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Nickles M, Hunt S, Turcios-Escobar S, Babwah A, Mobayed N, Murga-Zamalloa C, Bain M, Quigley J, Rubinstein P, Galvez C. Richter Syndrome Presenting as Subcutaneous Nodules and a Dermal Plaque. Am J Dermatopathol 2024; 46:443-446. [PMID: 38648045 DOI: 10.1097/dad.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
ABSTRACT Richter syndrome (RS) describes a phenomenon in which a patient with chronic lymphocytic leukemia (CLL) develops an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL). Reports of cutaneous RS remain exceedingly rare. We report a 61-year-old woman with relapsed/refractory CLL presenting with several subcutaneous nodules on her arms and legs and a single dermal plaque on her abdomen. Skin biopsy revealed a diagnosis of DLBCL, ABC-type, and her clinical status rapidly deteriorated following diagnosis. We review the variety of clinical presentations of cutaneous RS, its association with CLL, risk factors for RS development in CLL patients, and the distinctive histopathologic and immunophenotypic features of DLBCL. We hope to highlight the importance of prompt skin biopsy in patients with CLL presenting with progressive skin lesions and increase awareness of this aggressive clinical syndrome.
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Affiliation(s)
- Melissa Nickles
- Department of Dermatology, University of Illinois, Chicago, IL
| | - Samantha Hunt
- Department of Dermatology, University of Illinois, Chicago, IL
| | | | - Amaara Babwah
- Department of Hematology, University of Illinois, Chicago, IL; and
| | - Nisreen Mobayed
- Department of Internal Medicine, University of Illinois, Chicago, IL
| | | | - Michelle Bain
- Department of Dermatology, University of Illinois, Chicago, IL
| | - John Quigley
- Department of Hematology, University of Illinois, Chicago, IL; and
| | - Paul Rubinstein
- Department of Hematology, University of Illinois, Chicago, IL; and
| | - Carlos Galvez
- Department of Hematology, University of Illinois, Chicago, IL; and
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2
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Matos DM. CD5-negative chronic lymphocytic leukemia: Does this entity really exist? CYTOMETRY. PART B, CLINICAL CYTOMETRY 2024; 106:126-137. [PMID: 38017706 DOI: 10.1002/cyto.b.22151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Affiliation(s)
- Daniel Mazza Matos
- Flow Cytometry Section, Cell Processing Center (CPC), Center of Hematology and Hemotherapy of Ceará (HEMOCE), Fortaleza, Brazil
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3
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Al-Zubaidi HK, Hughes SF. The Use of CD200 in the Differential Diagnosis of B-Cell Lymphoproliferative Disorders. Br J Biomed Sci 2023; 80:11573. [PMID: 37822353 PMCID: PMC10563807 DOI: 10.3389/bjbs.2023.11573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
Background: B-Cell Lymphoproliferative Disorders (B-LPDs) are a group of heterogenous disorders characterised by the accumulation of B-cells in peripheral blood, bone marrow, lymph nodes and spleen. They have a variable disease course and outcome and many share similar features making differential diagnosis challenging. Therefore, accurate diagnosis is fundamental in particular for determining treatment options. Immunophenotyping by flow cytometry plays a crucial role in the diagnosis of B-LPDs. However, overlapping immunophenotyping patterns exist and the use of novel monoclonal antibodies has become increasingly important in immunophenotyping analysis. More recently differential expression of CD200 has been reported in various B-LPDs and that CD200 may improve the differentiation between chronic lymphocytic leukaemia (CLL) and mantle cell lymphoma (MCL). In this study CD200 expression is evaluated in different B-LPDs. Methods: A total of 100 samples were collected and analysed by immunophenotyping flow cytometry over a period of 1 year (2017-2018), by a panel of monoclonal antibodies including CD200. The percentage of CD200 and its expression intensity was evaluated and compared between different groups of B-LPDs. Results: All of the 50 cases of CLL expressed CD200 with moderate to bright intensity, 6 MCL cases lacked the expression of CD200. Furthermore, all 5 cases of hairy cell leukaemia (HCL) expressed CD200. Out of all B-LPDs evaluated, CD200 expression in HCL cases was noted to be the brightest. The other 39 cases were not found to be B-LPDs. Conclusion: CD200 has an important role in differentiating CLL from MCL, HCL has a consistent bright expression of CD200. By adding CD200 to the combinations of markers in routine testing panel, Immunophenotyping by flow cytometry can be an effective tool in the diagnosis of B-LPDs especially in cases with atypical immunophenotyping pattern. Our result support that CD200 can be added to routine testing panel as it is useful in differentiating them.
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MESH Headings
- Humans
- Antibodies, Monoclonal/metabolism
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Diagnosis, Differential
- Flow Cytometry
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/pathology
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Affiliation(s)
- Hanaan Kareem Al-Zubaidi
- Pathology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Stephen Fôn Hughes
- Maelor Academic Unite (MAU), Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
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4
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Cuesta-Mateos C, Brown JR, Terrón F, Muñoz-Calleja C. Of Lymph Nodes and CLL Cells: Deciphering the Role of CCR7 in the Pathogenesis of CLL and Understanding Its Potential as Therapeutic Target. Front Immunol 2021; 12:662866. [PMID: 33841445 PMCID: PMC8024566 DOI: 10.3389/fimmu.2021.662866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 01/13/2023] Open
Abstract
The lymph node (LN) is an essential tissue for achieving effective immune responses but it is also critical in the pathogenesis of chronic lymphocytic leukemia (CLL). Within the multitude of signaling pathways aberrantly regulated in CLL the homeostatic axis composed by the chemokine receptor CCR7 and its ligands is the main driver for directing immune cells to home into the LN. In this literature review, we address the roles of CCR7 in the pathophysiology of CLL, and how this chemokine receptor is of critical importance to develop more rational and effective therapies for this malignancy.
