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Kalmbach S, Grau M, Zapukhlyak M, Leich E, Jurinovic V, Hoster E, Staiger AM, Kurz KS, Weigert O, Gaitzsch E, Passerini V, Engelhard M, Herfarth K, Beiske K, Micci F, Möller P, Bernd HW, Feller AC, Klapper W, Stein H, Hansmann ML, Hartmann S, Dreyling M, Holte H, Lenz G, Rosenwald A, Ott G, Horn H. Novel insights into the pathogenesis of follicular lymphoma by molecular profiling of localized and systemic disease forms. Leukemia 2023; 37:2058-2065. [PMID: 37563306 PMCID: PMC10539171 DOI: 10.1038/s41375-023-01995-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
Knowledge on the pathogenesis of FL is mainly based on data derived from advanced/systemic stages of FL (sFL) and only small cohorts of localized FL (lFL) have been characterized intensively so far. Comprehensive analysis with profiling of somatic copy number alterations (SCNA) and whole exome sequencing (WES) was performed in 147 lFL and 122 sFL. Putative targets were analyzed for gene and protein expression. Overall, lFL and sFL, as well as BCL2 translocation-positive (BCL2+) and -negative (BCL2-) FL showed overlapping features in SCNA and mutational profiles. Significant differences between lFL and sFL, however, were detected for SCNA frequencies, e.g., in 18q-gains (14% lFL vs. 36% sFL; p = 0.0003). Although rare in lFL, gains in 18q21 were associated with inferior progression-free survival (PFS). The mutational landscape of lFL and sFL included typical genetic lesions. However, ARID1A mutations were significantly more often detected in sFL (29%) compared to lFL (6%, p = 0.0001). In BCL2 + FL mutations in KMT2D, BCL2, ABL2, IGLL5 and ARID1A were enriched, while STAT6 mutations more frequently occurred in BCL2- FL. Although the landscape of lFL and sFL showed overlapping features, molecular profiling revealed novel insights and identified gains in 18q21 as prognostic marker in lFL.
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Affiliation(s)
- Sabrina Kalmbach
- Department of Clinical Pathology, Robert-Bosch Hospital, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Michael Grau
- Department of Medicine A, Department of Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Myroslav Zapukhlyak
- Department of Medicine A, Department of Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Ellen Leich
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Center Main, Würzburg, Germany
| | - Vindi Jurinovic
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch Hospital, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Katrin S Kurz
- Department of Clinical Pathology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Oliver Weigert
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Erik Gaitzsch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Verena Passerini
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Marianne Engelhard
- Department for Radiotherapy, University Hospital of Essen, Essen, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Klaus Beiske
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- KG Jebsen center for B cell malignancies, Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Oslo University Hospital, Oslo, Norway
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | | | | | - Wolfram Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | | | - Sylvia Hartmann
- Institute of Pathology, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Harald Holte
- KG Jebsen center for B cell malignancies, Oslo, Norway
| | - Georg Lenz
- Department of Medicine A, Department of Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Center Main, Würzburg, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch Hospital, Stuttgart, Germany.
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
| | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch Hospital, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
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Follicular Lymphoma in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Biological Data. Cancers (Basel) 2023; 15:cancers15030785. [PMID: 36765742 PMCID: PMC9913816 DOI: 10.3390/cancers15030785] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The conceptual description of Follicular lymphoma (FL) in the 5th edition of the World Health Organization (WHO) classification of haematolymphoid tumors (WHO-HAEM5) has undergone significant revision. The vast majority of FL (85%) with a follicular growth pattern are composed of centrocytes and centroblasts, harbor the t(14;18)(q32;q21) translocation and are now termed classic FL (cFL). They are set apart from three related subtypes, FL with predominantly follicular growth pattern, FL with unusual cytological features (uFL) and follicular large B-cell lymphoma (FLBCL). In contrast to the revised 4th edition of the WHO classification of haematolymphoid tumors (WHO-HAEM4R), grading of cFL is no longer mandatory. FL with a predominantly diffuse growth pattern had been previously recognized in WHO-HAEM4R. It frequently occurs as a large tumor in the inguinal region and is associated with CD23 expression. An absence of the IGH::BCL2 fusion and frequent STAT6 mutations along with 1p36 deletion or TNFRSF14 mutation is typical. The newly introduced subtype of uFL includes two subsets that significantly diverge from cFL: one with "blastoid" and one with "large centrocyte" variant cytological features. uFL more frequently displays variant immunophenotypic and genotypic features. FLBCL is largely identical to WHO-HAEM4R FL grade 3B and renaming was done for reasons of consistency throughout the classification. In-situ follicular B-cell neoplasm, pediatric-type FL, duodenal-type FL and primary cutaneous follicle center lymphoma are categorized as discrete entities. In addition, novel findings concerning underlying biological mechanisms in the pathogenesis of early and systemic follicular lymphoma will be presented.
