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Papaleo N, Climent F, Tapia G, Luizaga L, Azcarate J, Bosch-Schips J, Muñoz-Marmol AM, Salido M, Lome-Maldonado C, Vazquez I, Colomo L. Round-robin testing for LMO2 and MYC as immunohistochemical markers to screen MYC rearrangements in aggressive large B-cell lymphoma. Virchows Arch 2024; 485:307-314. [PMID: 37368083 PMCID: PMC11329383 DOI: 10.1007/s00428-023-03584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/25/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
Aggressive large B-cell lymphomas (aLBCL) include a heterogeneous group of lymphomas with diverse biological features. One of the approaches to the diagnosis of aLBCL is based on the identification of MYC rearrangements (MYC-R), in addition to BCL2 and BCL6 rearrangements by genetic techniques, mainly fluorescent in situ hybridization (FISH). Because of the low incidence of MYC-R, the identification of useful immunohistochemistry markers to select cases for MYC FISH testing may be useful in daily practice. In a previous work, we identified a strong association between the profile CD10 positive/LMO2 negative expression and the presence of MYC-R in aLBCL and obtained good intralaboratory reproducibility. In this study, we wanted to evaluate external reproducibility. To evaluate whether LMO2 can be a reproducible marker between observers 50 aLBCL cases were circulated among 7 hematopathologists of 5 hospitals. Fleiss' kappa index for LMO2 and MYC were 0.87 and 0.70, respectively, indicating high agreement between observers. In addition, during 2021-2022, the enrolled centers included LMO2 in their diagnostic panels to evaluate prospectively the utility of the marker, and 213 cases were analyzed. Comparing LMO2 with MYC, the group of CD10 positive cases showed higher specificity (86% vs 79%), positive predictive value (66% vs 58%), likelihood positive value (5.47 vs 3.78), and accuracy (83% vs 79%), whereas the negative predictive values remained similar (90% vs 91%). These findings place LMO2 as a useful and reproducible marker to screen MYC-R in aLBCL.
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MESH Headings
- Humans
- LIM Domain Proteins/genetics
- LIM Domain Proteins/metabolism
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Proto-Oncogene Proteins c-myc/genetics
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/metabolism
- Adaptor Proteins, Signal Transducing/analysis
- Immunohistochemistry
- Gene Rearrangement
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Proto-Oncogene Proteins/genetics
- Reproducibility of Results
- Male
- Female
- Middle Aged
- Aged
- In Situ Hybridization, Fluorescence
- Predictive Value of Tests
- Adult
- Prospective Studies
- Aged, 80 and over
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Affiliation(s)
- Natalia Papaleo
- Department of Pathology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Barcelona, Spain
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gustavo Tapia
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Luis Luizaga
- Department of Pathology, Hospital Mutua Terrassa, Terrassa, Barcelona, Spain
| | - Juan Azcarate
- Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jan Bosch-Schips
- Department of Pathology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana M Muñoz-Marmol
- Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Marta Salido
- Department of Pathology, Hospital del Mar, Institute Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | - Carmen Lome-Maldonado
- Department of Pathology, Hospital del Mar, Institute Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | - Ivonne Vazquez
- Department of Pathology, Hospital del Mar, Institute Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain
| | - Luis Colomo
- Universitat Pompeu Fabra, Barcelona, Spain.
- Department of Pathology, Hospital del Mar, Institute Hospital del Mar d'Investigacions Mediques (IMIM), Barcelona, Spain.