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Affiliation(s)
- Carlos Cuesta-Mateos
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria- Instituto de La Princesa (IIS-IP), Madrid, Spain.,IMMED S.L., Immunological and Medicinal Products, Madrid, Spain.,Catapult Therapeutics BV, Lelystad, Netherlands
| | - Jennifer R Brown
- Chronic Lymphocytic Leukemia (CLL) Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Fernando Terrón
- IMMED S.L., Immunological and Medicinal Products, Madrid, Spain.,Catapult Therapeutics BV, Lelystad, Netherlands
| | - Cecilia Muñoz-Calleja
- Immunology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria- Instituto de La Princesa (IIS-IP), Madrid, Spain.,School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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5
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Karam M, Hasan K, Mohammed N, Yassin A, Mustafa S, Abdulrahman L, Polis R, Numan G, Mohammed S, Shamoon R, Rashid B, Jalal S, Yousif R, Mohamed Z, Mahmood T, Abdulla B, Abdullah D, Ahmed Z, Getta H. The pattern of bone marrow involvement among chronic lymphocytic leukemia patients and its impact on the disease outcome in Kurdistan Region of Iraq. IRAQI JOURNAL OF HEMATOLOGY 2021. [DOI: 10.4103/ijh.ijh_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Dirilenoglu F, Yukselen OO, Mocan G. Spindle cell melanoma coexisting with chronic lymphocytic leukemia/small lymphocytic lymphoma: a rare collision tumor in multiple sites. J Cutan Pathol 2020; 47:1215-1219. [PMID: 32959377 DOI: 10.1111/cup.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
A strong association has been reported between chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) and malignant melanoma (MM). In rare cases of MM, lymphoid malignancies may be detected incidentally during sentinel lymph node biopsies. In this case, we found a unique collision of MM and CLL infiltration in the skin. An 88-year-old male patient presented with a mass on the nasal root. Histopathological examination of the skin biopsy specimen revealed a deeply infiltrative, atypical spindle cell proliferation in the background of a collagenous stroma. Accompanying this lesion, there were foci of monotonous lymphoid cell populations involving skin appendages. In the immunohistochemical studies, the spindle cells were diffusely positive for S100, and focally positive for Melan-A and HMB45; the lymphoid cells were positive for CD20, CD5, and Bcl-2 and negative for CD3, Bcl-6, CD10, and Cyclin D1. Histopathological and immunohistochemical findings were consistent with diagnoses of spindle cell melanoma and CLL. Interestingly, these two tumors together in their same morphological appearance were confirmed in a subsequent liver biopsy. Active skin surveillance of patients with CLL may be important to detect MM at an early stage that correlates with a better prognosis.
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Affiliation(s)
- Fikret Dirilenoglu
- Department of Pathology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Ozen Ozden Yukselen
- Department of Pathology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Gamze Mocan
- Department of Pathology, Faculty of Medicine, Near East University, Nicosia, Cyprus
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7
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Utz JL, Bell H, Wright WF, George TI. “Soccer-Ball” Lymphocytosis. J Osteopath Med 2020; 120:286. [DOI: 10.7556/jaoa.2020.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Hemati M, Rasouli Nejad Z, Shokri MR, Ghahremanfard F, Mir Mohammadkhani M, Kokhaei P. IL-27 impact on NK cells activity: Implication for a robust anti-tumor response in chronic lymphocytic leukemia. Int Immunopharmacol 2020; 82:106350. [PMID: 32120343 DOI: 10.1016/j.intimp.2020.106350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Interleukin 27 (IL-27) belongs to IL-12 cytokine family, has shown anti-tumor potential in several solid tumors, as well as hematologic malignancies. IL-27 can inhibit tumor growth and progression through direct and indirect mechanisms, such as inhibition of proliferation, angiogenesis, induction of apoptosis in tumor cells, and anti-tumor immune response. B-CLL is characterized by remarkable immune perturbation, which leads to disease complications and reduced effectiveness of the treatment. Natural killer cells (NK) are considered as an important arm for the elimination of transformed cells. However, NK cells have shown significant impairment in patients with CLL. Here we analyzed the activity of recombinant human (rh) IL-27-stimulated NK cells in bone marrow (BM) and peripheral blood (PB) of CLL patients using cell surface flow cytometry assessment, and cytotoxicity assay. We showed that rhIL-27 can increase CD69 on NK cells both in BM and PB. Interestingly, BM-NK cells treated with rhIL-27 exhibited a significant increase in degranulation and NK cell-mediated cytotoxicity as compared with untreated NK cells, whereas it did not improve NK cell activity of PB. These observations added further explanation to the anti-tumor activity of IL-27 and also could pave the way to adoption immunostimulatory adjuvant for therapies in CLL.
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Affiliation(s)
- Maral Hemati
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran; Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Zahra Rasouli Nejad
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran; Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad-Reza Shokri
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Majid Mir Mohammadkhani
- Health Research Center of Semnan University of Medical Sciences, Semnan, Iran; Department of Epidemiology and Biostatistics, Semnan University of Medical Sciences, Semnan, Iran
| | - Parviz Kokhaei
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Oncology-Pathology, BioClinicum, Karolinska University Hospital Solna and Karolinska Institute, Stockholm, Sweden.
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9
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Basabaeen AA, Abdelgader EA, BaHashwan OS, Babekir EA, Abdelateif NM, Bamusa SA, Abdelrahim SO, Altayeb OA, Fadul EA, Ibrahim IK. Combined analysis of ZAP-70 and CD38 expression in sudanese patients with B-cell chronic lymphocytic leukemia. BMC Res Notes 2019; 12:282. [PMID: 31122288 PMCID: PMC6533771 DOI: 10.1186/s13104-019-4319-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the ZAP-70 and CD38 expressions and their combined expressions in Sudanese B-CLL patients and their relationships with clinical and hematological characteristics as well as the disease staging at presentation. RESULTS In the present cross-sectional descriptive study, analysis of ZAP-70 expression showed that 36/110 (32.7%) patients positively expressed ZAP-70 and insignificant higher presentation in intermediate and at advanced stages as well as no correlation was seen with hematological parameters and clinical features compared with negatively ZAP-70, on the other hand, 41/110 (37.3%) were CD38+ and no significant correlation was shown with the stage at presentation, clinical characteristics (except Splenomegaly, P = 0.02) and hematological parameters. However, in combined expressions of both ZAP-70 and CD38 together, 20/110 (18.2%) were concordantly ZAP-70+/CD38+, 53/110 (48.2%) concordantly ZAP-70-/CD38- and 37/110 (33.6%) either ZAP-70+ or CD38+, and these three groups showed insignificant correlation with clinical (except Splenomegaly, P = 0.03) and hematological parameters, and the stage at presentation. Our data showed the combined analysis of these two markers, lead to classify our patients into three subgroups (either concordant positive, negative or discordant expressions) with statistically insignificant correlation with clinical presentation (except Splenomegaly), hematological parameters and stage at presentation of B-CLL patients.
