101
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Reddy NM, Thieblemont C. Maintenance therapy following induction chemoimmunotherapy in patients with diffuse large B-cell lymphoma: current perspective. Ann Oncol 2017; 28:2680-2690. [PMID: 29045503 DOI: 10.1093/annonc/mdx358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Maintenance therapy has proven efficacy in indolent non-Hodgkin lymphoma (NHL), yet its role in diffuse large B-cell lymphoma (DLBCL) is an area of ongoing investigation. While DLBCL is potentially curable, >30% of patients relapse following front-line therapy and have a poor prognosis, especially those with refractory disease. Maintenance therapy holds promise to maintain response post-induction. PATIENTS AND METHODS Keyword searches were carried out in PubMed and congress abstracts of 'diffuse large B-cell lymphoma' and 'maintenance' and focused on phase II/III studies of maintenance following front-line induction. RESULTS Although used in indolent forms of NHL, studies of maintenance therapy with rituximab in patients with DLBCL responding to front-line R-CHOP (rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone) have not improved efficacy and are not recommended. Targeted agents enzastaurin and everolimus reported results from the phase III studies PRELUDE and PILLAR-2, respectively, both of which showed no proven maintenance benefit following front-line chemoimmunotherapy induction. Overall, the reported efficacy results with these agents in the maintenance setting do not outweigh the risks. Lenalidomide for maintenance has been reported in three studies. Results from two phase II trials on lenalidomide maintenance revealed positive outcomes in higher-risk patients following induction, resulting in improved progression-free survival in relapsed DLBCL patients who were ineligible for transplantation. First analysis from the phase III REMARC trial showed a significant improvement in progression-free survival for lenalidomide versus placebo, with no difference in overall survival, following front-line R-CHOP induction in elderly patients. CONCLUSIONS Based on currently available studies of DLBCL maintenance therapies, initial results in front-line, as well as the relapsed setting, with immunomodulators such as lenalidomide show promise for further research to identify appropriate patients who would most benefit. Overall, this review of maintenance studies underscores the need for additional analyses of patient subtypes, clinical risk status, and molecular profiles, with careful consideration of study end points.
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Affiliation(s)
- N M Reddy
- Department of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, USA;.
| | - C Thieblemont
- Department of Hemato-Oncology, Hôpital Saint-Louis, Paris, France.
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102
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A multi-institutional outcomes analysis of patients with relapsed or refractory DLBCL treated with ibrutinib. Blood 2017; 130:1676-1679. [DOI: 10.1182/blood-2017-05-786988] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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103
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Riedell PA, Bishop MR. Post-autologous transplant maintenance therapies in lymphoma: current state and future directions. Bone Marrow Transplant 2017; 53:11-21. [PMID: 28967896 DOI: 10.1038/bmt.2017.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 01/11/2023]
Abstract
Disease relapse following high-dose chemotherapy and autologous stem cell transplant (ASCT) remains the principal cause of mortality in patients with relapsed or refractory lymphomas. In an effort to prevent post-ASCT relapse, a number of studies have evaluated the role of maintenance therapy with varying success. In diffuse large B-cell lymphoma, studies evaluating maintenance rituximab (MR) following ASCT failed to demonstrate improved outcomes. In follicular lymphoma, MR was associated with an improvement in PFS; however, no overall survival (OS) benefit was noted. Emerging data evaluating MR in mantle cell lymphoma (MCL) have demonstrated improvements in PFS, although a consistent improvement in OS has yet to be demonstrated. Given the aggressive and incurable nature of MCL, it is prudent for practitioners to weigh the risks and benefits of MR in the post-ASCT setting. Similarly, post-ASCT maintenance therapy with brentuximab vedotin in Hodgkin lymphoma, has led to improved PFS and may be considered in those with a high risk of relapse. Ongoing clinical studies evaluating a multitude of novel maintenance therapies are crucial to the efforts of further defining and optimizing the role of post-transplant maintenance therapy in lymphoma.
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Affiliation(s)
- P A Riedell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M R Bishop
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
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104
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Farooq U, Maurer MJ, Thompson CA, Thanarajasingam G, Inwards DJ, Micallef I, Macon W, Syrbu S, Lin T, Lin Y, Ansell SM, Nowakowski GS, Habermann TM, Cerhan JR, Link BK. Clinical heterogeneity of diffuse large B cell lymphoma following failure of front-line immunochemotherapy. Br J Haematol 2017; 179:50-60. [PMID: 28653407 PMCID: PMC5612860 DOI: 10.1111/bjh.14813] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022]
Abstract
This study aimed to describe the patterns of care and outcomes of diffuse large B cell lymphoma (DLBCL) after failure of front line anthracycline-based immunochemotherapy (IC). Patients with newly diagnosed lymphoma were prospectively enrolled in Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellzence. All DLBCL and primary mediastinal B-cell lymphoma (PMBL) patients treated with front-line anthracycline-based IC were followed for relapse. Patients with relapse on follow-up and subsequently retreated were included in this analysis. 1039 patients received anthracycline-based IC between 2002 and 2012, of which 244 relapsed and were subsequently retreated. Across all therapies, overall survival at 4 years (OS4) from relapse was 28% and 103 patients ultimately underwent autologous haematopoietic cell transplant (autoHCT) with OS4 from autoHCT of 51%. Patients relapsing after 12 months from initial diagnosis had OS4 of 47% but those with a transient or no response to initial therapy had OS4 of only 13%. Outcomes of relapsed or refractory DLBCL differ substantially when categorized by response to initial therapy, timing of relapse and opportunity to undergo autoHCT. The design and interpretation of uncontrolled trials should account for this heterogeneity in patients with relapsed DLBCL.
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Affiliation(s)
- Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | | | | | | | | | - William Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Sergei Syrbu
- Department of Laboratory Medicine and Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Tasha Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - James R. Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Brian K. Link
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa Hospitals and Clinics, Iowa City, IA
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105
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Goy A. Succeeding in Breaking the R-CHOP Ceiling in DLBCL: Learning From Negative Trials. J Clin Oncol 2017; 35:3519-3522. [PMID: 28926287 DOI: 10.1200/jco.2017.74.7360] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Andre Goy
- Andre Goy, Hackensack University Medical Center, Hackensack, NJ
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106
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Czuczman MS, Trněný M, Davies A, Rule S, Linton KM, Wagner-Johnston N, Gascoyne RD, Slack GW, Brousset P, Eberhard DA, Hernandez-Ilizaliturri FJ, Salles G, Witzig TE, Zinzani PL, Wright GW, Staudt LM, Yang Y, Williams PM, Lih CJ, Russo J, Thakurta A, Hagner P, Fustier P, Song D, Lewis ID. A Phase 2/3 Multicenter, Randomized, Open-Label Study to Compare the Efficacy and Safety of Lenalidomide Versus Investigator's Choice in Patients with Relapsed or Refractory Diffuse Large B-Cell Lymphoma. Clin Cancer Res 2017; 23:4127-4137. [PMID: 28381416 PMCID: PMC8171498 DOI: 10.1158/1078-0432.ccr-16-2818] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 12/19/2022]
Abstract
Purpose: Randomized, multicenter, open-label, phase 2/3 trial investigating lenalidomide versus investigator's choice (IC) in relapsed/refractory diffuse large B-cell lymphoma (DLBCL).Experimental Design: Patients with DLBCL who received ≥2 prior therapies were stratified by DLBCL subtype [germinal center B-cell (GCB) vs. non-GCB; determined by immunohistochemistry (IHC)] and then randomized 1:1 to lenalidomide (25 mg/day, 21 days of 28-day cycle) or IC (gemcitabine, rituximab, etoposide, or oxaliplatin). Crossover to lenalidomide was permitted for IC-treated patients with radiologically confirmed progressive disease. The primary endpoint was overall response rate (ORR). Progression-free survival (PFS), overall survival, and subtype analysis [GCB vs. activated B-cell (ABC)] using gene expression profiling (GEP) were exploratory endpoints.Results: Stage 1: 102 DLBCL patients (by IHC: non-GCB, n = 54; GCB, n = 48) received ≥1 dose of lenalidomide or IC. Hematologic treatment-emergent adverse events with lenalidomide versus IC included neutropenia (42.6%; 36.4%), anemia (33.3%; 47.3%), thrombocytopenia (24.1%; 43.6%), and leukopenia (5.6%; 12.7%), respectively. Overall, lenalidomide-treated patients had an ORR of 27.5% versus 11.8% in IC (ORRs were similar regardless of IHC-defined DLBCL subtype). Median PFS was increased in patients receiving lenalidomide (13.6 weeks) versus IC (7.9 weeks; P = 0.041), with greater improvements in non-GCB patients (15.1 vs. 7.1 weeks, respectively; P = 0.021) compared with GCB (10.1 vs. 9.0 weeks, respectively; P = 0.550).Conclusions: The clinical benefit of lenalidomide monotherapy in DLBCL patients was more evident in the non-GCB subtype. Exploratory analyses suggest that this preferential benefit was more pronounced in the GEP-defined ABC population, demonstrating a need for additional studies of lenalidomide in DLBCL using GEP subtyping. Clin Cancer Res; 23(15); 4127-37. ©2017 AACR.
