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Usart M, Stetka J, Luque Paz D, Hansen N, Kimmerlin Q, Almeida Fonseca T, Lock M, Kubovcakova L, Karjalainen R, Hao-Shen H, Börsch A, El Taher A, Schulz J, Leroux JC, Dirnhofer S, Skoda RC. Loss of Dnmt3a increased self-renewal and resistance to pegIFNα in JAK2-V617F-positive myeloproliferative neoplasms. Blood 2024:blood.2023020270. [PMID: 38493481 DOI: 10.1182/blood.2023020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Pegylated interferon alpha (pegIFNα) can induce molecular remissions in JAK2-V617F-positive myeloproliferative neoplasms (MPN) patients by targeting long-term hematopoietic stem cells (LT-HSCs). Additional somatic mutations in genes regulating LT-HSC self-renewal, such as DNMT3A, have been reported to have poorer responses to pegIFNα. We investigated if DNMT3A loss leads to alterations in JAK2-V617F LT-HSCs functions conferring resistance to pegIFNα treatment in a mouse model of MPN and in hematopoietic progenitors from MPN patients. Long-term treatment with pegIFNα normalized blood parameters, reduced splenomegaly and JAK2-V617F-chimerism in single-mutant JAK2-V617F (VF) mice. However, pegIFNα in VF;Dnmt3aΔ/Δ (VF;DmΔ/Δ) mice worsened splenomegaly and failed to reduce JAK2-V617F-chimerism. Furthermore, LT-HSCs from VF;DmΔ/Δ mice compared to VF were less prone to accumulate DNA damage and exit dormancy upon pegIFNα treatment. RNA-sequencing showed that IFNα induced stronger upregulation of inflammatory pathways in LT-HSCs from VF;DmΔ/Δ compared to VF mice, indicating that the resistance of VF;DmΔ/Δ LT-HSC was not due to failure in IFNα signaling. Transplantations of bone marrow from pegIFNα treated VF;DmΔ/Δ mice gave rise to more aggressive disease in secondary and tertiary recipients. Liquid cultures of hematopoietic progenitors from MPN patients with JAK2-V617F and DNMT3A mutation showed increased percentages of JAK2-V617F-positive colonies upon IFNα exposure, whereas in patients with JAK2-V617F alone the percentages of JAK2-V617F-positive colonies decreased or remained unchanged. PegIFNα combined with 5-azacytidine only partially overcame resistance in VF;DmΔ/Δ mice. However, this combination strongly decreased the JAK2-mutant allele burden in mice carrying VF mutation only, showing potential to inflict substantial damage preferentially to the JAK2-mutant clone.
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Affiliation(s)
- Marc Usart
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jan Stetka
- University Hospital Basel and University of Basel, Switzerland, Basel, Switzerland
| | - Damien Luque Paz
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, CRCI2NA, F-49000, Angers, France, ANGERS, France
| | - Nils Hansen
- University Hospital of Basel, Basel, Switzerland
| | - Quentin Kimmerlin
- University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Melissa Lock
- University Hospital Basel and University of Basel, Switzerland, Basel, Switzerland
| | - Lucia Kubovcakova
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riikka Karjalainen
- University Hospital Basel and University of Basel, Switzerland, Basel, Switzerland
| | - Hui Hao-Shen
- Swiss Institute of Bioinformatics, Basel, Switzerland, Switzerland
| | | | - Athimed El Taher
- University Hospital Basel and University of Basel, Basel, Switzerland
| | | | | | | | - Radek C Skoda
- University Hospital Basel and University of Basel, Basel, Switzerland
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Rai S, Zhang Y, Grockowiak E, Kimmerlin Q, Hansen N, Stoll CB, Usart M, Luque Paz D, Hao-Shen H, Zhu Y, Roux J, Bader MS, Dirnhofer S, Farady CJ, Schroeder T, Méndez-Ferrer S, Skoda RC. IL-1β promotes MPN disease initiation by favoring early clonal expansion of JAK2-mutant hematopoietic stem cells. Blood Adv 2024; 8:1234-1249. [PMID: 38207211 PMCID: PMC10912850 DOI: 10.1182/bloodadvances.2023011338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT JAK 2-V617F is the most frequent somatic mutation causing myeloproliferative neoplasm (MPN). JAK2-V617F can be found in healthy individuals with clonal hematopoiesis of indeterminate potential (CHIP) with a frequency much higher than the prevalence of MPNs. The factors controlling the conversion of JAK2-V617F CHIP to MPN are largely unknown. We hypothesized that interleukin-1β (IL-1β)-mediated inflammation can favor this progression. We established an experimental system using bone marrow (BM) transplantations from JAK2-V617F and GFP transgenic (VF;GFP) mice that were further crossed with IL-1β-/- or IL-1R1-/- mice. To study the role of IL-1β and its receptor on monoclonal evolution of MPN, we performed competitive BM transplantations at high dilutions with only 1 to 3 hematopoietic stem cells (HSCs) per recipient. Loss of IL-1β in JAK2-mutant HSCs reduced engraftment, restricted clonal expansion, lowered the total numbers of functional HSCs, and decreased the rate of conversion to MPN. Loss of IL-1R1 in the recipients also lowered the conversion to MPN but did not reduce the frequency of engraftment of JAK2-mutant HSCs. Wild-type (WT) recipients transplanted with VF;GFP BM that developed MPNs had elevated IL-1β levels and reduced frequencies of mesenchymal stromal cells (MSCs). Interestingly, frequencies of MSCs were also reduced in recipients that did not develop MPNs, had only marginally elevated IL-1β levels, and displayed low GFP-chimerism resembling CHIP. Anti-IL-1β antibody preserved high frequencies of MSCs in VF;GFP recipients and reduced the rate of engraftment and the conversion to MPN. Our results identify IL-1β as a potential therapeutic target for preventing the transition from JAK2-V617F CHIP to MPNs.
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Affiliation(s)
- Shivam Rai
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Yang Zhang
- Department of Biosystems Science and Engineering, Eidgenössische Technische Hochschule Zurich, Basel, Switzerland
| | - Elodie Grockowiak
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
- Department of Hematology, University of Cambridge, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Quentin Kimmerlin
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nils Hansen
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Cedric B. Stoll
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marc Usart
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Damien Luque Paz
- University of Angers, Nantes Université, CHU Angers, INSERM, CNRS, CRCI2NA, Angers, France
| | - Hui Hao-Shen
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Yexuan Zhu
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
- Department of Hematology, University of Cambridge, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Julien Roux
- Department of Biomedicine, Bioinformatics core facility, University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Michael S. Bader
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | | | - Timm Schroeder
- Department of Biosystems Science and Engineering, Eidgenössische Technische Hochschule Zurich, Basel, Switzerland
| | - Simón Méndez-Ferrer
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, United Kingdom
- Department of Hematology, University of Cambridge, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Radek C. Skoda
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
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Codilupi T, Szybinski J, Arunasalam S, Jungius S, Dunbar AC, Stivala S, Brkic S, Albrecht C, Vokalova L, Yang JL, Buczak K, Ghosh N, Passweg JR, Rovo A, Angelillo-Scherrer A, Pankov D, Dirnhofer S, Levine RL, Koche R, Meyer SC. Development of Resistance to Type II JAK2 Inhibitors in MPN Depends on AXL Kinase and Is Targetable. Clin Cancer Res 2024; 30:586-599. [PMID: 37992313 PMCID: PMC10831334 DOI: 10.1158/1078-0432.ccr-23-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/21/2023] [Accepted: 11/20/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Myeloproliferative neoplasms (MPN) dysregulate JAK2 signaling. Because clinical JAK2 inhibitors have limited disease-modifying effects, type II JAK2 inhibitors such as CHZ868 stabilizing inactive JAK2 and reducing MPN clones, gain interest. We studied whether MPN cells escape from type ll inhibition. EXPERIMENTAL DESIGN MPN cells were continuously exposed to CHZ868. We used phosphoproteomic analyses and ATAC/RNA sequencing to characterize acquired resistance to type II JAK2 inhibition, and targeted candidate mediators in MPN cells and mice. RESULTS MPN cells showed increased IC50 and reduced apoptosis upon CHZ868 reflecting acquired resistance to JAK2 inhibition. Among >2,500 differential phospho-sites, MAPK pathway activation was most prominent, while JAK2-STAT3/5 remained suppressed. Altered histone occupancy promoting AP-1/GATA binding motif exposure associated with upregulated AXL kinase and enriched RAS target gene profiles. AXL knockdown resensitized MPN cells and combined JAK2/AXL inhibition using bemcentinib or gilteritinib reduced IC50 to levels of sensitive cells. While resistant cells induced tumor growth in NOD/SCID gamma mice despite JAK2 inhibition, JAK2/AXL inhibition largely prevented tumor progression. Because inhibitors of MAPK pathway kinases such as MEK are clinically used in other malignancies, we evaluated JAK2/MAPK inhibition with trametinib to interfere with AXL/MAPK-induced resistance. Tumor growth was halted similarly to JAK2/AXL inhibition and in a systemic cell line-derived mouse model, marrow infiltration was decreased supporting dependency on AXL/MAPK. CONCLUSIONS We report on a novel mechanism of AXL/MAPK-driven escape from type II JAK2 inhibition, which is targetable at different nodes. This highlights AXL as mediator of acquired resistance warranting inhibition to enhance sustainability of JAK2 inhibition in MPN.
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Affiliation(s)
- Tamara Codilupi
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakub Szybinski
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefanie Arunasalam
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Sarah Jungius
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew C. Dunbar
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simona Stivala
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sime Brkic
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Camille Albrecht
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lenka Vokalova
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julie L. Yang
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katarzyna Buczak
- Proteomics Core Facility Biozentrum, University of Basel, Basel, Switzerland
| | - Nilabh Ghosh
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakob R. Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dmitry Pankov
- Immunology Program, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stefan Dirnhofer
- Department of Pathology, University Hospital Basel, Basel, Switzerland
| | - Ross L. Levine
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Koche
- Human Oncology and Pathogenesis Program and Leukemia service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sara C. Meyer
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ivanova VS, Davies J, Menter T, Wild D, Müller A, Krasniqi F, Stenner F, Papachristofilou A, Dirnhofer S, Tzankov A. Primary bone diffuse large B-cell lymphoma (PB-DLBCL): a distinct extranodal lymphoma of germinal centre origin, with a common EZB-like mutational profile and good prognosis. Histopathology 2024; 84:525-538. [PMID: 37965677 DOI: 10.1111/his.15096] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/03/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023]
Abstract
AIMS Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is not recognized as a separate entity by the current classification systems. Here we define and highlight its distinctive clinical presentation, morphology, phenotype, gene expression profile (GEP), and molecular genetics. METHODS We collected 27 respective cases and investigated their phenotype, performed gDNA panel sequencing covering 172 genes, and carried out fluorescence in situ hybridization to evaluate MYC, BCL2, and BCL6 translocations. We attempted to genetically subclassify cases using the Two-step classifier and performed GEP for cell-of-origin subtyping and in silico comparison to uncover up- and downregulated genes as opposed to other DLBCL. RESULTS Most cases (n = 22) were germinal centre B-cell-like (GCB) by immunohistochemistry and all by GEP. Additionally, PB-DLBCL had a mutational profile similar to follicular lymphoma and nodal GCB-DLBCL, with the exception of more frequent TP53 and B2M mutations. The GEP of PB-DLBCL was unique, and the frequency of BCL2 rearrangements was lower compared to nodal GCB-DLBCL. The Two-step classifier categorized eight of the cases as EZB, three as ST2, and one as MCD. CONCLUSION This study comprehensively characterizes PB-DLBCL as a separate entity with distinct clinical and morpho-molecular features. These insights may aid in developing tailored therapeutic strategies and shed light on its pathogenesis.
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Affiliation(s)
- Vanesa-Sindi Ivanova
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - John Davies
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Damian Wild
- Divison of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Anne Müller
- Institute of Molecular Cancer Research, University of Zurich, Zurich, Switzerland
| | - Fatime Krasniqi
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Frank Stenner
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | | | - Stefan Dirnhofer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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Usart M, Hansen N, Stetka J, Almeida Fonseca T, Guy A, Kimmerlin Q, Rai S, Hao-Shen H, Roux J, Dirnhofer S, Skoda RC. The glutaminase inhibitor CB-839 targets metabolic dependencies of JAK2-mutant hematopoiesis in MPN. Blood Adv 2024:bloodadvances.2023010950. [PMID: 38295283 DOI: 10.1182/bloodadvances.2023010950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/04/2024] [Accepted: 01/21/2024] [Indexed: 02/02/2024] Open
Abstract
Hyperproliferation of myeloid and erythroid cells in myeloproliferative neoplasms driven by the JAK2-V617F mutation is associated with altered metabolism. Given the central role of glutamine in anabolic and catabolic pathways, we examined the effects of pharmacologically inhibiting glutaminolysis, i.e. the conversion of glutamine (Gln) to glutamate (Glu), using CB-839, a small molecular inhibitor of the enzyme glutaminase (GLS). We show that CB-839 strongly reduced the mitochondrial respiration rate of bone marrow cells from JAK2-V617F mutant (VF) mice, demonstrating a marked dependence of these cells on Gln-derived ATP production. Consistently, in vivo treatment with CB-839 normalized blood glucose levels, reduced splenomegaly and decreased erythrocytosis in VF mice. These effects were more pronounced when CB-839 was combined with the JAK1/2 inhibitor ruxolitinib or the glycolysis inhibitor 3PO, indicating possible synergies when co-targeting different metabolic and oncogenic pathways. Furthermore, we show that the inhibition of glutaminolysis with CB-839 preferentially lowered the proportion of JAK2-mutant hematopoietic stem cells (HSCs). The total number of HSCs was decreased by CB-839, primarily by reducing HSCs in the G1 phase of the cell cycle. CB-839 in combination with ruxolitinib also strongly reduced myelofibrosis at later stages of MPN. In line with the effects shown in mice, proliferation of CD34+ hematopoietic stem and progenitor cells from PV patients was inhibited by CB-839 at nanomolar concentrations. These data suggest that inhibiting glutaminase alone or in combination with inhibitors of glycolysis or JAK2 inhibitors represents an attractive new therapeutic approach to MPN.
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Affiliation(s)
- Marc Usart
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nils Hansen
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jan Stetka
- University Hospital Basel and University of Basel, Switzerland, Basel, Switzerland
| | | | - Alexandre Guy
- Department of Biomedicine, University Hospital Basel and University of Basel, Switzerland
| | - Quentin Kimmerlin
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Shivam Rai
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hui Hao-Shen
- University Hospital of Basel, Basel, Switzerland
| | - Julien Roux
- University of Basel and University Hospital Basel, Basel, Switzerland
| | | | - Radek C Skoda
- University Hospital Basel and University of Basel, Basel, Switzerland
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Ivanova VS, Vela V, Dirnhofer S, Dobbie M, Stenner F, Knoblich J, Tzankov A, Menter T. Molecular characterization and genetic subclassification comparison of diffuse large B-cell lymphoma (DLBCL) - real-life experience with 74 cases. Pathobiology 2023:000535938. [PMID: 38128501 DOI: 10.1159/000535938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity. Lately, several algorithms achieving therapeutically and prognostically relevant DLBCL subclassification have been published. METHODS A cohort of 74 routine DLBCL cases was broadly characterized by immunohistochemistry (IHC), fluorescence in situ hybridization (FISH) of the BCL2, BCL6 and MYC loci, and comprehensive high throughput sequencing (HTS). Based on the genetic alterations found, cases were reclassified using two probabilistic tools - LymphGen and Two-step classifier, allowing for comparison of the two models. RESULTS Hans and Tally's overall IHC-based subclassification success rate was 96% and 82%, respectively. HTS and FISH data allowed the LymphGen algorithm to successfully classify 11/55 cases, (1 - BN2, 7 - EZB, 1 - MCD, and 2 - genetically composite EZB/N1). The total subclassification rate was 20%. On the other hand, the Two-step classifier categorized 36/55 cases, with 65.5% success (9 - BN2, 12 - EZB, 9 - MCD, 2 - N1, and 4 - ST2). Clinical correlations highlighted MCD as an aggressive subtype associated with higher relapse and mortality. CONCLUSIONS The Two-step algorithm has a better success rate at subclassifying DLBCL cases based on genetic differences. Further improvement of the classifiers is required to increase the number of classifiable cases and thus prove their applicability in routine diagnostics.
