1
|
Enemark MBH, Wolter K, Campbell AJ, Andersen MD, Sørensen EF, Hybel TE, Madsen C, Lauridsen KL, Plesner TL, Hamilton-Dutoit SJ, Honoré B, Ludvigsen M. Proteomics identifies apoptotic markers as predictors of histological transformation in patients with follicular lymphoma. Blood Adv 2023; 7:7418-7432. [PMID: 37824846 PMCID: PMC10758743 DOI: 10.1182/bloodadvances.2023011299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
Follicular lymphoma (FL) is an indolent lymphoma with a generally favorable prognosis. However, histological transformation (HT) to a more aggressive disease leads to markedly inferior outcomes. This study aims to identify biological differences predictive of HT at the time of initial FL diagnosis. We show differential protein expression between diagnostic lymphoma samples from patients with subsequent HT (subsequently-transforming FL [st-FL]; n = 20) and patients without HT (nontransforming FL [nt-FL]; n = 34) by label-free quantification nano liquid chromatography-tandem mass spectrometry analysis. Protein profiles identified patients with high risk of HT. This was accompanied by disturbances in cellular pathways influencing apoptosis, the cytoskeleton, cell cycle, and immune processes. Comparisons between diagnostic st-FL samples and paired transformed FL (n = 20) samples demonstrated differential protein profiles and disrupted cellular pathways, indicating striking biological differences from the time of diagnosis up to HT. Immunohistochemical analysis of apoptotic proteins, CASP3, MCL1, BAX, BCL-xL, and BCL-rambo, confirmed higher expression levels in st-FL than in nt-FL samples (P < .001, P = .015, P = .003, P = .025, and P = .057, respectively). Moreover, all 5 markers were associated with shorter transformation-free survival (TFS; P < .001, P = .002, P < .001, P = .069, and P = .010, respectively). Notably, combining the expression of these proteins in a risk score revealed increasingly inferior TFS with an increasing number of positive markers. In conclusion, proteomics identified altered protein expression profiles (particularly apoptotic proteins) at the time of FL diagnosis, which predicted later transformation.
Collapse
Affiliation(s)
- Marie Beck Hairing Enemark
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Katharina Wolter
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Maja Dam Andersen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Trine Engelbrecht Hybel
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Madsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Bent Honoré
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Maja Ludvigsen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Jiménez-Ubieto A, Martín-Muñoz A, Poza M, Dorado S, García-Ortiz A, Revilla E, Sarandeses P, Ruiz-Heredia Y, Baumann T, Rodríguez A, Calbacho M, Sánchez PM, Pina JMS, García-Sancho AM, Figaredo G, Gil-Alós D, Rufián L, Rodríguez M, Carneros L, Martínez-Laperche C, Bastos-Oreiro M, Wang C, Cedena MT, Rapado I, de Toledo P, Gallardo M, Valeri A, Ayala R, Martínez-López J, Barrio S. Personalized monitoring of circulating tumor DNA with a specific signature of trackable mutations after chimeric antigen receptor T-cell therapy in follicular lymphoma patients. Front Immunol 2023; 14:1188818. [PMID: 37342332 PMCID: PMC10277746 DOI: 10.3389/fimmu.2023.1188818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 06/22/2023] Open
Abstract
Background CART therapy has produced a paradigm shift in the treatment of relapsing FL patients. Strategies to optimize disease surveillance after these therapies are increasingly necessary. This study explores the potential value of ctDNA monitoring with an innovative signature of personalized trackable mutations. Method Eleven FL patients treated with anti-CD19 CAR T-cell therapy were included. One did not respond and was excluded. Genomic profiling was performed before starting lymphodepleting chemotherapy to identify somatic mutations suitable for LiqBio-MRD monitoring. The dynamics of the baseline mutations (4.5 per patient) were further analyzed on 59 cfDNA follow-up samples. PET/CT examinations were performed on days +90, +180, +365, and every six months until disease progression or death. Results After a median follow-up of 36 months, all patients achieved a CR as the best response. Two patients progressed. The most frequently mutated genes were CREBBP, KMT2D and EP300. Simultaneous analysis of ctDNA and PET/CT was available for 18 time-points. When PET/CT was positive, two out of four ctDNA samples were LiqBio-MRD negative. These two negative samples corresponded to women with a unique mesenteric mass in two evaluations and never relapsed. Meanwhile, 14 PET/CT negative images were mutation-free based on our LiqBio-MRD analysis (100%). None of the patients had a negative LiqBio-MRD test by day +7. Interestingly, all durably responding patients had undetectable ctDNA at or around three months after infusion. Two patients presented discordant results by PET/CT and ctDNA levels. No progression was confirmed in these cases. All the progressing patients were LiqBio-MRD positive before progression. Conclusion This is a proof-of-principle for using ctDNA to monitor response to CAR T-cell therapy in FL. Our results confirm that a non-invasive liquid biopsy MRD analysis may correlate with response and could be used to monitor response. Harmonized definitions of ctDNA molecular response and pinpointing the optimal timing for assessing ctDNA responses are necessary for this setting. If using ctDNA analysis, we suggest restricting follow-up PET/CT in CR patients to a clinical suspicion of relapse, to avoid false-positive results.
