1
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Chang EWY, Yang VS, Ong SY, Kang HX, Lim BY, de Mel S, Ng EKY, Poon ML, Tan YH, Chiang J, Poon E, Somasundaram N, Farid M, Tang T, Tao M, Khoo LP, Cheng CL, Huang D, Ong CK, Lim ST, Chan JY. Clinical features and prognostic outcomes of angioimmunoblastic T cell lymphoma in an Asian multicenter study. Leuk Lymphoma 2023; 64:1782-1791. [PMID: 37477443 DOI: 10.1080/10428194.2023.2235043] [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: 05/05/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
In our Asian multicenter retrospective study, we investigated the clinical prognostic factors affecting the outcomes of AITL patients and identified a novel prognostic index relevant in the Asian context. In our 174-patient cohort, the median PFS and OS was 1.8 years and 5.6 years respectively. Age > 60, bone marrow involvement, total white cell count >12 × 109/L and raised serum lactate dehydrogenase were associated with poorer PFS and OS in multivariate analyses. This allowed for a prognostic index (AITL-PI) differentiating patients into low (0-1 factors, n = 64), moderate (2 factors, n = 59) and high-risk (3-4 factors, n = 49) subgroups with 5-year OS of 84.0%, 44.0% and 28.0% respectively (p < 0.0001). POD24 proved to be strongly prognostic (5-year OS 24% vs 89%, p < 0.0001). Exploratory gene expression studies were performed and disparate immune cell profiles and cell signaling signatures were seen in the low risk group as compared to the intermediate and high risk groups.
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Affiliation(s)
- Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Institute of Molecular and Cell Biology, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Shin Yeu Ong
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | - Boon Yee Lim
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
| | - Sanjay de Mel
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Esther Ka Yan Ng
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Michelle Limei Poon
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Dachuan Huang
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Choon Kiat Ong
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore, Singapore
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2
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Goh J, De Mel S, Hoppe MM, Mohd Abdul Rashid MB, Zhang XY, Jaynes P, Ka Yan Ng E, Rahmat NDB, Jayalakshmi, Liu CX, Poon L, Chan E, Lee J, Chee YL, Koh LP, Tan LK, Soh TG, Yuen YC, Loi HY, Ng SB, Goh X, Eu D, Loh S, Ng S, Tan D, Cheah DMZ, Pang WL, Huang D, Ong SY, Nagarajan C, Chan JY, Ha JCH, Khoo LP, Somasundaram N, Tang T, Ong CK, Chng WJ, Lim ST, Chow EK, Jeyasekharan AD. An ex vivo platform to guide drug combination treatment in relapsed/refractory lymphoma. Sci Transl Med 2022; 14:eabn7824. [PMID: 36260690 DOI: 10.1126/scitranslmed.abn7824] [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] [Indexed: 11/02/2022]
Abstract
Although combination therapy is the standard of care for relapsed/refractory non-Hodgkin's lymphoma (RR-NHL), combination treatment chosen for an individual patient is empirical, and response rates remain poor in individuals with chemotherapy-resistant disease. Here, we evaluate an experimental-analytic method, quadratic phenotypic optimization platform (QPOP), for prediction of patient-specific drug combination efficacy from a limited quantity of biopsied tumor samples. In this prospective study, we enrolled 71 patients with RR-NHL (39 B cell NHL and 32 NK/T cell NHL) with a median of two prior lines of treatment, at two academic hospitals in Singapore from November 2017 to August 2021. Fresh biopsies underwent ex vivo testing using a panel of 12 drugs with known efficacy against NHL to identify effective single and combination treatments. Individualized QPOP reports were generated for 67 of 75 patient samples, with a median turnaround time of 6 days from sample collection to report generation. Doublet drug combinations containing copanlisib or romidepsin were most effective against B cell NHL and NK/T cell NHL samples, respectively. Off-label QPOP-guided therapy offered at physician discretion in the absence of standard options (n = 17) resulted in five complete responses. Among patients with more than two prior lines of therapy, the rates of progressive disease were lower with QPOP-guided treatments than with conventional chemotherapy. Overall, this study shows that the identification of patient-specific drug combinations through ex vivo analysis was achievable for RR-NHL in a clinically applicable time frame. These data provide the basis for a prospective clinical trial evaluating ex vivo-guided combination therapy in RR-NHL.