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Chamuleau MED, Stenner F, Chitu DA, Novak U, Minnema MC, Geerts P, Stevens WBC, Zenz T, van Imhoff GW, Wu KL, Demandt AMP, Kersten MJ, Terpstra WE, Tick LW, Deeren D, Van Den Neste E, Gregor M, Veelken H, Böhmer LH, Caspar CB, Mutsaers P, Refos JM, Sewsaran R, Fu L, Seefat RL, Uyl-de Groot CA, Dirnhofer S, Van Den Brand M, de Jong D, Nijland M, Lugtenburg P. R-CODOX-M/R-IVAC versus DA-EPOCH-R in patients with newly diagnosed Burkitt lymphoma (HOVON/SAKK): final results of a multicentre, phase 3, open-label, randomised trial. Lancet Haematol 2023; 10:e966-e975. [PMID: 37922925 DOI: 10.1016/s2352-3026(23)00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Patients with newly diagnosed high-risk Burkitt lymphoma are treated with high-intensity immune-chemotherapy regimens such as R-CODOX-M/R-IVAC or with lower-intensity regimens such as DA-EPOCH-R. The aim of this study was to make a formal comparison between these regimens. METHODS This multicentre, phase 3, open-label, randomised study was done in 26 clinical centres in the Netherlands, Belgium, and Switzerland. Eligible patients were aged 18-75 years with newly diagnosed high-risk Burkitt lymphoma without CNS involvement. Patients were randomly assigned to two cycles of R-CODOX-M/R-IVAC (R-CODOX-M: rituximab 375 mg/m2 on day 1 and 9, cyclophosphamide 800 mg/m2 on day 1, cyclophosphamide 200 mg/m2 on days 2-5, vincristine 1·5 mg/m2 on days 1 and 8, doxorubicin 40 mg/m2 on day 1, and methotrexate 3000 mg/m2 on day 10; R-IVAC: rituximab 375 mg/m2 on days 3 and 7, iphosphamide 1500 mg/m2 on days 1-5, etoposide 60 mg/m2 on days 1-5, and cytarabin 2000 mg/m2 on day 1 and 2) or six cycles of DA-EPOCH-R (dose-adjusted etoposide 50-124 mg/m2 on days 1-4, prednisolone 120 mg/m2 on days 1-5, vincristine 0·4 mg/m2 on days 1-4, dose-adjusted cyclophosphamide 480-1866 mg/m2 on day 5, dose-adjusted doxorubicin 10-24·8 mg/m2 on days 1-4, rituximab 375 mg/m2 on days 1 and 5). Patients older than 65 years received a dose modified R-CODOX-M/R-IVAC. All drugs were intravenous except for prednisolone, which was oral. Patients also received four intrathecal CNS administrations with cytarabin (70 mg) and four with methotrexate (15 mg). Patients were stratified by centre, leukemic disease, and HIV-positivity. The primary endpoint was progression-fee survival. All analyses were done by modified intention-to-treat, excluding randomly assigned patients who were subsequently found to have CNS involvement or diagnosis other than Burkitt lymphoma at study entry. This study is registered with the European Clinical Trial Register, EudraCT2013-004394-27. FINDINGS Due to a slow accrual, the study was closed prematurely on Nov 15, 2021. Between Aug 4, 2014, and Sept 17, 2021, 89 patients were enrolled and randomly assigned to receive R-CODOX-M/R-IVAC (n=46) or DA-EPOCH-R (n=43). Five patients were excluded after random assignment (three in the R-CODOX-M/R-IVAC group [one diagnosis other than Burkitt lymphoma at study entry according to local pathology and two CNS involvement] and two in the DA-EPOCH-R group [one diagnosis other than Burkitt lymphoma at study entry according to local pathology and one CNS involvement]. 84 remaining patients were included in the modified intention-to-treat analysis. 73 (87%) of 84 patients were male, 76 (90%) presented with stage III or IV disease, and nine (11%) had HIV-positive Burkitt lymphoma. Median patient age was 52 years (IQR 37-64). With a median follow-up of 28·5 months (IQR 13·2-43·7), 2-year progression-free survival was 76% (95% CI 60-86%) in the R-CODOX-M/R-IVAC group and 70% (54-82%) in the DA-EPOCH-R group (hazard ratio 1·42, 95% CI 0·63-3·18; p=0·40). There were two deaths in the R-CODOX-M/R-IVAC group (one infection [treatment related] and one due to disease progression [not treatment related]) and one death in the DA-EPOCH-R group (COVID-19 infection [treatment related]). In the R-CODOX-M/R-IVAC group, four patients went off-protocol because of toxic effects, versus none in the DA-EPOCH-R group. Patients treated with R-CODOX-M/R-IVAC had more infectious adverse events (24 [56%] of 43 patients had at least one grade 3-5 infection vs 14 [34%] of 41 patients in the DA-EPOCH-R group). INTERPRETATION The trial stopped early, but the available data suggest that while DA-EPOCH-R did not result in superior progression-free survival compared with R-CODOX-M/R-IVAC, it was associated with fewer toxic effects and need for supportive care. DA-EPOCH-R appears to be an additional valid therapeutic option for patients with high-risk Burkitt lymphoma without CNS involvement. FUNDING The Dutch Cancer Society and the Schumacher-Kramer Foundation.
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Affiliation(s)
- Martine E D Chamuleau
- Department of Hematology, Amsterdam University Medical Center, Location VU, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands.
| | - Frank Stenner
- Department of Oncology, University Hospital Basel, University of Basel, Basel, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Dana A Chitu
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Urban Novak
- Department of Medical Oncology, Inselspital /Bern University Hospital, Bern, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Paul Geerts
- Department of Hematology, Isala Clinics, Zwolle, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Gustaaf W van Imhoff
- Department of Hematology, University Medical Center Groningen, Groningen, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Ka Lung Wu
- Department of Hematology, Ziekenhuis Netwerk Antwerpen, Stuivenberg, Antwerp, Belgium; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Astrid M P Demandt
- Division of Hematology, Department of Internal Medicine, School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Marie Jose Kersten
- Department of Hematology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Wim E Terpstra
- Department of Hematology, Amsterdam-Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Lidwine W Tick
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Dries Deeren
- Department of Hematology, Algemeen Ziekenhuis Delta, Roeselare, Belgium; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Eric Van Den Neste
- Department of Hematology, Cliniques universitaires Université catholique de Louvain Saint-Luc, Belgium
| | - Michael Gregor
- Department of Hematology, Luzerner Kantonsspital, Luzern, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Hendrik Veelken
- Department of Hematology, Leiden University Medical Center, Leiden, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Lara H Böhmer
- Department of Hematology Haga Teaching Hospital, The Hague, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Clemens B Caspar
- Department of Internal Medicine, Division of Medical Oncology and Hematology, Kantonsspital Baden, Baden, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Pim Mutsaers
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Jeannine M Refos
- Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Robby Sewsaran
- Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Liping Fu
- Pathology Facility, Amsterdam University Medical Center, Location VU, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Rianne L Seefat
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Netherlands
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Michiel Van Den Brand
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Daphne de Jong
- Department of Pathology, Amsterdam University Medical Center, Location VU, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Marcel Nijland
- Department of Hematology, University Medical Center Groningen, Groningen, Netherlands; Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON), Amsterdam, Netherlands
| | - Pieternella Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
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Novak U, Fehr M, Schär S, Dreyling M, Schmidt C, Derenzini E, Zander T, Hess G, Mey U, Ferrero S, Mach N, Boccomini C, Böttcher S, Voegeli M, Cairoli A, Ivanova VS, Menter T, Dirnhofer S, Scheibe B, Gadient S, Eckhardt K, Zucca E, Driessen C, Renner C. Combined therapy with ibrutinib and bortezomib followed by ibrutinib maintenance in relapsed or refractory mantle cell lymphoma and high-risk features: a phase 1/2 trial of the European MCL network (SAKK 36/13). EClinicalMedicine 2023; 64:102221. [PMID: 37781158 PMCID: PMC10541470 DOI: 10.1016/j.eclinm.2023.102221] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background The Bruton's tyrosine kinase inhibitor ibrutinib and the proteasome inhibitor bortezomib have single-agent activity, non-overlapping toxicities, and regulatory approval in mantle cell lymphoma (MCL). In vitro, their combination provides synergistic cytotoxicity. In this investigator-initiated phase 1/2 trial, we established the recommended phase 2 dose of ibrutinib in combination with bortezomib, and assessed its efficacy in patients with relapsed or refractory MCL. Methods In this phase 1/2 study open in 15 sites in Switzerland, Germany and Italy, patients with relapsed or refractory MCL after ≤2 lines of chemotherapy and both ibrutinib-naïve and bortezomib-naïve received six cycles of ibrutinibb and bortezomib, followed by ibrutinib maintenance. For the phase 1 study, a standard 3 + 3 dose escalation design was used to determine the recommended phase 2 dose of ibrutinib in combination with bortezomib. The primary endpoint in phase 1 was the dose limiting toxicities in cycle 1. The phase 2 study was an open-label, single-arm trial with a Simon's two-stage min-max design, with a primary endpoint of overall response rate (ORR) assessed by CT/MRI. This study was registered with ClinicalTrials.gov, NCT02356458. Findings Between August 2015 and September 2016, nine patients were treated in the phase 1 study, and 49 patients were treated between November 2016 and March 2020 in the phase 2 of the trial. The ORR was 81.8% (90% CI 71.1, 89.8%, CR(u) 21.8%) which increased with continued ibrutinib (median 10.6 months) to 87.3%, (CR(u) 41.8%). 75.6% of patients had at least one high-risk feature (Ki-67 > 30%, blastoid or pleomorphic variant, p53 overexpression, TP53 mutations and/or deletions). In these patients, ibrutinib and bortezomib were also effective with an ORR of 74%, increasing to 82% during maintenance. With a median follow-up of 25.4 months, the median duration of response was 22.7, and the median PFS was 18.6 months. PFS reached 30.8 and 32.9 months for patients with a CR or Cru, respectively. Interpretation The combination of ibrutinib and bortezomib shows durable efficacy in patients with relapsed or refractory MCL, also in the presence of high-risk features. Funding SAKK (Hubacher Fund), Swiss State Secretariat for Education, Research and Innovation, Swiss Cancer Research Foundation, and Janssen.
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Affiliation(s)
- Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin Fehr
- Department of Medical Oncology and Haematology, Kantonsspital Sankt Gallen, Switzerland
| | - Sämi Schär
- SAKK Competence Centre, Bern, Switzerland
| | - Martin Dreyling
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Christian Schmidt
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Enrico Derenzini
- Onco-Haematology Division, IEO European Institute of Oncology IRCCS, Department of Health Sciences, University of Milan, Italy
| | - Thilo Zander
- Division of Medical Oncology, Luzerner Kantonsspital, Switzerland
| | - Georg Hess
- University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Ulrich Mey
- Department of Oncology and Haematology, Kantonsspital Graubünden, Switzerland
| | - Simone Ferrero
- Haematology Department of Molecular Biotechnologies and Health Sciences, University of Torino, and Haematology 1, AOU “Città della Salute e della Scienza di Torino”, Italy
| | - Nicolas Mach
- Department of Oncology, University Hospital of Geneva, Switzerland
| | | | - Sebastian Böttcher
- Department of Medicine, Clinic III, Rostock University Medical Centre, Germany
| | - Michèle Voegeli
- Department of Haematology and Oncology, Kantonsspital Baselland, Liestal, Switzerland
| | - Anne Cairoli
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Vanesa-Sindi Ivanova
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Menter
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | | | | | | | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Christoph Driessen
- Department of Medical Oncology and Haematology, Kantonsspital Sankt Gallen, Switzerland
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9
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Konantz M, Williams M, Merkel T, Reiss A, Dirnhofer S, Meyer SC, Valent P, George TI, Tzankov A, Hartmann K. Increased TIM-3 and galectin-9 serum levels in patients with advanced systemic mastocytosis. J Allergy Clin Immunol 2023; 152:1019-1024. [PMID: 37423405 DOI: 10.1016/j.jaci.2023.07.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Systemic mastocytosis is characterized by expansion of clonal mast cells in various tissues. Several biomarkers with diagnostic and therapeutic potential have recently been characterized in mastocytosis, such as the serum marker tryptase and the immune checkpoint molecule PD-L1. OBJECTIVE We aimed to investigate whether serum levels of other checkpoint molecules are altered in systemic mastocytosis and whether these proteins are expressed in mastocytosis infiltrates in the bone marrow. METHODS Levels of different checkpoint molecules were analyzed in serum of patients with different categories of systemic mastocytosis and healthy controls and correlated to disease severity. Bone marrow biopsies from patients with systemic mastocytosis were stained to confirm expression. RESULTS Serum levels of TIM-3 and galectin-9 were increased in systemic mastocytosis, particularly in advanced subtypes, compared with healthy controls. TIM-3 and galectin-9 levels were also found to correlate with other biomarkers of systemic mastocytosis, such as serum tryptase and KIT D816V variant allele frequency in the peripheral blood. Moreover, we observed expression of TIM-3 and galectin-9 in mastocytosis infiltrates in bone marrow. CONCLUSIONS Together, our results demonstrate for the first time that serum levels of TIM-3 and galectin-9 are increased in advanced systemic mastocytosis. Moreover, TIM-3 and galectin-9 are expressed in bone marrow infiltrates in mastocytosis. These findings provide a rationale for exploring TIM-3 and galectin-9 as diagnostic markers and eventually therapeutic targets in systemic mastocytosis, particularly in advanced forms.
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Affiliation(s)
- Martina Konantz
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Margaret Williams
- ARUP Laboratories, Salt Lake City, Utah; University of Utah, Salt Lake City, Utah
| | - Tamara Merkel
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Antonia Reiss
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Department of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sara C Meyer
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Tracy I George
- ARUP Laboratories, Salt Lake City, Utah; University of Utah, Salt Lake City, Utah
| | - Alexandar Tzankov
- Department of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Karin Hartmann
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland; Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland.
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10
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Quintanilla-Martinez L, Laurent C, Soma L, Ng SB, Climent F, Ondrejka SL, Zamo A, Wotherspoon A, de Leval L, Dirnhofer S, Leoncini L. Emerging entities: high-grade/large B-cell lymphoma with 11q aberration, large B-cell lymphoma with IRF4 rearrangement, and new molecular subgroups in large B-cell lymphomas. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:281-298. [PMID: 37555980 PMCID: PMC10541818 DOI: 10.1007/s00428-023-03590-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023]
Abstract
Emerging entities and molecular subgroups in large B-cell lymphomas (LBCLs) were discussed during the 2022 European Association for Haematopathology/Society for Hematopathology workshop in Florence, Italy. This session focused on newly recognized diseases and their diagnostic challenges. High-grade/large B-cell lymphoma with 11q aberration (HG/LBCL-11q) is defined by chromosome 11q-gains and telomeric loss. FISH analysis is recommended for the diagnosis. HG/LBCL-11q can occur in the setting of immunodeficiency, including ataxia-telangiectasia, and predominates in children. The morphological spectrum of these cases is broader than previously thought with often Burkitt-like morphology and coarse apoptotic bodies. It has a Burkitt-like immunophenotype (CD10+, BCL6+, BCL2-) but MYC expression is weak or negative, lacks MYC rearrangement, and is in contrast to Burkitt lymphoma 50% of the cases express LMO2. LBCL with IRF4 rearrangement (LBCL-IRF4) occurs mainly in the pediatric population but also in adults. LBCL-IRF4 has an excellent prognosis, with distinguishing molecular findings. IRF4 rearrangements, although characteristic of this entity, are not specific and can be found in association with other chromosomal translocations in other large B-cell lymphomas. Other molecular subgroups discussed included primary bone diffuse large B-cell lymphoma (PB-DLBCL), which has distinctive clinical presentation and molecular findings, and B-acute lymphoblastic leukemia (B-ALL) with IGH::MYC translocation recently segregated from Burkitt lymphoma with TdT expression. This latter disorder has molecular features of precursor B-cells, often tetrasomy 1q and recurrent NRAS and KRAS mutations. In this report, novel findings, recommendations for diagnosis, open questions, and diagnostic challenges raised by the cases submitted to the workshop will be discussed.