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MESH Headings
- ADP-ribosyl Cyclase 1/blood
- ADP-ribosyl Cyclase 1/genetics
- ADP-ribosyl Cyclase 1/immunology
- Adult
- Aged
- B-Lymphocytes/immunology
- B-Lymphocytes/pathology
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Cross-Sectional Studies
- Female
- Gene Expression
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Membrane Glycoproteins/blood
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/immunology
- Middle Aged
- Neoplasm Staging
- Prospective Studies
- Splenomegaly/diagnosis
- Splenomegaly/genetics
- Splenomegaly/immunology
- Splenomegaly/pathology
- Sudan
- ZAP-70 Protein-Tyrosine Kinase/blood
- ZAP-70 Protein-Tyrosine Kinase/genetics
- ZAP-70 Protein-Tyrosine Kinase/immunology
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Affiliation(s)
- Ameen Abdulaziz Basabaeen
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
- Ministry of Health & Population, Hadhramout, Yemen
| | | | - Othman Saeed BaHashwan
- Department of Family Medicine, Faculty of Medicine, University of Gezira, Wad Medani, Sudan
| | - Ebtihal Ahmed Babekir
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
| | - Nour Mahmoud Abdelateif
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
| | | | - Saadia Osman Abdelrahim
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
| | - Osama Ali Altayeb
- Flow Cytometry Laboratory for Leukemia & Lymphoma Diagnosis, Khartoum, Sudan
| | - Eman Abbass Fadul
- Flow Cytometry Laboratory for Leukemia & Lymphoma Diagnosis, Khartoum, Sudan
| | - Ibrahim Khider Ibrahim
- Department of Hematology, Faculty of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudan
- Department of Hematology, School of Medical Sciences, University Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan Malaysia
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10
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Correia RP, Matos E Silva FA, Bacal NS, Campregher PV, Hamerschlak N, Amarante-Mendes GP. ZAP-70 expression is associated with increased CD4 central memory T cells in chronic lymphocytic leukemia: cross-sectional study. Hematol Transfus Cell Ther 2018; 40:317-325. [PMID: 30370409 PMCID: PMC6200686 DOI: 10.1016/j.htct.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/28/2018] [Indexed: 01/17/2023] Open
Abstract
Background Although chronic lymphocytic leukemia is basically a B cell disease, its pathophysiology and evolution are thought to be significantly influenced by T cells, as these are probably the most important interaction partner of neoplastic B cells, participating in their expansion, differentiation and survival. Chronic lymphocytic leukemia B cells may also drive functional and phenotypic changes of non-malignant T cells. There are few data about the association between memory T cells and prognosis, especially related to ZAP-70, a common reliable surrogate of the gold standard chronic lymphocytic leukemia prognostic markers. Objective The aim of this study was to investigate whether the expression of ZAP-70 in chronic lymphocytic leukemia patients is associated with abnormal patterns of the distribution of naïve and memory T cells related to crosstalk between these cells. Methods In this cross-sectional, controlled study, patients with chronic lymphocytic leukemia were compared with healthy blood donors regarding the expression of ZAP-70 and the distribution of naïve and memory T cell subsets in peripheral blood as measured by flow cytometry. Results ZAP-70 positive patients presented an increased frequency and absolute number of central memory CD4+ T cells, but not CD8+ T cells, compared to ZAP-70 negative patients and age-matched apparently healthy donors. Conclusions Because central memory CD4+ T cells are located in lymph nodes and express CD40L, we consider that malignant ZAP-70-positive B cells may receive beneficial signals from central memory CD4+ T cells as they accumulate, which could contribute to more aggressive disease.
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Affiliation(s)
- Rodolfo Patussi Correia
- Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Nydia Strachman Bacal
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Centro de Hematologia de São Paulo (CHSP), São Paulo, SP, Brazil
| | - Paulo Vidal Campregher
- Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson Hamerschlak
- Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Gustavo Pessini Amarante-Mendes
- Instituto de Ciências Biomédicas, Universidade de São Paulo (ICB USP), São Paulo, SP, Brazil.,Instituto Nacional de Ciência e Tecnologia (INCT), Brazil
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11
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Daugaard I, Hussmann D, Kristensen L, Kristensen T, Kjeldsen TE, Nyvold CG, Larsen TS, Møller MB, Hansen LL, Wojdacz TK. Chronic lymphocytic leukemia patients with heterogeneously or fully methylated LPL promotor display longer time to treatment. Epigenomics 2018; 10:1155-1166. [PMID: 30182737 DOI: 10.2217/epi-2018-0020] [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] [Indexed: 12/18/2022] Open
Abstract
AIM We investigated whether DNA methylation regulates expression of LPL and PI3K complex genes in chronic lymphocytic leukemia (CLL) and evaluated the prognostic significance of LPL promoter methylation in CLL patients. Patients & methods: Methylation of LPL promoter was assessed in 112 patients using methylation-sensitive high-resolution melting (MS-HRM). RESULTS Patients with a fully or heterogeneously methylated LPL promoter had significantly longer median time to treatment (p < 0.001) and 75% lower (hazard ratio: 0.25; 95% CI: 0.15-0.42; p < 0.001) risk of requirement for treatment as opposed to patients with nonmethylated promoter. Multivariate modeling confirmed independent prognostic value of these findings. CONCLUSION Chronic lymphocytic leukemia patients with a fully or heterogeneously methylated LPL gene promoter display indolent disease course and acquisition of heterogeneous methylation of LPL promoter is insufficient to induce gene expression.