Collapse
Affiliation(s)
- Ana Jiménez-Ubieto
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Alejandro Martín-Muñoz
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
- Altum sequencing Co., Madrid, Spain
| | - María Poza
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Sara Dorado
- Altum sequencing Co., Madrid, Spain
- Computational Science Department, Carlos III University, Madrid, Spain
| | - Almudena García-Ortiz
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Enrique Revilla
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pilar Sarandeses
- Departamento de Medicina Nuclear, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Yanira Ruiz-Heredia
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
- Altum sequencing Co., Madrid, Spain
| | - Tycho Baumann
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Antonia Rodríguez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - María Calbacho
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Pilar Martínez Sánchez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - José María Sánchez Pina
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | | | - Gloria Figaredo
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Daniel Gil-Alós
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Laura Rufián
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
- Altum sequencing Co., Madrid, Spain
| | - Margarita Rodríguez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
- Altum sequencing Co., Madrid, Spain
| | - Laura Carneros
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | | | | | - Chongwu Wang
- Hosea Precision Medical Technology Co., Ltd., Weihai, Shangdong, China
| | - María-Teresa Cedena
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Inmaculada Rapado
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Paula de Toledo
- Computational Science Department, Carlos III University, Madrid, Spain
| | - Miguel Gallardo
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Antonio Valeri
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Rosa Ayala
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Joaquín Martínez-López
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Santiago Barrio
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
- Altum sequencing Co., Madrid, Spain
| |
Collapse
|
3
|
Jiménez-Ubieto A, Poza M, Martin-Muñoz A, Ruiz-Heredia Y, Dorado S, Figaredo G, Rosa-Rosa JM, Rodriguez A, Barcena C, Navamuel LP, Carrillo J, Sanchez R, Rufian L, Juárez A, Rodriguez M, Wang C, de Toledo P, Grande C, Mollejo M, Casado LF, Calbacho M, Baumann T, Rapado I, Gallardo M, Sarandeses P, Ayala R, Martínez-López J, Barrio S. Real-life disease monitoring in follicular lymphoma patients using liquid biopsy ultra-deep sequencing and PET/CT. Leukemia 2023; 37:659-669. [PMID: 36596983 DOI: 10.1038/s41375-022-01803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
In the present study, we screened 84 Follicular Lymphoma patients for somatic mutations suitable as liquid biopsy MRD biomarkers using a targeted next-generation sequencing (NGS) panel. We found trackable mutations in 95% of the lymph node samples and 80% of the liquid biopsy baseline samples. Then, we used an ultra-deep sequencing approach with 2 · 10-4 sensitivity (LiqBio-MRD) to track those mutations on 151 follow-up liquid biopsy samples from 54 treated patients. Positive LiqBio-MRD at first-line therapy correlated with a higher risk of progression both at the interim evaluation (HRINT 11.0, 95% CI 2.10-57.7, p = 0.005) and at the end of treatment (HREOT, HR 19.1, 95% CI 4.10-89.4, p < 0.001). Similar results were observed by PET/CT Deauville score, with a median PFS of 19 months vs. NR (p < 0.001) at the interim and 13 months vs. NR (p < 0.001) at EOT. LiqBio-MRD and PET/CT combined identified the patients that progressed in less than two years with 88% sensitivity and 100% specificity. Our results demonstrate that LiqBio-MRD is a robust and non-invasive approach, complementary to metabolic imaging, for identifying FL patients at high risk of failure during the treatment and should be considered in future response-adapted clinical trials.
