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Kuhlman JJ, Moustafa MA, Jiang L, Iqbal M, Seegobin K, Wolcott Z, Ayala E, Ansell S, Rosenthal A, Paludo J, Micallef I, Johnston P, Inwards D, Habermann T, Kharfan-Dabaja M, Witzig TE, Nowakowski GS, Tun HW. Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e815-e825. [PMID: 35534379 DOI: 10.1016/j.clml.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting. MATERIALS AND METHODS Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings. RESULTS Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival. CONCLUSION L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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Affiliation(s)
| | | | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Karan Seegobin
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Zoe Wolcott
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Steve Ansell
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ
| | - Jonas Paludo
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Ivana Micallef
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Patrick Johnston
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - David Inwards
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Thomas Habermann
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Thomas E Witzig
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Han W Tun
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL.
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Mitsui T, Yokohama A, Koiso H, Saito A, Toyama K, Shimizu H, Ishizaki T, Irisawa H, Takizawa M, Saitoh T, Murayama K, Matsumoto M, Handa H, Hirato J, Kojima M, Murakami H, Tsukamoto N. Prognostic impact of trisomy 21 in follicular lymphoma. Br J Haematol 2018; 184:570-577. [PMID: 30417943 DOI: 10.1111/bjh.15664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022]
Abstract
The chromosomal abnormalities associated with follicular lymphoma (FL) prognosis are not fully elucidated. Here, we evaluated the pattern of chromosomal abnormalities in FL, and clarified the correlations between the cytogenetic features and clinical outcome. Cytogenetic analysis was performed using standard methods of Giemsa-banding at diagnosis for 201 FL patients admitted to our hospitals between 2001 and 2013. The identified chromosomal abnormalities were: t(14;18)(q32;q21) (59·2%), +X (17·9%), del(6)(q)/-6 (16·9%), +7 (14·4%), abnormality of 1q12-21/1q (12·9%), del(13)(q)/-13 (11·9%), abnormality of 3q27 (10·4%), abnormality of 10q22-24 (10·0%), +12/dup(12)(q) (10·0%), abnormality of 1p21-22/1p (9·0%), +18 (9·0%), del(17)(p)/-17 (5·0%), and a complex karyotype (54·7%). Patients with trisomy 21 had a significantly shorter progression-free survival (P = 0·00171) and overall survival (OS) (P < 0·001) than those without trisomy 21; additionally, patients with trisomy 21 in the rituximab-treated cohort also had a significantly shorter OS (P = 0·000428). Multivariate analysis identified trisomy 21 as an independent risk factor in our cohorts with or without t(14;18) (P = 0·015). In conclusion, the presence of trisomy 21 was an independent risk factor for in FL. Chromosomal analysis of FL patients at diagnosis can provide useful information about their expected survival.
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Affiliation(s)
- Takeki Mitsui
- Department of Haematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Yokohama
- Division of Blood Transfusion Service, Gunma University Hospital, Maebashi, Japan
| | - Hiromi Koiso
- Department of Haematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akio Saito
- Fujioka General Hospital, Fujioka, Japan
| | | | - Hiroaki Shimizu
- Department of Haematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takuma Ishizaki
- Department of Haematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Irisawa
- Division of Haematology, Gunma Prefectural Cancer Centre, Ohta, Japan
| | - Makiko Takizawa
- Department of Haematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takayuki Saitoh
- Department of Laboratory Sciences, Gunma University Graduate School of Health Science, Maebashi, Japan
| | - Kayoko Murayama
- Division of Haematology, Gunma Prefectural Cancer Centre, Ohta, Japan
| | - Morio Matsumoto
- Division of Haematology, National Hospital Organization Shibukawa Medical Centre, Shibukawa, Japan
| | - Hiroshi Handa
- Department of Haematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Junko Hirato
- Department of Pathology, Gunma University Hospital, Maebashi, Japan
| | - Masaru Kojima
- Department of Anatomic and Diagnostic Pathology, Dokkyo University School of Medicine, Mibu, Japan
| | - Hirokazu Murakami
- Department of Laboratory Sciences, Gunma University Graduate School of Health Science, Maebashi, Japan
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Sheng IY, Treaba DO, Bishop KD. Infiltrative Rash Secondary to Leukemic-Phase Diffuse Large B-Cell Lymphoma With t(14;18), CDKN2A and MLL Deletion. J Hematol 2017; 6:90-95. [PMID: 32300400 PMCID: PMC7155845 DOI: 10.14740/jh327w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 07/31/2017] [Indexed: 11/25/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous and highly aggressive subtype of non-Hodgkin’s lymphoma. It commonly presents as rapidly-growing, painless lymphadenopathy (LAD). DLBCL presenting in leukemic-phase is rare, with fewer than 40 cases published. Chemotherapy remains the standard approach, although selecting the correct regimen has become more perplexing in patients with CDKN2A mutations. Patients with MLL- and CDKN2A-positive DLBCL may benefit from therapy with a dose-adjusted regimen of rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (DA-R-EPOCH) compared to traditional rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP). Herein, we report a case of leukemic-phase DLBCL presenting as a cutaneous eruption of the bilateral lower extremities, which has not been previously reported in the literature.