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Affiliation(s)
- Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard-Karls-University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Liebermeisterstrasse 8, 72076, Tübingen, Germany.
- Cluster of Excellence iFIT (EXC2180) "Image-guided and functionally Instructed Tumor therapies" Eberhard-Karls-University, Tübingen, Germany.
| | - Camille Laurent
- Department of Pathology, Toulouse University Hospital Center, Cancer Institute, University of Toulouse-Oncopole, Toulouse, France
| | - Lorinda Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alberto Zamo
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | | | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
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11
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Ondrejka SL, Amador C, Climent F, Ng SB, Soma L, Zamo A, Dirnhofer S, Quintanilla-Martinez L, Wotherspoon A, Leoncini L, de Leval L. Follicular helper T-cell lymphomas: disease spectrum, relationship with clonal hematopoiesis, and mimics. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:349-365. [PMID: 37500795 PMCID: PMC10541838 DOI: 10.1007/s00428-023-03607-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Follicular helper T-cell lymphomas (TFH lymphomas) were discussed in session V of the lymphoma workshop of the European Association for Haematopathology (EA4HP)/Society for Hematopathology (SH) 2022 meeting in Florence, Italy. The session focused on the morphologic spectrum of TFH lymphoma, including its three subtypes: angioimmunoblastic-type (AITL), follicular-type, and not otherwise specified (NOS). The submitted cases encompassed classic examples of TFH lymphoma and unusual cases such as those with early or indolent presentations, associated B-cell proliferations, or Hodgkin/Reed-Sternberg-like cells. The relationship between TFH lymphoma and clonal hematopoiesis was highlighted by several cases documenting divergent evolution of myeloid neoplasm and AITL from shared clonal mutations. The distinction between TFH lymphoma and peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), was stressed, and many challenging examples were presented. Various cases highlighted the difficulties of differentiating TFH lymphoma from other established types of lymphoma and reactive conditions. Cutaneous T-cell lymphoma expressing TFH markers, particularly when resulting in lymph node involvement, should be distinguished from TFH lymphomas. Additional immunophenotyping and next-generation sequencing studies were performed on various cases in this session, highlighting the importance of these technologies to our current understanding and classification of TFH lymphomas.
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Affiliation(s)
- Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Catalina Amador
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, USA
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lorinda Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Alberto Zamo
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
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12
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Zamò A, van den Brand M, Climent F, de Leval L, Dirnhofer S, Leoncini L, Ng SB, Ondrejka SL, Quintanilla-Martinez L, Soma L, Wotherspoon A. The many faces of nodal and splenic marginal zone lymphomas. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:317-331. [PMID: 37656249 PMCID: PMC10542713 DOI: 10.1007/s00428-023-03633-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
Session 3 of the lymphoma workshop of the XXI joint meeting of the European Association for Haematopathology and the Society for Hematopathology took place in Florence, Italy, on September 22, 2022. The topics of this session were splenic and nodal marginal zone lymphomas, transformation in marginal zone lymphomas, and pediatric nodal marginal zone lymphomas and their differential diagnosis as well as related entities. Forty-two cases in these categories were submitted to the workshop, including splenic lymphomas (marginal zone and diffuse red pulp lymphomas), transformed marginal zone lymphomas (splenic and nodal), nodal marginal zone lymphomas with increased TFH-cells, and pediatric nodal marginal zone lymphomas. The case review highlighted some of the principal problems in the diagnosis of marginal zone lymphomas, including the difficulties in the distinction between splenic marginal zone lymphoma, splenic diffuse red pulp lymphoma, and hairy cell leukemia variant/splenic B-cell lymphoma with prominent nucleoli which requires integration of clinical features, immunophenotype, and morphology in blood, bone marrow, and spleen; cases of marginal zone lymphoma with markedly increased TFH-cells, simulating a T-cell lymphoma, where molecular studies (clonality and mutation detection) can help to establish the final diagnosis; the criteria for transformation of marginal zone lymphomas, which are still unclear and might require the integration of morphological and molecular data; the concept of an overlapping spectrum between pediatric nodal marginal zone lymphoma and pediatric-type follicular lymphoma; and the distinction between pediatric nodal marginal zone lymphoma and "atypical" marginal zone hyperplasia, where molecular studies are mandatory to correctly classify cases.
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Affiliation(s)
- Alberto Zamò
- Institute of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| | - Michiel van den Brand
- Pathology-DNA, Location Rijnstate Hospital, Wagnerlaan 55, 6815AD, Arnhem, The Netherlands.
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Lorinda Soma
- Department of Pathology, City of Hope Medical Center, Duarte, CA, USA
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13
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Di Napoli A, Soma L, Quintanilla-Martinez L, de Leval L, Leoncini L, Zamò A, Ng SB, Ondrejka SL, Climent F, Wotherspoon A, Dirnhofer S. Cavity-based lymphomas: challenges and novel concepts. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:299-316. [PMID: 37555981 PMCID: PMC10542738 DOI: 10.1007/s00428-023-03599-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
The 2022 European Association for Haematopathology/Society for Hematopathology lymphoma workshop session on cavity-based lymphomas included sixty-eight cases in seven sections. The disease entities discussed include primary effusion lymphomas (PEL), extracavitary primary effusion lymphomas and confounding entities (ECPEL), HHV8-negative B-lineage lymphomas-effusion based (EBV-negative, EBV-positive, and plasmablastic types), diffuse large B-cell lymphoma associated with chronic inflammation, fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and other lymphomas presenting as an effusion. All entities above are discussed; however, three are delved into greater detail given the challenges with classification: ECPEL, HHV8-negative effusion-based lymphomas, and FA-DLBCL. Cases exemplifying the diagnostic difficulty in differentiating ECPEL from HHV8-positive diffuse large B-cell lymphoma and germinotropic lymphoproliferative disorder were discussed. The more recently recognized effusion-based HHV8-negative large B-cell lymphoma is explored, with several cases submitted raising the question if this subset should be carved out as a specific entity, and if so, what should be the refining diagnostic criteria. Case submissions to the FA-DLBCL section yielded one of the largest case series to date, including classic cases, cases furthering the discussion on disease sites and prognosis, as well as novel concepts to be considered in this entity. The 2022 EA4HP/SH workshop cases allowed for further confirmation of the characteristics of some of the more historically accepted cavity-based lymphomas, as well as further inquiry and debate on relatively new or evolving entities.
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Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
| | - Lori Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology, and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | | | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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Zamò A, van den Brand M, Climent F, de Leval L, Dirnhofer S, Leoncini L, Ng SB, Ondrejka SL, Quintanilla-Martinez L, Soma L, Wotherspoon A. Correction to: The many faces of nodal and splenic marginal zone lymphomas. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:437. [PMID: 37695411 PMCID: PMC10541817 DOI: 10.1007/s00428-023-03646-y] [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: 09/12/2023]
Affiliation(s)
- Alberto Zamò
- Institute of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| | - Michiel van den Brand
- Pathology-DNA, Location Rijnstate Hospital, Wagnerlaan 55, 6815AD, Arnhem, The Netherlands.
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Lorinda Soma
- Department of Pathology, City of Hope Medical Center, Duarte, CA, USA
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15
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Di Napoli A, Soma L, Quintanilla-Martinez L, de Leval L, Leoncini L, Zamò A, Ng SB, Ondrejka SL, Climent F, Wotherspoon A, Dirnhofer S. Correction to: Cavity-based lymphomas: challenges and novel concepts. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:435. [PMID: 37747560 PMCID: PMC10541825 DOI: 10.1007/s00428-023-03664-w] [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: 09/26/2023]
Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
| | - Lori Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology, and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | | | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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16
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Climent F, Nicolae A, de Leval L, Dirnhofer S, Leoncini L, Ondrejka SL, Soma L, Wotherspoon A, Zamo A, Quintanilla-Martinez L, Ng SB. Cytotoxic peripheral T-cell lymphomas and EBV-positive T/NK-cell lymphoproliferative diseases: emerging concepts, recent advances, and the putative role of clonal hematopoiesis. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:333-348. [PMID: 37646869 PMCID: PMC10542298 DOI: 10.1007/s00428-023-03616-4] [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: 05/25/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
Cytotoxic peripheral T-cell lymphomas and EBV-positive T/NK-cell lymphoproliferative diseases were discussed at the 2022 European Association for Haematopathology/Society for Hematopathology lymphoma workshop held in Florence, Italy. This session focused on (i) primary nodal EBV-positive T and NK-cell lymphomas (primary nodal-EBV-TNKL), (ii) extranodal EBV-positive T/NK lymphoproliferative diseases (LPD) in children and adults, (iii) cytotoxic peripheral T-cell lymphomas, NOS (cPTCL-NOS), EBV-negative, and (iv) miscellaneous cases. Primary nodal-EBV-TNKL is a newly recognized entity which is rare, aggressive, and associated with underlying immune deficiency/immune dysregulation. All cases presented with lymphadenopathy but some demonstrated involvement of tonsil/Waldeyer's ring and extranodal sites. The majority of tumors are of T-cell lineage, and the most frequent mutations involve the epigenetic modifier genes, such as TET2 and DNMT3A, and JAK-STAT genes. A spectrum of EBV-positive T/NK LPD involving extranodal sites were discussed and highlight the diagnostic challenge with primary nodal-EBV-TNKL when these extranodal EBV-positive T/NK LPD cases demonstrate predominant nodal disease either at presentation or during disease progression from chronic active EBV disease. The majority of cPTCL-NOS demonstrated the TBX21 phenotype. Some cases had a background of immunosuppression or immune dysregulation. Interestingly, an unexpected association of cPTCL-NOS, EBV-positive and negative, with TFH lymphomas/LPDs was observed in the workshop cases. Similar to a published literature, the genetic landscape of cPTCL-NOS from the workshop showed frequent mutations in epigenetic modifiers, including TET2 and DNMT3A, suggesting a role of clonal hematopoiesis in the disease pathogenesis.
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Affiliation(s)
- Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - Alina Nicolae
- Department of Pathology, Hautepierre, University Hospital Strasbourg, Strasbourg, France
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lorinda Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Alberto Zamo
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Main Building, Level 3, 5 Lower Kent Ridge Road, Queenstown, Singapore.
- Cancer Science Institute of Singapore, National University of Singapore, Main Building, Level 3, 5 Lower Kent Ridge Road, Queenstown, Singapore.
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17
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Juskevicius D, Lundberg P, Tzankov A, Dirnhofer S, Stenner F. Genetic Factors in Familial Manifestation of Primary Mediastinal Large B-Cell Lymphoma over Two Generations. Pathobiology 2023; 90:422-428. [PMID: 37490879 PMCID: PMC10733924 DOI: 10.1159/000532053] [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: 04/26/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION Primary mediastinal large B-cell lymphoma (PMBL) is a rarely occurring lymphoid malignancy which typically affects young adults and presents itself as an anterior mediastinal mass. Gene expression profiling as well as somatic genetic analysis revealed that it is closely related to classical Hodgkin lymphoma, whereas morphologically, it tends to resemble diffuse large B-cell lymphoma. Familial clustering of PMBL is rare - only two reports have been published to date. While it is generally accepted that positive family history is associated with increased risk of developing a lymphoma, genetic risk factors which might predispose to PMBL are largely unknown. CASE PRESENTATION We performed germline and tumor genetic analyses by whole-exome sequencing and array-CGH of a family, in which the father and the son both developed a PMBL. Germline investigations of both affected patients and of their two unaffected family members have not been able to provide a single risk factor associated with lymphoma predisposition. In addition, genes that were previously implicated in increased risk for PMBL, namely MLL (KMT2A) and TIRAP, were found to be intact in all investigated family members. Somatic genetic investigations identified known as well as novel genetic aberrations in tumors of the affected subjects. CONCLUSION We conclude that predisposition to a PMBL might be inherited through a combination of low- or moderate-risk factors and provide a shortlist of the most likely selected candidates, which can be used in future studies.
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Affiliation(s)
- Darius Juskevicius
- Department of Laboratory Medicine, Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Pontus Lundberg
- Department of Laboratory Medicine, Diagnostic Hematology, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Pathology and Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland,
| | - Stefan Dirnhofer
- Institute of Pathology and Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frank Stenner
- Department of Oncology, University Hospital Basel, Basel, Switzerland
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18
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Fiegl A, Dirnhofer S, Juskevicius D, Zagrapan B, Dertinger S, Bösl A, Milos S, Brunner J, Bertolini F, Offner FA. Testicular Rosai-Dorfman disease clonally related to CMML - Case report and literature review. Pathol Res Pract 2023; 247:154548. [PMID: 37216748 DOI: 10.1016/j.prp.2023.154548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Rosai-Dorfman disease (RDD), a rare form of non-Langerhans cell histiocytosis with heterogenous clinical features, arises from precursor cells that give rise to cells of the histiocytic and monocytic lineages. An association with hematological neoplasms has been reported. Testicular RDD is rarely described, with only 9 reported cases in the literature. Genetic data to assess clonal relationships between RDD and other hematological neoplasms remain scarce. We describe an instance of testicular RDD against a background of chronic myelomonocytic leukemia (CMML), with genetic studies in both neoplasms. CASE PRESENTATION A 72-year-old patient with a history of CMML sought evaluation of growing bilateral testicular nodules. Solitary testicular lymphoma was suspected; orchidectomy was performed. The diagnosis of testicular RDD was established morphologically and confirmed immunohistochemically. Molecular analysis of testicular lesions and of archived patient bone marrow revealed the KRAS variant c 0.35 G>A / p.G12D in both, suggesting a clonal relationship. CONCLUSION These observations support classifying RDD as a neoplasm that can be clonally related to myeloid neoplasms.
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Affiliation(s)
- August Fiegl
- Institute of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital of Basel, Basel, Switzerland.
| | - Darius Juskevicius
- Department of Laboratory Medicine, University Hospital of Basel, Basel, Switzerland
| | - Branislav Zagrapan
- Institute of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Susanne Dertinger
- Institute of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Andreas Bösl
- Institute of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Stella Milos
- Department of Urology, City Hospital Bregenz, Bregenz, Austria
| | - Jürgen Brunner
- Department of Urology, City Hospital Bregenz, Bregenz, Austria
| | - Franz Bertolini
- Department of Internal Medicine, City Hospital Dornbirn, Dornbirn, Austria
| | - Felix A Offner
- Institute of Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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19
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Stetka J, Usart M, Kubovcakova L, Rai S, Rao TN, Sutter J, Hao-Shen H, Dirnhofer S, Geier F, Bader MS, Passweg JR, Manolova V, Dürrenberger F, Ahmed N, Schroeder T, Ganz T, Nemeth E, Silvestri L, Nai A, Camaschella C, Skoda RC. Iron is a modifier of the phenotypes of JAK2-mutant myeloproliferative neoplasms. Blood 2023; 141:2127-2140. [PMID: 36758212 DOI: 10.1182/blood.2022017976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
JAK 2-V617F mutation causes myeloproliferative neoplasms (MPNs) that can manifest as polycythemia vera (PV), essential thrombocythemia (ET), or primary myelofibrosis. At diagnosis, patients with PV already exhibited iron deficiency, whereas patients with ET had normal iron stores. We examined the influence of iron availability on MPN phenotype in mice expressing JAK2-V617F and in mice expressing JAK2 with an N542-E543del mutation in exon 12 (E12). At baseline, on a control diet, all JAK2-mutant mouse models with a PV-like phenotype displayed iron deficiency, although E12 mice maintained more iron for augmented erythropoiesis than JAK2-V617F mutant mice. In contrast, JAK2-V617F mutant mice with an ET-like phenotype had normal iron stores comparable with that of wild-type (WT) mice. On a low-iron diet, JAK2-mutant mice and WT controls increased platelet production at the expense of erythrocytes. Mice with a PV phenotype responded to parenteral iron injections by decreasing platelet counts and further increasing hemoglobin and hematocrit, whereas no changes were observed in WT controls. Alterations of iron availability primarily affected the premegakaryocyte-erythrocyte progenitors, which constitute the iron-responsive stage of hematopoiesis in JAK2-mutant mice. The orally administered ferroportin inhibitor vamifeport and the minihepcidin PR73 normalized hematocrit and hemoglobin levels in JAK2-V617F and E12 mutant mouse models of PV, suggesting that ferroportin inhibitors and minihepcidins could be used in the treatment for patients with PV.