Collapse
Affiliation(s)
- Ana Jiménez-Ubieto
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.
| | - María Poza
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | | | - Yanira Ruiz-Heredia
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.,Altum sequencing Co., Madrid, Spain
| | - Sara Dorado
- Altum sequencing Co., Madrid, Spain.,Computational Science Department, Carlos III University, Madrid, Spain
| | | | - Juan Manuel Rosa-Rosa
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Antonia Rodriguez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Carmen Barcena
- Hospital Universitario 12 de Octubre, Departamento de Anatomía Patológica, Madrid, Spain
| | | | | | - Ricardo Sanchez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.,Altum sequencing Co., Madrid, Spain
| | - Laura Rufian
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.,Altum sequencing Co., Madrid, Spain
| | - Alexandra Juárez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.,Altum sequencing Co., Madrid, Spain
| | - Margarita Rodriguez
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.,Altum sequencing Co., Madrid, Spain
| | - Chongwu Wang
- Hosea Precision Medical Technology Co., Ltd., Weihai, Shangdong, China
| | - Paula de Toledo
- Computational Science Department, Carlos III University, Madrid, Spain
| | | | | | | | - María Calbacho
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Tycho Baumann
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Inmaculada Rapado
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Miguel Gallardo
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain.,H12O-CNIO Haematological Malignancies Clinical Research Unit, CNIO, Madrid, Spain
| | - Pilar Sarandeses
- Hospital Universitario 12 de Octubre, Departamento de Medicina Nuclear, Madrid, Spain
| | - Rosa Ayala
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Joaquín Martínez-López
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain
| | - Santiago Barrio
- Department of Hematology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CNIO, CIBERONC, Madrid, Spain. .,Altum sequencing Co., Madrid, Spain.
| |
Collapse
|
4
|
Genetics of Transformed Follicular Lymphoma. HEMATO 2022. [DOI: 10.3390/hemato3040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histological transformation (HT) to a more aggressive disease–mostly diffuse large B-cell lymphoma–is considered one of the most dismal events in the clinical course of follicular lymphoma (FL). Current knowledge has not found a single biological event specific for HT, although different studies have highlighted common genetic alterations, such as TP53 and CDKN2A/B loss, and MYC translocations, among others. Together, they increase genomic complexity and mutational burden at HT. A better knowledge of HT pathogenesis would presumably help to find diagnostic biomarkers allowing the identification of patients at high-risk of transformation, as well as the discrimination from patients with FL recurrence, and those who remain in remission. This would also help to identify new drug targets and the design of clinical trials for the treatment of transformation. In the present review we provide a comprehensive overview of the genetic events frequently identified in transformed FL contributing to the switch towards aggressive behaviour, and we will discuss current open questions in the field of HT.
