1
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Martín García-Sancho A, Baile M, Rodríguez G, Dlouhy I, Sancho JM, Jarque I, González-Barca E, Salar A, Espeso M, Grande C, Bergua J, Montes-Moreno S, Redondo A, Enjuanes A, Campo E, López-Guillermo A, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from GELTAMO. Br J Haematol 2023; 203:202-211. [PMID: 37485564 DOI: 10.1111/bjh.18989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with relapsed or refractory (RR) disease have poor outcomes with current salvage regimens. We conducted a phase 2 trial to analyse the safety and efficacy of adding lenalidomide to R-ESHAP (LR-ESHAP) in patients with RR DLBCL. Subjects received 3 cycles of lenalidomide 10 mg/day on days 1-14 of every 21-day cycle, in combination with R-ESHAP at standard doses. Responding patients underwent autologous stem-cell transplantation (ASCT). The primary endpoint was the overall response rate (ORR) after 3 cycles. Centralized cell-of-origin (COO) classification was performed. Forty-six patients were included. The ORR after LR-ESHAP was 67% (35% of patients achieved complete remission). Patients with primary refractory disease (n = 26) had significantly worse ORR than patients with non-refractory disease (54% vs. 85%, p = 0.031). No differences in response rates according to the COO were observed. Twenty-eight patients (61%) underwent ASCT. At a median follow-up of 41 months, the estimated 3-year PFS and OS were 42% and 48%, respectively. The most common grade ≥3 adverse events were thrombocytopenia (70% of patients), neutropenia (67%) and anaemia (35%). There were no treatment-related deaths during LR-ESHAP cycles. In conclusion, LR-ESHAP is a feasible salvage regimen with promising efficacy results for patients with RR DLBCL.
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Affiliation(s)
- A Martín García-Sancho
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - M Baile
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
| | - G Rodríguez
- Hematology Department, Hospital Universitario Virgen del Rocío/Virgen Macarena, Sevilla, Spain
| | - I Dlouhy
- Hematology Department, Hospital Clinic, Barcelona, Spain
| | - J M Sancho
- Hematology Department, Hospital Germans Trias i Pujol/ICO-IJC, Badalona, Spain
| | - I Jarque
- Hematology Department, Hospital Universitari i Plotècnic La Fe, CIBERONC, Valencia, Spain
| | - E González-Barca
- Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de-Barcelona, Barcelona, Spain
| | - A Salar
- Hematology Department, Hospital del Mar, Barcelona, Spain
| | - M Espeso
- Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - C Grande
- Hematology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Bergua
- Hematology Department, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - S Montes-Moreno
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Redondo
- Hematology Department, Hospital Virgen del Puerto, Plasencia, Spain
| | - A Enjuanes
- Unidad de Genómica del IDIBAPS, Barcelona, Spain
| | - E Campo
- Pathology Department, Hospital Clinic, Barcelona, Spain
| | | | - D Caballero
- Hematology Department, Hospital Universitario de Salamanca-IBSAL, CIBERONC, Universidad de Salamanca, Salamanca, Spain
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2
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Velasco R, Mercadal S, Vidal N, Alañá M, Barceló MI, Ibáñez-Juliá MJ, Bobillo S, Caldú Agud R, García Molina E, Martínez P, Cacabelos P, Muntañola A, García-Catalán G, Sancho JM, Camro I, Lado T, Erro ME, Gómez-Vicente L, Salar A, Caballero AC, Solé-Rodríguez M, Gállego Pérez-Larraya J, Huertas N, Estela J, Barón M, Barbero-Bordallo N, Encuentra M, Dlouhy I, Bruna J, Graus F. Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study. J Neurooncol 2020; 148:545-554. [PMID: 32524392 DOI: 10.1007/s11060-020-03547-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.
