-Glehen A, Coiffier B. Double-hit and double-protein-expression lymphomas: aggressive and refractory lymphomas. Lancet Oncol 2015; 16:e555-e567. [DOI: 10.1016/s1470-2045(15)00005-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 01/28/2023]
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Masqué-Soler N, Szczepanowski M, Kohler CW, Aukema SM, Nagel I, Richter J, Siebert R, Spang R, Burkhardt B, Klapper W. Clinical and pathological features of Burkitt lymphoma showing expression of BCL2--an analysis including gene expression in formalin-fixed paraffin-embedded tissue. Br J Haematol 2015. [PMID: 26218299 DOI: 10.1111/bjh.13624] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The differential diagnosis between Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) can be challenging. BL has been reported to express less BCL2 than DLBCL, but this issue has not been analysed systematically. BL expressing BCL2 can be considered to be MYC/BCL2 co-expressors, a feature that is associated with poorer outcome in DLBCL but that has not been correlated with outcome in BL so far. We analysed the expression of BCL2 in 150 cases of conventionally diagnosed BL using two different BCL2 antibodies. BCL2 expression was detected in 23% of the cases, though the expression varied in intensity and number of positive cells. We did not detect any relevant differences in clinical presentation and outcome between BCL2-positive and BCL2-negative BL in a subgroup of 43 cases for which detailed clinical data were available. An independent cohort of 17 BL with expression of BCL2 were analysed molecularly, with 13 of 17 cases classified as molecularly defined BL (Burkitt Lymphoma) using gene expression profiling on formalin-fixed paraffin-embedded tissues. The four lymphomas diagnosed molecularly as intermediates did not differ in clinical presentation and outcome from molecularly defined BL.
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Affiliation(s)
- Neus Masqué-Soler
- Department of Pathology, Haematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
| | - Monika Szczepanowski
- Department of Pathology, Haematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
| | - Christian W Kohler
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Sietse M Aukema
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
| | - Inga Nagel
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
| | - Julia Richter
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
| | - Rainer Spang
- Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Birgit Burkhardt
- Paediatric Haematology and Oncology, University Children's Hospital, Münster, Germany
| | - Wolfram Klapper
- Department of Pathology, Haematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel/Christian-Albrecht University, Kiel, Germany
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