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Affiliation(s)
| | - Marek Trněný
- Department of Hematology, Charles University Hospital, Prague, Czech Republic
| | - Andrew Davies
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Simon Rule
- Department of Haematology, Derriford Hospital, Plymouth, United Kingdom
| | - Kim M Linton
- Division of Molecular and Clinical Cancer Sciences, The Christie Foundation Trust, Manchester, United Kingdom
| | - Nina Wagner-Johnston
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Randy D Gascoyne
- Centre for Lymphoid Cancers, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancers, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pierre Brousset
- Laboratoire D'Anatomie Pathologique, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - David A Eberhard
- Department of Pathology/Laboratory Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Gilles Salles
- Hematology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Thomas E Witzig
- Departments of Laboratory Medicine and Pathology and Hematology, Mayo Clinic, Rochester, Minnesota
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology, University of Bologna, Bologna, Italy
| | - George W Wright
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Louis M Staudt
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Yandan Yang
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - P Mickey Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, Maryland
| | - Chih-Jian Lih
- Molecular Characterization and Clinical Assay Development Laboratory, Leidos Biomedical Research Inc. and Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | | | | | | | | | - Dale Song
- Celgene Corporation, Summit, New Jersey
| | - Ian D Lewis
- Divison of Haematology, Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia
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107
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Di Rocco A, De Angelis F, Ansuinelli M, Foà R, Martelli M. Is now the time for molecular driven therapy for diffuse large B-cell lymphoma? Expert Rev Hematol 2017; 10:761-774. [PMID: 28712322 DOI: 10.1080/17474086.2017.1356714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Recent genetic and molecular discoveries regarding alterations in diffuse large B-cell lymphoma (DLBCL) deeply changed the approach to this lymphoproliferative disorder. Novel additional predictors of outcomes and new therapeutic strategies are being introduced to improve outcomes. Areas covered: This review aims to analyse the recent molecular discoveries in DLBCL, the rationale of novel molecular driven treatments and their impact on DLBCL prognosis, especially in ABC-DLBCL and High Grade B Cell Lymphoma. Pre-clinical and clinical evidences are reviewed to critically evaluate the novel DLBCL management strategies. Expert commentary: New insights in DLBCL molecular characteristics should guide the therapeutic approach; the results of the current studies which are investigating safety and efficacy of novel 'X-RCHOP' will probably lead, in future, to a cell of origin (COO) based upfront therapy. Moreover, it is necessary to identify early patients with DLBCL who carried MYC, BCL2 and/or BCL6 rearrangements double hit lymphomas (DHL) because they should not receive standard R-CHOP but high intensity treatment as reported in many retrospective studies. New prospective trials are needed to investigate the more appropriate treatment of DHL.
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Affiliation(s)
- Alice Di Rocco
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Federico De Angelis
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Michela Ansuinelli
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Robin Foà
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Maurizio Martelli
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
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108
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Chiappella A, Santambrogio E, Castellino A, Nicolosi M, Vitolo U. Integrating novel drugs to chemoimmunotherapy in diffuse large B-cell lymphoma. Expert Rev Hematol 2017; 10:697-705. [DOI: 10.1080/17474086.2017.1350164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Annalisa Chiappella
- Città della Salute e della Scienza Hospital and University, Hematology, Turin, Italy
| | - Elisa Santambrogio
- Città della Salute e della Scienza Hospital and University, Hematology, Turin, Italy
| | - Alessia Castellino
- Città della Salute e della Scienza Hospital and University, Hematology, Turin, Italy
| | - Maura Nicolosi
- Città della Salute e della Scienza Hospital and University, Hematology, Turin, Italy
| | - Umberto Vitolo
- Città della Salute e della Scienza Hospital and University, Hematology, Turin, Italy
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109
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Patrascu AM, Streba L, Patrascu Ş, Nacea J, Mogoanta L, Rotaru I. Correlation between Immunohistochemical Subtype and Clinicopathological Features in Patients with Diffuse Large B-cell Lymphoma. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:253-257. [PMID: 30595885 PMCID: PMC6284833 DOI: 10.12865/chsj.43.03.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/18/2022]
Abstract
The aim of this study was to establish correlations between certain clinical, biological, therapeutic factors and diffuse large B-cell lymphoma (DLBCL) subtypes. For this purpose, between January 2007 and December 2016 a total number of 97 patients with de novo diffuse large B-cell lymphoma were analyzed. Patients with a high prognostic index and non-GCB DLBCL positively correlated and exhibited lower survival rates than low IPI, GCB patients. IPI scoring system and cell-of-origin classification should be used together as a single valid prognostic evaluation tool for DLBCL.
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Affiliation(s)
- Ana-Maria Patrascu
- Department of Hematology, University of Medicine and Pharmacy of Craiova, Romania
| | - Liliana Streba
- Department of Oncology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ş Patrascu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Janina Nacea
- Department of Hematology, University of Medicine and Pharmacy of Craiova, Romania
| | - L Mogoanta
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | - Ionela Rotaru
- Department of Hematology, University of Medicine and Pharmacy of Craiova, Romania
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110
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Therapeutic Options in Diffuse Large B-Cell Lymphoma - A Retrospective Study and Review of the Literature. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:269-274. [PMID: 30595888 PMCID: PMC6284846 DOI: 10.12865/chsj.43.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/16/2017] [Indexed: 11/18/2022]
Abstract
The aim of this retrospective study was to assess the differences between standard R-CHOP and other Rituximab-associated chemotherapy (R-miniCHOP and R-CHOEP) regimens in terms of survival and potential adverse effects. The six-month survival outcomes of 94 diffuse large B-cell lymphomas (DLBCL) patients indicated no statistical difference between overall survival and disease-free survival in the two subgroups. The biological response to therapy (blood count, LDH levels) was similar in both subgroups. Despite having different clinical indications, R-miniCHOP and R-CHOEP provide viable therapeutic alternatives to the standard R-CHOP regimen.
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111
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Leonard JP, Martin P, Roboz GJ. Practical Implications of the 2016 Revision of the World Health Organization Classification of Lymphoid and Myeloid Neoplasms and Acute Leukemia. J Clin Oncol 2017; 35:2708-2715. [PMID: 28654364 DOI: 10.1200/jco.2017.72.6745] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A major revision of the WHO classification of lymphoid and myeloid neoplasms and acute leukemia was released in 2016. A key motivation for this update was to include new information available since the 2008 version with clinical relevance for the diagnosis, prognosis, and therapy of patients. With > 100 entities described, it is important for the clinician to understand features that may be important in daily practice, whereas researchers need to incorporate the new classification scheme into study development and analysis. In this review, we highlight the key aspects of the 2016 update with particular importance to routine patient care and clinical trial design.
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Affiliation(s)
- John P Leonard
- All authors: Weill Cornell Medicine and New York Presbyterian Hospital, New York NY
| | - Peter Martin
- All authors: Weill Cornell Medicine and New York Presbyterian Hospital, New York NY
| | - Gail J Roboz
- All authors: Weill Cornell Medicine and New York Presbyterian Hospital, New York NY
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112
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How I treat patients with aggressive lymphoma at high risk of CNS relapse. Blood 2017; 130:867-874. [PMID: 28611025 DOI: 10.1182/blood-2017-03-737460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/11/2017] [Indexed: 12/25/2022] Open
Abstract
Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis.
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113
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Sujobert P, Salles G, Bachy E. Molecular Classification of Diffuse Large B-cell Lymphoma: What Is Clinically Relevant? Hematol Oncol Clin North Am 2017; 30:1163-1177. [PMID: 27888873 DOI: 10.1016/j.hoc.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Major progress in the understanding of diffuse large B-cell lymphoma (DLBCL) biology has been made in the last decade. Many specific compounds have now entered early phase clinical trials. However, further efforts are needed to find an accurate, fast, reproducible, and affordable technique to translate DLBCL subtype determination by gene expression profiles into clinical application. This article discusses the advantages and drawbacks of the currently available techniques of DLBCL subtype determination as well as important prognostic implications related to the cell of origin. Furthermore, the article provides a schematic description of how molecularly defined DLBCL subtypes could guide tailored therapy.