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Los-de Vries GT, Stevens WBC, van Dijk E, Langois-Jacques C, Clear AJ, Stathi P, Roemer MGM, Mendeville M, Hijmering NJ, Sander B, Rosenwald A, Calaminici M, Hoster E, Hiddemann W, Gaulard P, Salles G, Horn H, Klapper W, Xerri L, Burton C, Tooze RM, Smith AG, Buske C, Scott DW, Natkunam Y, Advani R, Sehn LH, Raemaekers J, Gribben J, Kimby E, Kersten MJ, Maucort-Boulch D, Ylstra B, de Jong D. Genomic and microenvironmental landscape of stage I follicular lymphoma, compared with stage III/IV. Blood Adv 2022; 6:5482-5493. [PMID: 35816682 PMCID: PMC9631713 DOI: 10.1182/bloodadvances.2022008355] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022] Open
Abstract
Although the genomic and immune microenvironmental landscape of follicular lymphoma (FL) has been extensively investigated, little is known about the potential biological differences between stage I and stage III/IV disease. Using next-generation sequencing and immunohistochemistry, 82 FL nodal stage I cases were analyzed and compared with 139 FL stage III/IV nodal cases. Many similarities in mutations, chromosomal copy number aberrations, and microenvironmental cell populations were detected. However, there were also significant differences in microenvironmental and genomic features. CD8+ T cells (P = .02) and STAT6 mutations (false discovery rate [FDR] <0.001) were more frequent in stage I FL. In contrast, programmed cell death protein 1-positive T cells, CD68+/CD163+ macrophages (P < .001), BCL2 translocation (BCL2trl+) (P < .0001), and KMT2D (FDR = 0.003) and CREBBP (FDR = 0.04) mutations were found more frequently in stage III/IV FL. Using clustering, we identified 3 clusters within stage I, and 2 clusters within stage III/IV. The BLC2trl+ stage I cluster was comparable to the BCL2trl+ cluster in stage III/IV. The two BCL2trl- stage I clusters were unique for stage I. One was enriched for CREBBP (95%) and STAT6 (64%) mutations, without BLC6 translocation (BCL6trl), whereas the BCL2trl- stage III/IV cluster contained BCL6trl (64%) with fewer CREBBP (45%) and STAT6 (9%) mutations. The other BCL2trl- stage I cluster was relatively heterogeneous with more copy number aberrations and linker histone mutations. This exploratory study shows that stage I FL is genetically heterogeneous with different underlying oncogenic pathways. Stage I FL BCL2trl- is likely STAT6 driven, whereas BCL2trl- stage III/IV appears to be more BCL6trl driven.
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Affiliation(s)
- G. Tjitske Los-de Vries
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Erik van Dijk
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Carole Langois-Jacques
- Université Lyon 1, Villeurbanne, France, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de recherche (UMR) 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Andrew J. Clear
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Phylicia Stathi
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Margaretha G. M. Roemer
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Matias Mendeville
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Nathalie J. Hijmering
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Birgitta Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, and Comprehensive Cancer Center Mainfranken, Germany
| | - Maria Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Eva Hoster
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), LMU University, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Philippe Gaulard
- Department of Pathology, Henri Mondor University Hospital, Assistance Pyblique- Hospitaux de Paris (APHP), INSERM U955, Université Paris-Est, Créteil, France
| | - Gilles Salles
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heike Horn
- Institute for Clinical Pathology, Robert-Bosch-Krankenhaus, Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart, Germany
| | - Wolfram Klapper
- Institute of Pathology, University of Schleswig-Holstein, Kiel, Germany
| | - Luc Xerri
- Département de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - Catherine Burton
- Haematological Malignancy Diagnostic Service, St. James University Hospital, Leeds, United Kingdom
| | - Reuben M. Tooze
- Division of Haematology & Immunology, Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Alexandra G. Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Christian Buske
- Institute of Experimental Cancer Research, Comprehensive Cancer Center (CCC) Ulm, Universitätsklinikum Ulm, Ulm, Germany
| | - David W. Scott
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, BC, Canada
| | | | - Ranjana Advani
- Department of Hematology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA
| | - Laurie H. Sehn
- BC Cancer Centre for Lymphoid Cancer and The University of British Columbia, Vancouver, BC, Canada
| | - John Raemaekers
- Department of Hematology, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary, University of London, London, United Kingdom
| | - Eva Kimby
- Department of Medicine, Division of Hematology, Karolinska Institute, Stockholm, Sweden; and
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center (UMC), University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Delphine Maucort-Boulch
- Université Lyon 1, Villeurbanne, France, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de recherche (UMR) 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France
| | - Bauke Ylstra
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Molecular Cytogenetic Profiling Reveals Similarities and Differences Between Localized Nodal and Systemic Follicular Lymphomas. Hemasphere 2022; 6:e767. [PMID: 35974958 PMCID: PMC9371558 DOI: 10.1097/hs9.0000000000000767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
Recently, we have developed novel highly promising gene expression (GE) classifiers discriminating localized nodal (LFL) from systemic follicular lymphoma (SFL) with prognostic impact. However, few data are available in LFL especially concerning hotspot genetic alterations that are associated with the pathogenesis and prognosis of SFL. A total of 144 LFL and 527 SFL, enrolled in prospective clinical trials of the German Low Grade Lymphoma Study Group, were analyzed by fluorescence in situ hybridization to detect deletions in chromosomes 1p, 6q, and 17p as well as BCL2 translocations to determine their impact on clinical outcome of LFL patients. The frequency of chromosomal deletions in 1p and 17p was comparable between LFL and SFL, while 6q deletions and BCL2 translocations more frequently occurred in SFL. A higher proportion of 1p deletions was seen in BCL2-translocation–positive LFL, compared with BCL2-translocation–negative LFL. Deletions in chromosomes 1p, 6q, and 17p predicted clinical outcome of patients with SFL in the entire cohort, while only deletions in chromosome 1p retained its negative prognostic impact in R-CHOP–treated SFL. In contrast, no deletions in one of the investigated genetic loci predicted clinical outcome in LFL. Likewise, the presence or absence of BCL2 translocations had no prognostic impact in LFL. Despite representing a genetic portfolio closely resembling SFL, LFL showed some differences in deletion frequencies. BCL2 translocation and 6q deletion frequency differs between LFL and SFL and might contribute to distinct genetic profiles in LFL and SFL.