Collapse
|
5
|
Alonso-Álvarez S, Manni M, Montoto S, Sarkozy C, Morschhauser F, Wondergem MJ, Guarini A, Magnano L, Alcoceba M, Chamuleau M, Galimberti S, Gomes da Silva M, Holte H, Zucca E, Lockmer S, Aurer I, Marcheselli L, Stepanishyna Y, Caballero Barrigón MD, Salles G, Federico M. Primary refractory follicular lymphoma: a poor outcome entity with high risk of transformation to aggressive B cell lymphoma. Eur J Cancer 2021; 157:132-139. [PMID: 34508995 DOI: 10.1016/j.ejca.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary refractory (PREF) follicular lymphoma (FL) has a completely different clinical course from that of FL that responds to front-line treatments. In addition to having poor responses to salvage therapies, it seems that patients with PREF are at increased risk of histological transformation (HT). The Aristotle consortium presented the opportunity of investigating the risk of HT in a very large series of cases. Thus, we investigated the risk of HT in patients with PREF FL compared with that of responding patients or in stable disease and ultimately their outcome. METHODS Six thousand three hundred thirty-nine patients from the Aristotle database were included in the analysis. These patients had a histologically confirmed grade 1, 2 or 3a FL diagnosed between 1997 and 2013. The primary end-points were the cumulative incidence (CI) of HT at the first progression or relapse and the survival after transformation. FINDINGS The 5-year CI of HT among patients with PREF was 34% (95% confidence interval (CI): 27-43), whilst it was 7.1% (95% CI: 6.0-8.5) in the group of patients with partial response (PR) or stable disease (SD) (PR + SD) and 3.5% (95% CI: 3.0-4.2) in the group of patients achieving complete response (CR). The 5-year survival after relapse (SAR) was 33% (95% CI: 28-39) for the PREF group, 57% (95% CI 54-61) in patients with PR, 51% (95% CI 43-58) in the SD group after first-line therapy and 63% (95% CI: 66-72) in patients with CR after initial treatment (p-value <0.001). The 5-year SAR for those patients with PREF who developed HT was 21% (95% CI: 12-31), clearly diminished when compared with those patients with PREF who did not experience HT (38% [95% CI: 31-44]) (p-value = 0.001). INTERPRETATION Patients with PREF FL have a dismal outcome and an associated very high rate of HT that further worsens their poor prognosis.
Collapse
Affiliation(s)
- Sara Alonso-Álvarez
- Department of Haematology, Hospital Universitario Central de Asturias, Spain.
| | - Martina Manni
- CHIMOMODepartment, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Montoto
- St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Clémentine Sarkozy
- INSERM 1052, Charles Mérieux Lyon-1 Faculty, Claude Bernard University, Lyon, France
| | - Franck Morschhauser
- Department of Clinical Haematology, CHU Lille, Unite GRITA, Universite de Lille 2, Lille, France
| | - Marielle J Wondergem
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Attilio Guarini
- Haematology Unit, IRCCS IstitutoTumori "Giovanni Paolo II", Bari, Italy
| | - Laura Magnano
- Department of Haematology, Hospital Clinic of Barcelona, Spain
| | - Miguel Alcoceba
- Department of Hematology, Hospitalario Universitario de Salamanca (HUS/IBSAL) and CIBERONC, Salamanca, Spain
| | - Martine Chamuleau
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Harald Holte
- Department of Oncology, Radiumhospitalet, Oslo University Hospital, Norway
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland (IOSI), Ospedale San Giovanni, Bellinzona, Switzerland
| | - Sandra Lockmer
- Dep. of Hematology, Karolinska University Hospital and Dep. of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Igor Aurer
- Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb and Medical School, University of Zagreb, Croatia
| | | | - Yana Stepanishyna
- CHIMOMODepartment, University of Modena and Reggio Emilia, Modena, Italy; Department of Oncohematology, National Cancer Institute, Kiev, Ukraine
| | | | - Gilles Salles
- Gilles SALLES, Lymphoma Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Massimo Federico
- CHIMOMODepartment, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
6
|
Mozas P, Sorigué M, López-Guillermo A. Follicular lymphoma: an update on diagnosis, prognosis, and management. Med Clin (Barc) 2021; 157:440-448. [PMID: 34210513 DOI: 10.1016/j.medcli.2021.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
Follicular lymphoma, the most common indolent lymphoma, originates from germinal centre B-cells of the lymphoid follicle, and is characterized by t(14;18). Clinical manifestations include the presence of lymphadenopathy, sometimes accompanied by constitutional symptoms or cytopenia. Diagnosis is established through the identification of a B-cell proliferation of nodular pattern in the lymph node biopsy. Upon staging with PET-CT and bone marrow biopsy, a significant proportion of patients do not need immediate treatment. When therapy is indicated, commonly used regimens include anti-CD20 immunotherapy with or without chemotherapy. Although overall survival for most patients is prolonged, relapses are very frequent, and early relapse and transformation to an aggressive lymphoma portend a much worse prognosis. New therapies are under development, which will most likely change outcomes for FL patients in the near future.
