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Peckham-Gregory EC, Boff LM, Schraw JM, Spector LG, Linabery AM, Erhardt EB, Ribeiro KB, Allen CE, Scheurer ME, Lupo PJ. Role of non-chromosomal birth defects on the risk of developing childhood Hodgkin lymphoma: A Children's Oncology Group study. Pediatr Blood Cancer 2024; 71:e30822. [PMID: 38146016 DOI: 10.1002/pbc.30822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Non-chromosomal birth defects are an important risk factor for several childhood cancers. However, these associations are less clear for Hodgkin lymphoma (HL). Therefore, we sought to more fully elucidate the association between non-chromosomal birth defects and HL risk. PROCEDURE Information on cases (n = 517) diagnosed with HL (ages of 0-14) at Children's Oncology Group Institutions for the period of 1989-2003 was obtained. Control children without a history of cancer (n = 784) were identified using random digit dialing and individually matched to cases on sex, race/ethnicity, age, and geographic location. Parents completed comprehensive interviews and answered questions including whether their child had been born with a non-chromosomal birth defect. To test the association between birth defects and HL risk, conditional logistic regression was applied to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Children born with any non-chromosomal birth defect were not more likely to be diagnosed with HL at 0-14 years of age (aOR: 0.91; 95% CI: 0.69-1.21). No associations were detected between major or minor birth defects and HL (aOR: 1.34; 95% CI: 0.67-2.67 and aOR: 0.88; 95% CI: 0.57-1.34, respectively). Similarly, no association was observed for children born with any birth defect and EBV-positive HL (aOR: 0.57; 95% CI: 0.25-1.26). CONCLUSIONS Previous assessments of HL in children with non-chromosomal birth defects have been limited. Using data from the largest case-control study of HL in those <15 years of age, we did not observe strong associations between being born with a birth defect and HL risk.
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Affiliation(s)
- Erin C Peckham-Gregory
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Lucas Maschietto Boff
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Jeremy M Schraw
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Logan G Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota Masonic Cancer Center, Minneapolis, Minnesota, USA
| | - Amy M Linabery
- Department of Pediatrics, Neuroscience Institute, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Erik B Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
| | - Karina B Ribeiro
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Carl E Allen
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Feigin Center, Houston, Texas, USA
- Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, USA
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van Bladel DAG, Stevens WBC, Kroeze LI, de Groen RAL, de Groot FA, van der Last-Kempkes JLM, Berendsen MR, Rijntjes J, Luijks JACW, Bonzheim I, van der Spek E, Plattel WJ, Pruijt JFM, de Jonge-Peeters SDPWM, Velders GA, Lensen C, van Bladel ER, Federmann B, Hoevenaars BM, Pastorczak A, van der Werff ten Bosch J, Vermaat JSP, Nooijen PTGA, Hebeda KM, Fend F, Diepstra A, van Krieken JHJM, Groenen PJTA, van den Brand M, Scheijen B. A significant proportion of classic Hodgkin lymphoma recurrences represents clonally unrelated second primary lymphoma. Blood Adv 2023; 7:5911-5924. [PMID: 37552109 PMCID: PMC10558751 DOI: 10.1182/bloodadvances.2023010412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
Despite high cure rates in classic Hodgkin lymphoma (cHL), relapses are observed. Whether relapsed cHL represents second primary lymphoma or an underlying T-cell lymphoma (TCL) mimicking cHL is underinvestigated. To analyze the nature of cHL recurrences, in-depth clonality testing of immunoglobulin (Ig) and T-cell receptor (TCR) rearrangements was performed in paired cHL diagnoses and recurrences among 60 patients, supported by targeted mutation analysis of lymphoma-associated genes. Clonal Ig rearrangements were detected by next-generation sequencing (NGS) in 69 of 120 (58%) diagnoses and recurrence samples. The clonal relationship could be established in 34 cases, identifying clonally related relapsed cHL in 24 of 34 patients (71%). Clonally unrelated cHL was observed in 10 of 34 patients (29%) as determined by IG-NGS clonality assessment and confirmed by the identification of predominantly mutually exclusive gene mutations in the paired cHL samples. In recurrences of >2 years, ∼60% of patients with cHL for whom the clonal relationship could be established showed a second primary cHL. Clonal TCR gene rearrangements were identified in 14 of 125 samples (11%), and TCL-associated gene mutations were detected in 7 of 14 samples. Retrospective pathology review with integration of the molecular findings were consistent with an underlying TCL in 5 patients aged >50 years. This study shows that cHL recurrences, especially after 2 years, sometimes represent a new primary cHL or TCL mimicking cHL, as uncovered by NGS-based Ig/TCR clonality testing and gene mutation analysis. Given the significant therapeutic consequences, molecular testing of a presumed relapse in cHL is crucial for subsequent appropriate treatment strategies adapted to the specific lymphoma presentation.
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Affiliation(s)
| | - Wendy B. C. Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leonie I. Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruben A. L. de Groen
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fleur A. de Groot
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Jos Rijntjes
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Irina Bonzheim
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Wouter J. Plattel
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Gerjo A. Velders
- Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Chantal Lensen
- Department of Hematology, Bernhoven Hospital, Uden, The Netherlands
| | - Esther R. van Bladel
- Department of Internal Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - Birgit Federmann
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
- Department of Translational Immunology, German Cancer Research Center, Medical Hospital Tübingen, Tübingen, Germany
| | | | - Agata Pastorczak
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Jutte van der Werff ten Bosch
- Department of Pediatric Hematology and Oncology, University Hospital Brussels, Brussels, Belgium
- Department of Pediatrics, Paola Children’s Hospital, Antwerp, Belgium
| | - Joost S. P. Vermaat
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Falko Fend
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Blanca Scheijen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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Mahat U, Ambani NM, Rotz SJ, Radhakrishnan K. Heterozygous CTLA4 splice site mutation c.458-1G > C presenting with immunodeficiency and variable degree of immune dysregulation in three generation kindred of Caribbean descent. Pediatr Hematol Oncol 2021; 38:658-662. [PMID: 33900894 DOI: 10.1080/08880018.2021.1906802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cytotoxic T-lymphocyte-associated protein 4 (CTLA4) is an immune checkpoint, which downregulates T cell activation and T regulatory cell function. CTLA4 haploinsufficiency (CTLA4 HI) leads to T cell hyperactivation, immunodeficiency and variable degree of immune dysregulation. Furthermore, CTLA4 HI predisposes affected individuals to development of various cancers. Less well understood is the penetrance and expressivity of CTLA4 mutations. We describe five members of a single family with heterozygous CTLA4 splice site mutation c.458-1G > C, previously shown to result in CTLA-4 HI, who presented with immunodeficiency and variable degree of immune dysregulation. The host, environmental and the epigenetic factors affecting the penetrance and expressivity of CTLA4 mutations merits further investigation.
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Affiliation(s)
- Upendra Mahat
- Department of Pediatric Hematology Oncology and BMT, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Nila Mistry Ambani
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Seth J Rotz
- Department of Pediatric Hematology Oncology and BMT, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Kadakkal Radhakrishnan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Children's, Cleveland, Ohio, USA
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