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Yanagida E, Miyoshi H, Takeuchi M, Shimono J, Nakashima K, Yamada K, Kawamoto K, Moritsubo M, Shimasaki Y, Inoue K, Imamoto T, Furuta T, Kohno K, Ohshima K. Clinicopathological analysis of immunohistochemical expression of immune checkpoint molecules in follicular lymphoma. Hematol Oncol 2022; 40:530-540. [PMID: 35122292 DOI: 10.1002/hon.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/23/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
Follicular lymphoma (FL) is characterized by an indolent clinical course and a high relapse rate, and often exhibits a diffuse pattern beyond the follicular area. Our group previously reported that immune checkpoint (ICP) pathways, such as programmed cell death (PD-1) and programmed death ligand 1 (PD-L1), are poor prognostic factors for diffuse large B-cell lymphoma and adult T-cell leukemia/lymphoma.In this study, the association between the expression of multiple ICP molecules according to immunohistochemistry and clinicopathological features in FL was determined via immunostaining of 173 biopsy samples. Membrane and/or cytoplasm expression of CD86 (nCD86) and PD-L1 (nPD-L1) was found in tumor cells, whereas PD-1 (miPD-1), Galectin-9 (miGalectin-9), OX40 (miOX40), CTLA-4 (miCTLA-4), Tim-3 (miTim-3), OX40L (miOX40L), and LAG-3 (miLAG-3) were expressed in non-neoplastic stromal cells. MiPD-1 expression was significantly higher in the follicular area than in the diffuse area (p=0.0450). Expression of miOX40 and miCTLA-4 was significantly higher in the diffuse area than in the follicular area (respectively, p=0.0053 and p=0.0092). MiTim-3 tended to be higher in the diffuse area than in the follicular area (p=0.0616). MiTim-3 was significantly higher in relapse cases than in new-onset cases (p=0.0440); miLAG-3 tended to be higher in relapse cases than in new-onset cases (p=0.0622, not significant). The miOX40L-high FL group had a significantly worse overall survival than the miOX40L-low group (p=0.0320).The expression of multiple ICP molecules on several cells reflects activated anti-tumor immunity and the unique FL microenvironment. Further studies on gene expression or genomic abnormalities will reveal the clinical and biological significance of ICP molecules in FL. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eriko Yanagida
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Mai Takeuchi
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Joji Shimono
- Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Kazutaka Nakashima
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kyohei Yamada
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Keisuke Kawamoto
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Mayuko Moritsubo
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Yasumasa Shimasaki
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kanako Inoue
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Teppei Imamoto
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Takuya Furuta
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kei Kohno
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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Yuda S, Miyagi Maeshima A, Taniguchi H, Ito Y, Hatta S, Suzuki T, Makita S, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Izutsu K. Clinicopathological factors and tumor microenvironment markers predicting watch-and-wait discontinuation in 82 patients with follicular lymphoma. Eur J Haematol 2021; 107:157-165. [PMID: 33905571 DOI: 10.1111/ejh.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In this study, we aimed to determine the clinicopathological factors influencing the treatment-free period in patients with follicular lymphoma (FL) using a watch-and-wait (WW) strategy. METHODS We retrospectively assessed histopathological parameters of 82 patients with FL. RESULTS The median time from diagnosis to WW discontinuation was 62 months (range, 3-138), and median follow-up was 86 months (range, 3-183). Intermediate or high-risk Follicular Lymphoma International Prognostic Index score (P = .012), non-duodenal-type (P = .011), higher numbers of interfollicular CD4+ (P = .038) and intrafollicular FOXP3+ cells (P = .024) in the tumor microenvironment, and Ki-67 index ≥10% (P = .031) were significant adverse factors for WW discontinuation in univariate analyses. CONCLUSION Patients with adverse factors for WW discontinuation should be carefully observed during follow-up.