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Affiliation(s)
- Pierre Sujobert
- Laboratory of Hematology, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite 69310, France; Université Claude Bernard Lyon1, Université de Lyon, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Lyon, France
| | - Gilles Salles
- Université Claude Bernard Lyon1, Université de Lyon, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Lyon, France; Department of Hematology, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite 69310, France.
| | - Emmanuel Bachy
- Université Claude Bernard Lyon1, Université de Lyon, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Lyon, France; Department of Hematology, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite 69310, France
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114
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Staiger AM, Ziepert M, Horn H, Scott DW, Barth TFE, Bernd HW, Feller AC, Klapper W, Szczepanowski M, Hummel M, Stein H, Lenze D, Hansmann ML, Hartmann S, Möller P, Cogliatti S, Lenz G, Trümper L, Löffler M, Schmitz N, Pfreundschuh M, Rosenwald A, Ott G. Clinical Impact of the Cell-of-Origin Classification and the MYC/ BCL2 Dual Expresser Status in Diffuse Large B-Cell Lymphoma Treated Within Prospective Clinical Trials of the German High-Grade Non-Hodgkin's Lymphoma Study Group. J Clin Oncol 2017; 35:2515-2526. [PMID: 28525305 DOI: 10.1200/jco.2016.70.3660] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To explore the prognostic impact and interdependence of the cell-of-origin (COO) classification, dual expression (DE) of MYC and BCL2 proteins, and MYC, BCL2, and BCL6 translocations in two prospectively randomized clinical trials of patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Overall, 452 formalin-fixed paraffin-embedded samples from two prospective, randomized DLBCL trials (RICOVER-60, prospective, randomized study for patients > 60 years, all IPI groups; and R-MegaCHOEP, prospective, randomized study for patients ≤ 60 years with age-adjusted IPI 2,3) of the German High-Grade Non-Hodgkin Lymphoma Study Group were analyzed with the Lymph2Cx assay for COO classification, with immunohistochemistry for MYC and BCL2, and with fluorescent in situ hybridization for MYC, BCL2, and BCL6 rearrangements. Results COO classification was successful in 414 of 452 samples. No significant differences with respect to COO (activated B-cell [ABC]-like DLBCL v germinal center B-cell [GCB]-like DLBCL) were observed in event-free survival, progression-free survival, and overall survival in patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the RICOVER-60 trial. Also, no differences with respect to COO were observed in multivariable analyses adjusted for International Prognostic Index factors in event-free survival (hazard ratio [HR] of ABC-like disease v GCB-like disease, 1.0; 95% CI, 0.6 to 1.6; P = .93), progression-free survival (HR, 1.1; 95% CI, 0.6 to 1.8; P = .82), and overall survival (HR, 1.0; 95% CI, 0.6 to 1.8; P = .96). Similar results were observed in the R-MegaCHOEP trial. In patients treated with R-CHOP, DE status was associated with significantly inferior survival compared with nonDE within the GCB, but not within the ABC subgroup. DE status was associated with significantly inferior outcome compared with patients with ABC-like DLBCL without DE (5-year PFS rate, 39% [95% CI,19% to 59%] v 68% [95% CI, 52% to 85%]; P = .03) and compared with patients with GCB-like DLBCL without DE. When data from patients with nonDE were analyzed separately, the outcome of patients in the ABC subgroup was inferior to that of patients in the GCB subgroup (5-year PFS rate, 68% [95% CI, 52% to 85%] v 85% [95% CI, 74% to 96%]; P = .04). Conclusion COO profiling in two prospective randomized DLBCL trials failed to identify prognostic subgroups, whereas dual expression of MYC and BCL2 was predictive of poor survival. Evaluation of prognostic or predictive biomarkers in the management of DLBCL, such as the COO, within prospective clinical trials will be important in the future.
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Affiliation(s)
- Annette M Staiger
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Marita Ziepert
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heike Horn
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - David W Scott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Thomas F E Barth
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heinz-Wolfram Bernd
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Alfred C Feller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Wolfram Klapper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Monika Szczepanowski
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Hummel
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Harald Stein
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Dido Lenze
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Martin-Leo Hansmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sylvia Hartmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Peter Möller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sergio Cogliatti
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Georg Lenz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Lorenz Trümper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Markus Löffler
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Norbert Schmitz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Pfreundschuh
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andreas Rosenwald
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - German Ott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
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Chiappella A, Castellino A, Nicolosi M, Santambrogio E, Vitolo U. Diffuse Large B-cell Lymphoma in the elderly: standard treatment and new perspectives. Expert Rev Hematol 2017; 10:289-297. [PMID: 28290728 DOI: 10.1080/17474086.2017.1305264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is the most common histotype in non Hodgkin lymphoma, with a peak incidence in the sixth decade. The standard treatment for elderly FIT DLBCL patients is Rituximab-CHOP; in unfit and frail patients, chemotherapy at reduced intensity should be considered. Areas covered: In this article, we will review use of standard therapies and new drugs investigated such as immonomudulating agents (IMiDs), Bruton Tyrosine Kinase (BTK), in fit, unfit, frail and very elderly DLCBL patients. Expert commentary: R-CHOP21 in fit DLBCL patients is still the standard of care, while in elderly unfit patients a reduction of doses of cytotoxic drugs or schemes that avoid antracycline should be considered. The Comprensive Geriatric Assesment based in age, comorbidities and functional abilities of daily living is an important tool in elderly, in order to discriminate between fit, unfit or frail patients. Novel drugs represent valid therapeutic options in relapsed/refractory setting so continued participation in clinical trials should be encouraged.
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Affiliation(s)
- Annalisa Chiappella
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Alessia Castellino
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Maura Nicolosi
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Elisa Santambrogio
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
| | - Umberto Vitolo
- a Hematology , Città della Salute e della Scienza Hospital and University , Turin , Italy
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Abstract
Diffuse large B-cell lymphoma (DLBCL) comprises a heterogeneous group with pathophysiological, genetic and clinical features. Many patients can be cured with R-CHOP therapy, which is the current standard regimen. Despite recent progress in improving patient survival, the 40% survival of DLBCL patients remains poor. Therefore, the most important issue for patients with DLBCL remains the development of a new front-line therapy. Several studies have reported that intensified chemotherapy with dose-adjusted EPOCH-R or R-ACVBP was superior to R-CHOP. Gene expression profiling has identified two distinct forms of DLBCL: activated B cell-like (ABC) and germinal center B-cell-like (GCB) types. ABC DLBCL exhibits a worse prognosis than GCB DLBCL by molecular diagnosis after R-CHOP therapy. Next-generation sequencing has identified unique oncogenic mechanisms and genetic complexity, which has provided rational therapeutic targets. There are also a number of biomarkers, including CD5, and prognostic factors. Efforts to distinguish many biomarkers will be crucial for individualized treatment in the future.
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine
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Ferreri AJM, Sassone M, Zaja F, Re A, Spina M, Rocco AD, Fabbri A, Stelitano C, Frezzato M, Rusconi C, Zambello R, Couto S, Ren Y, Arcari A, Bertoldero G, Nonis A, Scarfò L, Calimeri T, Cecchetti C, Chiozzotto M, Govi S, Ponzoni M. Lenalidomide maintenance in patients with relapsed diffuse large B-cell lymphoma who are not eligible for autologous stem cell transplantation: an open label, single-arm, multicentre phase 2 trial. LANCET HAEMATOLOGY 2017; 4:e137-e146. [DOI: 10.1016/s2352-3026(17)30016-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 12/24/2022]
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Law AD, Prakash G, Khadwal A, Das A, Varma S, Malhotra P. L-PROBe: A Novel Non-anthracycline Combination Chemotherapy Regimen for Aggressive B Cell Non-Hodgkin Lymphoma in Elderly Patients. Indian J Hematol Blood Transfus 2017; 33:61-68. [PMID: 28194058 DOI: 10.1007/s12288-016-0655-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 02/02/2016] [Indexed: 12/11/2022] Open
Abstract
The management of aggressive B cell lymphomas in elderly patients is associated with poor tolerability of commonly used chemotherapeutic agents. The safety and tolerability of a novel combination chemotherapy regimen utilizing rituximab, lenalidomide, bendamustine, vincristine and prednisolone was assessed in a series of elderly patients with new onset or relapsed/refractory aggressive B cell lymphoma and inability to receive conventional chemotherapy due to poor performance status and/or significant comorbidities. Ten patients (7 male, 3 female) with a median age of 72 years (range 58-79 years) received therapy with lenalidomide (10 mg/day on days 1-14), rituximab (375 mg/m2 on day 1), bendamustine (90 mg/m2 on days 1 and 2), vincristine (1.4 mg/m2 on day 1) and prednisolone (60 mg/m2/day on days 1-5) with cycles repeated every 28 days. Grade 3/4 hematological toxicities included neutropenia (30 %), anemia (30 %) and thrombocytopenia (10 %). An overall response rate of 40 % was observed with a median survival of 120 days (range 14-286 days). Three of the patients who responded achieved complete remission at the end of six cycles of therapy. This combination chemotherapy appears to be well tolerated and effective in elderly patients with poor performance status. Larger controlled studies are indicated to clearly demonstrate applicability of this novel regimen.
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Affiliation(s)
- Arjun Datt Law
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Nandagopal L, Mehta A. Treatment approaches of hard-to-treat non-Hodgkin lymphomas. Expert Rev Hematol 2017; 10:259-273. [DOI: 10.1080/17474086.2017.1283214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Amitkumar Mehta
- Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Jaffe ES, Barr PM, Smith SM. Understanding the New WHO Classification of Lymphoid Malignancies: Why It's Important and How It Will Affect Practice. Am Soc Clin Oncol Educ Book 2017; 37:535-546. [PMID: 28561690 PMCID: PMC6324533 DOI: 10.1200/edbk_175437] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Improved delineation of lymphoid malignancy biology has prompted refinement of the 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tumors with a new framework introduced in 2016. This knowledge has provided valuable insights regarding management. Early clonal proliferations have been set apart given their limited potential for malignant dissemination. Increasing knowledge of molecular drivers of aggressive lymphomas has allowed subclassification and opportunity for clinical investigations to personalize therapy. New insights into T-cell pathophysiology has allowed grouping based on shared molecular and cellular features. This article will summarize the key changes in terms of diagnosis and histopathologic definitions, the impact of these changes on clinical management, and the challenges of future research in this field.