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Affiliation(s)
- Iben Daugaard
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Dianna Hussmann
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Louise Kristensen
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense C, Denmark
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense C, Denmark
| | - Tina E Kjeldsen
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Charlotte G Nyvold
- Department of Haematology, Odense University Hospital, Sdr. Bouldvard 29, 5000 Odense C, Denmark
| | - Thomas S Larsen
- Department of Haematology, Odense University Hospital, Sdr. Bouldvard 29, 5000 Odense C, Denmark
| | - Michael B Møller
- Department of Pathology, Odense University Hospital, J. B. Winsløws Vej 15, 5000 Odense C, Denmark
| | - Lise Lotte Hansen
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark
| | - Tomasz K Wojdacz
- Department of Biomedicine, Aarhus University, Bartholins Allé 6, DK-8000 Aarhus C, Denmark.,Aarhus Institute of Advanced Studies, Høegh-Guldbergs Gade 6B, DK-8000 Aarhus C, Denmark
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12
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Starostka D, Kriegova E, Kudelka M, Mikula P, Zehnalova S, Radvansky M, Papajik T, Kolacek D, Chasakova K, Talianova H. Quantitative assessment of informative immunophenotypic markers increases the diagnostic value of immunophenotyping in mature CD5-positive B-cell neoplasms. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:576-587. [DOI: 10.1002/cyto.b.21607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Affiliation(s)
- David Starostka
- Department of Clinical Haematology; Hospital in Havirov; Czech Republic
| | - Eva Kriegova
- Department of Immunology; Palacky University & University Hospital Olomouc; Czech Republic
| | - Milos Kudelka
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science; Technical University of Ostrava; Czech Republic
| | - Peter Mikula
- Department of Clinical Haematology; Hospital in Havirov; Czech Republic
| | - Sarka Zehnalova
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science; Technical University of Ostrava; Czech Republic
| | - Martin Radvansky
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science; Technical University of Ostrava; Czech Republic
| | - Tomas Papajik
- Department of Haemato-oncology; Palacky University & University Hospital Olomouc; Czech Republic
| | - David Kolacek
- Department of Clinical Haematology; Hospital in Havirov; Czech Republic
| | | | - Hana Talianova
- Department of Clinical Haematology; Hospital in Havirov; Czech Republic
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13
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Evaluation of Caspase-9b and PP2Acα2 as potential biomarkers for chronic lymphocytic leukemia. Biomark Res 2016; 4:9. [PMID: 27152197 PMCID: PMC4857392 DOI: 10.1186/s40364-016-0063-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/26/2016] [Indexed: 11/17/2022] Open
Abstract
Background Disruption of alternative splicing in apoptotic factors has been associated to chronic lymphocytic leukemia among other cancers and hematological malignancies. The proapoptotic proteins Caspase-9 and PP2Acα are functionally related in a direct interaction, which constitutes a promising target for cancer therapy. Both proteins present aberrant mRNA splicing variants that are antiapoptotic (Caspase-9b) and catalytically inactive (PP2Acα2), respectively. Results In this work we have analyzed the relative abundance of the aberrant spliced forms Caspase-9b and PP2Acα2 in several cell lines and chronic lymphocytic leukemia patients and correlated it with several parameters of the disease. Despite 40 % of the patients presented Caspase-9b dysregulation, there was no direct association between alterations in Caspase-9b relative abundance and the parameters analyzed in medical records. More importantly, PP2Acα2 dysregulation was observed in 88 % of CLL patients and was related with advanced stages of the malignancy. Conclusions Caspase-9b dysregulation seemed to be associated with the disease, although the differences between healthy donors and CLL patients were not statistically significant. However, PP2Acα2 dysregulation was significantly different between healthy donors and CLL patients and correlated with Binet B and C stages; therefore, we propose the use of PP2Acα2 dysregulation as a potential biomarker for advanced stages of chronic lymphocytic leukemia.
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14
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Wallace ME, Alcantara MB, Minoda Y, Kannourakis G, Berzins SP. An emerging role for immune regulatory subsets in chronic lymphocytic leukaemia. Int Immunopharmacol 2015; 28:897-900. [PMID: 25862133 DOI: 10.1016/j.intimp.2015.03.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/28/2015] [Indexed: 01/22/2023]
Abstract
The last few years has seen the burgeoning of a new category of therapeutics for cancer targeting immune regulatory pathways. Antibodies that block the PD-1/PD-L1 interaction are perhaps the most prominent of these new anti-cancer therapies, but several other inhibitory receptor ligand interactions have also shown promise as targets in clinical trials, including CTLA-4/CD80 and Lag-3/MHC class II. Related to this is a rapidly improving knowledge of 'regulatory' lymphocyte lineages, including NKT cells, MAIT cells, B regulatory cells and others. These cells have potent cytokine responses that can influence the functioning of other immune cells and many researchers believe that they could be effective targets for therapies designed to enhance immune responses to cancer. This review will outline our current understanding of FOXP3+ 'Tregs', NKT cells, MAIT cells and B regulatory cells immune regulatory cell populations in cancer, with a particular focus on chronic lymphocytic leukaemia (CLL). We will discuss evidence linking CLL with immune regulatory dysfunction and the potential for new therapies targeting regulatory cells.
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Affiliation(s)
- Morgan E Wallace
- Federation University, Ballarat, Victoria, Australia; Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia
| | - Marice B Alcantara
- Federation University, Ballarat, Victoria, Australia; Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia
| | - Yosuke Minoda
- Federation University, Ballarat, Victoria, Australia; Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia
| | - George Kannourakis
- Federation University, Ballarat, Victoria, Australia; Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia
| | - Stuart P Berzins
- Federation University, Ballarat, Victoria, Australia; Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia; Department of Microbiology and Immunology, University of Melbourne, Parkville, Victoria, Australia.
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15
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Kristensen L, Kristensen T, Abildgaard N, Thomassen M, Frederiksen M, Mourits-Andersen T, Møller MB. High expression of PI3K core complex genes is associated with poor prognosis in chronic lymphocytic leukemia. Leuk Res 2015; 39:555-60. [PMID: 25840748 DOI: 10.1016/j.leukres.2015.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 02/13/2015] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in the Western world. Autophagy is a highly conserved process in eukaryotic cells. In CLL autophagy is involved in mediating the effect of chemotherapy but the role of autophagy in CLL pathogenesis remains unknown. In the present study, we used real-time RT-PCR to analyze expression of the PIK3C3, PIK3R4, and BECN1 genes. These genes encode the components of the PI3K core complex, which is central to initiation of autophagy. A consecutive series of 149 well-characterized CLL cases from Region of Southern Denmark were included in the study. All three genes were observed to be independent markers of prognosis in CLL with high expression being associated with more aggressive disease. With this clear association with outcome in CLL, these genes thereby represent promising candidates for future functional studies on the role of autophagy in CLL, and they may further represent targets of treatment.
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Affiliation(s)
- Louise Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Thomas Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Department of Genetics, Odense University Hospital, Odense, Denmark
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16
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Ghamlouch H, Ouled-Haddou H, Guyart A, Regnier A, Trudel S, Claisse JF, Fuentes V, Royer B, Marolleau JP, Gubler B. Phorbol myristate acetate, but not CD40L, induces the differentiation of CLL B cells into Ab-secreting cells. Immunol Cell Biol 2014; 92:591-604. [PMID: 24797583 PMCID: PMC4134517 DOI: 10.1038/icb.2014.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 11/29/2022]
Abstract
In this study, we investigated the capacity of chronic lymphocytic leukemia (CLL) B cells to undergo terminal differentiation into Ig-secreting plasma cells in T cell-independent and T cell-dependent responses. We used a two-step model involving stimulation with phorbol myristate acetate (PMA) and CD40L, together with cytokines (PMA/c and CD40L/c), for 7 days. We describe immunophenotypic modifications, changes in the levels of mRNA and protein for transcription factors and morphological and functional events occurring during the differentiation of CLL B cells into antibody-secreting cells (ASCs). The induction of differentiation differed significantly between the CD40L/c and PMA/c culture systems. The PMA/c culture system allowed CLL B cells to differentiate into IgM-secreting cells with an immunophenotype and molecular profile resembling those of preplasmablasts. By contrast, CD40L/c-stimulated cells had a phenotype and morphology similar to those of activated B cells and resembling those of the CLL B cells residing in the lymph node and bone marrow. These data suggest that the CLL B cells are not frozen permanently at a stage of differentiation and are able to differentiate into ASCs as appropriate stimulation are provided. The data presented here raise questions about the molecular processes and stimulation required for CLL B-cell differentiation and about the inability of CD40 ligand to induce differentiation of the CLL B cells.