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Affiliation(s)
- Sayako Yuda
- Departments of Pathology, National Cancer Center Hospital, Tokyo, Japan.,Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Yuta Ito
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Shunsuke Hatta
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomotaka Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
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Sorigue M, Cañamero E, Sancho JM. Precision medicine in follicular lymphoma: Focus on predictive biomarkers. Hematol Oncol 2020; 38:625-639. [PMID: 32700331 DOI: 10.1002/hon.2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
Current care for patients with follicular lymphoma (FL) offers most of them long-term survival. Improving it further will require careful patient selection. This review focuses on predictive biomarkers (ie, those whose outcome correlations depend on the treatment strategy) in FL, because awareness of what patient subsets benefit most or least from each therapy will help in this task. The first part of this review aims to summarize what biomarkers are predictive in FL, the magnitude of the effect and the quality of the evidence. We find predictive biomarkers in the setting of (a) indication of active treatment, (b) front-line induction (use of anthracyline-based regimens, CHOP vs bendamustine, addition of rituximab), (c) post-(front-line)induction (rituximab maintenance, radioimmunotherapy), and (d) relapse (hematopoietic stem cell transplant) and targeted agents. The second part of this review discusses the challenges of precision medicine in FL, including (a) cost, (b) clinical relevance considerations, and (c) difficulties over the broad implementation of biomarkers. We then provide our view on what biomarkers may become used in the next few years. We conclude by underscoring the importance of assessing the potential predictiveness of available biomarkers to improve patient care but also that there is a long road ahead before reaching their broad implementation due to remaining scientific, technological, and economic hurdles.
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Eloi Cañamero
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
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Xie M, Jiang Q, Zhao S, Zhao J, Ye X, Qian W. Prognostic value of tissue-infiltrating immune cells in tumor microenvironment of follicular lymphoma: A meta-analysis. Int Immunopharmacol 2020; 85:106684. [PMID: 32540726 DOI: 10.1016/j.intimp.2020.106684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The follicular lymphoma (FL) microenvironment is composed of follicular dendritic cells (FDCs), tumor-infiltrating CD4/CD8+ T cells (TILs), follicular regulatory T (Treg) cells, lymphoma-associated macrophages (LAMs), and immune checkpoint-related immune cells, all of which are relevant in the prognosis of FL, but their results remain controversial. Therefore, we performed this systematic review to explore the relationship between the FL microenvironment and prognosis. METHODS Relevant studies were identified from PubMed, EMBASE and the Cochrane Library. Twenty-three trials involving 3336 patients with FL were included for analysis. RESULTS This meta-analysis confirmed the unfavorable prognostic role of high CD21+/CD23+ FDC density in overall survival (OS) and progression-free survival (PFS). CD8+ or granzyme B+ TILs instead of CD4+ TILs are indicators for good OS. FoxP3+ Treg cells was not associated with prognosis, and even in subgroup analysis neither the number of cells nor the infiltration pattern had predictive value. A high degree of CD68+ macrophage infiltration was a negative prognostic factor for OS, but was associated with good prognosis in the rituximab-era subgroup. Although there was no correlation between PD1-positive immune cells and prognosis, subtypes with the follicular helper T (TFH) or exhausted T cell (TEX) phenotype tended to influence prognosis. The HR in the short time to transformation (TTT) analyses suggested that high CD68+ LAM numbers, diffuse pattern of FOXP3+ Treg cells and PD1+ cells, and high PD-L1 cell numbers are adverse factors leading to early transformation. CONCLUSIONS Multiple tissue-infiltratingimmune cells in microenvironment play critical and different roles in FL prognosis.
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Affiliation(s)
- Mixue Xie
- Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Qi Jiang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Shuqi Zhao
- Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Jing Zhao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Xiujin Ye
- Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
| | - Wenbin Qian
- Department of Haematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
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9
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Localized- and advanced-stage follicular lymphomas differ in their gene expression profiles. Blood 2020; 135:181-190. [PMID: 31697802 DOI: 10.1182/blood.2019000560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022] Open
Abstract
The genetic background of follicular lymphomas (FLs) diagnosed in advanced clinical stages III/IV, and which are frequently characterized by t(14;18), has been substantially unraveled. Molecular features, as exemplified in the clinicogenetic risk model m7FLIPI, are important tools in risk stratification. In contrast, little information is available concerning localized-stage FL (clinical stages I/II), which accounts for ∼20% of newly diagnosed FL in which the detection rate of t(14;18) is only ∼50%. To investigate the genetic background of localized-stage FL, patient cohorts with advanced-stage FL or localized-stage FL, uniformly treated within phase 3 trials of the German Low-Grade Lymphoma Study Group, were comparatively analyzed. Targeted gene expression (GE) profiling of 184 genes using nCounter technology was performed in 110 localized-stage and 556 advanced-stage FL patients. By penalized Cox regression, a prognostic GE signature could not be identified in patients with advanced-stage FL, consistent with results from global tests and univariate regression. In contrast, it was possible to define robust GE signatures discriminating localized-stage and advanced-stage FL (area under the curve, 0.98) by penalized logistic regression. Of note, 3% of samples harboring an "advanced-stage signature" in the localized-stage cohort exhibited inferior failure-free survival (hazard ratio [HR], 7.1; P = .0003). Likewise, in the advanced-stage cohort, 7% of samples with a "localized-stage signature" had prolonged failure-free survival (HR, 2.3; P = .017) and overall survival (HR, 3.4; P = .072). These data support the concept of a biological difference between localized-stage and advanced-stage FL that might contribute to the superior outcome of localized FL.