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Affiliation(s)
- Elaine S Jaffe
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Paul M Barr
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Sonali M Smith
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
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State-of-the-art Therapy for Advanced-stage Diffuse Large B-cell Lymphoma. Hematol Oncol Clin North Am 2016; 30:1147-1162. [DOI: 10.1016/j.hoc.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nowakowski GS, Blum KA, Kahl BS, Friedberg JW, Baizer L, Little RF, Maloney DG, Sehn LH, Williams ME, Wilson WH, Leonard JP, Smith SM. Beyond RCHOP: A Blueprint for Diffuse Large B Cell Lymphoma Research. J Natl Cancer Inst 2016; 108:djw257. [PMID: 27986884 PMCID: PMC6080361 DOI: 10.1093/jnci/djw257] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/14/2016] [Accepted: 09/30/2016] [Indexed: 12/16/2022] Open
Abstract
Diffuse large B cell lymphoma (DLBCL) comprises multiple molecular and biological subtypes, resulting in a broad range of clinical outcomes. With standard chemoimmunotherapy, there remains an unacceptably high treatment failure rate in certain DLBCL subsets: activated B cell (ABC) DLBCL, double-hit lymphoma defined by the dual translocation of MYC and BCL2, dual protein-expressing lymphomas defined by the overexpression of MYC and BCL2, and older patients and those with central nervous system involvement. The main research challenges for DLBCL are to accurately identify molecular subsets and to determine if specific chemotherapy platforms and targeted agents offer differential benefit. The ultimate goal should be to maximize initial cure rates to improve long-term survival while minimizing toxicity. In particular, a frontline trial should focus on biologically defined risk groups not likely to be cured with cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-CHOP). An additional challenge is to develop effective and personalized strategies in the relapsed setting, for which there is no current standard other than autologous stem cell transplantation, which benefits a progressively smaller proportion of patients. Relapsed/refractory DLBCL is the ideal setting for testing novel agents and new biomarker tools and will require a national call for biopsies to optimize discovery in this setting. Accordingly, the development of tools with both prognostic and predictive utility and the individualized application of new therapies should be the main priorities. This report identifies clinical research priorities for critical areas of unmet need in this disease.
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Affiliation(s)
- Grzegorz S Nowakowski
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Kristie A Blum
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Brad S Kahl
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Jonathan W Friedberg
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Lawrence Baizer
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Richard F Little
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - David G Maloney
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Laurie H Sehn
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Michael E Williams
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Wyndham H Wilson
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - John P Leonard
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
| | - Sonali M Smith
- Department of Medicine, Mayo Clinic, Rochester, MN (GSN); Department of Internal Medicine, Ohio State University, Columbus, OH (KAB); Department of Medicine, Oncology Division, Washington University, St. Louis, MO (BSK); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester, Rochester, NY (JWF); Coordinating Center for Clinical Trials (LB), Division of Cancer Treatment and Diagnosis (RFL), and Center for Cancer Research (WHW), National Cancer Institute, National Institute of Health, Bethesda, MD; Division of Oncology, University of Washington, Seattle WA (DGM); British Colombia Cancer Agency, Vancouver, BC (LHS); Department of Medicine, University of Virginia, Charlottesville, VA (MEW); Department of Medicine, Weil Cornell University, New York, NY (JPL); Department of Medicine, University of Chicago, Chicago, IL (SMS)
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Garciaz S, Coso D, Schiano de Colella JM, Bouabdallah R. Lenalidomide for the treatment of B-cell lymphoma. Expert Opin Investig Drugs 2016; 25:1103-16. [PMID: 27414850 DOI: 10.1080/13543784.2016.1208170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Although the combination of an anti-CD20 monoclonal antibody and chemotherapy has widely improved survival of patients with B-cell lymphoma, the disease still relapses. A better understanding of the biology of lymphomas has highlighted the role of the cell of origin in response to treatment and outcome. Lenalidomide represents an attractive therapeutic option due to its original mechanism of action. AREAS COVERED In this review, the authors describe the pharmacological properties of lenalidomide, and the rational for its use in B-cell lymphomas; focusing on diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), and mantle cell lymphoma (MCL). They discuss the mechanism of action of the drug and its current and future clinical development. They also review the current data in relapsed/refractory situations as well as in first-line treatment. EXPERT OPINION Lenalidomide is an oral non-chemotherapy immunomodulatory agent with an acceptable toxicity profile and manageable side-effects. Efficacy has widely been demonstrated, especially in MCL, FL and non-Germinal Center DLBCL patients. Further studies are now warranted to better define the strategy for the use of lenalidomide in B-NHL patients, and clarify which subgroup of patients will really benefit of lenalidomide as part of first-line treatment or in a relapsed/refractory setting.
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Affiliation(s)
- Sylvain Garciaz
- a Department of Hematology, Institut Paoli-Calmettes , Université de la Méditerranée , Marseille , France
| | - Diane Coso
- a Department of Hematology, Institut Paoli-Calmettes , Université de la Méditerranée , Marseille , France
| | | | - Réda Bouabdallah
- a Department of Hematology, Institut Paoli-Calmettes , Université de la Méditerranée , Marseille , France
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125
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Mondello P, Steiner N, Willenbacher W, Ferrero S, Ghione P, Marabese A, Pitini V, Cuzzocrea S, Mian M. Lenalidomide in Relapsed or Refractory Diffuse Large B-Cell Lymphoma: Is It a Valid Treatment Option? Oncologist 2016; 21:1107-12. [PMID: 27382029 DOI: 10.1634/theoncologist.2016-0103] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/05/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the advent of new treatment strategies, many patients with diffuse large B-cell lymphoma (DLBCL) relapse or die of the disease. Prospective clinical trials have demonstrated that lenalidomide is an effective and safe treatment option, especially for non-germinal center B-cell (non-GCB) DLBCL. However, routine clinical data are lacking, which is why we provide the results of the so-far largest relapsed/refractory (R/R) DLBCL real-life analysis. METHODS We retrospectively assessed 123 R/R DLBCL patients who received either 15 or 25 mg/day of lenalidomide from January 2006 to January 2015. RESULTS During a median follow-up period of 4.5 years, complete remission was achieved in 32% and a partial remission in 33% non-GCB patients compared with 0% and 3% in the GCB group (p < .001 and .001, respectively), with median response durations of 15 and 5 months, respectively (p < .001). Lenalidomide at 25 mg was superior to 15 mg in terms of response (complete remission 21% and partial remission 23% vs. 0% and 8%; p = .007 and .05) and median response duration (10 vs. 4 months; p = .03). Toxicity was limited and reversible. Median progression-free survival differed between non-GCB and GCB patients (37 vs. 30 months; p < .001) and between the two dosages (24 vs. 34 months; p = .002). However, overall survival was similar between the subgroups (38-42 months). CONCLUSION We provide evidence that lenalidomide is a valid treatment option for R/R DLBCL, with limited and reversible toxicity, and is more efficient in non-GCB DLBCL and at higher doses. IMPLICATIONS FOR PRACTICE Despite the advent of new treatment strategies, many patients with diffuse large B-cell lymphoma (DLBCL) relapse or die of the disease; hence, novel therapeutic approaches are urgently needed. This study confirms that lenalidomide is a valid and well-tolerated treatment option for relapsed/refractory (R/R) DLBCL. Superior outcomes were observed in non-germinal center B-cell (GCB) DLBCL, probably because of inhibition of the nuclear factor-κB pathway. Similarly, high drug doses resulted in greater clinical benefits. Overall, lenalidomide is a suitable therapeutic option for R/R DLBCL, especially in non-GCB DLBCL, and 25 mg/day dosing should be preferred.
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Affiliation(s)
- Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, Messina, Italy Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Normann Steiner
- Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Paola Ghione
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Alessandra Marabese
- Department of Hematology and Center for Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
| | - Vincenzo Pitini
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical, and Environmental Sciences, University of Messina, Messina, Italy
| | - Michael Mian
- Internal Medicine V, Hematology and Oncology, Medical University of Innsbruck, Innsbruck, Austria Department of Hematology and Center for Bone Marrow Transplantation, Ospedale di Bolzano, Bolzano, Italy
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126
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Clinical approach to diffuse large B cell lymphoma. Blood Rev 2016; 30:477-491. [PMID: 27596109 DOI: 10.1016/j.blre.2016.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 05/26/2016] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
Diffuse large B cell lymphoma (DLBCL) is the most common subtype of lymphoma. We now recognize that DLBCL corresponds to a biologically heterogeneous family of diseases. Given the potential for cure for most DLBCL patients, appropriate diagnostic and staging evaluation and therapy are essential. Here we review areas of consensus as well as controversy in the evaluation, treatment and monitoring of patients with DLBCL and its related subtypes.