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Affiliation(s)
- Jan Stetka
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Marc Usart
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lucia Kubovcakova
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Shivam Rai
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tata Nageswara Rao
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Joshua Sutter
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hui Hao-Shen
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Florian Geier
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
- Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Michael S Bader
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | | | | | - Nouraiz Ahmed
- Department of Biosystems Science and Engineering, Eidgenössische Technische Hochschule Zurich, Basel, Switzerland
| | - Timm Schroeder
- Department of Biosystems Science and Engineering, Eidgenössische Technische Hochschule Zurich, Basel, Switzerland
| | - Tomas Ganz
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Elizabeta Nemeth
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Laura Silvestri
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Antonella Nai
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
- Vita Salute San Raffaele University, Milan, Italy
| | - Clara Camaschella
- Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Radek C Skoda
- Experimental Hematology, Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
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20
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Rosenwald A, Menter T, Dirnhofer S. [Classification of aggressive B-cell lymphomas : News and open questions]. Pathologie (Heidelb) 2023; 44:166-172. [PMID: 36918411 PMCID: PMC10160218 DOI: 10.1007/s00292-023-01187-4] [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] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 03/16/2023]
Abstract
The 5th edition of the WHO classification (WHO-HAEM5) and the International Consensus Classification (ICC) show a broad consensus in the categorization of aggressive, large B‑cell lymphomas with expected minor impact only on the daily diagnostic routine. The changes compared to the 2017 revised WHO-HAEM4R are moderate and include updated names of entities, sharpened diagnostic criteria, and upgrades from provisional to definite entities. The definition of the most common aggressive B‑cell lymphoma, diffuse large B‑cell lymphoma (DLBCL), not otherwise specified (NOS), remains unchanged, and both classifications strongly encourage subtyping into germinal center B‑like (GCB) or the activated B‑like (ABC or non-GCB) DLBCL. DLBCL, NOS, should be separated from other large B‑cell lymphomas including large B‑cell lymphoma with IRF4 rearrangement (upgraded to a definite entity in both classifications) and large-cell/high-grade B‑cell lymphomas with 11q aberration. Aggressive B‑cell lymphomas with MYC and BCL2 rearrangements form a molecularly distinct group and are listed as definite entities in both classifications. This is in contrast to the more heterogeneous group of aggressive B‑cell lymphomas with MYC and BCL6 rearrangements that are recognized as a provisional entity in the ICC, while they fall into the DLBCL, NOS, or the HGBL, NOS, groups in the WHO-HAEM5.
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Affiliation(s)
- Andreas Rosenwald
- Institut für Pathologie, Universität Würzburg, Würzburg, Deutschland
| | - Thomas Menter
- Pathologie, Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Schönbeinstr. 40, 4031, Basel, Schweiz
| | - Stefan Dirnhofer
- Pathologie, Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Schönbeinstr. 40, 4031, Basel, Schweiz.
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21
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Song JY, Dirnhofer S, Piris MA, Quintanilla-Martínez L, Pileri S, Campo E. Diffuse large B-cell lymphomas, not otherwise specified, and emerging entities. Virchows Arch 2023; 482:179-192. [PMID: 36459219 DOI: 10.1007/s00428-022-03466-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/09/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive and heterogenous group of diseases and the most common subtype of non-Hodgkin lymphoma. In the past decade, there has been an explosion in molecular profiling that has helped to identify subgroups and shared oncogenic driving mechanisms. Since the 2017 World Health Organization (WHO) classification, additional studies investigating these genomic abnormalities and phenotypic findings have been reported. Here we review these findings in DLBCL and address the proposed changes by the 2022 International Consensus Classification.
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Affiliation(s)
- Joo Y Song
- Department of Pathology, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Miguel A Piris
- Servicio de Anatomia Patologica, Fundacion Jimenez Diaz, CIBERONC, Madrid, Spain
| | - Leticia Quintanilla-Martínez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany.,Cluster of Excellence iFIT, Image-Guided and Functionally Instructed Tumor Therapy, Tübingen, Germany
| | - Stefano Pileri
- Division of Hematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Elias Campo
- Hematopathology Unit, Hospital Clinic of Barcelona, Institute for Biomedical Research August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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22
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Dislich B, Hoch D, Dirnhofer S, Novak U, Banz Y. An unusual pseudolymphoma in the context of necrotizing fasciitis: A case report. Medicine (Baltimore) 2022; 101:e32457. [PMID: 36595811 PMCID: PMC9794286 DOI: 10.1097/md.0000000000032457] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE The diagnosis of lymphoma in routine diagnostics can be challenging due to clinical, morphological and immunphenotypical overlap with unusual reactive processes termed "pseudolymphomas." PATIENT CONCERNS 45-year-old male that underwent surgical debridement for a necrotizing fasciitis of the thigh with concomitant excision of a regional lymph node. DIAGNOSES The lymph node demonstrated an architecture-effacing activation and proliferation of lymphoblasts and was initially misdiagnosed as an aggressive lymphoma. Only in consideration of the clinical context and with the help of additional immunohistochemical and molecular analyses the final diagnosis of a reactive lymphadenopathy could be made. INTERVENTIONS No further therapy was required after the final diagnosis of a reactive lymphadenopathy was made. OUTCOMES The clinical follow-up was unremarkable, with no evidence of residual disease after 6 months. LESSONS This case report adds the parafollicular activation and proliferation of blasts and plasmablasts in the drainage area of an active infection to the spectrum of "pseudolymphomas" and reiterizes the importance of placing histopathological findings in the proper context.
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Affiliation(s)
- Bastian Dislich
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Dennis Hoch
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Stefan Dirnhofer
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Yara Banz
- Institute of Pathology, University of Bern, Bern, Switzerland
- * Correspondence: Yara Banz, Institute of Pathology, University of Bern, Bern 3008, Switzerland (e-mail: )
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23
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de Leval L, Alizadeh AA, Bergsagel PL, Campo E, Davies A, Dogan A, Fitzgibbon J, Horwitz SM, Melnick AM, Morice WG, Morin RD, Nadel B, Pileri SA, Rosenquist R, Rossi D, Salaverria I, Steidl C, Treon SP, Zelenetz AD, Advani RH, Allen CE, Ansell SM, Chan WC, Cook JR, Cook LB, d’Amore F, Dirnhofer S, Dreyling M, Dunleavy K, Feldman AL, Fend F, Gaulard P, Ghia P, Gribben JG, Hermine O, Hodson DJ, Hsi ED, Inghirami G, Jaffe ES, Karube K, Kataoka K, Klapper W, Kim WS, King RL, Ko YH, LaCasce AS, Lenz G, Martin-Subero JI, Piris MA, Pittaluga S, Pasqualucci L, Quintanilla-Martinez L, Rodig SJ, Rosenwald A, Salles GA, San-Miguel J, Savage KJ, Sehn LH, Semenzato G, Staudt LM, Swerdlow SH, Tam CS, Trotman J, Vose JM, Weigert O, Wilson WH, Winter JN, Wu CJ, Zinzani PL, Zucca E, Bagg A, Scott DW. Genomic profiling for clinical decision making in lymphoid neoplasms. Blood 2022; 140:2193-2227. [PMID: 36001803 PMCID: PMC9837456 DOI: 10.1182/blood.2022015854] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/15/2022] [Indexed: 01/28/2023] Open
Abstract
With the introduction of large-scale molecular profiling methods and high-throughput sequencing technologies, the genomic features of most lymphoid neoplasms have been characterized at an unprecedented scale. Although the principles for the classification and diagnosis of these disorders, founded on a multidimensional definition of disease entities, have been consolidated over the past 25 years, novel genomic data have markedly enhanced our understanding of lymphomagenesis and enriched the description of disease entities at the molecular level. Yet, the current diagnosis of lymphoid tumors is largely based on morphological assessment and immunophenotyping, with only few entities being defined by genomic criteria. This paper, which accompanies the International Consensus Classification of mature lymphoid neoplasms, will address how established assays and newly developed technologies for molecular testing already complement clinical diagnoses and provide a novel lens on disease classification. More specifically, their contributions to diagnosis refinement, risk stratification, and therapy prediction will be considered for the main categories of lymphoid neoplasms. The potential of whole-genome sequencing, circulating tumor DNA analyses, single-cell analyses, and epigenetic profiling will be discussed because these will likely become important future tools for implementing precision medicine approaches in clinical decision making for patients with lymphoid malignancies.
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Affiliation(s)
- Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Ash A. Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
- Stanford Cancer Institute, Stanford University, Stanford, CA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA
- Division of Hematology, Department of Medicine, Stanford University, Stanford, CA
| | - P. Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Elias Campo
- Haematopathology Section, Hospital Clínic, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Andrew Davies
- Centre for Cancer Immunology, University of Southampton, Southampton, United Kingdom
| | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jude Fitzgibbon
- Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Steven M. Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ari M. Melnick
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - William G. Morice
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ryan D. Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
- BC Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Bertrand Nadel
- Aix Marseille University, CNRS, INSERM, CIML, Marseille, France
| | - Stefano A. Pileri
- Haematopathology Division, IRCCS, Istituto Europeo di Oncologia, IEO, Milan, Italy
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Solna, Sweden
| | - Davide Rossi
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Itziar Salaverria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer and University of British Columbia, Vancouver, Canada
| | | | - Andrew D. Zelenetz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Ranjana H. Advani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Carl E. Allen
- Division of Pediatric Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | | | - Wing C. Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | - James R. Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Lucy B. Cook
- Centre for Haematology, Imperial College London, London, United Kingdom
| | - Francesco d’Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Kieron Dunleavy
- Division of Hematology and Oncology, Georgetown Lombardi Comprehensive Cancer Centre, Georgetown University Hospital, Washington, DC
| | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, AP-HP, Créteil, France
- Faculty of Medicine, IMRB, INSERM U955, University of Paris-Est Créteil, Créteil, France
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - John G. Gribben
- Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Olivier Hermine
- Service D’hématologie, Hôpital Universitaire Necker, Université René Descartes, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Daniel J. Hodson
- Wellcome MRC Cambridge Stem Cell Institute, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Eric D. Hsi
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Elaine S. Jaffe
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kennosuke Karube
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Kataoka
- Division of Molecular Oncology, National Cancer Center Research Institute, Toyko, Japan
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Wolfram Klapper
- Hematopathology Section and Lymph Node Registry, Department of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Rebecca L. King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Young H. Ko
- Department of Pathology, Cheju Halla General Hospital, Jeju, Korea
| | | | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - José I. Martin-Subero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Miguel A. Piris
- Department of Pathology, Jiménez Díaz Foundation University Hospital, CIBERONC, Madrid, Spain
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Laura Pasqualucci
- Institute for Cancer Genetics, Columbia University, New York, NY
- Department of Pathology & Cell Biology, Columbia University, New York, NY
- The Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Scott J. Rodig
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
| | | | - Gilles A. Salles
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Navarra, Cancer Center of University of Navarra, Cima Universidad de NavarraI, Instituto de Investigacion Sanitaria de Navarra, Centro de Investigación Biomédica en Red de Céncer, Pamplona, Spain
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer and University of British Columbia, Vancouver, Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer, BC Cancer and University of British Columbia, Vancouver, Canada
| | - Gianpietro Semenzato
- Department of Medicine, University of Padua and Veneto Institute of Molecular Medicine, Padova, Italy
| | - Louis M. Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Steven H. Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Judith Trotman
- Haematology Department, Concord Repatriation General Hospital, Sydney, Australia
| | - Julie M. Vose
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Oliver Weigert
- Department of Medicine III, LMU Hospital, Munich, Germany
| | - Wyndham H. Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Jane N. Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Pier L. Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istitudo di Ematologia “Seràgnoli” and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Emanuele Zucca
- Institute of Oncology Research and Oncology Institute of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer and University of British Columbia, Vancouver, Canada
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Kirsch M, Stehle GT, Konantz M, Passweg J, Dirnhofer S, Meyer SC, Hartmann K. Presence of neoplastic mast cells in ascites in advanced systemic mastocytosis. J Allergy Clin Immunol Pract 2022; 10:3035-3038.e1. [PMID: 35872218 DOI: 10.1016/j.jaip.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/28/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mark Kirsch
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Gregor T Stehle
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martina Konantz
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Department of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sara C Meyer
- Division of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Karin Hartmann
- Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland; Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland
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25
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Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, Brousset P, Cerroni L, de Leval L, Dirnhofer S, Dogan A, Feldman AL, Fend F, Friedberg JW, Gaulard P, Ghia P, Horwitz SM, King RL, Salles G, San-Miguel J, Seymour JF, Treon SP, Vose JM, Zucca E, Advani R, Ansell S, Au WY, Barrionuevo C, Bergsagel L, Chan WC, Cohen JI, d'Amore F, Davies A, Falini B, Ghobrial IM, Goodlad JR, Gribben JG, Hsi ED, Kahl BS, Kim WS, Kumar S, LaCasce AS, Laurent C, Lenz G, Leonard JP, Link MP, Lopez-Guillermo A, Mateos MV, Macintyre E, Melnick AM, Morschhauser F, Nakamura S, Narbaitz M, Pavlovsky A, Pileri SA, Piris M, Pro B, Rajkumar V, Rosen ST, Sander B, Sehn L, Shipp MA, Smith SM, Staudt LM, Thieblemont C, Tousseyn T, Wilson WH, Yoshino T, Zinzani PL, Dreyling M, Scott DW, Winter JN, Zelenetz AD. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood 2022; 140:1229-1253. [PMID: 35653592 PMCID: PMC9479027 DOI: 10.1182/blood.2022015851] [Citation(s) in RCA: 450] [Impact Index Per Article: 225.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
Since the publication of the Revised European-American Classification of Lymphoid Neoplasms in 1994, subsequent updates of the classification of lymphoid neoplasms have been generated through iterative international efforts to achieve broad consensus among hematopathologists, geneticists, molecular scientists, and clinicians. Significant progress has recently been made in the characterization of malignancies of the immune system, with many new insights provided by genomic studies. They have led to this proposal. We have followed the same process that was successfully used for the third and fourth editions of the World Health Organization Classification of Hematologic Neoplasms. The definition, recommended studies, and criteria for the diagnosis of many entities have been extensively refined. Some categories considered provisional have now been upgraded to definite entities. Terminology for some diseases has been revised to adapt nomenclature to the current knowledge of their biology, but these modifications have been restricted to well-justified situations. Major findings from recent genomic studies have impacted the conceptual framework and diagnostic criteria for many disease entities. These changes will have an impact on optimal clinical management. The conclusions of this work are summarized in this report as the proposed International Consensus Classification of mature lymphoid, histiocytic, and dendritic cell tumors.