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Affiliation(s)
- R Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain. .,Department of Neurology, Neuro-Oncology Unit, Hospital Universitari de Bellvitge and ICO L'Hospitalet, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - S Mercadal
- Department of Hematology, Catalan Institute of Oncology-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Vidal
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Pathology, Unit of Neuro-Oncology. Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Alañá
- Department of Neurology, Complejo Asistencial Universitario, Salamanca, Spain
| | - M I Barceló
- Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M J Ibáñez-Juliá
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Bobillo
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), University Hospital Vall d'Hebron, Barcelona, Spain
| | - R Caldú Agud
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E García Molina
- Department of Neurology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - P Martínez
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Cacabelos
- Department of Neurology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - A Muntañola
- Department of Hematology, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | - G García-Catalán
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J M Sancho
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - I Camro
- Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - T Lado
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M E Erro
- Neurology Department, Complejo Hospitalario de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - L Gómez-Vicente
- Department of Neurology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - A Salar
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - A C Caballero
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Solé-Rodríguez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Gállego Pérez-Larraya
- Departament of Neurology, Clínica Universidad de Navarra, IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - N Huertas
- Department of Neurology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - J Estela
- Department of Neurology, Hospital Parc Taulí, Sabadell, Spain
| | - M Barón
- Unit of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - N Barbero-Bordallo
- Department of Neurology, Hospital Universitario Rey Juan Carlos, HURJC-HUIE-HCV, Madrid, Spain
| | - M Encuentra
- Department of Hematology, Catalan Institute of Oncology-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - I Dlouhy
- Department of Hematology and Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - F Graus
- Department of Hematology and Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
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3
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Esteve-Arenys A, Valero JG, Chamorro-Jorganes A, Gonzalez D, Rodriguez V, Dlouhy I, Salaverria I, Campo E, Colomer D, Martinez A, Rymkiewicz G, Pérez-Galán P, Lopez-Guillermo A, Roué G. The BET bromodomain inhibitor CPI203 overcomes resistance to ABT-199 (venetoclax) by downregulation of BFL-1/A1 in in vitro and in vivo models of MYC+/BCL2+ double hit lymphoma. Oncogene 2018; 37:1830-1844. [PMID: 29353886 DOI: 10.1038/s41388-017-0111-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/16/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022]
Abstract
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, mostly known as double-hit lymphoma (DHL), is a rare entity characterized by morphologic and molecular features between Burkitt lymphoma and the clinically manageable diffuse large B-cell lymphoma (DLBCL). DHL patients usually undergo a rapidly progressing clinical course associated with resistance to standard chemo-immunotherapy. As a consequence, the prognosis of this entity is particularly poor with a median overall survival inferior to 1 year. ABT-199 (venetoclax) is a potent and selective small-molecule antagonist of BCL-2 recently approved for the treatment of a specific subtype of lymphoid neoplasm. In this study, we demonstrate that single-agent ABT-199 efficiently displaces BAX from BCL-2 complexes but fails to maintain a significant antitumor activity over time in most MYC+/BCL2+DHL cell lines and primary cultures, as well as in a xenograft mouse model of the disease. We further identify the accumulation of the BCL2-like protein BFL-1 to be a major mechanism involved in acquired resistance to ABT-199. Noteworthy, this phenomenon can be counteracted by the BET bromodomain inhibitor CPI203, since gene expression profiling identifies BCL2A1, the BFL-1 coding gene, as one of the top apoptosis-related gene modulated by this compound. Upon CPI203 treatment, simultaneous downregulation of MYC and BFL-1 further overcomes resistance to ABT-199 both in vitro and in vivo, engaging synergistic caspase-mediated apoptosis in DHL cultures and tumor xenografts. Together, these findings highlight the relevance of BFL-1 in DH lymphoma-associated drug resistance and support the combined use of a BCL-2 antagonist and a BET inhibitor as a promising therapeutic strategy for patients with aggressive DHL.
