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de Groen RAL, de Groot FA, Böhringer S, Kret EJ, de Haan LM, Noordenbos T, Blommers S, Jansen REW, van Wezel T, van Eijk R, Raghoo R, Ruano D, Boome LT, Terpstra V, Levenga H, Ahsmann E, Posthuma EFM, Focke-Snieders I, Hardi L, den Hartog WCE, van den Berg A, Mutsaers P, Lam K, van der Poel MWM, Hamid MA, Woei-A-Jin FJSH, Janssens A, Tousseyn T, Bovée JVMG, Koens L, Diepstra A, Cleven AHG, Kersten MJ, Jansen PM, Veelken H, Nijland M, Dekker TJA, Vermaat JSP. Superior survival in diffuse large B cell lymphoma of the bone with immune rich tumor microenvironment. Blood Cancer J 2025; 15:82. [PMID: 40301298 DOI: 10.1038/s41408-025-01291-z] [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: 11/01/2024] [Revised: 04/14/2025] [Accepted: 04/17/2025] [Indexed: 05/01/2025] Open
Abstract
With tumor genomic and gene-expression profiling (GEP), this study investigated the immune-molecular signatures of a unique cohort of diffuse large B-cell lymphoma of the bone (bone-DLBCL), including primary bone (PB-DLBCL, n = 52) and polyostotic-DLBCL (n = 20), in comparison to nodal DLBCLs with germinal center B-cell (GCB) phenotype (nodal-DLBCL-GCB, n = 34). PB-DLBCL and polyostotic-DLBCL shared similar genomic profiles and transcriptomic signatures, justifying their collective analysis as bone-DLBCL. Differential incidences of EZH2, HIST1H1E, and MYC aberrations (p < 0.05) confirmed the distinct oncogenic evolution between bone-DLBCL and nodal-DLBCL-GCB. Differentially expressed genes were identified between bone-DLBCL and nodal-DLBCL-GCB (p < 0.001), substantiated by distinct gene-set enrichment analysis (GSEA). In contrast to a more 'depleted' phenotype for nodal-DLBCL-GCB, bone-DLBCL primarily exhibited an 'intermediate/rich' tumor microenvironment (TME) signature (p = 0.001), as determined by a previously published gene set. Unsupervised clustering defined two distinct groups that aligned with previously reported immune-enriched TME clusters: an 'immune-rich' cluster largely consisting of bone-DLBCLs (75%, p = 0.002) with superior survival (p = 0.030), and a poor-prognostic 'immune-low' cluster, including mostly nodal-DLBCL-GCB (61%). Single-sample (ss)GSEA showed higher scores for regulatory T cells, immunosuppressive/prolymphoma cytokines, and vascular endothelial cells in immune-rich samples (p < 0.001). Additionally, CIBERSORTx revealed a higher abundance of regulatory T cells and activated mast cells in the immune-rich cluster (p < 0.001). These findings were confirmed at protein level, where CD3 and FOXP3 immunochemistry showed significant overlap with the gene-expression data (p < 0.001). Conclusively, PB-DLBCL and polyostotic-DLBCL share immune-molecular TME characteristics, supporting their classification as a unified bone-DLBCL entity. The distinct immune-rich TME profile of bone-DLBCL associated with superior survival potentially shapes emerging immunomodulatory strategies.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Tumor Microenvironment/immunology
- Tumor Microenvironment/genetics
- Male
- Female
- Bone Neoplasms/mortality
- Bone Neoplasms/genetics
- Bone Neoplasms/immunology
- Bone Neoplasms/pathology
- Middle Aged
- Aged
- Adult
- Gene Expression Profiling
- Aged, 80 and over
- Prognosis
- Gene Expression Regulation, Neoplastic
- Transcriptome
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Affiliation(s)
- 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
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther J Kret
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorraine M de Haan
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Troy Noordenbos
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan Blommers
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Romée E W Jansen
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ronald van Eijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Richard Raghoo
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dina Ruano
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Liane Te Boome
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Valeska Terpstra
- Department of Pathology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Henriette Levenga
- Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands
| | - Els Ahsmann
- Department of Pathology, Groene Hart Hospital, Gouda, The Netherlands
| | | | | | - Lizan Hardi
- Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | | | - Anke van den Berg
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim Mutsaers
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - King Lam
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Marjolein W M van der Poel
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Myrurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Ann Janssens
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - Thomas Tousseyn
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, The Netherlands
- Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen H G Cleven
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pathology, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marie José Kersten
- Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Patty M Jansen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hendrik Veelken
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel Nijland
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim J A Dekker
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost S P Vermaat
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands.