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Affiliation(s)
- Elias Campo
- Haematopathology Section, Hospital Clínic of Barcelona, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Barcelona, Spain
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Pierre Brousset
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ahmet Dogan
- Laboratory of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Falko Fend
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
- Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jesus San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, CIBERONC, Pamplona, Spain
| | - John F Seymour
- Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Julie M Vose
- Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, NE
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, and Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ranjana Advani
- Stanford Cancer Center, Blood and Marrow Transplant Program, Stanford University, Stanford, CA
| | - Stephen Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wing-Yan Au
- Blood-Med Clinic, Hong Kong, People's Republic of China
| | - Carlos Barrionuevo
- Department of Pathology, Instituto Nacional de Enfermedades Neoplásicas, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Leif Bergsagel
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Francesco d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrew Davies
- Cancer Research UK Centre, Centre for Cancer Immunology, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research, Hospital of Perugia, University of Perugia , Perugia, Italy
| | - Irene M Ghobrial
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Harvard University, Boston, MA
| | - John R Goodlad
- National Health Service Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John G Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Eric D Hsi
- Department of Pathology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Brad S Kahl
- Oncology Division, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Won-Seog Kim
- Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shaji Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Camille Laurent
- Department of Pathology, Institut Universitaire du Cancer de Toulouse-Oncopole, and Laboratoire d'Excellence Toulouse Cancer, Toulouse, France
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - John P Leonard
- Weill Department of Medicine, Weill Medical College, Cornell University, New York, NY
| | - Michael P Link
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA
| | - Armando Lopez-Guillermo
- Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Maria Victoria Mateos
- Department of Hematology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cancer, Universidad de Salamanca, Salamanca, Spain
| | - Elizabeth Macintyre
- Laboratoire d'Onco-Hématologie, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris Cité and Institut Necker-Enfants Malades, Paris, France
| | - Ari M Melnick
- Division of Hematology and Oncology, Weill Medical College, Cornell University, New York, NY
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire de Lille, University Lille, Lille, France
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Marina Narbaitz
- Department of Pathology, Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina and Fundacion para combatir la leucemia (FUNDALEU), Buenos Aires, Argentina
| | - Astrid Pavlovsky
- Fundación para Combatir la Leucemia (FUNDALEU), Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | - Stefano A Pileri
- Haematopathology Division, IRCCS, Istituto Europeo di Oncologia, Milan, Italy
| | - Miguel Piris
- Jiménez Díaz Foundation University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Barbara Pro
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Vincent Rajkumar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Steven T Rosen
- Beckman Research Institute, and Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Birgitta Sander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laurie Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Sonali M Smith
- Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Catherine Thieblemont
- Service Hémato-Oncologie, AP-HP, Hôpital Saint-Louis, Paris, France
- DMU-DHI, Université de Paris-Paris Diderot, Paris, France
| | - Thomas Tousseyn
- Department of Pathology, Universitair Ziekenhuis Leuven Hospitals, Leuven, Belgium
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Pier-Luigi Zinzani
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seragnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Martin Dreyling
- Department of Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College, Cornell University, New York, NY
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Rai S, Grockowiak E, Hansen N, Luque Paz D, Stoll CB, Hao-Shen H, Mild-Schneider G, Dirnhofer S, Farady CJ, Méndez-Ferrer S, Skoda RC. Inhibition of interleukin-1β reduces myelofibrosis and osteosclerosis in mice with JAK2-V617F driven myeloproliferative neoplasm. Nat Commun 2022; 13:5346. [PMID: 36100613 PMCID: PMC9470591 DOI: 10.1038/s41467-022-32927-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/24/2022] [Indexed: 12/17/2022] Open
Abstract
Interleukin-1β (IL-1β) is a master regulator of inflammation. Increased activity of IL-1β has been implicated in various pathological conditions including myeloproliferative neoplasms (MPNs). Here we show that IL-1β serum levels and expression of IL-1 receptors on hematopoietic progenitors and stem cells correlate with JAK2-V617F mutant allele fraction in peripheral blood of patients with MPN. We show that the source of IL-1β overproduction in a mouse model of MPN are JAK2-V617F expressing hematopoietic cells. Knockout of IL-1β in hematopoietic cells of JAK2-V617F mice reduces inflammatory cytokines, prevents damage to nestin-positive niche cells and reduces megakaryopoiesis, resulting in decrease of myelofibrosis and osteosclerosis. Inhibition of IL-1β in JAK2-V617F mutant mice by anti-IL-1β antibody also reduces myelofibrosis and osteosclerosis and shows additive effects with ruxolitinib. These results suggest that inhibition of IL-1β with anti-IL-1β antibody alone or in combination with ruxolitinib could have beneficial effects on the clinical course in patients with myelofibrosis.
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Affiliation(s)
- Shivam Rai
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Elodie Grockowiak
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Nils Hansen
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Damien Luque Paz
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Cedric B Stoll
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Hui Hao-Shen
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Gabriele Mild-Schneider
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland
| | - Stefan Dirnhofer
- Department of Pathology, University Hospital Basel, 4031, Basel, Switzerland
| | | | - Simón Méndez-Ferrer
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge, CB2 0AW, UK
- Department of Hematology, University of Cambridge, Cambridge, CB2 0AW, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Radek C Skoda
- Department of Biomedicine, Experimental Hematology, University Hospital Basel, University of Basel, 4031, Basel, Switzerland.
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Menter T, Dirnhofer S, Tzankov A. [Differential diagnosis of reactive cytopenias]. Pathologie (Heidelb) 2022; 43:263-270. [PMID: 35925221 DOI: 10.1007/s00292-022-01076-2] [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] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
Reactive cytopenias are a frequent cause for bone marrow investigations, including bone marrow trephine biopsies, especially if clinical examination and laboratory analyses (e.g., detection of substrate deficiencies) cannot provide a sufficient explanation. The evaluation of such biopsies is primarily concerned with the exclusion of diseases that displace the normal hematopoiesis (infiltrates of acute leukemias or lymphomas and metastases), the exclusion of a myelodysplastic syndrome that classically results in ineffective hematopoiesis, or the detection of specific diseases, particularly infectious or histiocytic diseases (e.g., hemophagocytic lymphohistiocytosis).In this review, we describe characteristic morphologic changes of reactive cytopenias, focus on specific infectious and noninfectious clinical pictures, and distinguish them from malignant changes, especially myelodysplastic syndrome and underlying leukemia of large granular T lymphocytes. Drug-induced changes in hematopoiesis are described in another article in this issue.
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Affiliation(s)
- Thomas Menter
- Pathologie, Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Universität Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz
| | - Stefan Dirnhofer
- Pathologie, Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Universität Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz
| | - Alexandar Tzankov
- Pathologie, Institut für Medizinische Genetik und Pathologie, Universitätsspital Basel, Universität Basel, Schönbeinstrasse 40, 4031, Basel, Schweiz.
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Tzankov A, Facchetti F, Mühleisen B, Dirnhofer S. IRF8 Is a Reliable Monoblast Marker for Acute Monocytic Leukemias, But Does Not Discriminate Between Monoblasts and Plasmacytoid Dendritic Cells. Am J Surg Pathol 2022; 46:725-727. [PMID: 35195578 DOI: 10.1097/pas.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Fabio Facchetti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Beda Mühleisen
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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29
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Genta S, Ghilardi G, Cascione L, Juskevicius D, Tzankov A, Schär S, Milan L, Pirosa MC, Esposito F, Ruberto T, Giovanella L, Hayoz S, Mamot C, Dirnhofer S, Zucca E, Ceriani L. Integration of Baseline Metabolic Parameters and Mutational Profiles Predicts Long-Term Response to First-Line Therapy in DLBCL Patients: A Post Hoc Analysis of the SAKK38/07 Study. Cancers (Basel) 2022; 14:cancers14041018. [PMID: 35205765 PMCID: PMC8870624 DOI: 10.3390/cancers14041018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/13/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022] Open
Abstract
Accurate estimation of the progression risk after first-line therapy represents an unmet clinical need in diffuse large B-cell lymphoma (DLBCL). Baseline (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) parameters, together with genetic analysis of lymphoma cells, could refine the prediction of treatment failure. We evaluated the combined impact of mutation profiling and baseline PET/CT functional parameters on the outcome of DLBCL patients treated with the R-CHOP14 regimen in the SAKK38/07 clinical trial (NCT00544219). The concomitant presence of mutated SOCS1 with wild-type CREBBP and EP300 defined a group of patients with a favorable prognosis and 2-year progression-free survival (PFS) of 100%. Using an unsupervised recursive partitioning approach, we generated a classification-tree algorithm that predicts treatment outcomes. Patients with elevated metabolic tumor volume (MTV) and high metabolic heterogeneity (MH) (15%) had the highest risk of relapse. Patients with low MTV and favorable mutational profile (9%) had the lowest risk, while the remaining patients constituted the intermediate-risk group (76%). The resulting model stratified patients among three groups with 2-year PFS of 100%, 82%, and 42%, respectively (p < 0.001).
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Affiliation(s)
- Sofia Genta
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
| | - Guido Ghilardi
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland;
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Darius Juskevicius
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (D.J.); (A.T.); (S.D.)
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (D.J.); (A.T.); (S.D.)
| | - Sämi Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, 3008 Bern, Switzerland; (S.S.); (S.H.)
| | - Lisa Milan
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
| | - Maria Cristina Pirosa
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
| | - Fabiana Esposito
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
| | - Teresa Ruberto
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Stefanie Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, 3008 Bern, Switzerland; (S.S.); (S.H.)
| | - Christoph Mamot
- Division of Oncology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (D.J.); (A.T.); (S.D.)
| | - Emanuele Zucca
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (S.G.); (M.C.P.); (F.E.); (E.Z.)
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland;
- Department of Medical Oncology, Bern University Hospital, University of Bern, 3008 Bern, Switzerland
| | - Luca Ceriani
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6500 Bellinzona, Switzerland;
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (L.M.); (T.R.); (L.G.)
- Correspondence:
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30
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Bonfiglio F, Bruscaggin A, Guidetti F, Terzi di Bergamo L, Faderl M, Spina V, Condoluci A, Bonomini L, Forestieri G, Koch R, Piffaretti D, Pini K, Pirosa MC, Cittone MG, Arribas A, Lucioni M, Ghilardi G, Wu W, Arcaini L, Baptista MJ, Bastidas G, Bea S, Boldorini R, Broccoli A, Buehler MM, Canzonieri V, Cascione L, Ceriani L, Cogliatti S, Corradini P, Derenzini E, Devizzi L, Dietrich S, Elia AR, Facchetti F, Gaidano G, Garcia JF, Gerber B, Ghia P, Gomes da Silva M, Gritti G, Guidetti A, Hitz F, Inghirami G, Ladetto M, Lopez-Guillermo A, Lucchini E, Maiorana A, Marasca R, Matutes E, Meignin V, Merli M, Moccia A, Mollejo M, Montalban C, Novak U, Oscier DG, Passamonti F, Piazza F, Pizzolitto S, Rambaldi A, Sabattini E, Salles G, Santambrogio E, Scarfò L, Stathis A, Stüssi G, Geyer JT, Tapia G, Tarella C, Thieblemont C, Tousseyn T, Tucci A, Vanini G, Visco C, Vitolo U, Walewska R, Zaja F, Zenz T, Zinzani PL, Khiabanian H, Calcinotto A, Bertoni F, Bhagat G, Campo E, De Leval L, Dirnhofer S, Pileri SA, Piris MA, Traverse-Glehen A, Tzankov A, Paulli M, Ponzoni M, Mazzucchelli L, Cavalli F, Zucca E, Rossi D. Genetic and phenotypic attributes of splenic marginal zone lymphoma. Blood 2022; 139:732-747. [PMID: 34653238 DOI: 10.1182/blood.2021012386] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022] Open
Abstract
Splenic marginal zone B-cell lymphoma (SMZL) is a heterogeneous clinico-biological entity. The clinical course is variable, multiple genes are mutated with no unifying mechanism, and essential regulatory pathways and surrounding microenvironments are diverse. We sought to clarify the heterogeneity of SMZL by resolving different subgroups and their underlying genomic abnormalities, pathway signatures, and microenvironment compositions to uncover biomarkers and therapeutic vulnerabilities. We studied 303 SMZL spleen samples collected through the IELSG46 multicenter international study (NCT02945319) by using a multiplatform approach. We carried out genetic and phenotypic analyses, defined self-organized signatures, validated the findings in independent primary tumor metadata and in genetically modified mouse models, and determined correlations with outcome data. We identified 2 prominent genetic clusters in SMZL, termed NNK (58% of cases, harboring NF-κB, NOTCH, and KLF2 modules) and DMT (32% of cases, with DNA-damage response, MAPK, and TLR modules). Genetic aberrations in multiple genes as well as cytogenetic and immunogenetic features distinguished NNK- from DMT-SMZLs. These genetic clusters not only have distinct underpinning biology, as judged by differences in gene-expression signatures, but also different outcomes, with inferior survival in NNK-SMZLs. Digital cytometry and in situ profiling segregated 2 basic types of SMZL immune microenvironments termed immune-suppressive SMZL (50% of cases, associated with inflammatory cells and immune checkpoint activation) and immune-silent SMZL (50% of cases, associated with an immune-excluded phenotype) with distinct mutational and clinical connotations. In summary, we propose a nosology of SMZL that can implement its classification and also aid in the development of rationally targeted treatments.
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Affiliation(s)
- Ferdinando Bonfiglio
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Francesca Guidetti
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Martin Faderl
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Valeria Spina
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Adalgisa Condoluci
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luisella Bonomini
- International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| | - Gabriela Forestieri
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Ricardo Koch
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Deborah Piffaretti
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Katia Pini
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Maria Cristina Pirosa
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Micol Giulia Cittone
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Alberto Arribas
- Lymphoma Genomics, Institute of Oncology Research, Bellinzona, Switzerland
| | - Marco Lucioni
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and Università degli Studi di Pavia, Pavia, Italy
| | - Guido Ghilardi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Wei Wu
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Maria Joao Baptista
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Gabriela Bastidas
- Division of Hematology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Silvia Bea
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) 28029, Madrid, Spain
- Pathology Department, Hospital Clínic, Barcelona University, Barcelona, Spain
| | - Renzo Boldorini
- Division of Pathology, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
| | - Marco Matteo Buehler
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Vincenzo Canzonieri
- Pathology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luciano Cascione
- Lymphoma Genomics, Institute of Oncology Research, Bellinzona, Switzerland
| | - Luca Ceriani
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sergio Cogliatti
- Institute of Pathology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Enrico Derenzini
- Onco-hematology Division, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Liliana Devizzi
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Sascha Dietrich
- Division of Hematology, University Hospital Heidelberg, Heidelberg, Germany
| | - Angela Rita Elia
- Cancer Immunotherapy, Institute of Oncology Research, Bellinzona, Switzerland
| | - Fabio Facchetti
- Department of Molecular and Translational Medicine, Pathology Unit, Spedali Civili, Brescia, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Bernhard Gerber
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Hematology and Oncology, University of Zurich, Zurich, Switzerland
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia (CLL), IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Gomes da Silva
- Division of Hematology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Giuseppe Gritti
- Division of Hematology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Guidetti
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Felicitas Hitz
- Division of Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio, Alessandria, Italy
- Dipartimento di Medicina Traslazionale, University of Eastern Piedmont, Alessandria, Italy
| | | | - Elisa Lucchini
- Division of Hematology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Antonino Maiorana
- Division of Pathology, Universitá degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Estella Matutes
- Haematopathology Unit, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Michele Merli
- Division of Hematology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Alden Moccia
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Manuela Mollejo
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) 28029, Madrid, Spain
- Division of Pathology, Hospital Virgen de la Salud, Toledo, Spain
| | - Carlos Montalban
- Division of Hematology, MD Anderson Cancer Center, Madrid, Spain
| | - Urban Novak
- Department of Medical Oncology and University Cancer Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Graham Oscier
- Division of Hematology, University Hospitals Dorset, Bournemouth, United Kingdom
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Francesco Piazza
- Division of Hematology, Ospedale Universitario di Padova, Padova, Italy
| | - Stefano Pizzolitto
- Division of Pathology, General Hospital S Maria della Misericordia, Udine, Italy
| | - Alessandro Rambaldi
- Division of Hematology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Gilles Salles
- Faculté de Médecine et de Maïeutique Lyon Sud, Université de Lyon, Lyon, France
| | | | - Lydia Scarfò
- Strategic Research Program on Chronic Lymphocytic Leukemia (CLL), IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Anastasios Stathis
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Georg Stüssi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Julia T Geyer
- Division of Anatomic Pathology and Clinical Pathology, Weill Cornell Medical College, New York, NY
| | - Gustavo Tapia
- Division of Pathology, Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corrado Tarella
- Onco-hematology Division, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Catherine Thieblemont
- Assistance Publique-Hôpitaux de Paris, Hopital Saint-Louis, Hemato-Oncology Unit; Université de Paris, Paris, France
| | - Thomas Tousseyn
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | | | - Giorgio Vanini
- Department of Medical Oncology and University Cancer Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Italy
| | - Umberto Vitolo
- Candiolo Cancer Institute (FPO-IRCCS), Candiolo, Turin, Italy
| | - Renata Walewska
- Division of Hematology, University Hospitals Dorset, Bournemouth, United Kingdom
| | - Francesco Zaja
- Division of Hematology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Hossein Khiabanian
- Center for Systems and Computational Biology, Rutgers University, New Brunswick, NJ
| | - Arianna Calcinotto
- Cancer Immunotherapy, Institute of Oncology Research, Bellinzona, Switzerland
| | - Francesco Bertoni
- Lymphoma Genomics, Institute of Oncology Research, Bellinzona, Switzerland
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University, New York, NY
| | - Elias Campo
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)
- Pathology Department, Hospital Clínic, Barcelona University, Barcelona, Spain
| | - Laurence De Leval
- Division of Pathology, Institut Universitaire de Pathologie, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Stefano A Pileri
- Haematopathology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Miguel A Piris
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) 28029, Madrid, Spain
- Pathology Service, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Alexander Tzankov
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and Università degli Studi di Pavia, Pavia, Italy
| | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University and Pathology Unit San Raffaele Scientific Institute, Milan, Italy
| | - Luca Mazzucchelli
- Division of Pathology, Cantonal Institute of Pathology, Locarno, Switzerland
| | - Franco Cavalli
- Institute of Oncology Research, Bellinzona, Switzerland; and
| | - Emanuele Zucca
- International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Department of Medical Oncology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Davide Rossi
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Brune MM, Rau A, Overkamp M, Flaadt T, Bonzheim I, Schürch CM, Federmann B, Dirnhofer S, Fend F, Tzankov A. Molecular Progression of Myeloproliferative and Myelodysplastic/Myeloproliferative Neoplasms: A Study on Sequential Bone Marrow Biopsies. Cancers (Basel) 2021; 13:5605. [PMID: 34830756 PMCID: PMC8615857 DOI: 10.3390/cancers13225605] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Myeloproliferative neoplasms (MPN) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN) both harbor the potential to undergo myelodysplastic progression or acceleration and can transform into blast-phase MPN or MDS/MPN, a form of secondary acute myeloid leukemia (AML). Although the initiating transforming events are yet to be determined, current concepts suggest a stepwise acquisition of (additional) somatic mutations-apart from the initial driver mutations-that trigger disease evolution. In this study we molecularly analyzed paired bone marrow samples of MPN and MDS/MPN patients with known progression and compared them to a control cohort of patients with stable disease course. Cases with progression displayed from the very beginning a higher number of mutations compared to stable ones, of which mutations in five (ASXL1, DNMT3A, NRAS, SRSF2 and TP53) strongly correlated with progression and/or transformation, even if only one of these genes was mutated, and this particularly applied to MPN. TET2 mutations were found to have a higher allelic frequency than the putative driver mutation in three progressing cases ("TET2-first"), whereas two stable cases displayed a TET2-positive subclone ("TET2-second"), supporting the hypothesis that not only the sum of mutations but also their order of appearance matters in the course of disease. Our data emphasize the importance of genetic testing in MPN and MDS/MPN patients in terms of risk stratification and identification of imminent disease progression.