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Affiliation(s)
- A Esteve-Arenys
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - J G Valero
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - A Chamorro-Jorganes
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - D Gonzalez
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - V Rodriguez
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - I Dlouhy
- Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - I Salaverria
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - E Campo
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - D Colomer
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - A Martinez
- Hematopathology Unit, Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - G Rymkiewicz
- Department of Pathology, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - P Pérez-Galán
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - A Lopez-Guillermo
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - G Roué
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain. .,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain. .,Laboratory of Experimental Hematology, Department of Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
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4
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Magnano L, Balagué O, Dlouhy I, Rovira J, Karube K, Pinyol M, Rivas-Delgado A, Costa D, Martínez-Trillos A, González-Farre B, Martínez-Pozo A, Giné E, Colomer D, Delgado J, Villamor N, Campo E, López-Guillermo A. Clinicobiological features and prognostic impact of diffuse large B-cell lymphoma component in the outcome of patients with previously untreated follicular lymphoma. Ann Oncol 2017; 28:2799-2805. [PMID: 29045517 DOI: 10.1093/annonc/mdx407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The co-existence at diagnosis of follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) components (FL/DLBCL) has been considered a transformed lymphoma and accordingly treated although clinicobiological information on these patients is scarce. The aim of this study was to analyze the initial features and outcome of FL/DLBCL patients in the rituximab era. PATIENTS AND METHODS All patients consecutively diagnosed at a single institution with FL/DLBCL (n = 40), as well as those with pure FL (n = 328) or de novo DLBCL (n = 510) as controls. RESULTS The proportion of the DLBCL component was highly variable (median 50%). In 29 FL/DLBCL cases analyzed, the cell of origin was GCB in 86%, ABC in 10% and unclassifiable in 4%. NOTCH1-2 was mutated in 10% of these cases. The proportion of DLBCL component did not impact on overall survival (OS). Regarding initial characteristics, patients with FL/DLBCL were closer to FL in terms of primary nodal origin, good performance status and advanced stage, whereas the other features were intermediate between FL and DLBCL. FL/DLBCL patients were treated as DLBCL with no further intensification. Complete response and primary refractory rates were 65% and 20%, respectively, with these figures being similar to DLBCL and worse than FL. Progression-free survival and OS were intermediate between FL and DLBCL (5-year OS: 85%, 73% and 63% for FL, FL/DLBCL and DLBCL, respectively). FL/DLBCL histology did not reach independent prognostic value for OS in the multivariate analyses. CONCLUSIONS The outcome of FL/DLBCL patients is not worse than that of de novo DLBCL. These cases should be treated with immunochemotherapy as DLBCL, but intensification with ASCT may not be necessary. The biological insights of FL/DLBCL warrants further genetic and molecular studies.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Case-Control Studies
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Follicular/complications
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasm Recurrence, Local/complications
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Survival Rate
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Affiliation(s)
- L Magnano
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - O Balagué
- CIBERONC, Barcelona;; Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I Dlouhy
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - J Rovira
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - K Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus;; Faculty of Medicine, University of the Ryukyus, Japan
| | - M Pinyol
- CIBERONC, Barcelona;; Genomics Unit, IDIBAPS, Barcelona, Spain
| | - A Rivas-Delgado
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - D Costa
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - A Martínez-Trillos
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - B González-Farre
- CIBERONC, Barcelona;; Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Martínez-Pozo
- CIBERONC, Barcelona;; Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Giné
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - D Colomer
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - J Delgado
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - N Villamor
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - E Campo
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - A López-Guillermo
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona;.