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Affiliation(s)
- Hussein Ghamlouch
- EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Hakim Ouled-Haddou
- EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Aude Guyart
- EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Aline Regnier
- 1] EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France [2] Service d'Hématologie Clinique et Thérapie Cellulaire, CHU d'Amiens, Avenue René Laënnec, Amiens, France
| | - Stéphanie Trudel
- 1] EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France [2] Laboratoire d'Oncobiologie Moléculaire, CHU d'Amiens, Avenue René Laënnec, Amiens, France
| | - Jean-François Claisse
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU d'Amiens, Avenue René Laënnec, Amiens, France
| | - Vincent Fuentes
- EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France
| | - Bruno Royer
- 1] EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France [2] Service d'Hématologie Clinique et Thérapie Cellulaire, CHU d'Amiens, Avenue René Laënnec, Amiens, France
| | - Jean-Pierre Marolleau
- 1] EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France [2] Service d'Hématologie Clinique et Thérapie Cellulaire, CHU d'Amiens, Avenue René Laënnec, Amiens, France
| | - Brigitte Gubler
- 1] EA4666, Laboratoire d'Immunologie, UFR de Médecine, Université de Picardie Jules Verne, Amiens, France [2] Laboratoire d'Oncobiologie Moléculaire, CHU d'Amiens, Avenue René Laënnec, Amiens, France
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17
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Zhang G, Yang ZG, Bai J, Li Y, Xu HY, Long QH. Leukemias involving abdominal and pelvic lymph nodes: evaluation with contrast-enhanced MDCT. ABDOMINAL IMAGING 2014; 39:1063-9. [PMID: 24760322 DOI: 10.1007/s00261-014-0128-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To clarify features of lymph nodes associated with leukemia purposing to offer help for imaging diagnosis and differential diagnosis of leukemia. MATERIALS AND METHODS We retrospectively analyzed 47 patients with clinically proven leukemia involving the abdominal and pelvic lymph nodes. Of these 47 patients, 10 had acute myeloid leukemia, 9 had acute lymphocytic leukemia, and 28 had chronic lymphocytic leukemia. MDCT was used to determine lymph node features such as morphology, growth patterns, size, enhancement patterns, anatomical distribution, and manifestations in extramedullary organs. RESULTS Incidence of leukemia was higher in men than in women. Enlarged lymph nodes were more frequently conglomerated in chronic lymphocytic leukemia (96.4%) than in acute myeloid leukemia (50%) and acute lymphocytic leukemia (55.6%; P < 0.05 for both). Lymph nodes associated with chronic lymphocytic leukemia were larger than those associated with acute myeloid and lymphocytic leukemias (P < 0.05 for both). The enlarged lymph nodes appeared homogeneous (80.9%) and homogeneous mixed with peripheral (19.1%). No statistically significant differences were observed between the three types of leukemias with respect to enhancement patterns (all P > 0.05). The lymph nodes commonly associated with these three leukemias were located in the lesser omentum, upper and lower para-aortic regions, and groin region. CONCLUSIONS Our study showed that contrast-enhanced MDCT could accurately determine the enhancement patterns and anatomical distribution of lymph nodes associated with leukemia. Therefore, it is helpful for imaging diagnosis and differential diagnosis of leukemia.
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Affiliation(s)
- Ge Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu, 610041, Sichuan, China
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18
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Smolewski P, Witkowska M, Korycka-Wołowiec A. New insights into biology, prognostic factors, and current therapeutic strategies in chronic lymphocytic leukemia. ISRN ONCOLOGY 2013; 2013:740615. [PMID: 24027642 PMCID: PMC3763269 DOI: 10.1155/2013/740615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/20/2013] [Indexed: 11/17/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by the clonal proliferation and accumulation of mature B lymphocytes. CLL cells show an antiapoptotic profile, suggesting the important role of apoptosis inhibition in the disease development. However, there is some population of proliferating CLL cells, which may also play a role in progression of the disease. There are several newer, biological prognostic factors in CLL. Currently, cytogenetic abnormalities with different prognostic values seem to be the most biologically relevant. During the last decades, the treatment of CLL has been significantly changed. Different strategies such as monotherapy with chlorambucil and purine nucleoside analogues (PNA) used alone or in combination with cyclophosphamide have been introduced. Most recently, immunochemotherapy with anti-CD20 monoclonal antibody, rituximab, combined with fludarabine and cyclophosphamide, became a gold standard of first-line treatment in eligible CLL patients. Currently, new treatment strategies including new monoclonal antibodies, bendamustine, lenalidomide, or inhibitors of several cell signaling pathways are under clinical studies in resistant/relapsed CLL patients. Moreover, allogeneic stem cell transplantation has to be considered, especially in younger high risk patients, for example, those who are resistant to PNA or those with 17p deletion. In this paper, we present the most important recent advances in CLL biology and treatment.