Collapse
Affiliation(s)
- Pablo Mozas
- Servicio de Hematología, Hospital Clínic, Barcelona, España.
| | - Marc Sorigué
- Servicio de Hematología, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, España
| | - Armando López-Guillermo
- Servicio de Hematología, Hospital Clínic, Barcelona, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, España
| |
Collapse
|
7
|
Sorigue M, Cañamero E, Sancho JM. Precision medicine in follicular lymphoma: Focus on predictive biomarkers. Hematol Oncol 2020; 38:625-639. [PMID: 32700331 DOI: 10.1002/hon.2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
Current care for patients with follicular lymphoma (FL) offers most of them long-term survival. Improving it further will require careful patient selection. This review focuses on predictive biomarkers (ie, those whose outcome correlations depend on the treatment strategy) in FL, because awareness of what patient subsets benefit most or least from each therapy will help in this task. The first part of this review aims to summarize what biomarkers are predictive in FL, the magnitude of the effect and the quality of the evidence. We find predictive biomarkers in the setting of (a) indication of active treatment, (b) front-line induction (use of anthracyline-based regimens, CHOP vs bendamustine, addition of rituximab), (c) post-(front-line)induction (rituximab maintenance, radioimmunotherapy), and (d) relapse (hematopoietic stem cell transplant) and targeted agents. The second part of this review discusses the challenges of precision medicine in FL, including (a) cost, (b) clinical relevance considerations, and (c) difficulties over the broad implementation of biomarkers. We then provide our view on what biomarkers may become used in the next few years. We conclude by underscoring the importance of assessing the potential predictiveness of available biomarkers to improve patient care but also that there is a long road ahead before reaching their broad implementation due to remaining scientific, technological, and economic hurdles.
Collapse
Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Eloi Cañamero
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| |
Collapse
|
8
|
Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Rodriguez A, Lorza L, Martín A, Coria E, López-Guillermo A, Salar A, José Lahuerta J. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure without the need for immunotherapy. Hematol Oncol Stem Cell Ther 2019; 12:194-203. [DOI: 10.1016/j.hemonc.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/23/2019] [Indexed: 12/01/2022] Open
|
9
|
Sorigue M, Oliveira A, Mercadal S, Tapia G, Climent F, Perez-Roca L, Lorences I, Domingo-Domenech E, Cabezon M, Navarro JT, Gonzalez-Barca E, Zamora L, Ribera JM, Sureda A, Armengol MP, Sancho JM. m7FLIPI and targeted sequencing in high-risk follicular lymphoma. Hematol Oncol 2019; 37:564-568. [PMID: 31475375 DOI: 10.1002/hon.2674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/12/2019] [Accepted: 08/26/2019] [Indexed: 01/07/2023]
Abstract
Patients with follicular lymphoma (FL) refractory to front-line immunochemotherapy (ICT) have a poor overall survival (OS). Gene mutation analysis may be more accurate than classical risk factors to pick out these patients before treatment. This study aimed to describe the prevalence of selected genetic mutations in a cohort of patients with high-risk FL. Twenty-five patients with FL refractory to front-line ICT and 10 non-refractory patients matched for age, sex, and FLIPI score were included. We sequenced 18 genes (custom targeted sequencing panel) previously reported to potentially have prognostic impact, including the seven genes necessary to determine m7FLIPI risk. The 35 patients had a median age of 62. The FLIPI and FLIPI2 were high in 27 (84%) and 14 (48%), respectively. Three-year progression-free survival (PFS) and OS probabilities were 25% (95% CI, 13%-41%) and 53% (34%-69%), respectively. There were 73 variants in the 18 genes among the 35 patients. The median number of mutations per patient was 1 (interquartile range, 0-3). The most commonly mutated genes were CREBBP (11 of 35, 31%) and EP300 (10 of 35, 29%). EP300 mutations were associated with refractoriness to treatment (10 of 25 among refractory and 0 of 10 among non-refractory). In conclusion, in this study, patients with high-risk follicular lymphoma were genetically heterogeneous.