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Affiliation(s)
- Magdalena M. Brune
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4031 Basel, Switzerland; (M.M.B.); (S.D.)
| | - Achim Rau
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
| | - Mathis Overkamp
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
| | - Tim Flaadt
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
| | - Irina Bonzheim
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
| | - Christian M. Schürch
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
- Institute of Pathology, University of Bern, Murtenstrasse 8, CH-3008 Bern, Switzerland
| | - Birgit Federmann
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4031 Basel, Switzerland; (M.M.B.); (S.D.)
| | - Falko Fend
- Institute of Pathology and Neuropathology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.R.); (M.O.); (T.F.); (I.B.); (C.M.S.); (B.F.)
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, CH-4031 Basel, Switzerland; (M.M.B.); (S.D.)
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32
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Gasljevic G, Matter MS, Blatnik O, Unk M, Dirnhofer S. NUT Carcinoma: A Clinical, Morphological and Immunohistochemical Mimicker-The Role of RNA Sequencing in the Diagnostic Procedure. Int J Surg Pathol 2021; 30:273-277. [PMID: 34738485 PMCID: PMC9003774 DOI: 10.1177/10668969211047981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: NUT carcinoma is a highly aggressive and rare subset of squamous cell carcinoma with grim prognosis. It is under-recognized by both pathologists and oncologists. Recognition is challenging due to its rareness and the fact that its clinical and laboratory features as well as morphological and immunohistochemical characteristics may mimic other malignancies. Case presentation: An interesting case of NUT carcinoma in a 47-year-old male with a large tumor mass in the inferior part of the mediastinum and left lung and increased levels of serum alpha fetoprotein (AFP) is described. Immunohistochemical analysis of both the primary tumor in a bronchoscopy specimen and an excisional biopsy of a subcutaneous metastasis showed positivity for AFP and leukocyte common antigen (LCA) that were misleading and resulted in diagnostic pitfalls of mediastinal germ cell tumor (clinically) and hematolymphoid neoplasm (pathologic report). Immunohistochemical demonstration of NUT protein expression revealed the proper diagnosis, which was further confirmed by RNA sequencing revealing a BRD4-NUTM1 gene fusion.Conclusions: Since NUT carcinoma can show a wide spectrum of histological and immunophenotypic features and can clinically mimic other tumors, use of RNA sequencing with identification of specific NUTM1 fusion partner could be crucial when there are discrepant clinical and histopathological findings. As well, since the category of so-called NUTM1-rearranged neoplasms is rapidly expanding, identification of NUTM1 fusion partner may be essential for the appropriate clinical management.
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Affiliation(s)
- Gorana Gasljevic
- 68196Department of Pathology, Zaloska 2, Ljubljana 1000, Slovenia
| | - Matthias S Matter
- 30262University Hospital Basel, University of Basel, Basel, Switzerland
| | - Olga Blatnik
- 68196Department of Pathology, Zaloska 2, Ljubljana 1000, Slovenia
| | - Mojca Unk
- Department of Medical Oncology, Zaloska 2, Ljubljana 1000, Slovenia
| | - Stefan Dirnhofer
- 30262University Hospital Basel, University of Basel, Basel, Switzerland
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33
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Condoluci A, Théaudin M, Schwotzer R, Pazhenkottil AP, Arosio P, Averaimo M, Bacher U, Bode P, Cavalli A, Dirnhofer S, Djerbi N, Dobner S, Fehr T, Garofalo M, Gaspert A, Gerull S, Heimgartner R, Hübers A, Jung HH, Kessler C, Knöpfel R, Laptseva N, Magini G, Manka R, Mazzucchelli L, Meyer M, Mihaylova V, Monney P, Mylonas A, Nkoulou R, Pabst T, Pfister O, Rüfer A, Schmidt A, Seeger H, Stämpfli SF, Stirnimann G, Suter T, Treglia G, Tzankov A, Vetter F, Zweier M, Flammer AJ, Gerber B. Management of transthyretin amyloidosis. Swiss Med Wkly 2021; 151:w30053. [PMID: 34694105 DOI: 10.4414/smw.2021.w30053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Transthyretin amyloidosis (ATTR amyloidosis) is a disease caused by deposition of transthyretin fibrils in organs and tissues, which causes their dysfunction. The clinical heterogeneity of ATTR amyloidosis and the variable presentation of symptoms at early disease stages, historically meant treatment delays. Diagnostic tools and therapy options of ATTR amyloidosis have markedly improved in recent years. The first Swiss Amyloidosis Network (SAN) meeting (Zurich, Switzerland, January 2020) aimed to define a consensus statement regarding the diagnostic work-up and treatment for systemic amyloidosis, tailored to the Swiss healthcare system. A consortium of 45 clinicians and researchers from all Swiss regions and universities was selected by the SAN committee to represent all sub-specialty groups involved in care of patients with amyloidosis. A steering committee conducted the literature search and analysis, wrote the critical synthesis and elaborated a list of statements that were evaluated by all the participants. These recommendations will improve outcomes and quality of life for patients with ATTR amyloidosis. A global review of these guidelines is planned every 3 years with a formal meeting of all the involved experts.
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Affiliation(s)
- Adalgisa Condoluci
- Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Marie Théaudin
- Department of Neurology, Neuromuscular Unit, University Hospital and University of Lausanne, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Haematology, University Hospital of Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland.,Cardiac Imaging, Department of Nuclear Medicine, University Hospital and University of Zurich, Switzerland
| | - Paolo Arosio
- Department of Chemistry and Applied Biosciences, ETHZ, Zurich, Switzerland
| | | | - Ulrike Bacher
- Department of Haematology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Peter Bode
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Switzerland
| | - Andrea Cavalli
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Department of Medical Genetics and Pathology, University Hospital and University of Basel, Switzerland
| | - Nadia Djerbi
- Department of Medical Oncology and Haematology, University Hospital of Zurich, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Maura Garofalo
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Ariana Gaspert
- Department of Pathology and Molecular Pathology, University Hospital and University of Zurich, Switzerland
| | - Sabine Gerull
- Department of Hematology, Cantonal Hospital Aarau, Switzerland
| | - Raphael Heimgartner
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Annemarie Hübers
- Department of Neurology, University Hospital and University of Geneva, Switzerland
| | - Hans H Jung
- Department of Neurology, University Hospital and University Zurich, Switzerland
| | - Chiara Kessler
- Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Raphael Knöpfel
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Natallia Laptseva
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland
| | - Giulia Magini
- Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich,Switzerland
| | | | - Martin Meyer
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland
| | - Violeta Mihaylova
- Department of Neurology, University Hospital and University Zurich, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital and University of Lausanne, Switzerland
| | - Alessio Mylonas
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - René Nkoulou
- Department of Cardiology, University Hospital and University of Geneva, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital and University of Basel, Switzerland
| | - Axel Rüfer
- Department of Haematology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Adrian Schmidt
- Department of Internal Medicine, Clinic for Medical Oncology and Haematology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Harald Seeger
- Department of Nephrology, University Hospital and University Zurich, Switzerland
| | - Simon F Stämpfli
- Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital, University Hospital and University of Bern, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, University Hospital and University of Lausanne, Switzerland.,Faculty of Biomedical sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alexandar Tzankov
- Department of Medical Genetics and Pathology, University Hospital and University of Basel, Switzerland
| | - Friederike Vetter
- Department of Medical Oncology and Haematology, University Hospital of Zurich, Switzerland
| | - Markus Zweier
- Institute of Medical Genetics, University of Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Centre, University Hospital and University Zurich, Switzerland
| | - Bernhard Gerber
- Division of Haematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,University of Zurich, Switzerland
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34
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Genta S, Ghilardi G, Cascione L, Juskevicius D, Tzankov A, Schär S, Giovanella L, Hayoz S, Mamot C, Dirnhofer S, Zucca E, Ceriani L. INTEGRATION OF BASELINE METABOLIC PARAMETERS AND MUTATIONAL PROFILE PREDICTS OUTCOME IN DLBCL PATIENTS. A
POST HOC
ANALYSIS OF SAKK38/07 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.18_2879] [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)
- S Genta
- Oncology Institute of Southern Switzerland Clinic of Medical Oncology Bellinzona Switzerland
| | - G Ghilardi
- Oncology Institute of Southern Switzerland Clinic of Hematology Bellinzona Switzerland
| | - L Cascione
- Università della Svizzera Italiana Institute of Oncology Research Faculty of Biomedical Sciences Bellinzona Switzerland
| | - D Juskevicius
- University Hospital Basel, University of Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - A Tzankov
- University Hospital Basel, University of Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - S Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center Coordinating Center Bern Switzerland
| | - L Giovanella
- Imaging Institute of Southern Switzerland Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Bellinzona Switzerland
| | - S Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center Coordinating Center Bern Switzerland
| | - C Mamot
- Cantonal Hospital Aarau Division of Oncology Aarau Switzerland
| | - S Dirnhofer
- University Hospital Basel, University of Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - E Zucca
- Oncology Institute of Southern Switzerland Clinic of Medical Oncology Bellinzona Switzerland
| | - L Ceriani
- Imaging Institute of Southern Switzerland Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Bellinzona Switzerland
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35
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Novak U, Fehr M, Schär S, Dreyling M, Scheubeck G, Ramadan S, Zucca E, Zander T, Hess G, Mey U, Ferrero S, Mach N, Boccomini C, Böttcher S, Voegeli M, Cairoli A, Menter T, Dirnhofer S, Gadient S, Eckhardt K, Driessen C, Renner C. SAKK 36/13 ‐ IBRUTINIB PLUS BORTEZOMIB AND IBRUTINIB MAINTENANCE FOR RELAPSED AND REFRACTORY MANTLE CELL LYMPHOMA: FINAL REPORT OF A PHASE I/II TRIAL OF THE EUROPEAN MCL NETWORK. Hematol Oncol 2021. [DOI: 10.1002/hon.62_2879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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)
- U. Novak
- Inselspital, Bern University Hospital Medical Oncology Bern Switzerland
| | - M. Fehr
- Kantonsspital St. Gallen Department of Medical Oncology and Hematology St. Gallen Switzerland
| | - S. Schär
- SAKK Coordinating Center Bern Switzerland
| | - M. Dreyling
- Universität München‐Grossadern Medizinische Klinik III München Germany
| | - G. Scheubeck
- Universität München‐Grossadern Medizinische Klinik III München Germany
| | - S. Ramadan
- IEO, European Institute of Oncology IRCCS Onco‐Hematology Division Milano Italy
| | - E. Zucca
- Oncology Institute of Southern Switzerland Ospedale San Giovanni Bellinzona Switzerland
| | - T. Zander
- Kantonsspital Luzern Department Oncology Luzern Switzerland
| | - G. Hess
- Johannes Gutenberg Universität Mainz Universitätsmedizin Mainz Germany
| | - U. Mey
- Kantonsspital Graubünden Department of Oncology and Hematology Chur Switzerland
| | - S. Ferrero
- AOU "Città della Salute e della Scienza di Torino" Hematology 1 Torino Italy
| | - N. Mach
- University Hospital of Geneva Department of Oncology Genève Switzerland
| | - C. Boccomini
- AOU "Città della Salute e della Scienza di Torino" Hematology 1 Torino Italy
| | - S. Böttcher
- Rostock University Medical Center Department of Medicine, Clinic III ‐ Hematology, Oncology Palliative Medicine Rostock Germany
| | - M. Voegeli
- Kantonsspital Baselland Oncology Liestal Switzerland
| | - A. Cairoli
- CHUV University Hospital and University of Lausanne Service et Laboratoire Central d'Hématologie Département d'Oncologie Lausanne Switzerland
| | - T. Menter
- University Hospital Basel Institute of Pathology and Medical Genetics Basel Switzerland
| | - S. Dirnhofer
- University Hospital Basel Institute of Pathology and Medical Genetics Basel Switzerland
| | - S. Gadient
- SAKK Coordinating Center Bern Switzerland
| | | | - C. Driessen
- Kantonsspital St. Gallen Department of Medical Oncology and Hematology St. Gallen Switzerland
| | - C. Renner
- Onkozentrum, Hirslanden & Zürich Zürich Switzerland
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36
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Bonfiglio F, Bruscaggin A, Guidetti F, Terzi di Bergamo L, Faderl M, Spina V, Condoluci A, Bonomini L, Forestieri G, Koch R, Piffaretti D, Pini K, Pirosa MC, Cittone MG, Arribas A, Lucioni M, Ghilardi G, Wu W, Arcaini L, Baptista MJ, Bastidas G, Bea S, Boldorini R, Broccoli A, Canzonieri V, Cascione L, Ceriani L, Cogliatti S, Derenzini E, Devizzi L, Dietrich S, Elia AR, Facchetti F, Gaidano G, Garcia JF, Gerber B, Ghia P, Silva MG, Gritti G, Guidetti A, Hitz F, Inghirami G, Ladetto M, Lopez‐Guillermo A, Lucchini E, Maiorana A, Marasca R, Matutes E, Meignin V, Merli M, Moccia A, Mollejo M, Montalban C, Novak U, Oscier DG, Passamonti F, Piazza F, Pizzolitto S, Sabattini E, Salles G, Santambrogio E, Scarfó L, Stathis A, Stüssi G, Geyer JT, Tapia G, Thieblemont C, Tousseyn T, Tucci A, Visco C, Vitolo U, Zenz T, Zinzani PL, Khiabanian H, Calcinotto A, Bertoni F, Bhagat G, Campo E, Leval L, Dirnhofer S, Pileri SA, Piris MÁ, Traverse‐Glehen A, Tzankov A, Paulli M, Ponzoni M, Mazzucchelli L, Cavalli F, Zucca E, Rossi D. GENETIC AND PHENOTYPIC ATTRIBUTES OF SPLENIC MARGINAL ZONE LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.43_2879] [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: 11/05/2022]
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37
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Ceriani L, Milan L, Cascione L, Gritti G, Dalmasso F, Esposito F, Schär S, Bruno A, Dirnhofer S, Giovanella L, Hayoz S, Mamot C, Rambaldi A, Chauvie S, Zucca E. DEVELOPMENT AND VALIDATION OF A PET RADIOMICS PROGNOSTIC MODEL FOR DIFFUSE LARGE B CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.22_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L Ceriani
- Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Lugano Switzerland
| | - L Milan
- Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Lugano Switzerland
| | - L Cascione
- Università della Svizzera Italiana Institute of Oncology Research Faculty of Biomedical Sciences Bellinzona Switzerland
| | - G Gritti
- Azienda Ospedaliera Papa Giovanni XXIII Hematology Unit Bergamo Italy
| | - F Dalmasso
- Santa Croce e Carle Hospital Medical Physics Unit Cuneo Italy
| | - F Esposito
- Ente Ospedaliero Cantonale Institute of Southern Switzerland Clinic of Medical Oncology Bellinzona Switzerland
| | - Säm Schär
- Swiss Group for Clinical Cancer Research (SAKK) Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center Bern Switzerland
| | - A Bruno
- Azienda Ospedaliera Papa Giovanni XXIII Department of Nuclear Medicine Bergamo Italy
| | - S Dirnhofer
- University Hospital Basel Institute of Medical Genetics and Pathology Basel Switzerland
| | - L Giovanella
- Ente Ospedaliero Cantonale Clinic of Nuclear Medicine and PET/CT Center Lugano Switzerland
| | - S Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center Bern Switzerland
| | - C Mamot
- Cantonal Hospital Aarau Division of Oncology Aarau Switzerland
| | - A Rambaldi
- Azienda Ospedaliera Papa Giovanni XXIII Hematology Unit Bergamo Italy
| | - S Chauvie
- Santa Croce e Carle Hospital Medical Physics Unit Cuneo Italy
| | - E Zucca
- Ente Ospedaliero Cantonale Institute of Southern Switzerland Clinic of Medical Oncology Bellinzona Switzerland
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38
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Dirnhofer S, Vela V, Juskevicius D, Menter T, Tzankov A. MUTATIONAL LANDSCAPE OF MARGINAL ZONE B‐CELL LYMPHOMAS OF VARIOUS ORIGIN: ORGANOTYPIC ALTERATIONS AND DIAGNOSTIC POTENTIAL FOR ASSIGNMENT OF ORGAN ORIGIN. Hematol Oncol 2021. [DOI: 10.1002/hon.17_2880] [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)
- S Dirnhofer
- University Hospital Basel Pathology, Basel Switzerland
| | - V Vela
- University Hospital Basel Pathology, Basel Switzerland
| | - D Juskevicius
- University Hospital Basel Pathology, Basel Switzerland
| | - T Menter
- University Hospital Basel Pathology, Basel Switzerland
| | - A Tzankov
- University Hospital Basel Pathology, Basel Switzerland
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39
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Drexler B, Tzankov A, Martinez M, Baerlocher S, Passweg JR, Dirnhofer S, Tsakiris DA, Dirks J. Blast counts are lower in the aspirate as compared to trephine biopsy in acute myeloid leukemia and myelodysplastic syndrome expressing CD56. Int J Lab Hematol 2021; 43:1078-1084. [PMID: 33709561 DOI: 10.1111/ijlh.13508] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION CD56 is aberrantly expressed in myeloid neoplasms including myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Considering the adhesion effects of CD56, blast quantification in bone marrow might depend on the technique used to obtain respective diagnostic specimens. Therefore, the objective of our study was to investigate the impact of CD56-expression on blast counts in myeloid neoplasms comparing bone marrow aspirates to biopsies. METHODS We retrospectively analyzed 75 patients diagnosed with MDS and AML. We compared patients with (n = 36) and without (n = 39) CD56-expression by flow cytometry with respect to their blast quantities assessed on bone marrow aspirates versus biopsies. RESULTS The frequency of CD56-expression on blasts correlated with higher blast counts on biopsies vs. aspirate smears (rs = 0.52; P = .001). This difference in blast counts was only significant in the CD56 high expressing subgroup (median 68%, 5.5%-95% in biopsy compared to median 32.5%, 1.5%-90% in aspirate; P < .01). The percentage of CD56-positive blasts among the total blast population was lower in the peripheral blood compared to bone marrow (median 31%, 6%-88% vs. 55%, 14%-98%; P = .016). The discrepancy in the blast count between the aspirate and trephine biopsy would have led to misclassification of four cases as MDS instead of AML, if diagnosis had based on the bone marrow aspirate blast count alone. CONCLUSION Counting blasts in bone marrow aspirates of CD56-positive AML and MDS may be linked to underestimation, potentially leading to misclassification of these myeloid neoplasms, and should therefore be adjusted considering the results obtained on trephine biopsies for reliable diagnosis.