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127
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Salati M, Tarantino V, Maiorana A, Bettelli S, Luminari S. Durable remission in a patient with leptomeningeal relapse of a MYC/BCL6-positive double-hit DLBCL treated with lenalidomide monotherapy. Hematol Oncol 2016; 35:861-863. [PMID: 27301994 DOI: 10.1002/hon.2315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/15/2016] [Accepted: 05/06/2016] [Indexed: 12/23/2022]
Abstract
Secondary central nervous system involvement is an uncommon event that typically occurs early in the natural history of diffuse large B-cell lymphoma and presents as leptomeningeal dissemination in two-thirds of cases. The prognosis of this event is dismal, and treatment options are meagre. Although major validated risk factors for central nervous system dissemination are clinical, concomitant MYC/BCL2 rearrangements as well as MYC/BCL2 protein expression have been recently associated with an increased risk of this complication. Here we present the first case, to our knowledge, of a MYC/BCL6-positive double-hit diffuse large B-cell lymphoma relapsing in the leptomeninges that achieved an outstanding durable remission with single-agent lenalidomide following salvage chemotherapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Massimiliano Salati
- Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Vittoria Tarantino
- Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Bettelli
- Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Luminari
- Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, University of Modena and Reggio Emilia, Modena, Italy
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Zinzani PL, Rigacci L, Cox MC, Devizzi L, Fabbri A, Zaja F, Di Rocco A, Rossi G, Storti S, Fattori PP, Argnani L, Vitolo U. The efficacy of lenalidomide combination therapy in heavily pretreated non-Hodgkin lymphoma patients: an Italian observational, multicenter, retrospective study. Leuk Lymphoma 2016; 58:226-229. [PMID: 27252040 DOI: 10.1080/10428194.2016.1184755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pier Luigi Zinzani
- a Institute of Hematology "Seràgnoli," University of Bologna , Bologna , Italy
| | - Luigi Rigacci
- b Department of Haematology , "Careggi" Hospital , Firenze , Italy
| | - Maria Cristina Cox
- c Haematology Unit, AO Sant'Andrea, Department of Clinical and Experimental Medicine , La Sapienza University , Rome , Italy
| | - Liliana Devizzi
- d Division of Hematology , National Cancer Institute , Milan , Italy
| | - Alberto Fabbri
- e Division of Haematology , "S. Maria alle Scotte" Hospital , Siena , Italy
| | - Francesco Zaja
- f Department of Haematology, DISM, AOUD S. M. Misericordia , Udine , Italy
| | - Alice Di Rocco
- g Department of Cellular Biotechnologies and Haematology , "Sapienza" University , Rome , Italy
| | - Giuseppe Rossi
- h Department of Haematology , Spedali Civili , Brescia , Italy
| | - Sergio Storti
- i Centre for High Technology Research and Education in Biomedical Sciences, University "Cattolica del Sacro Cuore," Campobasso , Italy
| | - Pier Paolo Fattori
- j Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Lisa Argnani
- a Institute of Hematology "Seràgnoli," University of Bologna , Bologna , Italy
| | - Umberto Vitolo
- k AO Città della Salute e della Scienza di Torino , Torino , Italy
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129
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Ji D, Li Q, Cao J, Guo Y, Lv F, Liu X, Wang B, Wang L, Luo Z, Chang J, Wu X, Hong X. Thalidomide enhanced the efficacy of CHOP chemotherapy in the treatment of diffuse large B cell lymphoma: A phase II study. Oncotarget 2016; 7:33331-9. [PMID: 27129176 PMCID: PMC5078098 DOI: 10.18632/oncotarget.8973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/02/2016] [Indexed: 02/05/2023] Open
Abstract
Cyclophosphamide, doxorubicin, vincristine, and prednisolone plus rituximab (R-CHOP) is the standard treatment for patients with diffuse large B cell lymphoma (DLBCL). However, rituximab cannot be popularly applied in a considerable number of patients with DLBCL because of economic reasons. To develop a new regimen to improve the outcome of these patients is extremely important. In our study, sixty five patients with DLBCL were randomly assigned to thalidomide plus CHOP group (n=32) or to CHOP alone group (n=33). Objective response rates (ORR) and complete remission rates (CRR) were 96.7% and 80.6% in T-CHOP group versus 78.9 % and 57.8 % in CHOP group, respectively (P <0.05). At a median follow-up of 96 months, median PFS for T-CHOP group was still not reached yet, and in CHOP group it was 22.9 months (95% CI [0-50.4]). (P=0.163). Median overall survival (OS) for T-CHOP group was also not reached, and the estimated median OS for CHOP group was 83.5 months, the difference of OS between the two groups is not significant (p=0.263). But, in patients with Bcl-2 positive and Bcl-6 negative, the median PFS in T-CHOP group was longer than that in CHOP group (111.0 vs 8.5 months (P=0.017). In addition, thalidomide did not significantly increase the grade 3/4 toxicity of CHOP. We concluded that the addition of thalidomide to the CHOP regimen significantly improved the CRR and showed a trend of improving clinical outcome in patients with DLBCL, especially for patients with Bcl-2 positive and Bcl-6 negative B-cell phenotype, without increased toxicity.
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Affiliation(s)
- Dongmei Ji
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Qiu Li
- Department of Medical Oncology, West China Hospital of Medicine, Sichuan University, Chengdu 610041, P.R. China
| | - Junning Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Ye Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Fangfang Lv
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xiaojian Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Biyun Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Leiping Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Jianhua Chang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xianghua Wu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Xiaonan Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
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130
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Zinzani PL, Pellegrini C, Argnani L, Broccoli A. Prolonged disease-free survival in elderly relapsed diffuse large B-cell lymphoma patients treated with lenalidomide plus rituximab. Haematologica 2016; 101:e385-6. [PMID: 27247321 DOI: 10.3324/haematol.2016.147256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Italy
| | - Cinzia Pellegrini
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Italy
| | - Lisa Argnani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Italy
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131
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Impact of dual expression of MYC and BCL2 by immunohistochemistry on the risk of CNS relapse in DLBCL. Blood 2016; 127:2182-8. [DOI: 10.1182/blood-2015-10-676700] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/16/2016] [Indexed: 01/16/2023] Open
Abstract
Key Points
Dual expression of MYC and BCL2 is associated with an increased risk of CNS relapse in DLBCL treated with R-CHOP.
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132
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Morin RD, Assouline S, Alcaide M, Mohajeri A, Johnston RL, Chong L, Grewal J, Yu S, Fornika D, Bushell K, Nielsen TH, Petrogiannis-Haliotis T, Crump M, Tosikyan A, Grande BM, MacDonald D, Rousseau C, Bayat M, Sesques P, Froment R, Albuquerque M, Monczak Y, Oros KK, Greenwood C, Riazalhosseini Y, Arseneault M, Camlioglu E, Constantin A, Pan-Hammarstrom Q, Peng R, Mann KK, Johnson NA. Genetic Landscapes of Relapsed and Refractory Diffuse Large B-Cell Lymphomas. Clin Cancer Res 2016; 22:2290-300. [PMID: 26647218 DOI: 10.1158/1078-0432.ccr-15-2123] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Relapsed or refractory diffuse large B-cell lymphoma (rrDLBCL) is fatal in 90% of patients, and yet little is known about its biology. EXPERIMENTAL DESIGN Using exome sequencing, we characterized the mutation profiles of 38 rrDLBCL biopsies obtained at the time of progression after immunochemotherapy. To identify genes that may be associated with relapse, we compared the mutation frequency in samples obtained at relapse to an unrelated cohort of 138 diagnostic DLBCLs and separately amplified specific mutations in their matched diagnostic samples to identify clonal expansions. RESULTS On the basis of a higher frequency at relapse and evidence for clonal selection, TP53, FOXO1, MLL3 (KMT2C), CCND3, NFKBIZ, and STAT6 emerged as top candidate genes implicated in therapeutic resistance. We observed individual examples of clonal expansions affecting genes whose mutations had not been previously associated with DLBCL including two regulators of NF-κB: NFKBIE and NFKBIZ We detected mutations that may be affect sensitivity to novel therapeutics, such as MYD88 and CD79B mutations, in 31% and 23% of patients with activated B-cell-type of rrDLBCL, respectively. We also identified recurrent STAT6 mutations affecting D419 in 36% of patients with the germinal center B (GCB) cell rrDLBCL. These were associated with activated JAK/STAT signaling, increased phospho-STAT6 protein expression and increased expression of STAT6 target genes. CONCLUSIONS This work improves our understanding of therapeutic resistance in rrDLBCL and has identified novel therapeutic opportunities especially for the high-risk patients with GCB-type rrDLBCL. Clin Cancer Res; 22(9); 2290-300. ©2015 AACR.
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Affiliation(s)
- Ryan D Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada. Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Sarit Assouline
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada. McGill University, Montreal, Quebec, Canada
| | - Miguel Alcaide
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Arezoo Mohajeri
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Lauren Chong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasleen Grewal
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stephen Yu
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Daniel Fornika
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kevin Bushell
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Torsten Holm Nielsen
- Department of Internal Medicine, Copenhagen University Hospital, Roskilde, Denmark
| | | | - Michael Crump
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | - Bruno M Grande
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David MacDonald
- Department of Medicine, University of Dalhousie, Halifax, Nova Scotia, Canada
| | - Caroline Rousseau
- Quebec Clinical Research Organization in Cancer, Montreal, Quebec, Canada
| | | | - Pierre Sesques
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Remi Froment
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marco Albuquerque
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Yury Monczak
- Department of Pathology, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Celia Greenwood
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Department of Oncology, McGill University, Montreal, Quebec, Canada
| | | | | | - Errol Camlioglu
- Department of Radiology, Jewish General Hospital, Montreal, McGill University, Quebec, Canada
| | - André Constantin
- Department of Radiology, Jewish General Hospital, Montreal, McGill University, Quebec, Canada
| | - Qiang Pan-Hammarstrom
- Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden. Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China
| | - Roujun Peng
- Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden. Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China
| | - Koren K Mann
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada. McGill University, Montreal, Quebec, Canada
| | - Nathalie A Johnson
- Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada. McGill University, Montreal, Quebec, Canada.