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5
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Karube K, Enjuanes A, Dlouhy I, Jares P, Martin-Garcia D, Nadeu F, Ordóñez GR, Rovira J, Clot G, Royo C, Navarro A, Gonzalez-Farre B, Vaghefi A, Castellano G, Rubio-Perez C, Tamborero D, Briones J, Salar A, Sancho JM, Mercadal S, Gonzalez-Barca E, Escoda L, Miyoshi H, Ohshima K, Miyawaki K, Kato K, Akashi K, Mozos A, Colomo L, Alcoceba M, Valera A, Carrió A, Costa D, Lopez-Bigas N, Schmitz R, Staudt LM, Salaverria I, López-Guillermo A, Campo E. Integrating genomic alterations in diffuse large B-cell lymphoma identifies new relevant pathways and potential therapeutic targets. Leukemia 2017; 32:675-684. [PMID: 28804123 PMCID: PMC5843901 DOI: 10.1038/leu.2017.251] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 02/08/2023]
Abstract
Genome studies of diffuse large B-cell lymphoma (DLBCL) have revealed a large number of somatic mutations and structural alterations. However, the clinical significance of these alterations is still not well defined. In this study, we have integrated the analysis of targeted next-generation sequencing of 106 genes and genomic copy number alterations (CNA) in 150 DLBCL. The clinically significant findings were validated in an independent cohort of 111 patients. Germinal center B-cell and activated B-cell DLBCL had a differential profile of mutations, altered pathogenic pathways and CNA. Mutations in genes of the NOTCH pathway and tumor suppressor genes (TP53/CDKN2A), but not individual genes, conferred an unfavorable prognosis, confirmed in the independent validation cohort. A gene expression profiling analysis showed that tumors with NOTCH pathway mutations had a significant modulation of downstream target genes, emphasizing the relevance of this pathway in DLBCL. An in silico drug discovery analysis recognized 69 (46%) cases carrying at least one genomic alteration considered a potential target of drug response according to early clinical trials or preclinical assays in DLBCL or other lymphomas. In conclusion, this study identifies relevant pathways and mutated genes in DLBCL and recognizes potential targets for new intervention strategies.
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Affiliation(s)
- K Karube
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology and Cell Biology, Graduate School of Medicine and Faculty of Medicine, University of the Ryukyus, Nishihara, Japan
| | - A Enjuanes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - I Dlouhy
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - P Jares
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - D Martin-Garcia
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - F Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | | | - J Rovira
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - G Clot
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - C Royo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Navarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - B Gonzalez-Farre
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - A Vaghefi
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - G Castellano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - C Rubio-Perez
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Research Unit on Biomedical Informatics, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - D Tamborero
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Research Unit on Biomedical Informatics, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - J Briones
- Servei de Patologia, Hospital de Sant Pau, Barcelona, Spain
| | - A Salar
- Department of Pathology, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - J M Sancho
- ICO-Hospital Germans Trias i Pujol, Barcelona, Spain
| | - S Mercadal
- ICO-Hospital Duran i Reynals, L'Hospitalet, Barcelona, Spain
| | | | - L Escoda
- Department of Hematology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - H Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - K Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - K Miyawaki
- Department of Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - K Kato
- Department of Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - K Akashi