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Derenzini E, Mazzara S, Melle F, Motta G, Fabbri M, Bruna R, Agostinelli C, Cesano A, Corsini CA, Chen N, Righi S, Sabattini E, Chiappella A, Calleri A, Fiori S, Tabanelli V, Cabras A, Pruneri G, Vitolo U, Gianni AM, Rambaldi A, Corradini P, Zinzani PL, Tarella C, Pileri S. A three-gene signature based on MYC, BCL-2 and NFKBIA improves risk stratification in diffuse large B-cell lymphoma. Haematologica 2021; 106:2405-2416. [PMID: 32817282 PMCID: PMC8409021 DOI: 10.3324/haematol.2019.236455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Indexed: 12/24/2022] Open
Abstract
Recent randomized trials focused on gene expression-based determination of the cell of origin in diffuse large B-cell lymphoma could not show significant improvements by adding novel agents to standard chemoimmunotherapy. The aim of this study was the identification of a gene signature able to refine current prognostication algorithms and applicable to clinical practice. Here we used a targeted gene expression profiling panel combining the Lymph2Cx signature for cell of origin classification with additional targets including MYC, BCL-2 and NFKBIA, in 186 patients from two randomized trials (discovery cohort) (clinicaltrials gov. Identifier: NCT00355199 and NCT00499018). Data were validated in three independent series (two large public datasets and a real-life cohort). By integrating the cell of origin, MYC/BCL-2 double expressor status and NFKBIA expression, we defined a three-gene signature combining MYC, BCL-2 and NFKBIA (MBN-signature), which outperformed the MYC/BCL-2 double expressor status in multivariate analysis, and allowed further risk stratification within the germinal center B-cell/unclassified subset. The high-risk (MBN Sig-high) subgroup identified the vast majority of double hit cases and a significant fraction of activated B-cell-derived diffuse large B-cell lymphomas. These results were validated in three independent series including a cohort from the REMoDL-B trial, where, in an exploratory ad hoc analysis, the addition of bortezomib in the MBN Sig-high subgroup provided a progression free survival advantage compared with standard chemoimmunotherapy. These data indicate that a simple three-gene signature based on MYC, BCL-2 and NFKBIA could refine the prognostic stratification in diffuse large B-cell lymphoma, and might be the basis for future precision-therapy approaches.
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Affiliation(s)
- Enrico Derenzini
- Onco-Hematology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Saveria Mazzara
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Melle
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanna Motta
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Marco Fabbri
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Riccardo Bruna
- Onco-Hematology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Claudio Agostinelli
- Hematopathology Unit, Dept of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna, Italy
| | | | | | - Ning Chen
- NanoString Technologies Inc, Seattle, WA, USA
| | - Simona Righi
- Hematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna
| | - Elena Sabattini
- Hematopathology Unit, Dept of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna, Italy
| | - Annalisa Chiappella
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angelica Calleri
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Fiori
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Valentina Tabanelli
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonello Cabras
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Umberto Vitolo
- Multidisciplinary Oncology Outpatient Clinic, FPO-IRCCS, Candiolo (Torino), Italy
| | | | - Alessandro Rambaldi
- Hematology and Bone marrow Transplant Unit, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Italy
| | - Pier Luigi Zinzani
- Hematology, Dept of Experimental Diagnostic and Specialty Medicine (DIMES), Bologna University, Italy
| | - Corrado Tarella
- Onco-Hematology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
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Croci GA, Hoster E, Beà S, Clot G, Enjuanes A, Scott DW, Cabeçadas J, Veloza L, Campo E, Clasen-Linde E, Goswami RS, Helgeland L, Pileri S, Rymkiewicz G, Reinke S, Dreyling M, Klapper W. Reproducibility of histologic prognostic parameters for mantle cell lymphoma: cytology, Ki67, p53 and SOX11. Virchows Arch 2020; 477:259-267. [PMID: 31975037 DOI: 10.1007/s00428-020-02750-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/04/2020] [Accepted: 01/09/2020] [Indexed: 01/04/2023]
Abstract
Mantle cell lymphoma (MCL) shows a clinical aggressiveness that varies from patient to patient. Despite major advances in outcomes with current immunochemotherapy, the future development of therapies requires risk stratification to tailor therapy intensity. Within the group of reference pathologists for the ongoing trials of the European MCL Network, we performed a round robin test on a tissue microarray to evaluate the reproducibility in assessing the biomarkers of outcome in MCL. Cytological subtype, Ki67-index and expression of p53 and SOX11 were evaluated on 20 diagnostic tumour samples by eight participating labs independently. We demonstrate that the assessment of the proliferation index by counting the Ki67 positive cells as well as assessment of SOX11 and p53 expression status is reproducible between labs. For the most established prognostic biomarker, Ki67, the intra-class correlation coefficient was very good when assessed as a continuous parameter (0.87). The agreement was lower when the values were analysed in a dichotomized way applying the commonly used cutoff of 30% (kappa = 0.65, complete concordance of all labs in 13/20 (65%)). Cases with discrepant results between labs in the dichotomized analysis showed mean values close to the cutoff of 30%. Centralised scoring and digital image analysis revealed results in line with the scores from individual labs. All cases in our cohort were additionally assessed for gene expression signatures and of TP53 gene alterations. Given the good reproducibility when guidelines of assessment are applied, the biomarker studied in this inter-laboratory test presents potential candidates to be enhanced for risk-stratification in the future clinical trials.