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Affiliation(s)
- Jasmine Goh
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Sanjay De Mel
- NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Michal M Hoppe
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | | | - Xi Yun Zhang
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Patrick Jaynes
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Esther Ka Yan Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | | | - Jayalakshmi
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Clementine Xin Liu
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Limei Poon
- NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Esther Chan
- NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Joanne Lee
- NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Yen Lin Chee
- NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Liang Piu Koh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore
| | - Lip Kun Tan
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Singapore
| | - Teck Guan Soh
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Singapore
| | - Yi Ching Yuen
- Department of Pharmacy, National University Health System, Singapore 119074, Singapore
| | - Hoi-Yin Loi
- Department of Diagnostic Imaging, National University Hospital, Singapore 119074, Singapore
| | - Siok-Bian Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.,NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Xueying Goh
- Department of Otolaryngology, National University Hospital, Singapore 119074, Singapore
| | - Donovan Eu
- Department of Otolaryngology, National University Hospital, Singapore 119074, Singapore
| | - Stanley Loh
- Department of Diagnostic Imaging, National University Hospital, Singapore 119074, Singapore
| | - Sheldon Ng
- Department of Diagnostic Imaging, National University Hospital, Singapore 119074, Singapore
| | - Daryl Tan
- Mount Elizabeth Novena Hospital, Singapore 329563, Singapore.,Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore
| | - Daryl Ming Zhe Cheah
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Wan Lu Pang
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Dachuan Huang
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Shin Yeu Ong
- Department of Haematology, Singapore General Hospital, Singapore 169608, Singapore
| | | | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore 168582, Singapore
| | - Jeslin Chian Hung Ha
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore.,Genome Institute of Singapore, A*STAR, Singapore 138672, Singapore
| | - Wee-Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.,NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore 168582, Singapore.,Office of Education, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Edward K Chow
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.,NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.,N.1 Institute for Health, National University of Singapore, Singapore 117456, Singapore.,Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Anand D Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore.,NUS Center for Cancer Research (N2CR), Yong Loo Lin School of Medicine, National University Singapore, Singapore 117599, Singapore.,Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore 119074, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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3
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Teo YN, Teo YH, Khoo LP, Yin Chang EW, Tan YH, Chiang J, Yang VS, Poon E, Somasundaram N, Farid M, Tao M, Lim ST, Chan JY. MO30-5 Clinicopathological factors affecting prognosis in marginal zone lymphoma in an Asian tertiary cancer centre. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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4
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Lim JQ, Huang D, Chan JY, Laurensia Y, Wong EKY, Cheah DMZ, Chia BKH, Chuang WY, Kuo MC, Su YJ, Cai QQ, Feng Y, Rao H, Feng LN, Wei PP, Chen JR, Han BW, Lin GW, Cai J, Fang Y, Tan J, Hong H, Liu Y, Zhang F, Li W, Poon MLM, Ng SB, Jeyasekharan A, Ha JCH, Khoo LP, Chin ST, Pang WL, Kee R, Cheng CL, Grigoropoulos NF, Tang T, Tao M, Farid M, Puan KJ, Xiong J, Zhao WL, Khor CC, Hwang W, Kim WS, Campo E, Tan P, Teh BT, Chng WJ, Rötzschke O, Tousseyn T, Huang HQ, Rozen S, Lim ST, Shih LY, Bei JX, Ong CK. A genomic-augmented multivariate prognostic model for the survival of Natural-killer/T-cell lymphoma patients from an international cohort. Am J Hematol 2022; 97:1159-1169. [PMID: 35726449 DOI: 10.1002/ajh.26636] [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: 12/13/2021] [Revised: 05/17/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022]
Abstract
With lowering costs of sequencing and genetic profiling techniques, genetic drivers can now be detected readily in tumors but current prognostic models for Natural-killer/T cell lymphoma (NKTCL) have yet to fully leverage on them for prognosticating patients. Here, we used next-generation sequencing to sequence 260 NKTCL tumors, and trained a genomic prognostic model (GPM) with the genomic mutations and survival data from this retrospective cohort of patients using LASSO Cox regression. The GPM is defined by the mutational status of 13 prognostic genes and is weakly correlated with the risk-features in International Prognostic Index (IPI), Prognostic Index for Natural-Killer cell lymphoma (PINK) and PINK-Epstein-Barr virus (PINK-E). Cox-proportional hazard multivariate regression also showed that the new GPM is independent and significant for both progression-free survival (PFS, HR: 3.73, 95% CI 2.07-6.73; P<0.001) and overall survival (OS, HR: 5.23, 95% CI 2.57-10.65; P=0.001) with known risk-features of these indices. When we assign an additional risk-score to samples, which are mutant for the GPM, the Harrell's C-indices of GPM-augmented IPI, PINK and PINK-E improved significantly (P<0.001, χ2 test) for both PFS and OS. Thus, we report on how genomic mutational information could steer towards better prognostication of NKTCL patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jing Quan Lim
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore.,ONCO-ACP, Duke-NUS Medical School, 8 College Road, Singapore
| | - Dachuan Huang
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore.,ONCO-ACP, Duke-NUS Medical School, 8 College Road, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Yurike Laurensia
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Esther Kam Yin Wong
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Daryl Ming Zhe Cheah
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Burton Kuan Hui Chia
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Wen-Yu Chuang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Ming-Chung Kuo
- Chang Gung University, Taoyuan, Taiwan.,Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Jiun Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Qing-Qing Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanfen Feng
- Guangdong Provincial People's Hospital.,Guangdong Academy of Medical Sciences
| | - Huilan Rao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li-Na Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pan-Pan Wei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jie-Rong Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bo-Wei Han
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Guo-Wang Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu Fang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Tan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore.,Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Huangming Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanhui Liu
- Guangdong Provincial People's Hospital.,Guangdong Academy of Medical Sciences
| | - Fen Zhang
- Guangdong Provincial People's Hospital.,Guangdong Academy of Medical Sciences
| | - Wenyu Li
- Guangdong Provincial People's Hospital.,Guangdong Academy of Medical Sciences
| | - Michelle L M Poon
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Anand Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Health System, Singapore