Collapse
Affiliation(s)
- Marc Sorigue
- Department of Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anna Oliveira
- Department of Genomics, Institut Germans Trias i Pujol, Badalona, Spain
| | | | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Fina Climent
- Department of Pathology, Hospital Duran i Reynals, Spain
| | - Laia Perez-Roca
- Biobanc-Banc de Tumors, Institut Germans Trias i Pujol, Badalona, Spain
| | - Irian Lorences
- Biobanc-Banc de Tumors, Institut Germans Trias i Pujol, Badalona, Spain
| | | | - Marta Cabezon
- Department of Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Jose-Tomas Navarro
- Department of Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Lurdes Zamora
- Department of Hematology Laboratory, ICO-Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Josep-María Ribera
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anna Sureda
- Department of Hematology, Hospital Duran i Reynals, Spain
| | | | - Juan-Manuel Sancho
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| |
Collapse
|
10
|
Recent landmark studies in follicular lymphoma. Blood Rev 2019; 35:68-80. [DOI: 10.1016/j.blre.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
|
11
|
Bruna R, Benedetti F, Boccomini C, Patti C, Barbui AM, Pulsoni A, Musso M, Liberati AM, Gini G, Castellino C, Rossini F, Ciceri F, Rota-Scalabrini D, Stelitano C, Di Raimondo F, Tucci A, Devizzi L, Zoli V, Zallio F, Narni F, Dondi A, Parvis G, Semenzato G, Lanza F, Perrone T, Angrilli F, Billio A, Gueli A, Mantoan B, Rambaldi A, Gianni AM, Corradini P, Passera R, Ladetto M, Tarella C. Prolonged survival in the absence of disease-recurrence in advanced-stage follicular lymphoma following chemo-immunotherapy: 13-year update of the prospective, multicenter randomized GITMO-IIL trial. Haematologica 2019; 104:2241-2248. [PMID: 31666344 PMCID: PMC6821615 DOI: 10.3324/haematol.2018.209932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/10/2019] [Indexed: 01/31/2023] Open
Abstract
A prospective trial conducted in the period 2000-2005 showed no survival advantage for high-dose chemotherapy with rituximab and autograft (R-HDS) versus conventional chemotherapy with rituximab (CHOP-R) as first-line therapy in 134 high-risk follicular lymphoma patients aged <60 years. The study has been updated at the 13-year median follow up. As of February 2017, 88 (66%) patients were alive, with overall survival of 66.4% at 13 years, without a significant difference between R-HDS (64.5%) and CHOP-R (68.5%). To date, 46 patients have died, mainly because of disease progression (47.8% of all deaths), secondary malignancies (3 solid tumor, 9 myelodysplasia/acute leukemia; 26.1% of all deaths), and other toxicities (21.7% of all deaths). Complete remission was documented in 98 (73.1%) patients and associated with overall survival, with 13-year estimates of 77.0% and 36.8% for complete remission versus no-complete remission, respectively. Molecular remission was documented in 39 (65%) out of 60 evaluable patients and associated with improved survival. In multivariate analysis, complete remission achievement had the strongest effect on survival (P<0.001), along with younger age (P=0.002) and female sex (P=0.013). Overall, 50 patients (37.3%) survived with no disease recurrence (18 CHOP-R, 32 R-HDS). This follow up is the longest reported on follicular lymphoma treated upfront with rituximab-chemotherapy and demonstrates an unprecedented improvement in survival compared to the pre-rituximab era, regardless of the use of intensified or conventional treatment. Complete remission was the most important factor for prolonged survival and a high proportion of patients had prolonged survival in their first remission, raising the issue of curability in follicular lymphoma. (Registered at clinicaltrials.gov identifier: 00435955)
Collapse
Affiliation(s)
- Riccardo Bruna
- Onco-Hematology Division, IEO, European Institute of Oncology IRCCS, Milano
| | | | | | - Caterina Patti
- Hematology Division, Azienda Villa Sofia-Cervello, Palermo
| | | | - Alessandro Pulsoni
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Roma
| | | | | | | | | | | | | | | | | | | | | | - Liliana Devizzi
- University Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | | | - Francesco Zallio
- SC Ematologia AO SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | - Guido Parvis
- Division of Internal Medicine, S. Luigi Hospital, Orbassano
| | | | | | | | | | | | - Angela Gueli
- Onco-Hematology Division, IEO, European Institute of Oncology IRCCS, Milano
| | - Barbara Mantoan
- Hematology University Division, Città della Salute Hospital, Torino
| | - Alessandro Rambaldi
- Hematology Division, Papa Giovanni XXIII Hospital, Bergamo.,Department of Oncology and Onco-Hematology, University of Milan, Milano
| | | | - Paolo Corradini