- Department of Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - A Mozos
- Servei de Patologia, Hospital de Sant Pau, Barcelona, Spain
| | - L Colomo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
| | - M Alcoceba
- CIBERONC, Madrid, Spain.,Unidad de Biología Molecular/Histocompatibilidad, Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - A Valera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Carrió
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - D Costa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - N Lopez-Bigas
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Research Unit on Biomedical Informatics, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - R Schmitz
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - L M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - I Salaverria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - A López-Guillermo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
| | - E Campo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,CIBERONC, Madrid, Spain
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6
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Rivas-Delgado A, Magnano L, Moreno-Velazquez M, Garcia O, Mozas P, Dlouhy I, Baumann T, Rovira J, Gonzalez B, Martinez A, Balague O, Delgado J, Villamor N, Campo E, Gine E, Sancho J, Lopez-Guillermo A. Progression-free survival shortens after each relapse in patients with follicular lymphoma treated in the rituximab era. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Rivas-Delgado
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - L. Magnano
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - M. Moreno-Velazquez
- Hematology Department, ICO-IJC-Hospital Germans Trias i Pujol; Universitat Autonoma de Barcelona; Badalona Spain
| | - O. Garcia
- Hematology Department, ICO-IJC-Hospital Germans Trias i Pujol; Universitat Autonoma de Barcelona; Badalona Spain
| | - P. Mozas
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - I. Dlouhy
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - T. Baumann
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - J. Rovira
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - B. Gonzalez
- Hematopathology Unit, Pathology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - A. Martinez
- Hematopathology Unit, Pathology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - O. Balague
- Hematopathology Unit, Pathology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - J. Delgado
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - N. Villamor
- Hematopathology Unit, Pathology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - E. Campo
- Hematopathology Unit, Pathology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - E. Gine
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
| | - J.M. Sancho
- Hematology Department, ICO-IJC-Hospital Germans Trias i Pujol; Universitat Autonoma de Barcelona; Badalona Spain
| | - A. Lopez-Guillermo
- Hematology Department, Hospital Clinic, IDIBAPS; Universitat de Barcelona; Barcelona Spain
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7
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Fox C, Bellei M, Manni M, Kim S, Ko Y, Shustov A, Cabrera M, Chiattone C, Horwitz S, Spina M, Advani R, Angrilli F, De Souza C, Dlouhy I, Fernandez-Alvarez R, Gabús R, Hitz F, Laszlo D, Montoto S, Nagler A, Pavlovsky A, Vitolo U, Zoppegno L, Federico M, Kim W. IMPROVED SURVIVAL OUTCOMES FOR PATIENTS WITH EXTRA-NODAL NK/T LYMPHOMA: DATA FROM 140 PATIENTS PROSPECTIVELY REGISTERED IN THE INTERNATIONAL T-CELL PROJECT. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C.P. Fox
- Nottingham University Hospitals NHS Trust, and Institute of Cancer Sciences, University of Birmingham; Nottingham UK
| | - M. Bellei
- Dept. Diagnostic, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - M. Manni
- Dept. Diagnostic, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - S.J. Kim
- Division of Hematology-Oncology; Samsung Medical Center; Seoul Republic of Korea
| | - Y.H. Ko
- Department of Pathology; Sungkyunkwan University; Seoul Republic of Korea
| | - A.R. Shustov
- Division of Hematology, FHCRC; University of Washington Medical Center; Seattle USA
| | - M.E. Cabrera
- Sección Hematología, Hospital del Salvador; Universidad de Chile; Santiago de Chile Chile