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10
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Xie M, Huang X, Ye X, Qian W. Prognostic and clinicopathological significance of PD-1/PD-L1 expression in the tumor microenvironment and neoplastic cells for lymphoma. Int Immunopharmacol 2019; 77:105999. [PMID: 31704289 DOI: 10.1016/j.intimp.2019.105999] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recently, unprecedented clinical efficacy was observed during treatment of many solid tumors because of the introduction of programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) immune checkpoint inhibitors. Preliminary clinical data indicates that checkpoint inhibition also represents a promising therapeutic strategy for certain lymphoid malignancies. However, PD-1/PD-L1 expression levels on neoplastic cells and in the tumor microenvironment vary among subtypes and their prognostic implications remain uncertain. MAIN BODY Here, we review the clinicopathological significance of PD-1/PD-L1 expression in lymphomas. Increased infiltration of PD-1+ tumor-infiltrating lymphocytes (TILs) is a favorable prognostic factor in diffuse large B-cell lymphoma (DLBCL) but not in Hodgkin's lymphoma (HL). Higher numbers of PD-1+ TILs were observed in follicular lymphoma (FL) than in other subtypes of B-cell lymphoma; however, its prognostic significance remains controversial. Infiltration of PD-L1+ immune cells showed a trend toward better overall survival in nasal natural killer (NK)/T-cell lymphoma and adult T-cell leukemia/lymphoma, more likely to be classified as activated macrophages and dendritic cells in microenvironment but its biological effect is not clarified. Peripheral PD-1+ T cells could be detected in blood samples from DLBCL and chronic lymphocytic leukemia (CLL) and correlated with disease progression and poor prognosis. PD-1+ neoplastic T cells were more frequently observed in cutaneous T-cell lymphoma, including Sézary syndrome and mycosis fungoides, which may be involved in the progression of epithelial-derived T lymphoma. Studies on PD-L1 expression in neoplastic cells mostly focused on DLBCL. PD-L1+ neoplastic cells were observed only in a small subset of DLBCL, mainly associated with activated B cell (ABC) subtypes and Epstein-Barr virus (EBV) positivity; however, its prognostic role remains controversial. In either T or B lymphoma, elevated serum or plasma levels of soluble PD-L1 represent adverse prognostic factors. Notably, in clinical trials of classical HL, the frequency of 9p24.1 chromosome alterations increases the abundance of PD-1 ligand expression, appearing to predict responses to anti-PD-1/PD-L1 therapy. The cytogenetic alterations affecting chromosome 9p24.1 including the CIITA rearrangement were also frequently observed in certain specific subtypes of large B-cell lymphomas. CONCLUSIONS The clinical roles of PD-1/PD-L1 expression vary between subtypes of lymphoma. Future studies should delineate the prognostic and predictive roles of PD-1 and PD-L1 expression.
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Affiliation(s)
- Mixue Xie
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Xianbo Huang
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Xiujin Ye
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
| | - Wenbin Qian
- Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China; Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
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11
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Ciammella P, Luminari S, Arcaini L, Filippi AR. Renewed interest for low‐dose radiation therapy in follicular lymphomas: From biology to clinical applications. Hematol Oncol 2018; 36:723-732. [DOI: 10.1002/hon.2538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Stefano Luminari
- HaematologySanta Maria Nuova Hospital, IRCCS Reggio Emilia Italy
| | - Luca Arcaini
- Hematology UnitFondazione IRCCS Policlinico S. Matteo and University of Pavia Pavia Italy
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12
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Atanackovic D, Luetkens T. Biomarkers for checkpoint inhibition in hematologic malignancies. Semin Cancer Biol 2018; 52:198-206. [PMID: 29775689 DOI: 10.1016/j.semcancer.2018.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/27/2023]
Abstract
In the past few years we have seen remarkable paradigm shifts in the treatment of many solid tumors due to the introduction of inhibitors targeting immune checkpoints such as PD-1/PD-L1 and CTLA-4. Recent results indicate that checkpoint inhibition also represents a very promising approach for certain types of hematologic malignancies. Unfortunately, treatment with checkpoint inhibitors is also associated with substantial toxicities and high costs and only a subset of patients appears to derive clinical benefit from these treatments. This demonstrates the urgent need for biomarkers for the identification of patient populations that are likely to respond to this type of therapy and/or have fewer side effects. Here, we have reviewed available information on the prognostic and predictive value of biomarkers for anti-CTLA-4 and anti-PD-1/PD-L1 as the most commonly used checkpoint inhibitors. There are currently no reliable biomarkers capable of predicting responses to anti-CTLA-4 agents, such as ipilimumab, in hematologic malignancies. Certain polymorphisms in the CTLA-4 gene, however, seem to have an impact on the patients' outcome, especially in the case of chronic lymphocytic leukemia (CLL). There is now sufficient data supporting PD-L1 expression levels in the tumor tissue as an independent prognostic factor in B cell lymphomas such as diffuse large B-cell lymphoma (DLBCL). Overexpression of PD-L1 in the tumor tissue and elevated serum levels of soluble PD-L1 may also represent adverse prognostic factors in certain subtypes of T cell lymphomas. Finally, expression levels of PD-L1 also seem to predict responses to anti-PD-1/PD-L1 approaches in patients with Hodgkin lymphoma. Future studies will have to further delineate the prognostic/predictive role of PD-L1 expression as a biomarker in hematologic malignancies and may be able to identify confounding variables, which will hopefully to some extent be generalizable to other types of anti-tumor immunotherapies.