- University Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano.,Department of Oncology and Onco-Hematology, University of Milan, Milano
| | - Roberto Passera
- Nuclear Medicine Division, Città della Salute Hospital, Torino
| | - Marco Ladetto
- SC Ematologia AO SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - Corrado Tarella
- Onco-Hematology Division, IEO, European Institute of Oncology IRCCS, Milano .,Department of Health Sciences, University of Milan, Milano, Italy
| |
Collapse
|
12
|
Sorigue M, Bishton M, Domingo-Domenech E, McMillan A, Prusila R, García O, Kuusisto M, Condom M, Tapia G, Ribera JM, Kuittinen O, Fox CP, Sancho JM. Refractoriness to rituximab-based therapy and elevated serum B2-microglobulin predict for inferior survival in marginal zone lymphoma. Leuk Lymphoma 2019; 60:2524-2531. [PMID: 30942640 DOI: 10.1080/10428194.2019.1594212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Short responses to immunochemotherapy predict for an inferior OS in follicular lymphoma. We set out to determine whether this is also the case in marginal zone lymphoma. A group of 139 marginal zone lymphoma (MZL) patients treated with front-line immuno- or immunochemotherapy (I/ICT) were categorized into I/ICT-refractory (non-response or relapse/progression within six months of treatment response assessment) or I/ICT-sensitive. Twenty-three patients (17%) were refractory. Refractory patients had inferior OS (4-yr probabilities of 57% vs. 83%, p = .0003) as did those with beta2-microglobulin (B2M)>3 mg/L (4-yr probabilities of 80% vs. 100%, p = .0029). On multivariable analysis they both showed a borderline significant correlation with OS (p = .06 and .07, respectively). B2M > 3 mg/L was also an adverse prognostic factor for progression-free survival in both univariable (4-yr probability of 61% vs. 83%, p = .02) and multivariable analysis (HR 2.9, p = .02). In conclusion, B2M and refractoriness to I/ICT may identify patients with MZL at higher risk of inferior survival.
Collapse
Affiliation(s)
- Marc Sorigue
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Mark Bishton
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | | | - Andrew McMillan
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Roosa Prusila
- Department of Oncology, MRC, Oulu University Hospital , Oulu , Finland
| | - Olga García
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Milla Kuusisto
- Department of Oncology, North Karelia Central Hospital , Joensuu , Finland
| | - Maria Condom
- Department of Hematology, Hospital Duran i Reynals , Barcelona , Spain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Josep-María Ribera
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| | - Outi Kuittinen
- Department of Oncology, MRC, Oulu University Hospital , Oulu , Finland
| | - Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Juan-Manuel Sancho
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol. Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona , Badalona , Spain
| |
Collapse
|
13
|
Refractoriness to immunochemotherapy in follicular lymphoma: Predictive factors and outcome. Hematol Oncol 2019; 37:114. [DOI: 10.1002/hon.2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Jiménez-Ubieto A, Grande C, Caballero D, Yáñez L, Novelli S, Hernández-Garcia MT, Manzanares M, Arranz R, Ferreiro JJ, Bobillo S, Mercadal S, Galeo A, Jiménez JL, Moraleda JM, Vallejo C, Albo C, Pérez E, Marrero C, Magnano L, Palomera L, Jarque I, Martínez-Sánchez P, Martín A, Coria E, López-Guillermo A, Salar A, Lahuerta JJ. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment. Hematol Oncol 2018; 36:765-772. [PMID: 30129233 DOI: 10.1002/hon.2553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/04/2018] [Accepted: 08/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Lucrecia Yáñez
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Reyes Arranz
- Hospital Universitario La Princesa, Madrid, Spain
| | | | | | - Santiago Mercadal
- Hospital Universitario de Bellvitge, l'Hospitalet de Llobregat, Spain
| | - Andrea Galeo
- Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | - Elena Pérez
- Hospital Universitario Morales de Messeguer, Murcia, Spain
| | - Carmen Marrero
- Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain
| | | | - Luis Palomera
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Sorigue M, Sancho JM. The persistent uncertainty of when to recommend allogeneic stem cell transplantation in follicular iymphoma. Cancer 2018; 124:3454-3455. [PMID: 29878336 DOI: 10.1002/cncr.31565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/17/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Germans Trias i Pujol Hospital, Recerca Josep Carreras Institute, Autonomous University of Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Germans Trias i Pujol Hospital, Recerca Josep Carreras Institute, Autonomous University of Barcelona, Badalona, Spain