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Affiliation(s)
- Beatrice Drexler
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Maria Martinez
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | | | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | | | - Jan Dirks
- Division of Hematology, University Hospital Basel, Basel, Switzerland
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Vela V, Juskevicius D, Prince SS, Cathomas G, Dertinger S, Diebold J, Bubendorf L, Horcic M, Singer G, Zettl A, Dirnhofer S, Tzankov A, Menter T. Deciphering the genetic landscape of pulmonary lymphomas. Mod Pathol 2021; 34:371-379. [PMID: 32855441 DOI: 10.1038/s41379-020-00660-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/17/2022]
Abstract
Pulmonary lymphoid malignancies comprise various entities, 80% of them are pulmonary marginal zone B-cell lymphomas (PMZL). So far, little is known about point mutations in primary pulmonary lymphomas. We characterized the genetic landscape of primary pulmonary lymphomas using a customized high-throughput sequencing gene panel covering 146 genes. Our cohort consisted of 28 PMZL, 14 primary diffuse large B-cell lymphomas (DLBCL) of the lung, 7 lymphomatoid granulomatoses (LyG), 5 mature small B-cell lymphomas and 16 cases of reactive lymphoid lesions. Mutations were detected in 22/28 evaluable PMZL (median 2 mutation/case); 14/14 DLBCL (median 3 mutations/case) and 4/7 LyG (1 mutation/case). PMZL showed higher prevalence for mutations in chromatin modifier-encoding genes (44% of mutant genes), while mutations in genes related to the NF-κB pathway were less common (24% of observed mutations). There was little overlap between mutations in PMZL and DLBCL. MALT1 rearrangements were more prevalent in PMZL than BCL10 aberrations, and both were absent in DLBCL. LyG were devoid of gene mutations associated with immune escape. The mutational landscape of PMZL differs from that of extranodal MZL of other locations and also from splenic MZL. Their landscape resembles more that of nodal MZL, which also show a predominance of mutations of chromatin modifiers. The different mutational composition of pulmonary DLBCL compared to PMZL suggests that the former probably do not present transformations. DLBCL bear more mutations/case and immune escape gene mutations compared to LyG, suggesting that EBV infection in LyG may substitute for mutations.
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Affiliation(s)
- Visar Vela
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Darius Juskevicius
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Spasenija Savic Prince
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gieri Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | | | - Joachim Diebold
- Institute of Pathology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Lukas Bubendorf
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Milo Horcic
- Institute for Histologic und Cytologic Diagnostics AG, Aarau, Switzerland
| | - Gad Singer
- Institute of Pathology, Cantonal Hospital Baden, Baden, Switzerland
| | - Andreas Zettl
- Institute of Pathology, Viollier AG, Allschwil, Switzerland
| | - Stefan Dirnhofer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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41
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Huettl KS, Staiger AM, Horn H, Frontzek F, Goodlad JR, Tapia G, Rosenwald A, Klapper W, Fend F, Climent F, Castellvi J, Tzankov A, Dirnhofer S, Baptista MJ, Navarro JT, Anagnostopoulos I, Hartmann W, Lenz G, Ott G. Cytokeratin expression in plasmablastic lymphoma - a possible diagnostic pitfall in the routine work-up of tumours. Histopathology 2020; 78:831-837. [PMID: 33165992 DOI: 10.1111/his.14300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/13/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS Plasmablastic lymphoma (PBL) is a rare aggressive B-cell lymphoma that frequently arises at extranodal sites in the setting of immunosuppression. The diagnosis of PBL is complex, owing to a frequent solid or cohesive growth pattern, and an often unusual immunophenotype. Several case reports have described cytokeratin (CK) expression in PBL, introducing a diagnostic pitfall. The aim of this study was to determine the frequency of CK expression in PBL in the largest series available to date. METHODS AND RESULTS By using immunohistochemistry in a cohort of 72 PBLs, we identified CK8/18 positivity in 11 of 72 cases (15%) and AE1/3 positivity in six of 65 cases (9%), clearly contrasting with a control series of non-PBL aggressive B-cell lymphomas (one of 96 diffuse large B-cell lymphomas), as well as with data in the literature describing only occasional CK expression in haematological neoplasms. CONCLUSIONS Our data indicate CK expression in a substantial number (15%) of PBLs. In view of the particular morphological features of PBL and its frequent negativity for the common leukocyte antigen and B-cell markers, this feature represents a pitfall in the routine diagnostic work-up of PBL, and requires more extensive immunohistochemical and molecular characterisation of cases entering the differential diagnosis.
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Affiliation(s)
- Katrin S Huettl
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - 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
| | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.,Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen, Germany
| | - Fabian Frontzek
- Medical Department A, Haematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - John R Goodlad
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Gustavo Tapia
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andreas Rosenwald
- Institute of Pathology, Universität Würzburg and Comprehensive Cancer Centre Mainfranken (CCCMF), Würzburg, Germany
| | - Wolfram Klapper
- Institute of Pathology, Haematopathology Section and Lymph Node Registry, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Centre Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Josep Castellvi
- Department of Pathology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - José-Tomas Navarro
- Department of Haematology, ICO-Germans Trias I Pujol, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Ioannis Anagnostopoulos
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, & Berlin Institute of Health; Medical Department of Hematology, Oncology & Tumor Immunology, Virchow Campus & Molekulares Krebsforschungszentrum, Berlin, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Medical Department A, Haematology, Oncology and Pneumology, University of Münster, Münster, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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42
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Schwotzer R, Flammer AJ, Gerull S, Pabst T, Arosio P, Averaimo M, Bacher VU, Bode P, Cavalli A, Concoluci A, Dirnhofer S, Djerbi N, Dobner SW, Fehr T, Garofalo M, Gaspert A, Heimgartner R, Hübers A, Jung HH, Kessler C, Knöpfel R, Laptseva N, Manka R, Mazzucchelli L, Meyer M, Mihaylova V, Monney P, Mylonas A, Nkoulou R, Pazhenkottil A, Pfister O, Rüfer A, Schmidt A, Seeger H, Stämpfli SF, Stirnimann G, Suter T, Théaudin M, Treglia G, Tzankov A, Vetter F, Zweier M, Gerber B. Expert recommendation from the Swiss Amyloidosis Network (SAN) for systemic AL-amyloidosis. Swiss Med Wkly 2020; 150:w20364. [PMID: 33277911 DOI: 10.4414/smw.2020.20364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Systemic amyloidosis is a heterogeneous group of diseases associated with protein misfolding into insoluble beta-sheet rich structures that deposit extracellularly in different organs, eventually compromising their function. There are more than 30 different proteins, known to be amyloidogenic with “light chain” (AL)-amyloidosis being the most common type, followed by transthyretin (ATTR)-, and amyloid protein A (AA)-amyloidosis. Systemic amyloidosis is a rare disease with an incidence of around 10 patients in 1 million inhabitants. Recently several new therapeutic options have been developed for subgroups of amyloidosis patients, and the introduction of novel therapies for plasma cell myeloma has led to an increase in the therapeutic armamentarium for plasma cell disorders, including AL amyloidosis. Among them, proteasome inhibitors, immunomodulatory agents (-imids), and monoclonal antibodies have been successfully introduced into clinical practice. Still, high-quality data from randomised controlled trials regarding the benefit of these cost-intensive drugs in AL amyloidosis are widely lacking, and due to the rarity of the disease many physicians will not gain routine experience in the management of these frail patients. The diagnosis of AL amyloidosis relies on a close collaboration between clinicians, pathologists, imaging experts, and sometimes geneticists. Diagnosis and treatment options in this complex disorder should be discussed in dedicated multidisciplinary boards. In January 2020, the first meeting of the Swiss Amyloidosis Network took place in Zurich, Switzerland. One aim of this meeting was to establish a consensus guideline regarding the diagnostic work-up and the treatment recommendations for systemic amyloidosis tailored to the Swiss health care system. Forty-five participants from different fields in medicine discussed many aspects of amyloidosis. These are the Swiss Amyloidosis Network recommendations which focus on diagnostic work-up and treatment of AL-amyloidosis.
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Affiliation(s)
- Rahel Schwotzer
- Department of Medical Oncology and Haematology, University Hospital Zurich, Switzerland
| | | | - Sabine Gerull
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Thomas Pabst
- Department of Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Paolo Arosio
- Departement of Chemistry and Applied Biosciences. 'ETHZ', Zurich, Switzerland
| | | | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Peter Bode
- Departement of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Cavalli
- Institute of Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland / Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Adalgisa Concoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Stefan Dirnhofer
- Departement of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Nadia Djerbi
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan W Dobner
- Departement of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Thomas Fehr
- Departement of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Maura Garofalo
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | - Ariana Gaspert
- Departement of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Raphael Heimgartner
- Departement of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Annemarie Hübers
- Departement of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - Hans H Jung
- Departement of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Chiara Kessler
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Raphael Knöpfel
- Departement of Internal Medicine, Hospital Thusis, Thusis, Switzerland
| | - Natallia Laptseva
- Departement of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Hospital, Zurich, Switzerland / Departement of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Martin Meyer
- Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Violeta Mihaylova
- Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessio Mylonas
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - René Nkoulou
- Department of Cardiology, University Hospital and University of Geneva, Geneva, Switzerland
| | - Aju Pazhenkottil
- Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital and University of Basel, Basel, Switzerland
| | - Axel Rüfer
- Department of Hematology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Adrian Schmidt
- Department of Internal Medicine, Clinic for Medical Oncology and Hematology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Harald Seeger
- Department of Nephrology, University Hospital and University Zurich, Zurich, Switzerland
| | - Simon F Stämpfli
- Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Guido Stirnimann
- University Clinic for Visceral Surgery and Medicine, University Hospital Inselspital and University of Bern, Bern, Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marie Théaudin
- Department of Neurology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland / Department of Nuclear Medicine and Molecular Imaging, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alexandar Tzankov
- Department of Medical Genetics and Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - Friederike Vetter
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Markus Zweier
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Bernhard Gerber
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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43
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Menter T, Tzankov A, Dirnhofer S. The tumor microenvironment of lymphomas: Insights into the potential role and modes of actions of checkpoint inhibitors. Hematol Oncol 2020; 39:3-10. [PMID: 33105031 DOI: 10.1002/hon.2821] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/14/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
The tumor microenvironment (TME) - a term comprising non-neoplastic cells and extracellular matrix as well as various cytokines, chemokines, growth factors, and other substances in the vicinity of tumor cells - is an integrative part of most tumors including lymphomas. Interactions between lymphoma cells and the TME are vital for survival and proliferation of the former. In addition, lymphoma cells often reprogram the TME to protect them from defense mechanisms of the host's immune system. In this review, we will introduce the role of the tumor microenvironment (TME) for lymphoma cells looking at direct cell-cell interactions as well as cytokine-related communications. The immunomodulative/immunosuppressive role of the TME is more and more coming into the focus of potential new targeted therapies, and thus a special attention will be given to the interactions of immune checkpoints such as programed cell death protein 1 and L1 (PD-1/PD-L1), T-cell immunoglobulin and mucin-domain containing protein-3 (TIM-3), lymphocyte-activation gene 3 (LAG-3), and cytotoxic T-lymphocyte-associated protein-4 (CTLA4) with the TME, as well as their expression by both lymphoma cells and cells of the TME. Aspects of the TME will be discussed for indolent and aggressive B-cell lymphomas, Hodgkin lymphomas, and T-cell lymphomas. In addition, the potential influence of other immunomodulators such as lenalidomide will be briefly touched. The complex role of the TME is in the focus of new therapeutic options. In order to exploit its full therapeutic potential, however, a thorough understanding of TME biology and interaction between lymphoma cells and the TME, as well as the host's immune system and the TME is necessary.