| | - Jeslin Chian Hung Ha
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Lay Poh Khoo
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Suk Teng Chin
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Wan Lu Pang
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Rebecca Kee
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Chee Leong Cheng
- Department of Pathology, Singapore General Hospital, 20 College Road, Academia, Singapore
| | | | - Tiffany Tang
- ONCO-ACP, Duke-NUS Medical School, 8 College Road, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore
| | - Kia Joo Puan
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), 8A Biomedical Grove, Singapore, Singapore
| | - Jie Xiong
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Li Zhao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chiea Chuen Khor
- Genome Institute of Singapore, 60 Biopolis Street Genome, Singapore
| | - William Hwang
- Director's office, National Cancer Centre, Singapore
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Elias Campo
- Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain
| | - Patrick Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Genome Institute of Singapore, 60 Biopolis Street Genome, Singapore.,Division of Cancer and Stem Cell Biology, Duke-NUS Medical School, 8 College Road, Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, 11 Hospital Drive, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore.,Division of Cancer and Stem Cell Biology, Duke-NUS Medical School, 8 College Road, Singapore
| | - Wee-Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Olaf Rötzschke
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), 8A Biomedical Grove, Sinagpore, Singapore
| | - Thomas Tousseyn
- KU Leuven, Department of Imaging and Pathology, Translational Cell and Tissue Research Lab, Herestraat 49, Leuven, Belgium.,UZ Leuven, Department of Pathology, Leuven, Belgium
| | - Hui-Qiang Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Steve Rozen
- Division of Cancer and Stem Cell Biology, Duke-NUS Medical School, 8 College Road, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, 8 College Road, Singapore
| | - Soon Thye Lim
- Director's office, National Cancer Centre, Singapore.,Office of Education, Duke-NUS Medical School, Singapore
| | - Lee-Yung Shih
- Chang Gung University, Taoyuan, Taiwan.,Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Jin-Xin Bei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, 11 Hospital Drive, Singapore.,Genome Institute of Singapore, 60 Biopolis Street Genome, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, 8 College Road, Singapore
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5
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Teo YH, Teo YN, Khoo LP, Chang EWY, Tan YH, Chiang J, Yang VS, Poon E, Somasundaram N, Farid M, Tao M, Lim ST, Chan JY. Clinicopathological factors affecting prognosis in marginal zone lymphoma in Asian patients: a cohort study. Leuk Lymphoma 2022; 63:2723-2726. [DOI: 10.1080/10428194.2022.2086242] [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: 10/18/2022]
Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yao Neng Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Institute of Molecular and Cell Biology, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore
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6
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Tay T, Somasundaram N, Lim C, Khoo LP, Goh AZK, Lee YS, Liu X, Tao M, Quek R, Farid M, Poon E, Chan JYS, Chang EWY, Yang VSW, Goh YT, Tan D, Diong C, Grigoropoulos NF, Nagarajan C, Poon M, de Mel S, Jeyasekharan A, Chan EHL, Lee J, Chee YL, Lim ST, Tang T. Treatment outcomes of T and natural-killer/T-cell lymphoma with ifosfamide, carboplatin and etoposide chemotherapy. Cancer Rep (Hoboken) 2022; 5:e1552. [PMID: 35481622 PMCID: PMC9458502 DOI: 10.1002/cnr2.1552] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Contemporary data of peripheral T-cell lymphoma (PTCL) and natural-killer/T-cell lymphoma (NKTL) patients treated with ifosfamide, carboplatin and etoposide (ICE) are limited. AIMS We performed a retrospective analysis to estimate outcomes of ICE-treated PTCL and NKTL patients at three tertiary cancer centres in Singapore. METHODS AND RESULTS Patients were identified through lymphoma databases from National Cancer Centre Singapore (NCCS), National University Hospital, Singapore (NUHS), and Singapore General Hospital (SGH). Responses and survival outcomes were determined from electronic medical records. A total of 75 patients with a median age of 50 were included. ICE was used as first-line treatment in 14 patients (19%) and as subsequent lines of treatment in 61 patients (81%). The overall response rates (ORR) for all patients was 63% (40% complete response [CR]). The ORR and CR in the first line were 86% and 64% respectively. At a median follow-up duration of 71.0 months, the median progression-free (PFS) and overall survival (OS) for all patients were 4.4 months (95%CI, 2.7-6.0) and 16 months (95%CI, 8.3-45.4) respectively. CONCLUSION In summary, ICE showed high ORR but poor PFS in relapsed/refractory PTCL and NKTL. ORR of ICE in the first line setting appears better than real-world CHOP data and warrants further study.
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Affiliation(s)
- Tricia Tay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Cindy Lim
- Division of Clinical Trials & Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Allan Zhi Kai Goh
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Yuh Shan Lee
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Xin Liu
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jason Y S Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Esther W Y Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Valerie S W Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Daryl Tan
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Colin Diong
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | | | | | - Michelle Poon
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Sanjay de Mel
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Anand Jeyasekharan
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Esther H L Chan
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Joanne Lee
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Yen Lin Chee
- Department of Haematology-Oncology, National University Hospital Singapore, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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7
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Ng DZ, Lee CY, Lam WW, Tong AK, Tan SH, Khoo LP, Tan YH, Chiang J, Chang EW, Chan JY, Poon EY, Somasundaram N, Farid H Rashid M, Tao M, Lim ST, Yang VS. Prognostication of diffuse large B-cell lymphoma patients with Deauville score of 3 or 4 at end-of-treatment PET evaluation: a comparison of the Deauville 5-point scale and the ΔSUVmax method. Leuk Lymphoma 2021; 63:256-259. [PMID: 34665693 DOI: 10.1080/10428194.2021.1992624] [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] [Indexed: 10/20/2022]
Abstract
Diffuse large B-cell lymphoma is treated with anti-CD 20 and multi-drug chemotherapy for cure. Positron emission tomography (PET) scans are performed at end of treatment (EOT) to assess response. EOT Deauville scores (DS) are equivocal for treatment response in some situations, requiring physicians to determine the need for further investigations or treatment. Studies have suggested the delta maximum standardised uptake value (ΔSUVmax) to be superior to DS for assessment of metabolic response at interim PET, although its use at EOT PET, especially in cases of equivocal response, has yet to be established. We investigated whether ΔSUVmax could better discriminate prognosis than DS 3 or 4 at EOT. ΔSUVmax did not outperform DS. Combination of DS 3 and International Prognostic Index (IPI) <3 selects for patients with extremely low risk of disease progression (HR 0.06, 95% CI 0.01 to 0.62, p 0.018) compared to DS 4 and IPI ≥3.