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Affiliation(s)
- Djordje Atanackovic
- Multiple Myeloma Program & Cancer Immunology, Division of Hematology and Hematologic Malignancies, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT, United States.
| | - Tim Luetkens
- Multiple Myeloma Program & Cancer Immunology, Division of Hematology and Hematologic Malignancies, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT, United States
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13
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Sites of extranodal involvement are prognostic in patients with stage 1 follicular lymphoma. Oncotarget 2017; 8:78410-78418. [PMID: 29108238 PMCID: PMC5667971 DOI: 10.18632/oncotarget.19240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives Follicular lymphoma (FL) is the most common indolent B cell lymphoma in the United States and a quarter of patients present with stage I disease. The objective of this study was to examine if primary site of disease influences survival in early stage lymphoma. Results The most common extranodal primary sites were the integumentary system (8%), followed by the GI tract (6.4%) and head & neck (5.6%). We stratified patients into a pre-rituximab era (1983-1998) and the rituximab era (1999-2011). In multivariable analysis, integumentary disease was associated with better overall survival (Hazard Ratio [HR], 0.77; Confidence Interval [CI], 0.66-0.9) while primary site FL of the nervous system (HR, 2.40; CI, 1.72-3.38) and the musculoskeletal system (HR, 2.14; CI, 1.44-3.18) were associated with worse overall survival when compared to primary nodal FL. Treatment in the pre-rituximab era, male gender and older age at diagnosis were associated with worse survival. Methods We queried the SEER database from 1983 to 2011. We included all adult patients (>18 years) with histologically confirmed stage I FL, active follow-up, and a single primary tumor. A total of 9,865 patients met eligibility criteria, with 2520 (25%) having an extranodal primary site. We classified the primary sites by organ or anatomic location into 11 sites. Conclusion Primary site of disease is a prognostic factor for patients with early stage FL and may help identify subsets of patients that could benefit from early, aggressive treatment.
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14
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McClanahan F, Sharp TG, Gribben JG. Catching up with solid tumor oncology: what is the evidence for a prognostic role of programmed cell death-ligand 1/programmed cell death-1 expression in B-cell lymphomas? Haematologica 2017; 101:1144-1158. [PMID: 27694502 DOI: 10.3324/haematol.2016.145904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/27/2016] [Indexed: 12/18/2022] Open
Abstract
Therapeutic strategies targeting the programmed cell death-ligand 1/programmed cell death-1 pathway have shown significant responses and good tolerability in solid malignancies. Although preclinical studies suggest that inhibiting programmed cell death-ligand 1/programmed cell death-1 interactions might also be highly effective in hematological malignancies, remarkably few clinical trials have been published. Determining patients who will benefit most from programmed cell death-ligand 1/programmed cell death-1-directed immunotherapy and whether programmed cell death-ligand 1/programmed cell death-1 are adequate prognostic markers becomes an increasingly important clinical question, especially as aberrant programmed cell death-ligand 1/programmed cell death-1 expression are key mediators of impaired anti-tumor immune responses in a range of B-cell lymphomas. Herein, we systematically review the published literature on the expression and prognostic value of programmed cell death-ligand 1/programmed cell death-1 in these patients and identify considerable differences in expression patterns, distribution and numbers of programmed cell death-ligand 1+/programmed cell death-1+cells, both between and within lymphoma subtypes, which is reflected in conflicting findings regarding the prognostic value of programmed cell death-ligand 1+/programmed cell death-1+ cells. This can be partly explained by differences in methodologies (techniques, protocols, cutoff values) and definitions of positivity. Moreover, lymphomagenesis, disease progression, and prognosis appear to be determined not only by the presence, numbers and distribution of specific subtypes of T cells, but also by other cells and additional immune checkpoints. Collectively, our findings indicate that programmed cell death-ligand 1/programmed cell death-1 interactions play an essential role in B-cell lymphoma biology and are of clinical importance, but that the overall outcome is determined by additional components. To categorize the exact prognostic value of programmed cell death-ligand 1/programmed cell death-1 expressing cells and cell types, efforts should be made to harmonize their assessment and interpretation, optimally within ongoing clinical immune checkpoint inhibitor trials, and to identify and validate novel high-throughput platforms.