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Affiliation(s)
- Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz, Ciolkowskiego 2 Street, 93-510 Lodz, Poland
| | - Magdalena Witkowska
- Department of Experimental Hematology, Medical University of Lodz, Ciolkowskiego 2 Street, 93-510 Lodz, Poland
| | - Anna Korycka-Wołowiec
- Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Ciolkowskiego 2 Street, 93-510 Lodz, Poland
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19
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Tadmor T, Shvidel L, Aviv A, Ruchlemer R, Bairey O, Yuklea M, Herishanu Y, Braester A, Levene N, Vernea F, Ben-Ezra J, Bejar J, Polliack A. Significance of bone marrow reticulin fibrosis in chronic lymphocytic leukemia at diagnosis. Cancer 2013; 119:1853-1859. [DOI: 10.1002/cncr.27930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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20
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Clinical Application of Array-Based Comparative Genomic Hybridization for the Identification of Prognostically Important Genetic Alterations in Chronic Lymphocytic Leukemia. Mol Diagn Ther 2012; 12:271-80. [DOI: 10.1007/bf03256292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Mahmoud HM, El-Sakhawy YN. Significance of Bcl-2 and Bcl-6 immunostaining in B-Non Hodgkin's lymphoma. Hematol Rep 2011; 3:e26. [PMID: 22593817 PMCID: PMC3269794 DOI: 10.4081/hr.2011.e26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 09/20/2011] [Accepted: 10/24/2011] [Indexed: 12/19/2022] Open
Abstract
The determination of prognosis for B-Non-Hodgkin's lymphoma (NHL) is known to be related to the multiple differences in tumor cell biology. Bcl-2 and Bcl-6 are two markers linked to germinal center B cells. Both markers are thought to have an effect on prognosis of mature B-cell neoplasms. Forty-four patients with chronic B-cell neoplasm were included; Bcl-2 and Bcl-6 expression by immunohistochemistry was examined. Bcl-2 protein was positive in 36.4% (16 of 44) of cases (62.5% of follicular lymphoma, 16.7% of mantle cell lymphoma and 30% of diffuse large B-cell lymphoma); the positive group implying a bad prognostic effect of the marker in NHL. Bcl-6 was positive in 13.6% (6 of 44) of cases (11.1% of mantle cell lymphoma and 40% of diffuse large B-cell lymphoma) and its positivity implies a better disease course. Bcl-2 and Bcl-6 can be used as prognostic marker in NHL.
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22
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de Oliveira FM, de Figueiredo Pontes LL, Bassi SC, Dalmazzo LFF, Falcão RP. Co-existence of t(6;13)(p21;q14.1) and trisomy 12 in chronic lymphocytic leukemia. Med Oncol 2011; 29:1227-30. [PMID: 21528409 DOI: 10.1007/s12032-011-9957-1] [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: 03/16/2011] [Accepted: 04/12/2011] [Indexed: 11/26/2022]
Abstract
We report a case of a 57-year-old man diagnosed with chronic lymphocytic leukemia (CLL) and presence of a rare t(6;13)(p21;q14.1) in association with an extra copy of chromosome 12. Classical cytogenetic analysis using the immunostimulatory combination of DSP30 and IL-2 showed the karyotype 47,XY,t(6;13)(p21;q14.1), +12 in 75% of the metaphase cells. Spectral karyotype analysis (SKY) confirmed the abnormality previously seen by G-banding. Additionally, interphase fluorescence in situ hybridization using an LSI CEP 12 probe performed on peripheral blood cells without any stimulant agent showed trisomy of chromosome 12 in 67% of analyzed cells (134/200). To the best of our knowledge, the association of t(6;13)(p21;q14.1) and +12 in CLL has never been described. The prognostic significance of these new findings in CLL remains to be elucidated. However, the patient has been followed up since 2009 without any therapeutic intervention and has so far remained stable.
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MESH Headings
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 13/genetics
- Chromosomes, Human, Pair 6/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Middle Aged
- Translocation, Genetic/genetics
- Trisomy/genetics
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Affiliation(s)
- Fábio Morato de Oliveira
- Department of Internal Medicine, Division of Hematology, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14049-900, Brazil.
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23
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Chromosomal aberrations in chronic lymphocytic leukemia detected by conventional cytogenetics with DSP30 as a single agent: comparison with FISH. Leuk Res 2011; 35:1032-8. [PMID: 21333354 DOI: 10.1016/j.leukres.2011.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/22/2011] [Accepted: 01/23/2011] [Indexed: 02/03/2023]
Abstract
The aim of our study was to estimate the usefulness for conventional cytogenetics (CC) of DSP30 as a single agent (CC-DSP30) for detecting the most important chromosomal aberrations revealed in CLL by FISH and to find other abnormalities possibly existing but undetected by FISH with standard probes. Using CC-DSP30, the metaphases suitable for analysis were obtained in 90% of patients. CC-DSP30 and FISH were similarly efficacious for detecting del(11)(q22) and trisomy 12, whereas FISH was more sensitive for del(13)(q14). Sole del(13)(q14) detected by FISH, in 50% of patients was associated with other aberrations revealed by CC-DSP30. Additionally, the most recurrent anomaly detected by CC-DSP30 were structural aberrations of chromosome 2.
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24
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Sarro SM, Unruh TL, Zuccolo J, Sanyal R, Luider JM, Auer-Grzesiak IA, Mansoor A, Deans JP. Quantification of CD20 mRNA and protein levels in chronic lymphocytic leukemia suggests a post-transcriptional defect. Leuk Res 2010; 34:1670-3. [DOI: 10.1016/j.leukres.2010.06.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 11/25/2022]
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25
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Samuel S, Tumilasci VF, Oliere S, Nguyên TLA, Shamy A, Bell J, Hiscott J. VSV oncolysis in combination with the BCL-2 inhibitor obatoclax overcomes apoptosis resistance in chronic lymphocytic leukemia. Mol Ther 2010; 18:2094-103. [PMID: 20842105 DOI: 10.1038/mt.2010.188] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In chronic lymphocytic leukemia (CLL), overexpression of antiapoptotic B-cell leukemia/lymphoma 2 (BCL-2) family members contributes to leukemogenesis by interfering with apoptosis; BCL-2 expression also impairs vesicular stomatitis virus (VSV)-mediated oncolysis of primary CLL cells. In the effort to reverse resistance to VSV-mediated oncolysis, we combined VSV with obatoclax (GX15-070)-a small-molecule BCL-2 inhibitor currently in phase 2 clinical trials-and examined the molecular mechanisms governing the in vitro and in vivo antitumor efficiency of combining the two agents. In combination with VSV, obatoclax synergistically induced cell death in primary CLL samples and reduced tumor growth in severe combined immunodeficient (SCID) mice-bearing A20 lymphoma tumors. Mechanistically, the combination stimulated the mitochondrial apoptotic pathway, as reflected by caspase-3 and -9 cleavage, cytochrome c release and BAX translocation. Combination treatment triggered the release of BAX from BCL-2 and myeloid cell leukemia-1 (MCL-1) from BAK, whereas VSV infection induced NOXA expression and increased the formation of a novel BAX-NOXA heterodimer. Finally, NOXA was identified as an important inducer of VSV-obatoclax driven apoptosis via knockdown and overexpression of NOXA. These studies offer insight into the synergy between small-molecule BCL-2 inhibitors such as obatoclax and VSV as a combination strategy to overcome apoptosis resistance in CLL.