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Affiliation(s)
- David Z Ng
- Internal Medicine Residency, SingHealth Services, Singapore
| | - Chuan Yaw Lee
- Internal Medicine Residency, SingHealth Services, Singapore
| | - Winnie W Lam
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Radiological Sciences Academic Clinical Programme, Singapore
| | - Aaron K Tong
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Radiological Sciences Academic Clinical Programme, Singapore
| | - Sze Huey Tan
- Biostatistics Unit, National Cancer Centre Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ya Hwee Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jianbang Chiang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Esther W Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jason Y Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Programme, Singapore
| | - Eileen Y Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Programme, Singapore
| | - Valerie S Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore.,Duke-NUS Medical School, Oncology Academic Clinical Programme, Singapore.,Translational Precision Oncology Laboratory, Institute of Molecular & Cell Biology, A*STAR, Singapore
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8
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Yang X, Khoo LP, Chang EWY, Yang VS, Poon E, Somasundaram N, Farid M, Tang TPL, Tao M, Lim ST, Chan JY. Treatment patterns and outcomes of older patients with mantle cell lymphoma in an Asian population. BMC Cancer 2021; 21:566. [PMID: 34001056 PMCID: PMC8130422 DOI: 10.1186/s12885-021-08326-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Significant progress has been made in the treatment outcomes of mantle cell lymphoma (MCL) since the introduction of cytarabine and rituximab in modern regimens. However, older patients may not readily tolerate these agents nor derive benefit. We investigated the impact of age on treatment patterns and clinical outcomes of MCL patients in an Asian population. Methods A retrospective study was conducted on patients (n = 66) diagnosed with MCL at the National Cancer Centre Singapore between 1998 and 2018. The median follow-up duration was 40 months. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models. Results The median age of the cohort was 59 years (range, 26–84), with a male predominance (73%). The majority (86%) had advanced stage 3–4 disease at diagnosis. Compared with younger patients, older patients aged ≥60 years (n = 32; 48.5%) presented more frequently with B-symptoms (75% vs 38%, p = 0.0028), anaemia (75% vs 35%, p = 0.0013), and carried higher prognostic risk scores (sMIPI high risk 84% vs 56%, p = 0.016). Non-cytarabine-based induction chemotherapy was more commonly administered in older patients (76% vs 32%, p = 0.0012). The 5-year overall survival (OS) and progression-free survival (PFS) was 68 and 25% respectively. In a multivariable model, older age (HR 3.42, 95%CI 1.48–7.92, p = 0.004) and anemia (HR 2.56, 95%CI 1.10–5.96, p = 0.029) were independently associated with poorer OS while older age (HR 2.24, 95%CI 1.21–4.14, p = 0.010) and hypoalbuminemia (HR 2.20, 95%CI 1.17–4.13, p = 0.014) were independently associated with poorer PFS. In an exploratory analysis, maintenance rituximab following induction chemotherapy improved PFS in younger patients, with median PFS of 131 months and 45 months with or without maintenance therapy respectively (HR 0.39, 95%CI 0.16–0.93, p = 0.035). In contrast, no survival benefit was observed in older patients. Conclusions We demonstrated in our analysis that older patients with MCL may harbor adverse clinical features and may not derive benefit from maintenance rituximab, highlighting the need for further research in this area of need. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08326-1.
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Affiliation(s)
- Xinyi Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Institute of Molecular and Cell Biology, Singapore City, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Tiffany Pooi Ling Tang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore.
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore City, 169610, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore City, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore City, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore City, Singapore.
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9
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Lim RMH, Chan NPX, Khoo LP, Cheng CL, Tan L, Poon EYL, Somasundaram N, Farid M, Tang TPL, Tao M, Lim ST, Chan JY. A Clinico-Genotypic Prognostic Index for De Novo Composite Diffuse Large B-Cell Lymphoma Arising from Follicular Lymphoma in Asian patients treated in the Rituximab Era. Sci Rep 2020; 10:4373. [PMID: 32152442 PMCID: PMC7062756 DOI: 10.1038/s41598-020-61378-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/24/2020] [Indexed: 11/09/2022] Open
Abstract
Composite follicular lymphoma with diffuse large B-cell lymphoma (FL/DLBCL) is uncommonly found on lymph node biopsy and represents a rare haematological malignancy. We aim to examine clinico-pathological features of patients with FL/DLBCL and investigate predictors of survival outcome. We included in our retrospective study patients with histologically-proven FL/DLBCL at diagnosis (n = 106) and who were subsequently treated with rituximab-based chemoimmunotherapy from 2002–2017 at the National Cancer Centre. The cohort consisted of 34 women and 72 men with a median age of 59 years (range, 24–82). In a multivariate model inclusive of known clinico-pathological parameters at diagnosis, advanced stage (p = 0.0136), presence of MYC and/or BCL6 rearrangement (p = 0.0376) and presence of B symptoms (p = 0.0405) were independently prognostic for worse overall survival (OS). The only remaining independent prognostic variables for worse OS after including first-line treatment data in the model were use of chemotherapy regimens other than R-CHOP (p = 0.0360) and lack of complete response to chemotherapy (p < 0.0001) besides the presence of B symptoms (p = 0.0022). We generated a Clinico-Genotypic Index by point-wise addition of all five adverse parameters (score of 0–1, 2, 3, 4–5) which revealed four prognostic risk groups with a predicted 5-year OS of 100%, 62%, 40% and 0% (p < 0.0001) accounting for 50.0%, 24.5%, 18.9% and 6.6% of the cohort respectively. We propose that R-CHOP should be the recommended first-line regimen for composite FL/DLBCL.