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Affiliation(s)
- Giorgio A Croci
- Hematopathology Section, Institute of Pathology and Lymph Node Registry, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany. .,Pathology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. .,UOC di Anatomia Patologica, IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 - 20122, Milano, Italy.
| | - Eva Hoster
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität Munich, Munich, Germany.,Department of Medicine III, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - Sílvia Beà
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Guillem Clot
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - Anna Enjuanes
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, Canada
| | - José Cabeçadas
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E, Lisbon, Portugal
| | - Luis Veloza
- Hematopathology Unit-Laboratory of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Elias Campo
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Barcelona, Spain.,Hematopathology Unit-Laboratory of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Rashmi S Goswami
- Sunnybrook Health Sciences Centre, Dept. of Laboratory Medicine and Molecular Diagnostics, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Lars Helgeland
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Stefano Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Grzegorz Rymkiewicz
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie Institute-Oncology Centre, Warsaw, Poland
| | - Sarah Reinke
- Hematopathology Section, Institute of Pathology and Lymph Node Registry, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital of the Ludwig Maximilians University Munich, Munich, Germany
| | - Wolfram Klapper
- Hematopathology Section, Institute of Pathology and Lymph Node Registry, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Robetorye RS, Ramsower CA, Rosenthal AC, Yip TK, Wendel Spiczka AJ, Glinsmann-Gibson BJ, Rimsza LM. Incorporation of Digital Gene Expression Profiling for Cell-of-Origin Determination (Lymph2Cx Testing) into the Routine Work-Up of Diffuse Large B-Cell Lymphoma. J Hematop 2019; 12:3-10. [PMID: 34447482 PMCID: PMC8386504 DOI: 10.1007/s12308-019-00344-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Diffuse large B-cell lymphomas (DLBCL) represent a clinically heterogeneous group of lymphomas that are classified together based on similarities in morphology and immunophenotype. Gene expression profiling further classifies DLBCL into distinct molecular subgroups based on cell-of-origin (COO), including Germinal Center B-cell type, Activated B-cell type, and Unclassified type. COO assignment of DLBCL has important biological and prognostic significance, as well as emerging therapeutic implications. Herein, we describe the first clinical validation of a digital gene expression profiling assay (Lymph2Cx) to perform COO assignment in the routine work-up of DLBCL using formalin-fixed paraffin-embedded (FFPE) tissue sections and describe the results of 90 consecutive DLBCL cases analyzed prospectively by a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA)-certified clinical molecular diagnostics laboratory.
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Affiliation(s)
- Ryan S. Robetorye
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Colleen A. Ramsower
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Allison C. Rosenthal
- Division of Hematology and Oncology, Department of Internal Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| | - Tameson K. Yip
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Amy J. Wendel Spiczka
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Betty J. Glinsmann-Gibson
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
| | - Lisa M. Rimsza
- Molecular Diagnostics Laboratory Arizona (MDAZL), Department of Laboratory Medicine and Pathology, Mayo Clinic in Arizona, Scottsdale, AZ
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