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Mercier M, Orvain C, Drieu La Rochelle L, Marchand T, Nunes Gomes C, Giltat A, Paillassa J, Clavert A, Farhi J, Rousselet MC, Gyan E, Houot R, Moles-Moreau MP, Hunault-Berger M. Impact of High-Dose Methotrexate on the Outcome of Patients with Diffuse Large B-Cell Lymphoma and Skeletal Involvement. Cancers (Basel) 2021; 13:cancers13122945. [PMID: 34204600 PMCID: PMC8231126 DOI: 10.3390/cancers13122945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) with extra nodal skeletal involvement is rare. It is currently unclear whether these lymphomas should be treated in the same manner as those without skeletal involvement. We retrospectively analyzed the impact of combining high-dose methotrexate (HD-MTX) with an anthracycline-based regimen and rituximab as first-line treatment in a cohort of 93 patients with DLBCL and skeletal involvement with long follow-up. Fifty patients (54%) received upfront HD-MTX for prophylaxis of CNS recurrence (high IPI score and/or epidural involvement) or because of skeletal involvement. After adjusting for age, ECOG, high LDH levels, and type of skeletal involvement, HD-MTX was associated with an improved PFS and OS (HR: 0.2, 95% CI: 0.1-0.3, p < 0.001 and HR: 0.1, 95% CI: 0.04-0.3, p < 0.001, respectively). Patients who received HD-MTX had significantly better 5-year PFS and OS (77% vs. 39%, p <0.001 and 83 vs. 58%, p < 0.001). Radiotherapy was associated with an improved 5-year PFS (74 vs. 48%, p = 0.02), whereas 5-year OS was not significantly different (79% vs. 66%, p = 0.09). A landmark analysis showed that autologous stem cell transplantation was not associated with improved PFS or OS. The combination of high-dose methotrexate and an anthracycline-based immunochemotherapy is associated with an improved outcome in patients with DLBCL and skeletal involvement and should be confirmed in prospective trials.
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Affiliation(s)
- Mélanie Mercier
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Service d’Hématologie, CH Bretagne Atlantique, 56000 Vannes, France
- Correspondence: (M.M.); (C.O.); Tel.: +33-(0)-241-35-44-72 (C.O.); Fax: +33-(0)-241-35-53-81 (C.O.)
| | - Corentin Orvain
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Université d’Angers, Inserm, CRCINA, 49000 Angers, France
- Correspondence: (M.M.); (C.O.); Tel.: +33-(0)-241-35-44-72 (C.O.); Fax: +33-(0)-241-35-53-81 (C.O.)
| | - Laurianne Drieu La Rochelle
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Service d’Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Tony Marchand
- Service d’Hématologie Clinique, CHU de Rennes, 35000 Rennes, France; (T.M.); (R.H.)
| | - Christopher Nunes Gomes
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Aurélien Giltat
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Jérôme Paillassa
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Aline Clavert
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Jonathan Farhi
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | | | - Emmanuel Gyan
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Service d’Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Roch Houot
- Service d’Hématologie Clinique, CHU de Rennes, 35000 Rennes, France; (T.M.); (R.H.)
| | - Marie-Pierre Moles-Moreau
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Mathilde Hunault-Berger
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Université d’Angers, Inserm, CRCINA, 49000 Angers, France
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