| | - C.S. Chiattone
- Departamento de Clínica Médica, FCM da Santa Casa de São Paulo; Centro de Linfomas Núcleo de Oncologia Hospital Samaritano; São Paulo Brazil
| | - S.M. Horwitz
- Dept. Medicine; Memorial Sloan-Kettering Cancer Center; New York USA
| | - M. Spina
- Medical Oncology A; Aviano National Cancer Institute; Aviano Italy
| | - R.H. Advani
- Division of Oncology; Stanford University School of Medicine; Stanford USA
| | - F. Angrilli
- Dip. Ematologia, Medicina Trasfusionale e Biotecnologie; UOSD Centro Diagnosi e Terapia Linfomi; PO Pescara, Pescara Italy
| | - C.A. De Souza
- Departamento de Clínica Médica; Universidade Estadual de Campinas; Campinas Brazil
| | - I. Dlouhy
- Hematology Department; Hospital Clinic; Barcelona Italy
| | | | - R. Gabús
- Service of Hematology and Bone Marrow Transplantation; Hospital Maciel; Montevideo Uruguay
| | - F. Hitz
- Department of Oncology/Haematology; Cantonal Hospital; St Gallen Switzerland
| | - D. Laszlo
- Division of Haemato-Oncology; IEO - Istituto Europeo di Oncologia; Milan Italy
| | - S. Montoto
- Department of Haematology; Barts Health NHS Trust; London Italy
| | - A. Nagler
- Department of Bone Marrow Transplantation; Tel-Aviv University; Tel-Aviv Israel
| | | | - U. Vitolo
- S.C. Ematologia, Dipartimento di Oncologia ed Ematologia, S.C. Ematologia, Dipartimento di Oncologia ed Ematologia; Torino Italy
| | - L. Zoppegno
- Hematologia, Hospital provincial San Martín de La Plata; Buenos Aires Argentina
| | - M. Federico
- Dept. Diagnostic, Clinical and Public Health Medicine; University of Modena and Reggio Emilia; Modena Italy
| | - W.S. Kim
- Division of Hematology-Oncology; Samsung Medical Center; Seoul Republic of Korea
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8
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Mercadal S, Vidal N, López-Parra M, Ibañez M, Caldú R, Bobillo S, Barceló I, García E, Martinez P, Cacabelos P, Dlouhy I, Sancho J, Muntañola A, Gómez L, Erro E, Gállego J, Salar A, Caballero A, Solé M, Huertas N, Estela J, Baron M, Barbero N, González-Barca E, Graus F, Velasco R. Initial management of primary central nervous system lymphoma in Spain in the last decade. The experience of the GELTAMO and Spanish neuro-oncology groups. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S. Mercadal
- Hematology; Catalan Institute of Oncology. Hospital Duran i Reynals., L'Hospitalet de Llobregat; Barcelona Spain
| | - N. Vidal
- Pathology; Hospital de Bellvitge, L'Hospitalet de Llobregat; Barcelona Spain
| | - M. López-Parra
- Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - M. Ibañez
- Neurology; Hospital Universitario i Politècnic La Fe; Valencia Spain
| | - R. Caldú
- Neurology; Hospital Universitario Miguel Servet; Zaragoza Spain
| | - S. Bobillo
- Hematology; Hospital Vall d'Hebrón; Barcelona Spain
| | - I. Barceló
- Neurology; Hospital Universitario Son Espases; Palma de Mallorca Spain
| | - E. García
- Neurology; Hospital Universitario Virgen de la Arrixaca; Murcia Spain
| | - P. Martinez
- Hematology; Hospital Universitario Doce de Octubre; Madrid Spain
| | - P. Cacabelos
- Neurology; Complejo hospitalario Santiago Compostela; Santiago Compostela Spain
| | - I. Dlouhy
- Hematology; Hospital Clínic; Barcelona Spain
| | - J. Sancho
- Hematology; ICO. Hospital Germans Trias i Pujol; Badalona Spain
| | - A. Muntañola
- Hematology; Hospital Mutua de Terrassa; Terrassa Spain
| | - L. Gómez
- Neurology; Hospital Quirón; Madrid Spain
| | - E. Erro
- Neurology; Hospital de Navarra; Pamplona Spain
| | - J. Gállego
- Neurology; Clínica Universitaria de Navarra; Pamplona Spain
| | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - A. Caballero
- Hematology; Hospital de Sant Pau; Barcelona Spain
| | - M. Solé
- Hematology; Hospital Virgen del Rocío; Sevilla Spain
| | - N. Huertas
- Neurology; Hospiatl Severo Ochoa; Leganés Spain
| | - J. Estela
- Neurology; Hospital Parc Taulí; Sabadell Spain
| | - M. Baron
- Neurology; Hospital Fundación Alcorcón; Alcorcón Spain
| | - N. Barbero
- Neurology; Hospital Rey Juan Carlos; Móstoles Spain
| | - E. González-Barca
- Hematology; Catalan Institute of Oncology. Hospital Duran i Reynals., L'Hospitalet de Llobregat; Barcelona Spain
| | - F. Graus