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Castillo JJ, Beltran BE, Miranda RN, Young KH, Chavez JC, Sotomayor EM. EBV-positive diffuse large B-cell lymphoma of the elderly: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol 2016; 91:529-37. [PMID: 27093913 DOI: 10.1002/ajh.24370] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/12/2016] [Accepted: 03/18/2016] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is a provisional entity included in the 2008 WHO classification of lymphoid neoplasms. It is a disease typically seen in the elderly and thought to be associated with chronic EBV infection and severe immunosuppression with a component of immunosenescence. Recent research, however, has suggested that EBV-positive DLBCL can be seen in younger, immunocompetent patients. The diagnosis of EBV-positive DLBCL of the elderly is made through a careful pathological evaluation. The differential diagnosis includes infectious mononucleosis (specifically in younger patients), lymphomatoid granulomatosis, Hodgkin lymphoma, and gray zone lymphoma, among others. Detection of EBV-encoded RNA (EBER) is considered standard for diagnosis; however, a clear cutoff for positivity has not been defined. The International Prognostic Index (IPI), and the Oyama score can be used for risk-stratification. The Oyama score includes age >70 years and presence of B symptoms. The expression of CD30 is emerging as a potential adverse, and targetable, prognostic factor. Patients with EBV-positive DLBCL should be staged and managed following similar guidelines than patients with EBV-negative DLBCL. It has been suggested, however, that EBV-positive patients have a worse prognosis than EBV-negative counterparts in the era of chemoimmunotherapy. There is an opportunity to study and develop targeted therapy in the management of patients with EBV-positive DLBCL.
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Affiliation(s)
- Jorge J. Castillo
- Division of Hematologic Malignancies; Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Brady E. Beltran
- Department of Oncology and Radiotherapy; Hospital Nacional Edgardo Rebagliati Martins; Lima Peru
| | - Roberto N. Miranda
- Department of Hematopathology; the University of Texas MD Anderson Cancer Center; Houston Texas
| | - Ken H. Young
- Department of Hematopathology; the University of Texas MD Anderson Cancer Center; Houston Texas
| | - Julio C. Chavez
- Division of Malignant Hematology, Moffitt Cancer Center & Research Institute, University of South Florida; Tampa Florida
| | - Eduardo M. Sotomayor
- Department of Hematology and Oncology; George Washington Cancer Center, George Washington University; Washington DC
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Nowakowski GS, Chiappella A, Witzig TE, Spina M, Gascoyne RD, Zhang L, Flament J, Repici J, Vitolo U. ROBUST: Lenalidomide-R-CHOP versus placebo-R-CHOP in previously untreated ABC-type diffuse large B-cell lymphoma. Future Oncol 2016; 12:1553-63. [PMID: 27089170 PMCID: PMC5551933 DOI: 10.2217/fon-2016-0130] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL), the major constituent of nongerminal center B-cell-like (non-GCB) DLBCL, is associated with poorer survival outcomes than GCB-type DLBCL. In Phase II studies, lenalidomide combined with R-CHOP (R(2)-CHOP) improved outcomes relative to historical R-CHOP in newly diagnosed DLBCL, particularly in non-GCB cases. ROBUST (CC-5013-DLC-002) is a randomized, double-blind, global, Phase III study of oral lenalidomide (15 mg, days 1-14) plus R-CHOP21 × 6 versus placebo-R-CHOP21 × 6 in patients with previously untreated ABC-type DLBCL. Subtyping is done within 3 calendar days by central laboratory gene-expression profiling of formalin-fixed paraffin-embedded biopsy tissue. The primary end point is progression-free survival. Secondary end points include response rates, overall survival and health-related quality of life.
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Affiliation(s)
| | - Annalisa Chiappella
- Division of Hematology, Città della Salute e della Scienza Hospital & University, Torino, Italy
| | - Thomas E Witzig
- Division of Hematology, Mayo Clinic, Rochester, MN 55902, USA
| | - Michele Spina
- Division of Medical Oncology, National Cancer Institute, Aviano, Italy
| | - Randy D Gascoyne
- Department of Pathology & Lymphoid Cancer Research, BC Cancer Agency & BC Cancer Research Centre, Vancouver, BC, Canada
| | - Lei Zhang
- Celgene Corporation, Summit, NJ 07901, USA
| | | | | | - Umberto Vitolo
- Division of Hematology, Città della Salute e della Scienza Hospital & University, Torino, Italy
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135
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Jin Z, Qing K, Ouyang Y, Liu Z, Wang W, Li X, Xu Z, Li J. Low dose of lenalidmide and PI3K/mTOR inhibitor trigger synergistic cytoxicity in activated B cell-like subtype of diffuse large B cell lymphoma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2016; 35:52. [PMID: 27009084 PMCID: PMC4806505 DOI: 10.1186/s13046-016-0327-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/17/2016] [Indexed: 12/16/2022]
Abstract
Background Activated B cell-like subtype of diffuse large B cell lymphoma (ABC-DLBCL) presents aggressive clinical courses and poor prognosis. Targeting key pathways may raise the possibility of improving clinical outcomes. Methods The synergetic effects were assessed by CCK-8 assay and measured by isobologram analysis. The NVP-Bez235 and lenalidomide cytotoxicity were measured by flow cytometry, Western Blot and si-RNA transfection. The combined treatment inducing tumor regression in vivo was performed in nude mice of OCI-Ly10 xenograft mouse model. Results Low dose of two agents represented significant inhibition of proliferation with CI value < 1. NVP-Bez235 combined with lenalidomide remarkably increased apoptosis through intrinsic pathway by upregulating Bim, Bax and downregulating Bcl-xL. Akt, especially NF-κB, played an important role in the synergetic effects. Cotreatment also induced the cell cycle to be arrested in G0/G1 phase, and decreased S phase by increasing p21 expression, downregulating cyclinA and diminishing CDK2 phosphorylation in Su-DHL2 and OCI-Ly3 but not in OCI-Ly10. Mice treated with NVP-Bez235/lenalidomide represented obvious tumor growth regression and prolonged overall survival. Conclusions Our findings demonstrated the synergistic effect of low dose of NVP-Bez235 and lenalidomide in ABC-DLBCL, the underlying mechanism may be multifunctional, involving apoptosis, Akt and NF-κB inactivation and cell cycle arrest. Cotreatment was also effective in vivo. These data pave the way for potential treatment of ABC-DLBCL with combination of NVP-Bez235 and lenalidomide.
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Affiliation(s)
- Zhen Jin
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kai Qing
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Ouyang
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhao Liu
- Department of Hematology, Shanghai Institute of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenfang Wang
- Shanghai Institute of Hematology, State Key Laboratory for Medical Genomics, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyang Li
- Department of Hematology, Shanghai Institute of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zizhen Xu
- Department of Laboratory Medicine, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, 197 Rui Jin Er Road, Shanghai, China.
| | - Junmin Li
- Department of Hematology, Shanghai Institute of Hematology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Galanina N, Petrich A, Nabhan C. The evolving role of lenalidomide in non-Hodgkin lymphoma. Leuk Lymphoma 2016; 57:1507-16. [DOI: 10.3109/10428194.2016.1146949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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137
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Jamil MO, Mehta A. Diffuse Large B-cell lymphoma: Prognostic markers and their impact on therapy. Expert Rev Hematol 2016; 9:471-7. [PMID: 26808217 DOI: 10.1586/17474086.2016.1146584] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of Non-Hodgkin lymphoma (NHL). DLBCL is clinically, pathologically and molecularly heterogeneous disease. Various clinical, pathological and molecular markers have been developed to characterize the disease. Based on these characterizations, new targeted agents are being investigated to optimize the treatment and improve the outcomes of DLBCL. Enhanced molecular understanding, invention of targeted agents and immunotherapy has opened the doors for improvement in the treatment of DLBCL. In this review, we will discuss various prognostic markers of DLBCL and their potential therapeutic implications.