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Affiliation(s)
- Fabienne McClanahan
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, UK Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Thomas G Sharp
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, UK
| | - John G Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, UK
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15
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Abas FS, Shana’ah A, Christian B, Hasserjian R, Louissaint A, Pennell M, Sahiner B, Chen W, Niazi MKK, Lozanski G, Gurcan M. Computer-assisted quantification of CD3+ T cells in follicular lymphoma. Cytometry A 2017; 91:609-621. [PMID: 28110507 PMCID: PMC10680104 DOI: 10.1002/cyto.a.23049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 12/19/2016] [Indexed: 01/01/2023]
Abstract
The advance of high resolution digital scans of pathology slides allowed development of computer based image analysis algorithms that may help pathologists in IHC stains quantification. While very promising, these methods require further refinement before they are implemented in routine clinical setting. Particularly critical is to evaluate algorithm performance in a setting similar to current clinical practice. In this article, we present a pilot study that evaluates the use of a computerized cell quantification method in the clinical estimation of CD3 positive (CD3+) T cells in follicular lymphoma (FL). Our goal is to demonstrate the degree to which computerized quantification is comparable to the practice of estimation by a panel of expert pathologists. The computerized quantification method uses entropy based histogram thresholding to separate brown (CD3+) and blue (CD3-) regions after a color space transformation. A panel of four board-certified hematopathologists evaluated a database of 20 FL images using two different reading methods: visual estimation and manual marking of each CD3+ cell in the images. These image data and the readings provided a reference standard and the range of variability among readers. Sensitivity and specificity measures of the computer's segmentation of CD3+ and CD- T cell are recorded. For all four pathologists, mean sensitivity and specificity measures are 90.97 and 88.38%, respectively. The computerized quantification method agrees more with the manual cell marking as compared to the visual estimations. Statistical comparison between the computerized quantification method and the pathologist readings demonstrated good agreement with correlation coefficient values of 0.81 and 0.96 in terms of Lin's concordance correlation and Spearman's correlation coefficient, respectively. These values are higher than most of those calculated among the pathologists. In the future, the computerized quantification method may be used to investigate the relationship between the overall architectural pattern (i.e., interfollicular vs. follicular) and outcome measures (e.g., overall survival, and time to treatment). © 2017 International Society for Advancement of Cytometry.
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Affiliation(s)
- Fazly S. Abas
- Center for e-Health, Faculty of Engineering and Technology, Multimedia University, Melaka, Malaysia
| | - Arwa Shana’ah
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Beth Christian
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Robert Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Berkman Sahiner
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Weijie Chen
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | | | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Metin Gurcan
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
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16
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Stevens WBC, Mendeville M, Redd R, Clear AJ, Bladergroen R, Calaminici M, Rosenwald A, Hoster E, Hiddemann W, Gaulard P, Xerri L, Salles G, Klapper W, Pfreundschuh M, Jack A, Gascoyne RD, Natkunam Y, Advani R, Kimby E, Sander B, Sehn LH, Hagenbeek A, Raemaekers J, Gribben J, Kersten MJ, Ylstra B, Weller E, de Jong D. Prognostic relevance of CD163 and CD8 combined with EZH2 and gain of chromosome 18 in follicular lymphoma: a study by the Lunenburg Lymphoma Biomarker Consortium. Haematologica 2017; 102:1413-1423. [PMID: 28411252 PMCID: PMC6643731 DOI: 10.3324/haematol.2017.165415] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/11/2017] [Indexed: 01/25/2023] Open
Abstract
In follicular lymphoma, studies addressing the prognostic value of microenvironment-related immunohistochemical markers and tumor cell-related genetic markers have yielded conflicting results, precluding implementation in practice. Therefore, the Lunenburg Lymphoma Biomarker Consortium performed a validation study evaluating published markers. To maximize sensitivity, an end of spectrum design was applied for 122 uniformly immunochemotherapy-treated follicular lymphoma patients retrieved from international trials and registries. The criteria were: early failure, progression or lymphoma-related death <2 years versus long remission, response duration of >5 years. Immunohistochemical staining for T cells and macrophages was performed on tissue microarrays from initial biopsies and scored with a validated computer-assisted protocol. Shallow whole-genome and deep targeted sequencing was performed on the same samples. The 96/122 cases with complete molecular and immunohistochemical data were included in the analysis. EZH2 wild-type (P=0.006), gain of chromosome 18 (P=0.002), low percentages of CD8+ cells (P=0.011) and CD163+ areas (P=0.038) were associated with early failure. No significant differences in other markers were observed, thereby refuting previous claims of their prognostic significance. Using an optimized study design, this Lunenburg Lymphoma Biomarker Consortium study substantiates wild-type EZH2 status, gain of chromosome 18, low percentages of CD8+ cells and CD163+ area as predictors of early failure to immunochemotherapy in follicular lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP [-like]), while refuting the prognostic impact of various other markers.