- Hematology; Hospital Clínic; Barcelona Spain
| | - R. Velasco
- Neurology; Hospital de Bellvitge, L'Hospitalet de Llobregat; Barcelona Spain
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9
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Martín A, Baile M, Rodríguez G, Dlouhy I, Sancho J, Jarque I, González-Barca E, Salar A, Espeso M, Grande C, Bergua J, Montes-Moreno S, López-Guillermo A, Campo E, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: A phase 2 study from the Spanish group GELTAMO. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- A. Martín
- Hematology; Hospital Universitario de Salamanca and IBSAL; Salamanca Spain
| | - M. Baile
- Hematology; Hospital Universitario de Salamanca and IBSAL; Salamanca Spain
| | - G. Rodríguez
- Hematology; UGC HH.UU. Virgen del Rocío / Virgen Macarena; Sevilla Spain
| | - I. Dlouhy
- Hematology; Hospital Clinic; Barcelona Spain
| | - J.M. Sancho
- Hematology; Hospital Germans Trias i Pujol / ICO-IJC, Barcelona; Badalona Spain
| | - I. Jarque
- Hematology; Hospital Universitario La Fe; Valencia Spain
| | - E. González-Barca
- Hematology; Hospital Duran i Reynals / ICO-IDIBELL, Hospitalet de Llobregat; Barcelona Spain
| | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - M. Espeso
- Hematology; Hospital Regional Universitario de Málaga; Málaga Spain
| | - C. Grande
- Hematology; Hospital Universitario 12 de Octubre; Madrid Spain
| | - J. Bergua
- Hematology; Hospital San Pedro de Alcántara; Cáceres Spain
| | - S. Montes-Moreno
- Pathology; Hospital Universitario Marqués de Valdecilla; Santander Spain
| | | | - E. Campo
- Pathology; Hospital Clinic; Barcelona Spain
| | - D. Caballero
- Hematology; Hospital Universitario de Salamanca and IBSAL; Salamanca Spain
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10
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Dlouhy I, Karube K, Enjuanes A, Salaverría I, Pérez-Galán P, Jares P, Martín-García D, Nadeu F, Rivas-Delgado A, Rovira J, Gonzalez B, Mozos A, Clot G, Sancho J, Salar A, Mercadal S, Escola L, Briones J, Colomo L, Alcoceba M, Valera A, Campo E, López-Guillermo A. GENE MUTATIONS AND COPY NUMBER ALTERATIONS (CNA) PREDICT FOR EARLY FAILURE IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) TREATED WITH R-CHOP. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- I. Dlouhy
- Hematology; Hospital Clinic Barcelona; Barcelona Spain
| | - K. Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine and Faculty of Medicine; University of the Ryukyus; Nishihara Japan
| | - A. Enjuanes
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - I. Salaverría
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - P. Pérez-Galán
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - P. Jares
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - D. Martín-García
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - F. Nadeu
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | | | - J. Rovira
- Hematology; Hospital Clinic Barcelona; Barcelona Spain
| | - B. Gonzalez
- Pathology; Hospital Clinic Barcelona; Barcelona Spain
| | - A. Mozos
- Pathology; Hospital Clinic Barcelona; Barcelona Spain
| | - G. Clot
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - J.M. Sancho
- Hematology; ICO-Hospital Germans Trias i Pujol; Barcelona Spain
| | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - S. Mercadal
- Hematology; ICO-Hospital Duran i Reynals; Barcelona Spain
| | - L. Escola
- Hematology; Hospital Universitari Joan XXIII; Tarragona Spain
| | - J. Briones
- Hematology; Hospital de Sant Pau; Barcelona Spain
| | - L. Colomo
- Pathology; Hospital del Mar; Barcelona Spain
| | - M. Alcoceba
- Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - A. Valera
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - E. Campo
- Hematology; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
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11
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Boccaccini D, Maioli M, Cannio M, Dlouhy I, Romagnoli M, Leonelli C, Boccaccini A. A lifetime prediction method based on Cumulative Flaw Length Theory. Ann Ital Chir 2012. [DOI: 10.1016/j.jeurceramsoc.2011.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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