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Berendsen MR, Bladel DAGV, Hesius E, de Groot FA, Kroeze LI, Rijntjes J, Luijks JACW, Hoevenaars B, Halilovic A, Nooijen P, Bladel EV, Jonge-Peeters SD, Lensen C, Pruijt H, van der Spek E, Vermaat JSP, Hess C, Hebeda KM, Stevens WBC, van Krieken JHJM, van den Brand M, Groenen PJTA, Scheijen B. Detection of Second Primary Lymphoma in Late Diffuse Large B-cell Lymphoma Recurrences. Mod Pathol 2023; 36:100119. [PMID: 36805792 DOI: 10.1016/j.modpat.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
Approximately one-third of patients with diffuse large B-cell lymphoma (DLBCL) relapse and often require salvage chemotherapy followed by autologous stem cell transplantation. In most cases, the clonal relationship between the first diagnosis and subsequent relapse is not assessed, thereby potentially missing the identification of second primary lymphoma. In this study, the clonal relationship of 59 paired DLBCL diagnoses and recurrences was established by next-generation sequencing-based detection of immunoglobulin gene rearrangements. Among 50 patients with interpretable results, 43 patients (86%) developed clonally related relapsed disease. This was observed in 100% of early recurrences (<2 years), 80% of the recurrences with an interval between 2 and 5 years, and 73% of late recurrences (≥5 years). On the other hand, 7 (14%) out of 50 patients displayed different dominant clonotypes in primary DLBCL and clinical recurrences, confirming the occurrence of second primary DLBCL; 37% of DLBCL recurrences that occurred ≥4 years after diagnosis were shown to be second primary lymphomas. The clonally unrelated cases were Epstein-Barr virus positive in 43% of the cases, whereas this was only 5% in the relapsed DLBCL cases. In conclusion, next-generation sequencing-based clonality testing in late recurrences should be considered in routine diagnostics to distinguish relapse from second primary lymphoma, as this latter group of patients with DLBCL may benefit from less-intensive treatment strategies.
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Affiliation(s)
- Madeleine R Berendsen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Diede A G van Bladel
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Eva Hesius
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fleur A de Groot
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leonie I Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Rijntjes
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen A C W Luijks
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brigiet Hoevenaars
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Altuna Halilovic
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Peet Nooijen
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Esther van Bladel
- Department of Hematology, Slingeland Hospital, Doetinchem, The Netherlands
| | | | - Chantal Lensen
- Department of Hematology, Bernhoven Hospital, Uden, The Netherlands
| | - Hans Pruijt
- Department of Hematology Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Joost S P Vermaat
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Corine Hess
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Konnie M Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Han J M van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Blanca Scheijen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.
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