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Affiliation(s)
- Muhammad O Jamil
- a Hematology & Oncology, Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Amitkumar Mehta
- a Hematology & Oncology, Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
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138
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Nowakowski GS, Czuczman MS. ABC, GCB, and Double-Hit Diffuse Large B-Cell Lymphoma: Does Subtype Make a Difference in Therapy Selection? Am Soc Clin Oncol Educ Book 2016:e449-57. [PMID: 25993209 DOI: 10.14694/edbook_am.2015.35.e449] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Personalized therapy for the treatment of patients with cancer is rapidly approaching and is an achievable goal in the near future. A substantial number of novel targets have been developed into therapeutic agents. There is a substantial variability to antitumor activity by novel therapeutics because of the unique heterogeneity and biology that exists both between and within lymphoma subtypes. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). Approximately 40% of patients have refractory disease or disease that will relapse after an initial response, and the majority of patients with relapsed DLBCL will succumb to the disease. There are two major biologically distinct molecular subtypes of DLBCL: germinal center B-cell (GCB) and activated B-cell (ABC). ABC DLBCL is associated with substantially worse outcomes when treated with standard chemoimmunotherapy. In addition to GCB and ABC subtypes, double-hit lymphomas (approximately 5% to 10% of patients) and double-expressor lymphomas, which overexpress MYC and BCL2 protein, are aggressive DLBCLs and are also associated with a poor prognosis. Double-hit lymphomas have concurrent chromosomal rearrangements of MYC plus BCL2 (or less likely, BCL6). Advances in molecular characterization techniques and the development of novel agents targeting specific subtypes of DLBCL have provided a foundation for personalized therapy of DLBCL based on molecular subtype. A number of early clinical trials evaluating combinations of novel targeted agents with standard chemotherapy (R-CHOP) have been completed and have demonstrated the feasibility of this approach with encouraging efficacy. As such, molecular classification of DLBCL is not only important for prognostication, but moves to center stage for personalization of therapy for DLBCL.
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Affiliation(s)
- Grzegorz S Nowakowski
- From the Division of Hematology, Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY
| | - Myron S Czuczman
- From the Division of Hematology, Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY
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139
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Martín A, Redondo AM, Dlouhy I, Salar A, González-Barca E, Canales M, Montes-Moreno S, Ocio EM, López-Guillermo A, Caballero D. Lenalidomide in combination with R-ESHAP in patients with relapsed or refractory diffuse large B-cell lymphoma: a phase 1b study from GELTAMO group. Br J Haematol 2016; 173:245-52. [DOI: 10.1111/bjh.13945] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/07/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Alejandro Martín
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
| | - Alba M. Redondo
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
| | - Iván Dlouhy
- Department of Haematology; Hospital Clinic; Barcelona Spain
| | - Antonio Salar
- Department of Haematology; Hospital del Mar; Barcelona Spain
| | - Eva González-Barca
- Department of Haematology; Institut Català D'Oncologia Duran I Reynals; L'Hospitalet de Llobregat Spain
| | - Miguel Canales
- Department of Haematology; Hospital Universitario La Paz; Madrid Spain
| | - Santiago Montes-Moreno
- Department of Pathology; Hospital Universitario Marqués de Valdecilla; IFIMAV; Santander Spain
| | - Enrique M. Ocio
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
- Centro de Investigación del Cáncer; IBMCC/CSIC-Universidad de Salamanca; Salamanca Spain
| | | | - Dolores Caballero
- Department of Haematology; Hospital Universitario de Salamanca-IBSAL; Salamanca Spain
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140
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Mondello P, Pitini V, Barresi V, Brea EJ, Di Mirto C, Arrigo C, Cuzzocrea S, Mian M. Extranodal diffuse large B-cell lymphoma with monoclonal gammopathy: an aggressive and primary refractory disease responding to an immunomodulatory agent. Exp Hematol Oncol 2016; 5:1. [PMID: 26740908 PMCID: PMC4702294 DOI: 10.1186/s40164-015-0030-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/29/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although the clinical outcome of patients with diffuse large B cell lymphoma (DLBCL) has been improved by the addition of rituximab to standard chemotherapy, almost one-third fails or relapses after first line treatment. The presence of monoclonal gammopathy (MG) is a known adverse prognostic factor for DLBCL. Because this subset of patients does not benefit from R-CHOP, new therapeutic options are required. Herein, we report the first case of extranodal DBCL of the lung with a concomitant MG who achieved a long lasting complete remission with lenalidomide. CASE PRESENTATION The 73-year-old male patient presented with lateral cervical lymphadenopathy, B symptoms, lactate dehydrogenase and beta2-microglobulin elevation. Computed tomography (CT) showed mediastinal lymphadenopathy and bilateral lung involvement. Biopsy of both disease locations revealed the presence of DLBCL. Successive bone marrow trephine biopsy proved the presence of concordant DLBCL involvement. At the time of diagnosis, a MG was present as well. The patient did not respond to the standard treatments, and subsequently underwent lenalidomide 25 mg/m(2) days 1-21 q28 plus dexamethasone 40 mg days 1-4, 9-12 e 17-20. This therapeutic regimen was efficacious and safe as salvage therapy in extranodal DBCL with a MG. Furthermore, we observed a close association between DLBCL response to therapy and MG levels, suggesting that the amount of M-protein might be a surrogate marker of disease response. CONCLUSION Although DLBCL associated with MG does not respond properly to the standard treatments, it is highly sensitive to lenalidomide, which is why we endorse its role as treatment of choice in this subset of patients. In addition, MG levels appear to correlate with tumor burden, suggesting that it might be a useful marker of disease response. Prospective trials to validate these observations are warranted.
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Affiliation(s)
- Patrizia Mondello
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy ; Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy ; Lymphoma Department, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY USA
| | - Vincenzo Pitini
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Valeria Barresi
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Elliott Joseph Brea
- Molecular Pharmacology and Chemistry Program, Sloan-Kettering Institute, New York, NY USA ; Weill Cornell Medical College, New York, NY USA
| | - Cristian Di Mirto
- Department of Human Pathology, University of Messina, Via Consolare Valeria, 98100 Messina, Italy
| | - Carmela Arrigo
- Department of Internal Medicine, University of Messina, Messina, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Michael Mian
- Department of Hematology and CBMT, Ospedale di Bolzano, Bolzano, Italy ; Universitätsklinik für Innere Medizin V, Hämatologie and Onkologie, Innsbruck, Austria
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141
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Gifford GK, Gill AJ, Stevenson WS. Molecular subtyping of diffuse large B-cell lymphoma: update on biology, diagnosis and emerging platforms for practising pathologists. Pathology 2016; 48:5-16. [DOI: 10.1016/j.pathol.2015.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/04/2023]
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Gupta E, Accurso J, Sluzevich J, Menke DM, Tun HW. Excellent Outcome of Immunomodulation or Bruton's Tyrosine Kinase Inhibition in Highly Refractory Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type. Rare Tumors 2015; 7:6067. [PMID: 26788279 PMCID: PMC4703925 DOI: 10.4081/rt.2015.6067] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 12/17/2022] Open
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) is a rare diffuse large B-cell lymphoma confined to the skin of the legs. The typical presentation is characterized by solitary or multiple growing plaques, usually confined to one leg. We report a case of PCDLBCL-LT of activated B-cell subtype characterized by multiple local relapses in the legs, initially, and systemic relapses about seven years after the diagnosis. Local relapses were sensitive to radiation therapy. Cutaneous and systemic relapses responded well to immunomodulatory therapy with lenalidomide followed by Bruton’s tyrosine kinase inhibition with ibrutinib. Ibrutinib is the only treatment that resulted in long-lasting complete remission. Lenalidomide and especially ibrutinib appear to have a significant activity against this lymphoma and should be incorporated in the treatment of this resistant and aggressive lymphoma. To our knowledge, this is the first case of PCDLBCL-LT reported in the literature exhibiting a complete response to ibrutinib.
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Affiliation(s)
- Eva Gupta
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville , FL, USA
| | - Joseph Accurso
- Department of Diagnostic Radiology, Mayo Clinic, Jacksonville , FL, USA
| | - Jason Sluzevich
- Department of Dermatology, Mayo Clinic, Jacksonville , FL, USA
| | - David M Menke
- Department of Pathology, Mayo Clinic, Jacksonville , FL, USA
| | - Han W Tun
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville , FL, USA
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143
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Sohani AR, Abramson JS. MYC/BCL2 double-expression vs. cell-of-origin classification in diffuse large B-cell lymphoma: do we need to know both? Leuk Lymphoma 2015; 57:509-11. [PMID: 26693593 DOI: 10.3109/10428194.2015.1115046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aliyah R Sohani
- a Department of Pathology , Massachusetts General Hospital , Boston , MA , USA
| | - Jeremy S Abramson
- b Center for Lymphoma, Massachusetts General Hospital Cancer Center , Boston , MA , USA
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Flinn IW, Bartlett NL, Blum KA, Ardeshna KM, LaCasce AS, Flowers CR, Shustov AR, Thress KS, Mitchell P, Zheng F, Skolnik JM, Friedberg JW. A phase II trial to evaluate the efficacy of fostamatinib in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Eur J Cancer 2015; 54:11-17. [PMID: 26707592 DOI: 10.1016/j.ejca.2015.10.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/05/2015] [Accepted: 10/07/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the safety and efficacy of fostamatinib in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). EXPERIMENTAL DESIGN Relapsed or refractory DLBCL patients originally received the oral spleen tyrosine kinase inhibitor, fostamatinib in a two-arm, randomised, double-blinded manner at either 100 mg twice a day (BID) or 200 mg BID until disease progression or unacceptable toxicity. The primary objective was to assess the overall response rate (ORR). Preliminary analysis showed limited efficacy and all subsequent patients were treated at 200 mg BID. Previously randomised patients were unblinded and given the opportunity to receive 200 mg BID. RESULTS Sixty-eight patients were treated (47 at 200 mg BID, 21 at 100 mg BID). Cell of origin analysis showed 58% germinal B-cell (GCB) origin, 30% activated B-cell (ABC) origin and 12% with an intermediate cell of origin signature. The most common treatment-related adverse events of all patients were diarrhoea (21% total, 6% grade 3/4), nausea (19% total, 3% grade 3/4), and, fatigue (18% total, 9% grade 3/4). The ORR rate was 3% across both arms and clinical benefit (≥ stable disease) was achieved for 13% of all patients. The cell of origin for patients with clinical benefit was GCB (4 patients), intermediate (4 patients) or unknown (1 patient). None of the patients with clinical benefit had ABC genotype. CONCLUSIONS While fostamatinib was generally well tolerated in this patient population, efficacy at these doses and schedule was poor. Unlike data with other B-cell antigen receptor pathway inhibitors, responses were not observed in the ABC genotype.