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Affiliation(s)
- Sara Samuel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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26
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Abstract
Chronic lymphocytic leukaemia (CLL) is the most common adult leukaemia in Europe and North America. The disease is characterized by proliferation and accumulation of small CD5+ B cells in blood, lymph nodes, spleen, liver and bone marrow. The natural clinical course of CLL is highly variable, and chemotherapy is usually not indicated in early and stable disease. However, patients with progressive and more advanced CLL require treatment. For many years, chlorambucil with or without corticosteroids was used in previously untreated patients with CLL. More recently, purine nucleoside analogues (PNAs) [fludarabine, cladribine and pentostatin] have been included in treatment approaches for this disease, and chlorambucil is no longer the leading standard everywhere. Currently, this drug is rather recommended for the treatment of older, unfit patients with co-morbidities, especially in European countries. Significantly higher overall response (OR) and complete response (CR) rates in patients treated initially with PNAs than in those treated with chlorambucil or cyclophosphamide-based combination regimens have been confirmed in randomized, prospective, multicentre trials. Moreover, PNAs administered in combination with cyclophosphamide produce higher response rates, including CR and molecular CR, compared with PNA as monotherapy. Recent reports suggest that the administration of monoclonal antibodies (mAbs) can significantly improve the course of CLL. At present, two mAbs have the most important clinical value in patients with CLL. The first is rituximab, a human mouse antibody that targets CD20 antigens, and the second is alemtuzumab, a humanized form of a rat antibody active against CD52. Several recent reports suggest that in patients with CLL, rituximab combined with a PNA can increase the OR and CR rates compared with PNA or rituximab alone, with acceptable toxicity. In randomized trials, the combination of rituximab with fludarabine and cyclophosphamide (FC-R regimen) demonstrated higher rates of OR, CR and progression-free survival in patients with previously untreated and relapsed or refractory CLL than fludarabine plus cyclophosphamide (FC regimen). Several reports have confirmed significant activity with alemtuzumab in relapsed or refractory CLL, as well as in previously untreated patients. Recently, several new agents have been investigated and have shown promise in treating patients with CLL. These treatments include new mAbs, agents targeting the antiapoptotic bcl-2 family of proteins and receptors involved in mediating survival signals from the microenvironment, antisense oligonucleotides and other agents. The most promising are new mAbs directed against the CD20 molecule, lumiliximab and anti-CD40 mAbs. Oblimersen, alvocidib (flavopiridol) and lenalidomide are also being evaluated both in preclinical studies and in early clinical trials. In recent years, a significant improvement in haematopoietic stem cell transplantation (HSCT) procedures in patients with high-risk CLL has been observed. However, the exact role of HSCT, autologous or allogeneic, in the standard management of CLL patients is still undefined.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lode, Copernicus Memorial Hospital, Lodz, Poland.
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27
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Translocation (6;13)(p21;q14.1) as a rare nonrandom cytogenetic abnormality in chronic lymphocytic leukemia. ACTA ACUST UNITED AC 2010; 198:66-70. [DOI: 10.1016/j.cancergencyto.2009.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/30/2009] [Accepted: 12/13/2009] [Indexed: 11/22/2022]
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28
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29
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Wilhelm K, Yang D. A review of pharmacologic options for previously untreated chronic lymphocytic leukemia. J Oncol Pharm Pract 2010; 17:91-103. [PMID: 20085962 DOI: 10.1177/1078155209354931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common adult leukemia and has a heterogeneous clinical course. Some patients experience an indolent disease course, which does not require treatment or affect their overall quality of life. Other patients present with symptomatic advanced disease that rapidly progresses and requires therapy. For these patients, chemotherapy is the mainstay of treatment and has undergone significant evolution in the past few decades. From alkylating agents to purine analogs, response rates have greatly improved with new chemotherapy regimens. The development of chemoimmunotherapy regimens has also transformed the treatment of CLL. This article will review front-line treatment options for CLL and discuss the updated National Comprehensive Cancer Network guidelines.
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Affiliation(s)
- Kaci Wilhelm
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 377, Houston, Texas 77030, USA
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30
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A mouse model for chronic lymphocytic leukemia based on expression of the SV40 large T antigen. Blood 2009; 114:119-27. [DOI: 10.1182/blood-2009-01-198937] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
The simian virus 40 (SV40) T antigen is a potent oncogene able to transform many cell types and has been implicated in leukemia and lymphoma. In this report, we have achieved sporadic SV40 T-antigen expression in mature B cells in mice, by insertion of a SV40 T antigen gene in opposite transcriptional orientation in the immunoglobulin (Ig) heavy (H) chain locus between the D and JH segments. SV40 T-antigen expression appeared to result from retention of the targeted germline allele and concomitant antisense transcription of SV40 large T in mature B cells, leading to chronic lymphocytic leukemia (CLL). Although B-cell development was unperturbed in young mice, aging mice showed accumulation of a monoclonal B-cell population in which the targeted IgH allele was in germline configuration and the wild-type IgH allele had a productive V(D)J recombination. These leukemic B cells were IgDlowCD5+ and manifested nonrandom usage of V, D, and J segments. VH regions were either unmutated, with preferential usage of the VH11 family, or manifested extensive somatic hypermutation. Our findings provide an animal model for B-CLL and show that pathways activated by SV40 T antigen play important roles in the pathogenesis of B-CLL.
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31
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Codony C, Crespo M, Abrisqueta P, Montserrat E, Bosch F. Gene expression profiling in chronic lymphocytic leukaemia. Best Pract Res Clin Haematol 2009; 22:211-22. [DOI: 10.1016/j.beha.2009.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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32
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Chuang SS, Liao YL, Liou CP, Wiggins ML, Ye H, Du MQ, Isaacson PG, Chang CC. Chronic lymphocytic leukemia with paraimmunoblastic transformation - with comparative genomic hybridization and review of the literature. Pathol Res Pract 2009; 206:276-81. [PMID: 19433347 DOI: 10.1016/j.prp.2009.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/07/2009] [Accepted: 04/07/2009] [Indexed: 11/24/2022]
Abstract
Richter's transformation (RT) is the development of a high-grade lymphoma in patients with B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). We report an extremely rare case with paraimmunoblastic transformation. A 78-year-old Taiwanese male had Rai stage 1 and Binet stage B CLL/SLL involving skin, peripheral blood (PB), and bone marrow (BM) with paraimmunoblastic transformation in the lymph node. Molecular/genomic studies showed the same clonal origin of tumor tissues at various locations with trisomy 12 and a deletion of chromosome 13q14. Interestingly, there seemed to be no additional chromosomal aberrations in the transformed nodal tissue, suggesting that the micro-environment rather than an additional genetic lesion contributed to the transformation. The patient received chemotherapy and was alive with disease after 33.5 months.
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Affiliation(s)
- Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Yung-Kang City 710, Tainan County, Taiwan.