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Affiliation(s)
- Iris Y Sheng
- Department of Internal Medicine, Rhode Island Hospital and Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903, USA
| | - Diana O Treaba
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Warren Alpert Medical School, 593 Eddy Street, Providence, RI 02903, USA
| | - Kenneth D Bishop
- Department of Hematology and Oncology, Sturdy Hospital, 211 Park St, Attleboro, MA 02703, USA
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Koduru PR, Chen W, Garcia R, Fuda F. Acquisition of a t(11;14)(q13;q32) in clonal evolution in a follicular lymphoma with a t(14;18)(q32;q21) and t(3;22)(q27;q11.2). Cancer Genet 2015; 208:303-9. [PMID: 25953460 DOI: 10.1016/j.cancergen.2015.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/25/2015] [Accepted: 03/06/2015] [Indexed: 12/22/2022]
Abstract
Chromosome translocations involving an immunoglobulin (IG) locus and another gene, either BCL or MYC, are common events in B-cell lymphoma. Occasionally, two IG loci, one with BCL and the other with MYC, are simultaneously involved; such cases are classified as double-hit (DH) lymphomas. These tumors often show intermediate histologic features between those of diffuse large B-cell lymphoma and those of Burkitt lymphoma. Patients with DH lymphoma have a poor prognosis. Rarely, lymphomas in which three IG loci are simultaneously involved with two different BCL genes and MYC have been reported. These cases are classified as triple-hit lymphomas; virtually all these are aggressive tumors with an even worse prognosis. We present here a unique case of follicular lymphoma (FL) with rearranged BCL2, BCL6, and BCL1 (also known as CCND1) genes. Lymphoma cells at first clinical relapse had a complex karyotype that included a t(3;22)(q27;q11) and t(14;18)(q32;q21). About 15 years after initial diagnosis, the lymphoma cells showed clonal cytogenetic evolution and acquired a t(11;14)(q13;q32). This article is the first case report of a low grade B-cell lymphoma that had three lymphoma-associated reciprocal translocations not involving MYC and that had a long indolent clinical course.
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MESH Headings
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 3/genetics
- Clonal Evolution
- Cyclin D1/genetics
- DNA-Binding Proteins/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Proto-Oncogene Proteins c-bcl-6
- Translocation, Genetic/genetics
- bcl-Associated Death Protein/genetics
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Affiliation(s)
- Prasad R Koduru
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Weina Chen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rolando Garcia
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Franklin Fuda
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
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Fiskvik I, Aamot HV, Delabie J, Smeland EB, Stokke T, Heim S, Holte H. Karyotyping of diffuse large B-cell lymphomas: loss of 17p is associated with poor patient outcome. Eur J Haematol 2013; 91:332-8. [PMID: 23859481 DOI: 10.1111/ejh.12171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cytogenetic studies of patients with diffuse large B-cell lymphoma (DLBCL) have revealed a large spectrum of chromosomal abnormalities, some of which may be clinically relevant. We wanted to evaluate possible associations between commonly acquired chromosome aberrations and prognosis in a large cohort of patients. METHODS All patients with DLBCL treated at our center during 1999-2010 with an abnormal G-banding karyotype determined on cells short-term cultured from diagnostic biopsies were included. Detailed information on staging, treatment, and outcome was available for all patients. RESULTS Of the 110 patients available for analysis, there were 48 deaths and 27 relapses after a median follow-up of 4.5 yr. Eleven different chromosomal abnormalities were detected in more than ten percent of patients. Of those, only loss of 17p, including the TP53 tumor suppressor gene, was significantly associated with inferior long-term prognosis. Five year overall and progression-free survival frequencies were 32% and 27% for patients with loss of 17p and 67% and 59% in patients without this abnormality. CONCLUSION In a relatively large cohort of patients with DLBCL analyzed by chromosome banding, loss of 17p was the only chromosomal abnormality associated with inferior survival in uni- and multivariate analysis.