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Affiliation(s)
- Ryan Mao Heng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie Pei Xin Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Leonard Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tiffany Pooi Ling Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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10
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Tan KM, Chia B, Lim JQ, Khoo LP, Cheng CL, Tan L, Poon E, Somasundaram N, Farid M, Tang TPL, Tao M, Cheah DMZ, Laurensia Y, Pang JWL, Song T, Tan J, Huang D, Kim SJ, Kim WS, Ong CK, Lim ST, Chan JY. A clinicohaematological prognostic model for nasal-type natural killer/T-cell lymphoma: A multicenter study. Sci Rep 2019; 9:14961. [PMID: 31628410 PMCID: PMC6802199 DOI: 10.1038/s41598-019-51522-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/13/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023] Open
Abstract
Extranodal NK/T-cell lymphoma, nasal type (NKTL) is an aggressive type of non-Hodgkin lymphoma closely associated with Epstein-Barr virus and characterized by varying degrees of systemic inflammation. We aim to examine the prognostic significance of peripheral blood neutrophil-lymphocyte ratio (NLR) in patients with NKTL. Therefore, we conducted a retrospective review of 178 patients with biopsy-proven NKTL from the National Cancer Centre Singapore and Samsung Medical Center, South Korea. Using receiver operating curve analysis, an optimal cut-off for high NLR (>3.5) in predicting overall survival (OS) was derived. Survival analysis was performed using the Kaplan-Meier method and multivariable Cox proportional regression. In patients with high NLR, estimated 5-year OS was 25% compared to 53% in those with low NLR. In multivariable analysis, high NLR, in addition to age ≥60 years, presence of B-symptoms and stage III/IV at diagnosis, was independently correlated with worse OS (HR 2.08; 95% CI 1.36 to 3.18; p = 0.0008) and progression-free survival (HR 1.66; 95% CI 1.11 to 2.46; p = 0.0128). A new prognostic index (NABS score) derived from these factors stratified patients into low (0), low-intermediate (1), high-intermediate (2) and high (3-4) risk subgroups, which were associated with 5-year OS of 76.5%, 55.7%, 29.2% and 0% respectively. In conclusion, high NLR is an independent prognostic marker and the NABS model can be used to risk-stratify NKTL patients.
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Affiliation(s)
- Khee Ming Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Burton Chia
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Quan Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Leonard Tan
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Tiffany Pooi Ling Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Daryl Ming Zhe Cheah
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Yurike Laurensia
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Jane Wan Lu Pang
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Tammy Song
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Tan
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | - Dachuan Huang
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore. .,Genome Institute of Singapore, A*STAR, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore. .,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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11
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Tang T, Khoo LP, Lim C, Ham JS, Kim SJ, Hong H, Phipps C, Lee YS, Tao M, Quek R, Farid M, Lin T, Kim WS, Lim ST. Outcomes of patients with peripheral T-cell lymphoma in first complete remission: data from three tertiary Asian cancer centers. Blood Cancer J 2017; 7:653. [PMID: 29242582 PMCID: PMC5802553 DOI: 10.1038/s41408-017-0030-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/14/2017] [Accepted: 10/20/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Cindy Lim
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Jun Soo Ham
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Huangming Hong
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Centre Guangzhou, Guangzhou, People's Republic of China
| | - Colin Phipps
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Yuh Shan Lee
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Tongyu Lin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Centre Guangzhou, Guangzhou, People's Republic of China
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sunkyunkwan University, Seoul, Korea
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. .,Oncology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.
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12
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Li Z, Xia Y, Feng LN, Chen JR, Li HM, Cui J, Cai QQ, Sim KS, Nairismägi ML, Laurensia Y, Meah WY, Liu WS, Guo YM, Chen LZ, Feng QS, Pang CP, Chen LJ, Chew SH, Ebstein RP, Foo JN, Liu J, Ha J, Khoo LP, Chin ST, Zeng YX, Aung T, Chowbay B, Diong CP, Zhang F, Liu YH, Tang T, Tao M, Quek R, Mohamad F, Tan SY, Teh BT, Ng SB, Chng WJ, Ong CK, Okada Y, Raychaudhuri S, Lim ST, Tan W, Peng RJ, Khor CC, Bei JX. Genetic risk of extranodal natural killer T-cell lymphoma: a genome-wide association study. Lancet Oncol 2016; 17:1240-7. [PMID: 27470079 DOI: 10.1016/s1470-2045(16)30148-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/05/2016] [Accepted: 05/05/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Extranodal natural killer T-cell lymphoma (NKTCL), nasal type, is a rare and aggressive malignancy that occurs predominantly in Asian and Latin American populations. Although Epstein-Barr virus infection is a known risk factor, other risk factors and the pathogenesis of NKTCL are not well understood. We aimed to identify common genetic variants affecting individual risk of NKTCL. METHODS We did a genome-wide association study of 189 patients with extranodal NKTCL, nasal type (WHO classification criteria; cases) and 957 controls from Guangdong province, southern China. We validated our findings in four independent case-control series, including 75 cases from Guangdong province and 296 controls from Hong Kong, 65 cases and 983 controls from Guangdong province, 125 cases and 1110 controls from Beijing (northern China), and 60 cases and 2476 controls from Singapore. We used imputation and conditional logistic regression analyses to fine-map the associations. We also did a meta-analysis of the replication series and of the entire dataset. FINDINGS Associations exceeding the genome-wide significance threshold (p<5 × 10(-8)) were seen at 51 single-nucleotide polymorphisms (SNPs) mapping to the class II MHC region on chromosome 6, with rs9277378 (located in HLA-DPB1) having the strongest association with NKTCL susceptibility (p=4·21 × 10(-19), odds ratio [OR] 1·84 [95% CI 1·61-2·11] in meta-analysis of entire dataset). Imputation-based fine-mapping across the class II MHC region suggests that four aminoacid residues (Gly84-Gly85-Pro86-Met87) in near-complete linkage disequilibrium at the edge of the peptide-binding groove of HLA-DPB1 could account for most of the association between the rs9277378*A risk allele and NKTCL susceptibility (OR 2·38, p value for haplotype 2·32 × 10(-14)). This association is distinct from MHC associations with Epstein-Barr virus infection. INTERPRETATION To our knowledge, this is the first time that a genetic variant conferring an NKTCL risk is noted at genome-wide significance. This finding underlines the importance of HLA-DP antigen presentation in the pathogenesis of NKTCL. FUNDING Top-Notch Young Talents Program of China, Special Support Program of Guangdong, Specialized Research Fund for the Doctoral Program of Higher Education (20110171120099), Program for New Century Excellent Talents in University (NCET-11-0529), National Medical Research Council of Singapore (TCR12DEC005), Tanoto Foundation Professorship in Medical Oncology, New Century Foundation Limited, Ling Foundation, Singapore National Cancer Centre Research Fund, and the US National Institutes of Health (1R01AR062886, 5U01GM092691-04, and 1R01AR063759-01A1).