| |
Collapse
|
16
|
Sorigue M, Tuset V, Sancho JM. Treatment of localized-stage follicular lymphoma. Eur J Haematol 2018; 101:245-256. [PMID: 29754401 DOI: 10.1111/ejh.13093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 12/15/2022]
Abstract
Follicular lymphoma (FL) is the most common indolent lymphoma, and it most frequently presents in an advanced stage. Therapeutic considerations for advanced stage are different from those of localized-stage FL, in which radiotherapy (RT) is generally recommended. However, the available evidence suffers from shortcomings that are relatively specific to this clinical entity due to its rarity and long survival with all available treatment modalities, including that most of the existing evidence originated at a time when diagnostic classifications, staging procedures and radiotherapeutic standards were different from those available today and when anti-CD20 monoclonal antibodies were not available. Available treatment modalities include observation, systemic therapy only, RT only and RT in combination with systemic therapy. We review the evidence available with each of them and the data from present-day clinical practice studies as well as briefly discuss what diagnostic and therapeutic developments may take place in the next few years.
Collapse
Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Victòria Tuset
- Department of Radiation Oncology, ICO Badalona, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| |
Collapse
|
17
|
Is there a role for the international prognostic index in follicular lymphoma? Ann Hematol 2017; 97:713-715. [DOI: 10.1007/s00277-017-3197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/28/2017] [Indexed: 01/18/2023]
|
18
|
Sorigue M, Sancho JM. Current prognostic and predictive factors in follicular lymphoma. Ann Hematol 2017; 97:209-227. [PMID: 29032510 DOI: 10.1007/s00277-017-3154-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/09/2017] [Indexed: 12/27/2022]
Abstract
Follicular lymphoma (FL) is generally considered an indolent disorder. With modern day treatments, long remissions are often achieved both in the front-line and relapsed setting. However, a subset of patients has a more aggressive course and a worse outcome. Their identification is the main purpose of modern day prognostic tools. In this review, we attempt to summarize the evidence concerning prognostic and predictive factors in FL, including (1) pre-treatment factors, from baseline clinical characteristics and imaging tests to histological grade, the microenvironment and genomic abnormalities; (2) post-treatment factors, i.e., depth of response, measured both by imaging tests and minimal residual disease; (3) factors at relapse and duration of response; and (4) prognostic factors in histological transformation. We conclude that, despite the existence of numerous tools, the availability of some of them is still limited; they generally suffer from notable downsides, and most have unproven predictive value, thus having scarce bearing on the choice of regimen at present. However, with the technological and scientific developments of the last few years, the potential for these prognostic factors is promising, particularly in combination, which will probably, in time, help guide therapeutic decisions.
Collapse
MESH Headings
- Antineoplastic Combined Chemotherapy Protocols
- Bone Marrow/drug effects
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Chromosomes, Human, Pair 14/chemistry
- Chromosomes, Human, Pair 18/chemistry
- Clinical Trials as Topic
- Disease-Free Survival
- Humans
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/mortality
- Mutation
- Neoplasm Grading
- Neoplasm, Residual/diagnostic imaging
- Neoplasm, Residual/drug therapy
- Neoplasm, Residual/genetics
- Neoplasm, Residual/mortality
- Positron-Emission Tomography
- Prognosis
- Recurrence
- Risk Factors
- Translocation, Genetic
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
Collapse
Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain.
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Ctra. Canyet, 08916, Badalona, Spain
| |
Collapse
|
19
|
Sorigue M, Sarrate E, Ribera JM, Sancho JM. The case for lymphoma-specific survival. Expert Rev Hematol 2017; 11:263-264. [PMID: 28806107 DOI: 10.1080/17474086.2017.1367659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marc Sorigue
- a Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Edurne Sarrate
- a Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Josep-Maria Ribera
- a Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| | - Juan-Manuel Sancho
- a Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras , Universitat Autònoma de Barcelona , Badalona , Spain
| |
Collapse
|