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Affiliation(s)
- Idun Fiskvik
- Department of Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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Sekimizu M, Sunami S, Nakazawa A, Hayashi Y, Okimoto Y, Saito AM, Horibe K, Tsurusawa M, Mori T. Chromosome abnormalities in advanced stage T-cell lymphoblastic lymphoma of children and adolescents: a report from Japanese Paediatric Leukaemia/Lymphoma Study Group (JPLSG) and review of the literature. Br J Haematol 2011; 154:612-7. [DOI: 10.1111/j.1365-2141.2011.08788.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Leich E, Ott G, Rosenwald A. Pathology, pathogenesis and molecular genetics of follicular NHL. Best Pract Res Clin Haematol 2011; 24:95-109. [PMID: 21658611 DOI: 10.1016/j.beha.2011.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Follicular lymphoma (FL) is a germinal centre-derived indolent B-cell lymphoma representing the second most common Non Hodgkin lymphoma in the Western world. This chapter focuses on the pathology of FL and summarizes the current knowledge about genetic and molecular features that are relevant for the pathogenesis of this neoplasm. The translocation t(14;18) is present in approximately 90% of FL leading to the upregulation of the anti-apoptotic protein BCL2, that may constitute a promising molecular target for therapeutic approaches. FL lacking the t(14;18) also exist, and B-cells carrying the t(14;18) can be detected in a subset of healthy individuals. In addition to the t(14;18), secondary genetic alterations are present in most FL and, more recently, deeper insights into the methylation and microRNA expression patterns in the tumour cells have been gained. The tumour microenvironment appears to be particularly important for the biology and the clinical course of FL.
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Affiliation(s)
- E Leich
- Institute of Pathology, University of Würzburg, Josef-Schneider-Str 2, 97080 Würzburg, Germany.
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Bacher U, Haferlach T, Alpermann T, Kern W, Schnittger S, Haferlach C. Several lymphoma-specific genetic events in parallel can be found in mature B-cell neoplasms. Genes Chromosomes Cancer 2010; 50:43-50. [DOI: 10.1002/gcc.20831] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Genomic alterations reveal potential for higher grade transformation in follicular lymphoma and confirm parallel evolution of tumor cell clones. Blood 2010; 116:1489-97. [DOI: 10.1182/blood-2010-03-272278] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Our aim was to examine the genetics of clonal evolution in follicular lymphoma (FL) and to identify genetic alterations associated with disease progression. A total of 100 biopsies from 44 patients diagnosed with t(14;18)-positive FL were examined by array comparative genomic hybridization. In 20 patients the patterns of somatic hypermutations (SHMs) in the variable region of heavy chain gene were additionally analyzed. Gain of chromosome X in male samples was a marker for poor outcome (P < .01). Gains involving chromosome 2, 3q, and 5 were exclusively present in FL biopsies from cases with higher grade transformation and were among the copy number alterations (CNAs) associated with inferior survival. Although we noted a trend for increasing genomic complexity in initial versus late FL samples, the overall frequencies of CNAs in initial and late FL biopsies showed a surprisingly stable pattern through the course of the disease. In 27 of cases the initial samples harbored CNAs that were absent in relapse samples, indicating that tumor cell clones at relapse were not direct descendants of initially dominating clones. The pattern of SHMs confirmed parallel development of tumor cell clones in 14 cases. Our findings support the hypothesis of common progenitor cells in FL.
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Mussolin L, Pillon M, Bonato P, Leszl A, Franceschetto G, Di Meglio A, d'Amore ESG, Sainati L, Rosolen A. Cytogenetic analysis of pediatric anaplastic large cell lymphoma. Pediatr Blood Cancer 2010; 55:446-51. [PMID: 20658615 DOI: 10.1002/pbc.22550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Anaplastic large cell lymphoma (ALCL) constitutes approximately 15% of pediatric and 3% of adult non-Hodgkin lymphomas. Most pediatric cases harbor the reciprocal translocation t(2;5)(p23;q35), involving the alk gene. Cytogenetic studies of ALCL have mostly been published as case-reports. The aim of this study was to determine the cytogenetic profiles of a series of pediatric ALCL and to compare them with pediatric and adult ALCL from the literature. METHODS Eighteen children treated at our Institution were studied by standard cytogenetic analysis and RT-PCR for the specific t(2;5) translocation product. Comparative analysis was performed on our findings and on the karyotypes of 48 pediatric and 39 adult ALCL reported in the literature. RESULTS Karyotype was obtained in 16/18 ALCL: 9 showed translocation t(2;5) and 1 an alk variant form. Structural and numeric chromosomal abnormalities were identified in both pediatric and adult series. Trisomies were found preferentially in pediatric patients (P = 0.013) and monosomies in adults (P = 0.038). Trisomy 7 was found in 22% (13/59) of pediatric cases with abnormal karyotype and only in 5% (2/38) of adults; monosomy of chromosome 13 in 13% (5/38) of adults and only in 2% (1/59) of pediatric patients and monosomy of chromosome 15 in 16% (6/38) of adults and in none of the pediatric ALCL. CONCLUSION Our data suggest that pediatric and adult ALCL are characterized by different numerical chromosomal abnormalities. Larger prospective studies may elucidate their potential prognostic impact.
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Affiliation(s)
- Lara Mussolin
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera, Università di Padova, Padova, Italy
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Clonal Evolution in t(14;18)-Positive Follicular Lymphoma, Evidence for Multiple Common Pathways, and Frequent Parallel Clonal Evolution. Clin Cancer Res 2008; 14:7180-7. [DOI: 10.1158/1078-0432.ccr-08-0752] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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