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Affiliation(s)
- Zheng Li
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Genome Institute of Singapore, Singapore
| | - Yi Xia
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li-Na Feng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie-Rong Chen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hong-Min Li
- State Key Laboratory of Molecular Oncology, Beijing, China; Department of Etiology and Carcinogenesis, Beijing Key Laboratory for Carcinogenesis and Cancer Prevention, Beijing, China; Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Cui
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Qing-Qing Cai
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | | | - Maarja-Liisa Nairismägi
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Yurike Laurensia
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | | | - Wen-Sheng Liu
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yun-Miao Guo
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li-Zhen Chen
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qi-Sheng Feng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Soo Hong Chew
- Department of Economics, National University of Singapore, Singapore
| | - Richard P Ebstein
- Department of Psychology, National University of Singapore, Singapore
| | | | | | - Jeslin Ha
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Lay Poh Khoo
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Suk Teng Chin
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Yi-Xin Zeng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Beijing Hospital, Beijing, China
| | - Tin Aung
- Singapore Eye Research Institute, Singapore
| | - Balram Chowbay
- Laboratory of Clinical Pharmacology, Division of Medical Sciences, Humphrey Oei Institute of Cancer Research, National Cancer Centre, Singapore; Clinical Pharmacology, SingHealth, Singapore; Office of Clinical Sciences, Duke-National University of Singapore Medical School, Singapore
| | | | - Fen Zhang
- Department of Pathology, Guangdong General Hospital, Guangzhou, China
| | - Yan-Hui Liu
- Department of Pathology, Guangdong General Hospital, Guangzhou, China
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Farid Mohamad
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Soo Yong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Department of Pathology, Singapore General Hospital, Singapore; Institute of Molecular and Cell Biology, A*STAR, Singapore; Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia; Department of Pathology, National University of Singapore, Singapore
| | - Bin Tean Teh
- Program in Cancer and Stem Cell Biology, Duke-National University of Singapore Medical School, Singapore; Institute of Molecular and Cell Biology, A*STAR, Singapore; Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Siok Bian Ng
- Department of Pathology, National University of Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Wee Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Yukinori Okada
- Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan; Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Soumya Raychaudhuri
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Center for Personalized Genetic Medicine, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Institute of Inflammation and Repair, University of Manchester, Manchester, UK; Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Soon Thye Lim
- Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore; Division of Medical Oncology, National Cancer Centre Singapore, Singapore; Office of Education, Duke-National University of Singapore Medical School, Singapore
| | - Wen Tan
- State Key Laboratory of Molecular Oncology, Beijing, China; Department of Etiology and Carcinogenesis, Beijing Key Laboratory for Carcinogenesis and Cancer Prevention, Beijing, China; Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rou-Jun Peng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chiea Chuen Khor
- Genome Institute of Singapore, Singapore; Singapore Eye Research Institute, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jin-Xin Bei
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Genome Institute of Singapore, Singapore; Center for Precision Medicine, Sun Yat-Sen University, Guangzhou, China.
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13
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Nairismägi ML, Tan J, Lim JQ, Nagarajan S, Ng CCY, Rajasegaran V, Huang D, Lim WK, Laurensia Y, Wijaya GC, Li ZM, Cutcutache I, Pang WL, Thangaraju S, Ha J, Khoo LP, Chin ST, Dey S, Poore G, Tan LHC, Koh HKM, Sabai K, Rao HL, Chuah KL, Ho YH, Ng SB, Chuang SS, Zhang F, Liu YH, Pongpruttipan T, Ko YH, Cheah PL, Karim N, Chng WJ, Tang T, Tao M, Tay K, Farid M, Quek R, Rozen SG, Tan P, Teh BT, Lim ST, Tan SY, Ong CK. JAK-STAT and G-protein-coupled receptor signaling pathways are frequently altered in epitheliotropic intestinal T-cell lymphoma. Leukemia 2016; 30:1311-9. [PMID: 26854024 PMCID: PMC4895162 DOI: 10.1038/leu.2016.13] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [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: 07/15/2015] [Revised: 01/07/2016] [Accepted: 01/18/2016] [Indexed: 12/11/2022]
Abstract
Epitheliotropic intestinal T-cell lymphoma (EITL, also known as type II enteropathy-associated T-cell lymphoma) is an aggressive intestinal disease with poor prognosis and its molecular alterations have not been comprehensively characterized. We aimed to identify actionable easy-to-screen alterations that would allow better diagnostics and/or treatment of this deadly disease. By performing whole-exome sequencing of four EITL tumor-normal pairs, followed by amplicon deep sequencing of 42 tumor samples, frequent alterations of the JAK-STAT and G-protein-coupled receptor (GPCR) signaling pathways were discovered in a large portion of samples. Specifically, STAT5B was mutated in a remarkable 63% of cases, JAK3 in 35% and GNAI2 in 24%, with the majority occurring at known activating hotspots in key functional domains. Moreover, STAT5B locus carried copy-neutral loss of heterozygosity resulting in the duplication of the mutant copy, suggesting the importance of mutant STAT5B dosage for the development of EITL. Dysregulation of the JAK-STAT and GPCR pathways was also supported by gene expression profiling and further verified in patient tumor samples. In vitro overexpression of GNAI2 mutants led to the upregulation of pERK1/2, a member of MEK-ERK pathway. Notably, inhibitors of both JAK-STAT and MEK-ERK pathways effectively reduced viability of patient-derived primary EITL cells, indicating potential therapeutic strategies for this neoplasm with no effective treatment currently available.