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Affiliation(s)
- Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
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44
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Zucca E, Cascione L, Ruberto T, Facchinelli D, Schär S, Hayoz S, Dirnhofer S, Giovanella L, Bargetzi M, Mamot C, Ceriani L. Prognostic models integrating quantitative parameters from baseline and interim positron emission computed tomography in patients with diffuse large B-cell lymphoma: post-hoc analysis from the SAKK38/07 clinical trial. Hematol Oncol 2020; 38:715-725. [PMID: 32947651 DOI: 10.1002/hon.2805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/14/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 12/22/2022]
Abstract
Positron emission computed tomography (PET/CT) in patients with diffuse large B-cell lymphoma (DLBCL) enrolled in a prospective clinical trial were reviewed to test the impact of quantitative parameters from interim PET/CT scans on overall (OS) and progression-free (PFS) survival. We centrally reviewed baseline and interim PET/CT scans of 138 patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone given every 14 days (R-CHOP14) in the SAKK38/07 trial (ClinicalTrial.gov identifier: NCT00544219). Cutoff values for maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and metabolic heterogeneity (MH) were defined by receiver operating characteristic analysis. Responses were scored using the Deauville scale (DS). Patients with DS 5 at interim PET/CT (defined by uptake >2 times higher than in normal liver) had worse PFS (P = 0.014) and OS (P < 0.0001). A SUVmax reduction (Δ) greater than 66% was associated with longer PFS (P = 0.0027) and OS (P < 0.0001). Elevated SUVmax , MTV, TLG, and MH at interim PET/CT also identified patients with poorer outcome. At multivariable analysis, ΔSUVmax and baseline MTV appeared independent outcome predictors. A prognostic model integrating ΔSUVmax and baseline MTV discriminated three risk groups with significantly (log-rank test for trend, P < 0.0001) different PFS and OS. Moreover, the integration of MH and clinical prognostic indices could further refine the prediction of OS. PET metrics-derived prognostic models perform better than the international indices alone. Integration of baseline and interim PET metrics identified poor-risk DLBCL patients who might benefit from alternative treatments.
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Affiliation(s)
- Emanuele Zucca
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Università della Svizzera italiana, Bellinzona, Switzerland.,Department of Medical Oncology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luciano Cascione
- Institute of Oncology Research, Università della Svizzera italiana, Bellinzona, Switzerland.,SIB-Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Teresa Ruberto
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Davide Facchinelli
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sämi Schär
- Coordinating Center, SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Stefanie Hayoz
- Coordinating Center, SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luca Giovanella
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.,Division of Nuclear Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | - Mario Bargetzi
- Oncology Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Christoph Mamot
- Oncology Center, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Luca Ceriani
- Institute of Oncology Research, Università della Svizzera italiana, Bellinzona, Switzerland.,Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
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45
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Pillonel V, Juskevicius D, Bihl M, Stenner F, Halter JP, Dirnhofer S, Tzankov A. Routine next generation sequencing of lymphoid malignancies: clinical utility and challenges from a 3-Year practical experience. Leuk Lymphoma 2020; 61:2568-2583. [PMID: 32623938 DOI: 10.1080/10428194.2020.1786560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Since 2016, a next-generation sequencing (NGS) panel targeting 68 genes frequently mutated in lymphoid malignancies is an accredited part of routine diagnostics at the Institute of Pathology in Basel, Switzerland. Here, we retrospectively evaluate the feasibility and utility of integrating this NGS platform into routine practice on 80 diagnostic cases of lymphoid proliferations. NGS analysis was useful in most instances, yielding a diagnostically, predictively and/or prognostically meaningful result. In 35 out of the 50 cases, in which conventional histopathological evaluation remained indecisive, molecular subtyping with the NGS panel was helpful to either confirm or support the favored diagnosis, enable a differential diagnosis, or seriously question a suspected diagnosis. A total of 61 actionable or potentially actionable mutations in 34 out of 80 cases that might have enabled patient selection for targeted therapies was detected. NGS panel analysis had implications for prognosis in all 15 cases interrogated for risk assessment.
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Affiliation(s)
- Vincent Pillonel
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland.,Department of Medical Oncology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Darius Juskevicius
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Michel Bihl
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Frank Stenner
- Department of Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Jörg P Halter
- Department of Medicine, Division of Hematology, University Hospital Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
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46
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Menter T, Hayoz S, Zucca E, Kimby E, Dirnhofer S, Tzankov A. Immunomodulatory drugs may overcome the negative prognostic role of active Th17 axis in follicular lymphoma: evidence from the SAKK35/10 trial. Br J Haematol 2020; 190:e258-e261. [PMID: 32525232 DOI: 10.1111/bjh.16876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Thomas Menter
- Institute of Pathology and Medical Genetics, University Hospital Basel, Bern, Switzerland
| | | | - Emanuele Zucca
- Division of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Bellinzona, Switzerland.,Department of Medical Oncology, Inselspital/Bern University Hospital, Bern, Switzerland
| | - Eva Kimby
- Division of Hematology, Department of Medicine at Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Dirnhofer
- Institute of Pathology and Medical Genetics, University Hospital Basel, Bern, Switzerland
| | - Alexandar Tzankov
- Institute of Pathology and Medical Genetics, University Hospital Basel, Bern, Switzerland
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47
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Lysenko V, Wildner-Verhey van Wijk N, Zimmermann K, Weller MC, Bühler M, Wildschut MHE, Schürch P, Fritz C, Wagner U, Calabresi L, Psaila B, Flavell RA, Vannucchi AM, Mead AJ, Wild PJ, Dirnhofer S, Manz MG, Theocharides APA. Enhanced engraftment of human myelofibrosis stem and progenitor cells in MISTRG mice. Blood Adv 2020; 4:2477-2488. [PMID: 32502268 PMCID: PMC7284099 DOI: 10.1182/bloodadvances.2019001364] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
The engraftment potential of myeloproliferative neoplasms in immunodeficient mice is low. We hypothesized that the physiological expression of human cytokines (macrophage colony-stimulating factor, interleukin-3, granulocyte-macrophage colony-stimulating factor, and thrombopoietin) combined with human signal regulatory protein α expression in Rag2-/-Il2rγ-/- (MISTRG) mice might provide a supportive microenvironment for the development and maintenance of hematopoietic stem and progenitor cells (HSPC) from patients with primary, post-polycythemia or post-essential thrombocythemia myelofibrosis (MF). We show that MISTRG mice, in contrast to standard immunodeficient NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ and Rag2-/-Il2rγ-/- mice, supported engraftment of all patient samples investigated independent of MF disease stage or risk category. Moreover, MISTRG mice exhibited significantly higher human MF engraftment levels in the bone marrow, peripheral blood, and spleen and supported secondary repopulation. Bone marrow fibrosis development was limited to 3 of 14 patient samples investigated in MISTRG mice. Disease-driving mutations were identified in all xenografts, and targeted sequencing revealed maintenance of the primary patient sample clonal composition in 7 of 8 cases. Treatment of engrafted mice with the current standard-of-care Janus kinase inhibitor ruxolitinib led to a reduction in human chimerism. In conclusion, the established MF patient-derived xenograft model supports robust engraftment of MF HSPCs and maintains the genetic complexity observed in patients. The model is suited for further testing of novel therapeutic agents to expedite their transition into clinical trials.
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Affiliation(s)
- Veronika Lysenko
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | | | - Kathrin Zimmermann
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Marie-Christine Weller
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Marco Bühler
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Mattheus H E Wildschut
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Patrick Schürch
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Christine Fritz
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Wagner
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Laura Calabresi
- Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero, Universitaria Careggi, University of Florence, Florence, Italy
| | - Bethan Psaila
- Haematopoietic Stem Cell Biology Laboratory, Medical Research Council Weatherall Institute of Molecular Medicine
- Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, and
- National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | | | - Alessandro M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliero, Universitaria Careggi, University of Florence, Florence, Italy
| | - Adam J Mead
- Haematopoietic Stem Cell Biology Laboratory, Medical Research Council Weatherall Institute of Molecular Medicine
- Medical Research Council Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, and
- National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany; and
| | - Stefan Dirnhofer
- Institute of Pathology, University Hospital, University of Basel, Basel, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Alexandre P A Theocharides
- Department of Medical Oncology and Hematology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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48
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Ceriani L, Gritti G, Cascione L, Pirosa MC, Polino A, Ruberto T, Stathis A, Bruno A, Moccia AA, Giovanella L, Hayoz S, Schär S, Dirnhofer S, Rambaldi A, Martinelli G, Mamot C, Zucca E. SAKK38/07 study: integration of baseline metabolic heterogeneity and metabolic tumor volume in DLBCL prognostic model. Blood Adv 2020; 4:1082-1092. [PMID: 32196557 PMCID: PMC7094027 DOI: 10.1182/bloodadvances.2019001201] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/01/2020] [Indexed: 01/07/2023] Open
Abstract
Several functional parameters from baseline (18)F-fluorodeoxyglucose positron emission tomography (PET)/computed tomography have been proposed as promising biomarkers of treatment efficacy in diffuse large B-cell lymphoma (DLBCL). We tested their ability to predict outcome in 2 cohorts of DLBCL patients receiving conventional immunochemotherapy (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone [R-CHOP] regimen), either every 14 (R-CHOP14) or 21 days (R-CHOP21). Baseline PET analysis was performed in 141 patients with DLBCL treated with R-CHOP14 in the prospective SAKK38/07 study (NCT00544219) of the Swiss Group for Clinical Cancer Research (testing set). Reproducibility was examined in a validation set of 113 patients treated with R-CHOP21. In the SAKK38/07 cohort, progression-free survival (PFS) at 5 years was 83% for patients with low metabolic tumor volume (MTV) and 59% for those with high MTV (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.6-7.0; P = .0005), whereas overall survival (OS) was 91% and 64%, respectively (HR, 4.4; 95% CI, 1.9-10; P = .0001). MTV was the most powerful predictor of outcome also in the validation set. Elevated metabolic heterogeneity (MH) significantly predicted poorer outcomes in the subgroups of patients with elevated MTV. A model integrating MTV and MH identified high-risk patients with shorter PFS (testing set: HR, 5.6; 95% CI, 1.8-17; P < .0001; validation set: HR, 5.6; 95% CI, 1.7-18; P = .0002) and shorter OS (testing set: HR, 9.5; 95% CI, 1.7-52; P < .0001; validation set: HR, 7.6; 95% CI, 2.0-28; P = .0003). This finding was confirmed by an unsupervised regression tree analysis indicating that prognostic models based on MTV and MH may allow early identification of refractory patients who might benefit from treatment intensification. This trial was registered at www.clinicaltrials.gov as #NCT00544219.
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Affiliation(s)
- Luca Ceriani
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Giuseppe Gritti
- Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Maria Cristina Pirosa
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Angela Polino
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Teresa Ruberto
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anastasios Stathis
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Andrea Bruno
- Department of Nuclear Medicine, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Alden A Moccia
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Division of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefanie Hayoz
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Sämi Schär
- Swiss Group for Clinical Cancer Research (SAKK) Coordinating Center, Bern, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Switzerland
| | - Alessandro Rambaldi
- Hematology Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | | | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Haefliger S, Marston K, Juskevicius D, Meyer-Schaller N, Forster A, Nicolet S, Komminoth P, Stauffer E, Cathomas G, Hoeller S, Tornillo L, Dirnhofer S, Terracciano LM, Bihl M, Matter MS. Molecular Profile of Gastrointestinal Stromal Tumors in Sixty-Eight Patients from a Single Swiss Institution. Pathobiology 2020; 87:171-178. [PMID: 32079019 DOI: 10.1159/000505407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/28/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. It has distinct molecular features and primarily affects the KIT and PDGFRA genes. OBJECTIVE We wanted to assess the molecular profile of 68 GIST patients who were sequenced consecutively between 2014 and 2019 at our institute of pathology. METHODS Our cohort comprised 60 primary and 8 metastatic GIST patients; 43 and 57% of the cases, respectively, were analyzed by Sanger sequencing or next-generation sequencing (NGS). RESULTS Of the 60 primary GIST patients, 47 (78%) showed a KIT mutation; 2 cases showed a double KIT mutation, and 1 of these was a therapy-naive GIST. Nine (15%) patients harbored a PDGFRA mutation, 2 (3%) had a BRAF mutation, 1 (2%) had a PIK3CA mutation, and 1 (2%) did not show any mutation. One BRAF and the PIK3CA mutation have not been described in GIST before. All metastatic GIST harbored exclusively KIT mutations. CONCLUSION A retrospective analysis of GIST sequenced at our institute revealed incidences of KIT and PDGFRA mutations comparable to those in other cohorts from Europe. Interestingly, we found 2 previously undescribed mutations in the BRAF and PIK3CA genes as well as 1 treatment-naive case with a double KIT mutation in exon 11.
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Affiliation(s)
- Simon Haefliger
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Katharina Marston
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Darius Juskevicius
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | | | - Anja Forster
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Nicolet
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Paul Komminoth
- Institute of Pathology, Stadtspital Triemli, Zürich, Switzerland
| | - Edouard Stauffer
- Institute of Pathology, Promed Laboratoire Médical SA, Fribourg, Switzerland
| | - Gieri Cathomas
- Institute of Pathology, Kantonsspital Basel-Land, Liestal, Switzerland
| | - Sylvia Hoeller
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Luigi Tornillo
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | | | - Michel Bihl
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland
| | - Matthias S Matter
- Institute of Pathology, University Hospital of Basel, Basel, Switzerland,
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50
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Vela V, Juskevicius D, Gerlach MM, Meyer P, Graber A, Cathomas G, Dirnhofer S, Tzankov A. High throughput sequencing reveals high specificity of TNFAIP3 mutations in ocular adnexal marginal zone B-cell lymphomas. Hematol Oncol 2020; 38:284-292. [PMID: 32012328 DOI: 10.1002/hon.2718] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/30/2019] [Revised: 01/15/2020] [Accepted: 01/24/2020] [Indexed: 11/08/2022]
Abstract
The majority of ocular adnexal (OA) lymphomas (OAL) are extranodal marginal zone lymphomas (MZL). First high throughput sequencing (HTS) studies on OA-MZL showed inconsistent results and the distribution of mutations in reactive lymphoid lesions of this anatomic region has not yet been sufficiently addressed. We characterized OAL and lymphoid lesions of the OA by targeted HTS. The study included 34 OA-MZL, 11 chronic conjunctivitis, five mature small cell B-cell lymphomas spreading to the OA, five diseases with increase of IgG4+ plasma cells, three Burkitt lymphomas (BL), three diffuse large B-cell lymphomas (DLBCL), three mantle cell lymphomas, three idiopathic orbital inflammations/orbital pseudo tumors (PT), and three OA lymphoid hyperplasia. All cases were negative for Chlamydia. The mutational number was highest in BL and lowest in PT. The most commonly (and exclusively) mutated gene in OA-MZL was TNFAIP3 (10 of 34 cases). Altogether, 20 out of 34 patients harbored mutually exclusive mutations of either TNFAIP3, BCL10, MYD88, ATM, BRAF, or NFKBIE, or nonexclusive mutations of IRF8, TNFRSF14, KLHL6, and TBL1XR1, all encoding for NK-κB pathway compounds or regulators. Thirteen patients (38%) had, to a great part, mutually exclusive mutations of chromatin modifier-encoding genes: KMT2D, CREBBP, BCL7A, DNMT3A, EP300, or HIST1H1E. Only four patients harbored co-occurring mutations of genes encoding for NK-κB compounds and chromatin modifiers. Finally, PTEN, KMT2D, PRDM1, and HIST1H2BK mutations were observable in reactive lymphoid lesions too, while such instances were devoid of NF-κB compound mutations and/or mutations of acetyltransferase-encoding genes. In conclusion, 80% of OA-MZL display mutations of either NK-κB compounds or chromatin modifiers. Lymphoid lesions of the OA bearing NF-κB compound mutations and/or mutations of acetyltransferase-encoding genes highly likely represent lymphomas.
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Affiliation(s)
- Visar Vela
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Darius Juskevicius
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Magdalena M Gerlach
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Peter Meyer
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland.,Eye Clinic, University Hospital Basel, Basel, Switzerland
| | - Anne Graber
- Cantonal Institute of Pathology, Liestal, Switzerland
| | | | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
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