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Croci GA, Au-Yeung RKH, Reinke S, Staiger AM, Koch K, Oschlies I, Richter J, Poeschel V, Held G, Loeffler M, Trümper L, Rosenwald A, Ott G, Spang R, Altmann B, Ziepert M, Klapper W. SPARC-positive macrophages are the superior prognostic factor in the microenvironment of diffuse large B-cell lymphoma and independent of MYC rearrangement and double-/triple-hit status. Ann Oncol 2021; 32:1400-1409. [PMID: 34438040 DOI: 10.1016/j.annonc.2021.08.1991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with respect to outcome. Features of the tumor microenvironment (TME) are associated with prognosis when assessed by gene expression profiling. However, it is uncertain whether assessment of the microenvironment can add prognostic information to the most relevant and clinically well-established molecular subgroups when analyzed by immunohistochemistry (IHC). PATIENTS AND METHODS We carried out a histopathologic analysis of biomarkers related to TME in a very large cohort (n = 455) of DLBCL treated in prospective trials and correlated with clinicopathologic and molecular data, including chromosomal rearrangements and gene expression profiles for cell-of-origin and TME. RESULTS The content of PD1+, FoxP3+ and CD8+, as well as vessel density, was not associated with outcome. However, we found a low content of CD68+ macrophages to be associated with inferior progression-free survival (PFS) and overall survival (OS; P = 0.023 and 0.040, respectively) at both univariable and multivariable analyses, adjusted for the factors of the International Prognostic Index (IPI), MYC break and BCL2/MYC and BCL6/MYC double-hit status. The subgroup of PDL1+ macrophages was not associated with survival. Instead, secreted protein acidic and cysteine rich (SPARC)-positive macrophages were identified as the subtype of macrophages most associated with survival. SPARC-positive macrophages and stromal cells directly correlated with favorable PFS and OS (both, P[log rank] <0.001, P[trend] < 0.001). The association of SPARC with prognosis was independent of the factors of the IPI, MYC double-/triple-hit status, Bcl2/c-myc double expression, cell-of-origin subtype and a recently published gene expression signature [lymphoma-associated macrophage interaction signature (LAMIS)]. CONCLUSIONS SPARC expression in the TME detected by a single IHC staining with fair-to-good interobserver reproducibility is a powerful prognostic parameter. Thus SPARC expression is a strong candidate for risk assessment in DLBCL in daily practice.
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Affiliation(s)
- G A Croci
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - R K H Au-Yeung
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - S Reinke
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - A M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tübingen, Germany
| | - K Koch
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - I Oschlies
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - J Richter
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - V Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology, and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - G Held
- DSHNHL Studiensekretariat, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - M Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - L Trümper
- Department of Hematology and Oncology, Georg-August Universität, Göttingen, Germany
| | - A Rosenwald
- Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken (CCCMF), Würzburg, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tübingen, Germany
| | - R Spang
- Statistical Bioinformatics, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - B Altmann
- DSHNHL Studiensekretariat, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - W Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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2
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Leich E, Hoster E, Wartenberg M, Unterhalt M, Siebert R, Koch K, Klapper W, Engelhard M, Puppe B, Horn H, Staiger AM, Stuhlmann-Laeisz C, Bernd HW, Feller AC, Hummel M, Lenze D, Stein H, Hartmann S, Hansmann ML, Möller P, Hiddemann W, Dreyling M, Ott G, Rosenwald A. Similar clinical features in follicular lymphomas with and without breaks in the BCL2 locus. Leukemia 2015; 30:854-60. [PMID: 26621338 DOI: 10.1038/leu.2015.330] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 01/18/2023]
Abstract
Approximately 15% of follicular lymphomas (FLs) lack breaks in the BCL2 locus. The aim of this study was to better define molecular and clinical features of BCL2-breakpoint/t(14;18)-negative FLs. We studied the presence of BCL2, BCL6 and MYC breaks by fluorescence in situ hybridization and the expression of BCL2, MUM1, CD10, P53 and Ki67 in large clinical trial cohorts of 540 advanced-stage FL cases and 116 early-stage disease FL patients treated with chemotherapy regimens and radiation, respectively. A total of 86% and 53% of advanced- and early-stage FLs were BCL2-breakpoint-positive, respectively. BCL2 was expressed in almost all FLs with BCL2 break and also in 86% and 69% of BCL2-breakpoint-negative advanced- and early-stage FLs, respectively. CD10 expression was significantly reduced in BCL2-breakpoint-negative FLs of all stages and MUM1 and Ki67 expression were significantly increased in BCL2-break-negative early-stage FLs. Patient characteristics did not differ between FLs with and without BCL2 breaks and neither did survival times in advanced-stage FLs. These results suggest that the molecular profile differs to some extent between FLs with and without BCL2 breaks and support the notion that FLs with and without BCL2 breaks belong to the same lymphoma entity.