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33
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van Gent R, Kater AP, Otto SA, Jaspers A, Borghans JAM, Vrisekoop N, Ackermans MAT, Ruiter AFC, Wittebol S, Eldering E, van Oers MHJ, Tesselaar K, Kersten MJ, Miedema F. In vivo dynamics of stable chronic lymphocytic leukemia inversely correlate with somatic hypermutation levels and suggest no major leukemic turnover in bone marrow. Cancer Res 2009; 68:10137-44. [PMID: 19074880 DOI: 10.1158/0008-5472.can-08-2325] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although accumulating evidence indicates that chronic lymphocytic leukemia (CLL) is a disease with appreciable cell dynamics, it remains uncertain whether this also applies to patients with stable disease. In this study, (2)H(2)O was administered to a clinically homogeneous cohort of nine stable, untreated CLL patients. CLL dynamics in blood and bone marrow were determined and compared with normal B-cell dynamics in blood from five healthy individuals who underwent a similar (2)H(2)O labeling protocol. Average CLL turnover rates (0.08-0.35% of the clone per day) were approximately 2-fold lower than average B-cell turnover rates from healthy individuals (0.34-0.89%), whereas the rate at which labeled CLL cells in blood disappeared (0.00-0.39% of B cells per day) was approximately 10-fold lower compared with labeled B cells from healthy individuals (1.57-4.24% per day). Leukemic cell turnover variables inversely correlated with the level of somatic hypermutation of the CLL clone (IgVH mutations). Although CLL cells in bone marrow had a higher level of label enrichment than CLL cells in blood, no difference between proliferation rates and proapoptotic and antiapoptotic profiles of CLL cells from these compartments was observed. These data suggest that, in stable disease, there is a biological relationship between the degree of somatic hypermutation of the CLL clone and its dynamics in vivo. Furthermore, in contrast to lymph nodes, the bone marrow does not seem to be a major CLL proliferation site.
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MESH Headings
- Apoptosis/genetics
- Bone Marrow/pathology
- Child, Preschool
- Female
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Infant
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Mutation
- RNA, Neoplasm/genetics
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Affiliation(s)
- Rogier van Gent
- Department of Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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Chronic lymphocytic leukemia/small lymphocytic lymphoma presenting as septic arthritis of the shoulder. Skeletal Radiol 2008; 37:1035-9. [PMID: 18521594 DOI: 10.1007/s00256-008-0512-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Revised: 04/09/2008] [Accepted: 04/21/2008] [Indexed: 02/02/2023]
Abstract
We report a case of a 53-year-old man presenting with shoulder pain mimicking septic arthritis. Laboratory findings were atypical. Biopsy performed to assess for possible osteomyelitis demonstrated chronic lymphocytic leukemia/small lymphocytic lymphoma. Intra-articular lymphoma is a rare but important consideration in patients with atypical clinical presentation. Imaging alone may be insufficient to render diagnosis as lymphoma can mimic infection, synovial hypertrophic processes, and depositional arthropathy.
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The transforming mutation E17K/AKT1 is not a major event in B-cell-derived lymphoid leukaemias. Br J Cancer 2008; 99:488-90. [PMID: 18665177 PMCID: PMC2527790 DOI: 10.1038/sj.bjc.6604512] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite the major role of the AKT/PKB family of proteins in the regulation of many growth and survival mechanisms in the cell, and the increasing evidence suggesting that AKT disruption could play a key role in many human malignancies, no major mutations of AKT genes had been reported, until very recently when Carpten et al reported a novel transforming mutation (E17K) in the pleckstrin homology domain of the AKT1 gene in solid tumours. Several laboratories are now screening for this mutation in different malignancies, and, recently, the mutation was described by Malanga et al in 1.9% of lung cancer patients. Considering the importance of the PI3K/AKT pathway in mediating survival and antiapoptotic signals in the B-cell types of chronic lymphocytic leukaemia (CLL) and acute lymphoblastic leukaemia (ALL), we sequenced the AKT1 exon 3 for the above mentioned mutation in 87 specimens, representing 45 CLLs, 38 ALLs and 4 prolymphocytic leukaemia (PLL) cases, which are all of B-cell origin. Our results show that the mutation E17K/AKT1 was not detected in the pleckstrin homology domain of AKT1 of the investigated cases. We conclude that this mutation is not a major event in B-cell-derived lymphoid leukaemias.
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Mahmoud IS, Sughayer MA, Mohammad HA, Awidi AS, EL-Khateeb MS, Ismail SI. The transforming mutation E17K/AKT1 is not a major event in B-cell-derived lymphoid leukaemias. Br J Cancer 2008. [PMID: 18665177 DOI: 10.1038/sj.bjc.6604512.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite the major role of the AKT/PKB family of proteins in the regulation of many growth and survival mechanisms in the cell, and the increasing evidence suggesting that AKT disruption could play a key role in many human malignancies, no major mutations of AKT genes had been reported, until very recently when Carpten et al reported a novel transforming mutation (E17K) in the pleckstrin homology domain of the AKT1 gene in solid tumours. Several laboratories are now screening for this mutation in different malignancies, and, recently, the mutation was described by Malanga et al in 1.9% of lung cancer patients. Considering the importance of the PI3K/AKT pathway in mediating survival and antiapoptotic signals in the B-cell types of chronic lymphocytic leukaemia (CLL) and acute lymphoblastic leukaemia (ALL), we sequenced the AKT1 exon 3 for the above mentioned mutation in 87 specimens, representing 45 CLLs, 38 ALLs and 4 prolymphocytic leukaemia (PLL) cases, which are all of B-cell origin. Our results show that the mutation E17K/AKT1 was not detected in the pleckstrin homology domain of AKT1 of the investigated cases. We conclude that this mutation is not a major event in B-cell-derived lymphoid leukaemias.
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Affiliation(s)
- I S Mahmoud
- Department of Biochemistry, Faculty of Medicine, University of Jordan, Amman 11942, Jordan
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37
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Gunn SR, Mohammed MS, Mellink CHM, Abruzzo LV, Robetorye RS. The HemeScan test for genomic prognostic marker assessment in chronic lymphocytic leukemia. ACTA ACUST UNITED AC 2008; 2:731-40. [DOI: 10.1517/17530059.2.6.731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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38
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39
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Kajtár B, Losonczy H. [Chronic lymphocytic leukemia]. Orv Hetil 2008; 149:806-7. [PMID: 18426763 DOI: 10.1556/oh.2008.28331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Béla Kajtár
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar Klinikai Központ Pécs Szigeti út 12. 7624.
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