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Huibers M, Abla O, Andrés M, Balagué O, Beishuizen A, Carraro E, Chiang A, Csóka M, David BA, de Ville de Goyet M, Gilad G, Hori D, Kotecha RS, Kabickova E, Klapper W, Miakova N, Minard-Colin V, Nakazawa A, Pillon M, Rigaud C, Salaverria I, Tölle I, Verdú-Amorós J, von Mersi H, Wössmann W, Burkhardt B, Attarbaschi A. Large B-cell lymphoma-IRF4+ in children and young people: time to reduce chemotherapy in a rare malignant mature B-cell neoplasm? Blood Adv 2024; 8:1509-1514. [PMID: 38290136 DOI: 10.1182/bloodadvances.2023012109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024] Open
Affiliation(s)
- Minke Huibers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Oussama Abla
- Division of Hematology and Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Mara Andrés
- Department of Pediatric Hematology and Oncology, University Hospital La Fe of Valencia, Valencia, Spain
| | - Olga Balagué
- Hematopathology section, Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Elisa Carraro
- Maternal and Child Health Department, Pediatric Hematology, Oncology and Stem Cell Transplant Center, University of Padova, Padova, Italy
| | - Alan Chiang
- Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Monika Csóka
- Pediatric Clinic (Tűzoltó Street Department), Semmelweis University, Budapest, Hungary
| | - Bianca-Andreea David
- Department of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Liège, Liège, Belgium
| | - Maëlle de Ville de Goyet
- Department of Pediatric Hematology and Oncology, Cliniques universitaires Saint-Luc, UC Louvain, Brussels, Belgium
| | - Gil Gilad
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center, Petah Tikva, and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daiki Hori
- Department of Hematology and Oncology for children and adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Rishi S Kotecha
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, Australia
- Leukaemia Translational Research Laboratory, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
| | - Edita Kabickova
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Wolfram Klapper
- Hematopathology Section, Department of Pathology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Natasha Miakova
- Department of Pediatric Hematology and Oncology, Federal Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy Cancer Campus, Paris-Sacaly University, Villejuif, France
| | - Atsuko Nakazawa
- Department of Clinical Research, Saitama Children's Medical Center, Saitama, Japan
| | - Marta Pillon
- Hematopathology section, Pathology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Charlotte Rigaud
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy Cancer Campus, Paris-Sacaly University, Villejuif, France
| | - Itziar Salaverria
- Department of Pathology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ida Tölle
- Pediatric Hematology and Oncology and NHL-BFM Study Center, University Hospital Münster, Münster, Germany
| | - Jaime Verdú-Amorós
- Department of Pediatric Hematology and Oncology, University Hospital La Fe of Valencia, Valencia, Spain
- Department of Pediatric Hematology and Oncology, Hospital Clínico Universitario, Biomedical Research Institute, INCLIVA, Valencia, Spain
| | - Hannah von Mersi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Wilhelm Wössmann
- Pediatric Hematology and Oncology and NHL-BFM Study Center, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology and NHL-BFM Study Center, University Hospital Münster, Münster, Germany
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
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Maguire J, Harvey H, Jones A, Law R, Bashir M, O'Brien O, Sargent J, Grant C, Flavin R. Clinical boundaries in adult cases of large B cell lymphoma with IRF4 rearrangement. Histopathology 2024; 84:399-401. [PMID: 37876327 DOI: 10.1111/his.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
AIMS Large B-cell lymphoma with IRF4 rearrangement (LBCL-IRF4) is a recently described entity included in the revised 4th edition of the WHO Classification of Haematolymphoid Tumours (2017). Here we highlight the difficulties in classification of those cases which arise in adult patients with unusual clinical features. RESULTS We present three cases with morphological and immunohistochemical features consistent with large B-cell lymphoma arising in adult patients, which were found to have isolated IRF4 rearrangements on FISH analysis. Each patient presented with advanced-stage disease and had a history of immunosuppression; clinical features that are not typical of LBCL-IRF4 and which make the distinction from DLBCL, not otherwise specified (NOS) challenging. CONCLUSION We propose that the clinical boundaries of LBCL-IRF4 arising in adult patients need further delineation to allow distinction from true cases of DLBCL, NOS.