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Affiliation(s)
- E Leich
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - E Hoster
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany
| | - M Wartenberg
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - M Unterhalt
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - R Siebert
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - K Koch
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Engelhard
- Department for Radiotherapy, University Hospital Essen, Essen, Germany
| | - B Puppe
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - H Horn
- Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart and University of Tübingen, Tübingen, Germany
| | - A M Staiger
- Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart and University of Tübingen, Tübingen, Germany
| | - C Stuhlmann-Laeisz
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - H W Bernd
- Institute of Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A C Feller
- Institute of Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - M Hummel
- Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany
| | - D Lenze
- Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany
| | - H Stein
- Pathodiagnostik Berlin, Berlin, Germany
| | - S Hartmann
- Institute of Pathology, University Hospital Frankfurt am, Frankfurt, Germany
| | - M L Hansmann
- Institute of Pathology, University Hospital Frankfurt am, Frankfurt, Germany
| | - P Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | - W Hiddemann
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - M Dreyling
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
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Horn H, Ziepert M, Wartenberg M, Staiger AM, Barth TFE, Bernd HW, Feller AC, Klapper W, Stuhlmann-Laeisz C, Hummel M, Stein H, Lenze D, Hartmann S, Hansmann ML, Möller P, Cogliatti S, Pfreundschuh M, Trümper L, Loeffler M, Glass B, Schmitz N, Ott G, Rosenwald A. Different biological risk factors in young poor-prognosis and elderly patients with diffuse large B-cell lymphoma. Leukemia 2015; 29:1564-70. [DOI: 10.1038/leu.2015.43] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 02/02/2023]
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Momose S, Weißbach S, Pischimarov J, Nedeva T, Bach E, Rudelius M, Geissinger E, Staiger AM, Ott G, Rosenwald A. The diagnostic gray zone between Burkitt lymphoma and diffuse large B-cell lymphoma is also a gray zone of the mutational spectrum. Leukemia 2015; 29:1789-91. [PMID: 25673238 DOI: 10.1038/leu.2015.34] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- S Momose
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - S Weißbach
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - J Pischimarov
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - T Nedeva
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - E Bach
- Department of Human Genetics, University of Würzburg, Würzburg, Germany
| | - M Rudelius
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - E Geissinger
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - A M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - A Rosenwald
- 1] Institute of Pathology, University of Würzburg, Würzburg, Germany [2] Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
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5
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Dengler MA, Weilbacher A, Gutekunst M, Staiger AM, Vöhringer MC, Horn H, Ott G, Aulitzky WE, van der Kuip H. Discrepant NOXA (PMAIP1) transcript and NOXA protein levels: a potential Achilles' heel in mantle cell lymphoma. Cell Death Dis 2014; 5:e1013. [PMID: 24457957 PMCID: PMC4040662 DOI: 10.1038/cddis.2013.552] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 09/14/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 01/08/2023]
Abstract
Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm with transient response to conventional chemotherapy. We here investigated the role of the Bcl-2 homology domain 3-only protein NOXA for life–death decision in MCL. Surprisingly, NOXA (PMAIP1) mRNA and NOXA protein levels were extremely discrepant in MCL cells: NOXA mRNA was found to be highly expressed whereas NOXA protein levels were low. Chronic active B-cell receptor signaling and to a minor degree cyclin D1 overexpression contributed to high NOXA mRNA expression levels in MCL cells. The phoshatidyl-inositol-3 kinase/AKT/mammalian target of rapamycin pathway was identified as the major downstream signaling pathway involved in the maintenance of NOXA gene expression. Interestingly, MCL cells adapt to this constitutive pro-apoptotic signal by extensive ubiquitination and rapid proteasomal degradation of NOXA protein (T½∼15–30 min). In addition to the proteasome inhibitor Bortezomib, we identified the neddylation inhibitor MLN4924 and the fatty acid synthase inhibitor Orlistat as potent inducers of NOXA protein expression leading to apoptosis in MCL. All inhibitors targeted NOXA protein turnover. In contrast to Bortezomib, MLN4924 and Orlistat interfered with the ubiquitination process of NOXA protein thereby offering new strategies to kill Bortezomib-resistant MCL cells. Our data, therefore, highlight a critical role of NOXA in the balance between life and death in MCL. The discrepancy between NOXA transcript and protein levels is essential for sensitivity of MCL to ubiquitin-proteasome system inhibitors and could therefore provide a druggable Achilles' heel of MCL cells.
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Affiliation(s)
- M A Dengler
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Auerbachstr. 112, Stuttgart 70376, Germany
| | - A Weilbacher
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Auerbachstr. 112, Stuttgart 70376, Germany
| | - M Gutekunst
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Auerbachstr. 112, Stuttgart 70376, Germany
| | - A M Staiger
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Auerbachstr. 112, Stuttgart 70376, Germany
| | - M C Vöhringer
- Second Department of Internal Medicine, Oncology and Hematology, Robert-Bosch-Hospital, Auerbachstr. 110, Stuttgart 70376, Germany
| | - H Horn
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Auerbachstr. 112, Stuttgart 70376, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Hospital, Auerbachstr. 110, Stuttgart 70376, Germany
| | - W E Aulitzky
- Second Department of Internal Medicine, Oncology and Hematology, Robert-Bosch-Hospital, Auerbachstr. 110, Stuttgart 70376, Germany
| | - H van der Kuip
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, and University of Tübingen, Auerbachstr. 112, Stuttgart 70376, Germany
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