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Affiliation(s)
- Ian W Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, USA.
| | - Nancy L Bartlett
- Siteman Cancer Center/Washington University School of Medicine, St. Louis, MO, USA
| | - Kristie A Blum
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Kirit M Ardeshna
- Sarah Cannon Research Institute United Kingdom/University College London, London, UK
| | | | | | - Andrei R Shustov
- Seattle Cancer Care Alliance/University of Washington, Seattle, WA, USA
| | | | | | - Fred Zheng
- Formerly at AstraZeneca, Wilmington, DE, USA
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Camicia R, Winkler HC, Hassa PO. Novel drug targets for personalized precision medicine in relapsed/refractory diffuse large B-cell lymphoma: a comprehensive review. Mol Cancer 2015; 14:207. [PMID: 26654227 PMCID: PMC4676894 DOI: 10.1186/s12943-015-0474-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 08/26/2015] [Indexed: 02/07/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a clinically heterogeneous lymphoid malignancy and the most common subtype of non-Hodgkin's lymphoma in adults, with one of the highest mortality rates in most developed areas of the world. More than half of DLBLC patients can be cured with standard R-CHOP regimens, however approximately 30 to 40 % of patients will develop relapsed/refractory disease that remains a major cause of morbidity and mortality due to the limited therapeutic options.Recent advances in gene expression profiling have led to the identification of at least three distinct molecular subtypes of DLBCL: a germinal center B cell-like subtype, an activated B cell-like subtype, and a primary mediastinal B-cell lymphoma subtype. Moreover, recent findings have not only increased our understanding of the molecular basis of chemotherapy resistance but have also helped identify molecular subsets of DLBCL and rational targets for drug interventions that may allow for subtype/subset-specific molecularly targeted precision medicine and personalized combinations to both prevent and treat relapsed/refractory DLBCL. Novel agents such as lenalidomide, ibrutinib, bortezomib, CC-122, epratuzumab or pidilizumab used as single-agent or in combination with (rituximab-based) chemotherapy have already demonstrated promising activity in patients with relapsed/refractory DLBCL. Several novel potential drug targets have been recently identified such as the BET bromodomain protein (BRD)-4, phosphoribosyl-pyrophosphate synthetase (PRPS)-2, macrodomain-containing mono-ADP-ribosyltransferase (ARTD)-9 (also known as PARP9), deltex-3-like E3 ubiquitin ligase (DTX3L) (also known as BBAP), NF-kappaB inducing kinase (NIK) and transforming growth factor beta receptor (TGFβR).This review highlights the new insights into the molecular basis of relapsed/refractory DLBCL and summarizes the most promising drug targets and experimental treatments for relapsed/refractory DLBCL, including the use of novel agents such as lenalidomide, ibrutinib, bortezomib, pidilizumab, epratuzumab, brentuximab-vedotin or CAR T cells, dual inhibitors, as well as mechanism-based combinatorial experimental therapies. We also provide a comprehensive and updated list of current drugs, drug targets and preclinical and clinical experimental studies in DLBCL. A special focus is given on STAT1, ARTD9, DTX3L and ARTD8 (also known as PARP14) as novel potential drug targets in distinct molecular subsets of DLBCL.
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Affiliation(s)
- Rosalba Camicia
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Stem Cell Research Laboratory, NHS Blood and Transplant, Nuffield Division of Clinical, Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.,MRC-UCL Laboratory for Molecular Cell Biology Unit, University College London, Gower Street, London, WC1E6BT, UK
| | - Hans C Winkler
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Institute of Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Paul O Hassa
- Institute of Veterinary Biochemistry and Molecular Biology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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146
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Using the pathology report in initial treatment decisions for diffuse large B-cell lymphoma: time for a precision medicine approach. Hematology 2015; 2015:618-24. [DOI: 10.1182/asheducation-2015.1.618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non Hodgkin lymphoma in the Western world, and is potentially curable with standard R-CHOP chemoimmunotherapy. Historically, clinical risk assessments provided prognostic information, but did not define treatment approach. We are now in an era where the heterogeneity of DLBCL is defined genetically and molecularly, and rational subset-specific therapeutic targets are guiding clinical trials. Primary mediastinal DLBCL is a unique clinicopathologic entity, and alternatives to R-CHOP may confer superior outcome. Rearrangement of the myc oncogene occurs in ∼10% of patients with DLBCL, and confers a very poor prognosis with standard R-CHOP, particularly when there is concomitant rearrangement of bcl-2, a condition referred to as “double-hit” DLBCL. A larger subset of DLBCL demonstrates overexpression of both myc and bcl-2 by immunohistochemistry. Cell of origin, determined by gene expression analysis, immunohistochemistry algorithms, or a novel Lymph2Cx platform, provides prognostic information, and guides therapeutic decisions in both relapsed and de novo disease. This article will define specific subsets of DLBCL and provide subtype-specific treatment options, including novel approaches under investigation. Understanding these key features of the pathology report, and limitations of these assays defining subsets of DLBCL, allows for an evolving precision medicine approach to this disease.
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147
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Wong KK, Ch'ng ES, Loo SK, Husin A, Muruzabal MA, Møller MB, Pedersen LM, Pomposo MP, Gaafar A, Banham AH, Green TM, Lawrie CH. Low HIP1R mRNA and protein expression are associated with worse survival in diffuse large B-cell lymphoma patients treated with R-CHOP. Exp Mol Pathol 2015; 99:537-45. [DOI: 10.1016/j.yexmp.2015.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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Millar A, Ellis M, Mollee P, Cochrane T, Fletcher J, Caudron A, Webster B, Trotman J. Deliverability and efficacy of R-CHOP chemotherapy in very elderly patients with diffuse large B-cell lymphoma: an Australian retrospective analysis. Intern Med J 2015; 45:1147-53. [DOI: 10.1111/imj.12889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/09/2015] [Indexed: 12/26/2022]
Affiliation(s)
- A. Millar
- University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - M. Ellis
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - P. Mollee
- Princess Alexandra Hospital; Brisbane Queensland Australia
- University of Queensland; Brisbane Queensland Australia
| | - T. Cochrane
- Gold Coast University Hospital; Gold Coast Queensland Australia
| | - J. Fletcher
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - A. Caudron
- Princess Alexandra Hospital; Brisbane Queensland Australia
| | - B. Webster
- Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - J. Trotman
- University of Sydney; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Sydney New South Wales Australia
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149
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Läubli H, Tzankov A, Juskevicius D, Degen L, Rochlitz C, Stenner-Liewen F. Lenalidomide monotherapy leads to a complete remission in refractory B-cell post-transplant lymphoproliferative disorder. Leuk Lymphoma 2015; 57:945-8. [PMID: 26295731 DOI: 10.3109/10428194.2015.1083563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Heinz Läubli
- a Department of Internal Medicine , Division of Medical Oncology, University Hospital Basel , Switzerland .,b Department of Biomedicine , Cancer Immunology Laboratory, University Hospital Basel , Switzerland
| | - Alexandar Tzankov
- c Institute of Pathology, University Hospital Basel , Switzerland , and
| | | | - Lukas Degen
- d Division of Gastroenterology and Hepatology, University Hospital Basel , Switzerland
| | - Christoph Rochlitz
- a Department of Internal Medicine , Division of Medical Oncology, University Hospital Basel , Switzerland
| | - Frank Stenner-Liewen
- a Department of Internal Medicine , Division of Medical Oncology, University Hospital Basel , Switzerland .,b Department of Biomedicine , Cancer Immunology Laboratory, University Hospital Basel , Switzerland
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150
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Clinical impact of molecular features in diffuse large B-cell lymphoma and follicular lymphoma. Blood 2015; 127:181-6. [PMID: 26447189 DOI: 10.1182/blood-2015-07-658401] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/03/2015] [Indexed: 02/08/2023] Open
Abstract
Our understanding of the pathogenesis and heterogeneity of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) has been dramatically enhanced by recent attempts to profile molecular features of these lymphomas. In this article, we discuss ways in which testing for molecular features may impact DLBCL and FL management if clinical trials are designed to incorporate such tests. Specifically, we discuss how distinguishing lymphomas on the basis of cell-of-origin subtypes or the presence of other molecular features is prognostically and therapeutically significant. Conversely, we discuss how the molecular similarities of DLBCL and FL have provided insight into the potential of both DLBCL and FL cases to respond to agents targeting alterations they have in common. Through these examples, we demonstrate how the translation of our understanding of cancer biology into improvements in patient outcomes depends on analyzing the molecular correlates of treatment outcomes in clinical trials and in routinely treated patients.
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