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Affiliation(s)
- Jessica Maguire
- Histopathology Department, St James's Hospital, Dublin 8, Ireland
| | - Harry Harvey
- Oncology Department, St James's Hospital, Dublin 8, Ireland
| | - Alfred Jones
- Haematology Department, Beaumont Hospital, Dublin 9, Ireland
| | - Ruth Law
- Histopathology Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Masoud Bashir
- Surgery Department, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | | | - Jeremy Sargent
- Haematology Department, Beaumont Hospital, Dublin 9, Ireland
| | - Cliona Grant
- Oncology Department, St James's Hospital, Dublin 8, Ireland
| | - Richard Flavin
- Histopathology Department, St James's Hospital, Dublin 8, Ireland
- Histopathology Department, Trinity College Dublin, Dublin 2, Ireland
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Salaverria I, Weigert O, Quintanilla-Martinez L. The clinical and molecular taxonomy of t(14;18)-negative follicular lymphomas. Blood Adv 2023; 7:5258-5271. [PMID: 37561599 PMCID: PMC10500559 DOI: 10.1182/bloodadvances.2022009456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/11/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023] Open
Abstract
Follicular lymphoma (FL) is a neoplasm derived from germinal center B cells, composed of centrocytes and centroblasts, with at least a focal follicular growth pattern. The t(14;18) translocation together with epigenetic deregulation through recurrent genetic alterations are now recognized as the hallmark of FL. Nevertheless, FL is a heterogeneous disease, clinically, morphologically, and biologically. The existence of FL lacking the t(14;18) chromosomal alteration highlights the complex pathogenesis of FL, and indicates that there are alternative pathogenetic mechanisms that can induce a neoplasm with follicular center B-cell phenotype. Based on their clinical presentation, t(14;18)-negative FLs can be divided into 3 broad groups: nodal presentation, extranodal presentation, and those affecting predominantly children and young adults. Recent studies have shed some light into the genetic alterations of t(14;18)-negative FL. Within the group of t(14;18)-negative FL with nodal presentation, cases with STAT6 mutations are increasingly recognized as a distinctive molecular subgroup, often cooccurring with CREBBP and/or TNFRSF14 mutations. FL with BCL6 rearrangement shows clinicopathological similarities to its t(14;18)-positive counterpart. In contrast, t(14;18)-negative FL in extranodal sites is characterized mainly by TNFRSF14 mutations in the absence of chromatin modifying gene mutations. FL in children have a unique molecular landscape when compared with those in adults. Pediatric-type FL (PTFL) is characterized by MAP2K1, TNFRSF14, and/or IRF8 mutations, whereas large B-cell lymphoma with IRF4 rearrangement is now recognized as a distinct entity, different from PTFL. Ultimately, a better understanding of FL biology and heterogeneity should help to understand the clinical differences and help guide patient management and treatment decisions.
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Affiliation(s)
- Itziar Salaverria
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Oliver Weigert
- Laboratory for Experimental Leukemia and Lymphoma Research, Ludwig-Maximilians-University Hospital, Munich, Germany
- Department of Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT “Image-guided and functionally Instructed Tumor therapies,” Eberhard-Karls University of Tübingen, Tübingen, Germany
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Quintanilla-Martinez L, Laurent C, Soma L, Ng SB, Climent F, Ondrejka SL, Zamo A, Wotherspoon A, de Leval L, Dirnhofer S, Leoncini L. Emerging entities: high-grade/large B-cell lymphoma with 11q aberration, large B-cell lymphoma with IRF4 rearrangement, and new molecular subgroups in large B-cell lymphomas. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:281-298. [PMID: 37555980 PMCID: PMC10541818 DOI: 10.1007/s00428-023-03590-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023]
Abstract
Emerging entities and molecular subgroups in large B-cell lymphomas (LBCLs) were discussed during the 2022 European Association for Haematopathology/Society for Hematopathology workshop in Florence, Italy. This session focused on newly recognized diseases and their diagnostic challenges. High-grade/large B-cell lymphoma with 11q aberration (HG/LBCL-11q) is defined by chromosome 11q-gains and telomeric loss. FISH analysis is recommended for the diagnosis. HG/LBCL-11q can occur in the setting of immunodeficiency, including ataxia-telangiectasia, and predominates in children. The morphological spectrum of these cases is broader than previously thought with often Burkitt-like morphology and coarse apoptotic bodies. It has a Burkitt-like immunophenotype (CD10+, BCL6+, BCL2-) but MYC expression is weak or negative, lacks MYC rearrangement, and is in contrast to Burkitt lymphoma 50% of the cases express LMO2. LBCL with IRF4 rearrangement (LBCL-IRF4) occurs mainly in the pediatric population but also in adults. LBCL-IRF4 has an excellent prognosis, with distinguishing molecular findings. IRF4 rearrangements, although characteristic of this entity, are not specific and can be found in association with other chromosomal translocations in other large B-cell lymphomas. Other molecular subgroups discussed included primary bone diffuse large B-cell lymphoma (PB-DLBCL), which has distinctive clinical presentation and molecular findings, and B-acute lymphoblastic leukemia (B-ALL) with IGH::MYC translocation recently segregated from Burkitt lymphoma with TdT expression. This latter disorder has molecular features of precursor B-cells, often tetrasomy 1q and recurrent NRAS and KRAS mutations. In this report, novel findings, recommendations for diagnosis, open questions, and diagnostic challenges raised by the cases submitted to the workshop will be discussed.
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Affiliation(s)
- Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard-Karls-University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Liebermeisterstrasse 8, 72076, Tübingen, Germany.
- Cluster of Excellence iFIT (EXC2180) "Image-guided and functionally Instructed Tumor therapies" Eberhard-Karls-University, Tübingen, Germany.
| | - Camille Laurent
- Department of Pathology, Toulouse University Hospital Center, Cancer Institute, University of Toulouse-Oncopole, Toulouse, France
| | - Lorinda Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alberto Zamo
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | | | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
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