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Affiliation(s)
- M-L Nairismägi
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - J Tan
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - J Q Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S Nagarajan
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - C C Y Ng
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - V Rajasegaran
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - D Huang
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - W K Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Y Laurensia
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - G C Wijaya
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Z M Li
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - I Cutcutache
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
| | - W L Pang
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S Thangaraju
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - J Ha
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - L P Khoo
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S T Chin
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S Dey
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - G Poore
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - L H C Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - H K M Koh
- Advanced Molecular Pathology Laboratory, Singapore Health Services, Singapore, Singapore
| | - K Sabai
- Advanced Molecular Pathology Laboratory, Singapore Health Services, Singapore, Singapore
| | - H-L Rao
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - K L Chuah
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Y-H Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore
| | - S-B Ng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
| | - S-S Chuang
- Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Pathology, Taipei Medical University and National Taiwan University, Taipei, Taiwan
| | - F Zhang
- Department of Pathology, Guangdong General Hospital, Guangzhou, China
| | - Y-H Liu
- Department of Pathology, Guangdong General Hospital, Guangzhou, China
| | - T Pongpruttipan
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Y H Ko
- Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - P-L Cheah
- Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia
| | - N Karim
- Department of Pathology, Hospital Raja Permaisuri Bainun, Ipoh, Malaysia
| | - W-J Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore, Singapore
| | - T Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - M Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - K Tay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - M Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - R Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S G Rozen
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore.,Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
| | - P Tan
- Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - B T Teh
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.,Program in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.,Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - S T Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Office of Education, Duke-NUS Medical School, Singapore, Singapore
| | - S-Y Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore.,Department of Pathology, Guangdong General Hospital, Guangzhou, China.,Department of Pathology, University of Malaya, Kuala Lumpur, Malaysia.,Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - C K Ong
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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14
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Tang T, Chen Z, Praditsuktavorn P, Khoo LP, Ruan J, Lim ST, Tan D, Phipps C, Lee YS, Goh YT, Hwang W, Tao M, Quek R, Farid M, Furman RR, Leonard JP, Martin P. Role of Surveillance Imaging in Patients With Peripheral T-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2015; 16:117-21. [PMID: 26796979 DOI: 10.1016/j.clml.2015.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/27/2015] [Accepted: 12/15/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The role of surveillance imaging (SI) in patients with peripheral T-cell lymphoma (PTCL) in first complete remission (CR1) is unclear. MATERIALS AND METHODS Patients with PTCL were identified through prospectively maintained T-cell lymphoma databases from the National Cancer Centre Singapore/Singapore General Hospital and Weill-Cornell Medical College after institutional review board approval. Patients with leukemia or indolent, composite, and cutaneous lymphomas were excluded. The patients' medical records were retrospectively reviewed to determine the frequency and type of SI used. Of those with relapse, the method of relapse detection and data on symptoms, signs, and elevated lactate dehydrogenase LDH were extracted. RESULTS A total of 338 patients were included in the present study. In the first year after achieving CR1, patients had an average of 1.2 and a median of 1 SI performed (range, 0-4). In the second year after achieving CR1, they had an average of 0.78 and a median of 1 SI performed (range, 0-4). Of the 135 patients who achieved CR1, 61 (45%) developed a relapse. Relapses were detected before SI in 48 (84%), and 9 patients had relapses detected during routine SI. Of the 9 patients whose relapses were detected during planned SI, only 3 did not have any symptoms or signs suggestive of relapsed disease. Of these 3 patients, 2 had angioimmunoblastic T-cell lymphoma and 1 had natural killer/T-cell lymphoma. CONCLUSION Most PTCL relapses were detected before planned SI, and most patients had symptoms with relapse. Only 3 patients (5.2%) were completely asymptomatic at relapse, suggesting a limited utility of routine imaging for detecting PTCL relapses.
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Affiliation(s)
- Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore; Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY.
| | - Zhengming Chen
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
| | | | - Lay Poh Khoo
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jia Ruan
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Daryl Tan
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Colin Phipps
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Yuh Shan Lee
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Yeow Tee Goh
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - William Hwang
- Department of Hematology, Singapore General Hospital, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Richard R Furman
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - John P Leonard
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York, NY
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15
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Tang TPL, Chen Z, Praditsuktavorn P, Khoo LP, Ruan J, Lim ST, Tan DC, Diong C, Lee YS, Tee GY, Hwang W, Tao M, Quek RHH, Tay K, Farid M, Furman RR, Leonard J, Martin P. Role of surveillance imaging in the management of peripheral T-cell lymphomas. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8543] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Jia Ruan
- Weill Cornell Medical College, New York, NY
| | | | | | - Colin Diong
- Singapore General Hospital, Singapore, Singapore
| | - Yuh Shan Lee
- Singapore General Hospital, Singapore, Singapore
| | - Goh Yeow Tee
- Singapore General Hospital, Singapore, Singapore
| | | | - Miriam Tao
- National Cancer Centre, Singapore, Singapore
| | | | - Kevin Tay
- National Cancer Centre, Singapore, Singapore
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16
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Chua CWL, Tay K, Tan IB, Tang T, Pan S, Kalaw E, Khoo LP, Ha J, Quek RHH, Tao M, Tan L, Teh BT, Lim ST, Tan SY. Association of tumor-associated macrophages of M2 subtype with outcome in follicular lymphoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8078] [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] [Indexed: 11/20/2022] Open
Abstract
8078 Background: Current methods used to prognosticate patients with follicular lymphoma (FL) include the Follicular Lymphoma International Prognostic Index (FLIPI) and tumor grade. However, they do not provide information on the biological and molecular features of FL. Recent data suggest that high tumor-associated macrophages (TAM) content may be an adverse prognostic factor in FL. However, TAM consists of two main subtypes, M1 and M2, with the former related to pro-inflammatory properties while the latter, anti-inflammatory functions. Currently, the prognostic impact of each individual subtype has not been elucidated and this may be more important than looking at TAM alone. Methods: Tumor specimens of 98 patients with FL diagnosed between 2005 and 2009 were investigated using immunohistochemistry and fluorescence in-situ hybridization (FISH) using break-apart FISH probes targeting BCL2, BCL6, MYC and IgH genes. Tumor specimens expressing a higher proportion of CD68+/CD163- in one high power field were defined as M1 subtype and those that expressed a greater proportion of CD68+/CD163+ were denoted as M2 subtype. Results: Amongst the 98 patients, 60 (61%) were of the M2 subtype, 59% presented with advanced disease, 47% were grade 3 and the median age was 59 years (21 – 88 years). Baseline characteristics including grade, stage and recurrent translocations did not significantly differ between the M1 and M2 groups. Similarly, there was also no difference in terms of treatment received (both Rituximab and chemotherapy) between the two groups. Despite these similarities, with a median follow-up of 3.2 years, the 3-year overall survival (OS) was significantly different (M1, 100% vs M2, 85%; p < 0.01). All 11 patients who died were of the M2 subtype (p=0.009). Conclusions: Our findings show that despite similar patient characteristics and treatment, there was, however, a statistically significant difference in OS, with the M2 subtype demonstrating an inferior outcome. The M2 TAM subtype rather than TAM alone may be a more important prognostic marker in FL, which could possibly be explained by its known biological anti-inflammatory function.
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Affiliation(s)
| | - Kevin Tay
- National Cancer Centre Singapore, Singapore, Singapore
| | - Iain B. Tan
- National Cancer Centre, Singapore, Singapore
| | - Tiffany Tang
- National Cancer Centre Singapore, Singapore, Singapore
| | - Summer Pan
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Lay Poh Khoo
- National Cancer Centre Singapore, Singapore, Singapore
| | - Jeslin Ha
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Miriam Tao
- National Cancer Centre, Singapore, Singapore
| | - Leonard Tan
- Singapore General Hospital, Singapore, Singapore
| | | | | | - Soo Yong Tan
- Singapore General Hospital, Singapore, Singapore
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17
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Abstract
In designing a total knee replacement (TKR) prosthesis catering for the Asian population, 62 sets of femur were harvested and analyzed. The morphometrical data obtained were found to be in good agreement with dimensions typical of the Asian knee and has reaffirmed the fact that Caucasian knees are generally larger than Asian knees. Subsequently, these data when treated using a multivariate statistical technique resulted in the establishment of major design parameters for six different sizes of femoral implants. An extra-small implant size with established dimensions and geometrical shape has surfaced from the study. The differences between the Asian knees and the Caucasian knees are discussed. Employing the established femoral dimensions and motion path of the knee joint, the articulating tibia profile was generated. All the sizes of implants were modeled using a computer-aided software package. Thereupon, these models that accurately fits the local Asian knee were transported into a dynamic and kinematic analysis software package. The tibiofemoral joint was modeled successfully as a slide curve joint to study intuitively the motion of the femur when articulating on the tibia surface. An optimal tibia profile could be synthesized to mimic the natural knee path motion. Details of the analysis are presented and discussed.
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Affiliation(s)
- F H Low
- School of Mechanical and Production Engineering, Nanyang Technological University, Singapore
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18
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Low FH, Khoo LP, Chua CK, Lo NN. Determination of the major dimensions of femoral implants using morphometrical data and principal component analysis. Proc Inst Mech Eng H 2000; 214:301-9. [PMID: 10902444 DOI: 10.1243/0954411001535796] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes the work that leads to the establishment of a set of major parameters for the design of symmetrical prosthetic implants for the Asian population. In the study, 62 sets of femurs harvested from cadavers were used. The morphometrical data obtained are compared with known results and found to be in good agreement with Asian knees. Subsequently, the data are treated and analysed using the principal component analysis, a statistical technique for analysing multivariate data. The analysis has resulted in the establishment of the major design parameters for six different sizes of femoral implants. Details of the analysis are presented. The major parameters obtained in this work are compared with those of existing implants. Results of the comparison are presented. The relationship between the anterio-posterior and medio-lateral dimensions is also examined and reported.
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Affiliation(s)
- F H Low
- Biomedical Engineering Research Centre, School of Mechanical and Production Engineering, Nanyang Technological University, Singapore
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19
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Abstract
This paper presents an approach for the establishment of a parametric model of knee joint prosthesis. Four different sizes of a commercial prosthesis are used as an example in the study. A reverse engineering technique was employed to reconstruct the prosthesis on CATIA, a CAD (computer aided design) system. Parametric models were established as a result of the analysis. Using the parametric model established and the knee data obtained from a clinical study on 21 pairs of cadaveric Asian knees, the development of a prototype prosthesis that suits a patient with a very small knee joint is presented. However, it was found that modification to certain parameters may be inevitable due to the uniqueness of the Asian knee. An avenue for rapid modelling and eventually economical production of a customized knee joint prosthesis for patients is proposed and discussed.
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Affiliation(s)
- L P Khoo
- School of Mechanical and Production Engineering, Nanyang Technological University, Singapore
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