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Affiliation(s)
| | - Matias Mendeville
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Robert Redd
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew J Clear
- Centre for Haemato-Oncology, Barts Cancer Institute, University of London, UK
| | - Reno Bladergroen
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maria Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, University of London, UK
| | - Andreas Rosenwald
- Institute of Pathology, Comprehensive Cancer Center Mainfranken, University of Würzburg, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital Grosshadern, Munich, Germany
| | - Philippe Gaulard
- Department of Pathology and Inserm U955, Hôpital Henri Mondor, University Paris-Est, Créteil, France
| | - Luc Xerri
- Département de Biopathologie, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Salles
- Service d'Hématologie,Hospices Civils de Lyon & Université Claude Bernard Lyon-1, UMR CNRS 5239, France
| | - Wolfram Klapper
- Institute of Pathology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Andrew Jack
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Randy D Gascoyne
- Department of Pathology & Medical Oncology, Centre for Lymphoid Cancer, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, CA, USA
| | - Ranjana Advani
- Department of Hematology, Stanford University School of Medicine, CA, USA
| | - Eva Kimby
- Department of Medicine, Division of Hematology, Karolinska Institute, Stockholm, Sweden
| | - Birgitta Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Laurie H Sehn
- Department of Pathology & Medical Oncology, Centre for Lymphoid Cancer, British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Anton Hagenbeek
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - John Raemaekers
- Department of Hematology, Radboudumc, Nijmegen, the Netherlands
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, University of London, UK
| | - Marie José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bauke Ylstra
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Edie Weller
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daphne de Jong
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
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17
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Xerri L, Huet S, Venstrom JM, Szafer-Glusman E, Fabiani B, Canioni D, Chassagne-Clément C, Dartigues-Cuilléres P, Charlotte F, Laurent C, Gelas-Dore B, Bolen CR, Punnoose E, Bouabdallah R, Brice P, Morschhauser F, Cartron G, Olive D, Salles G. Rituximab treatment circumvents the prognostic impact of tumor-infiltrating T-cells in follicular lymphoma patients. Hum Pathol 2017; 64:128-136. [PMID: 28414090 DOI: 10.1016/j.humpath.2017.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/13/2017] [Accepted: 03/26/2017] [Indexed: 01/10/2023]
Abstract
Previous immunohistochemical (IHC) studies showed controversial data about the prognostic value of tumor-infiltrating lymphocytes (TILs) in follicular lymphoma (FL). To clarify this issue, a large series of FL samples from rituximab-treated patients enrolled in the randomized PRIMA trial was examined. IHC was quantified using automated image analysis in 417, 287, 418, 406, 379, and 369 patients for CD3, CD4, CD8, PD1, ICOS, and FOXP3, respectively. RNAseq analysis was used to quantify TIL-related mRNA transcripts from 148 patients. When each IHC marker was used as a continuous variable in the whole cohort, high CD3 counts were associated with better progression-free survival (PFS) (P = .025). When an optimal IHC cut point was applied to the whole patient population, high CD3 counts and high PD1 counts were associated with better PFS (P = .011 and P = .044, respectively), whereas none of the other TIL markers had any significant correlation with outcome. When a stringent analysis was performed by dividing the whole cohort into a training set and a validation set, none of the TIL markers showed a prognostic significance in both groups. RNAseq analysis showed a significant correlation between high levels of CD3 and CD8 transcripts and better PFS (P = .001 and P = .037, respectively). No prognostic correlation was found as to the level of other immune gene transcripts. These results suggest that the IHC prognostic value of TILs is circumvented by rituximab treatment, although there is a trend for high numbers of CD3+ TILs to correlate with better PFS.
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Affiliation(s)
- Luc Xerri
- Department of Bio-Pathology, Hematology, and Tumor Immunology, Institut Paoli-Calmettes and Aix-Marseille Univ, Marseille, France; Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, Marseille, F-13009, France; CNRS, UMR7258, Marseille, F-13009, Institut Paoli-Calmettes, Marseille, F-13009, France; Aix-Marseille University, UM, 105, F-13284, Marseille, France.
| | - Sarah Huet
- INSERM1052, CNRS 5286, Centre de Recherche en Cancerologie de Lyon, Faculté de Médecine Lyon-Sud Charles Mérieux, Hospices Civils De Lyon, Laboratoire d'hématologie, F-69495 Pierre Bénite cedex
| | | | | | - Bettina Fabiani
- Department of Pathology, Centre Hospitalier Saint Antoine, F-75571 Paris, France
| | - Danielle Canioni
- Department of Pathology, Centre Hospitalier Necker, F-75743 Paris, France
| | | | | | - Fréderic Charlotte
- Department of Pathology, Centre Hospitalier Pitié-Salpêtriére, F-75651 France
| | - Camille Laurent
- Department of Pathology, INSERM U.1037, Institut Universitaire du Cancer-Oncopole, F-31059 Toulouse
| | - Benedicte Gelas-Dore
- INSERM1052, CNRS 5286, Centre de Recherche en Cancerologie de Lyon, Faculté de Médecine Lyon-Sud Charles Mérieux, Hospices Civils De Lyon, Laboratoire d'hématologie, F-69495 Pierre Bénite cedex
| | | | | | - Reda Bouabdallah
- Department of Bio-Pathology, Hematology, and Tumor Immunology, Institut Paoli-Calmettes and Aix-Marseille Univ, Marseille, France; Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, Marseille, F-13009, France; CNRS, UMR7258, Marseille, F-13009, Institut Paoli-Calmettes, Marseille, F-13009, France; Aix-Marseille University, UM, 105, F-13284, Marseille, France
| | - Pauline Brice
- Department of Hematology, Centre Hospitalier Saint Louis, F-75475 Paris, France
| | - Franck Morschhauser
- Department of Hematology, Hopital Claude Huriez, Unité GRITA, Université de Lille 2, F-59000 Lille, France
| | - Guillaume Cartron
- Departement of Hematology, CHU Montpellier, UMR CNRS-5235, F-34295 Montpellier, France
| | - Daniel Olive
- Department of Bio-Pathology, Hematology, and Tumor Immunology, Institut Paoli-Calmettes and Aix-Marseille Univ, Marseille, France; Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm, U1068, Marseille, F-13009, France; CNRS, UMR7258, Marseille, F-13009, Institut Paoli-Calmettes, Marseille, F-13009, France; Aix-Marseille University, UM, 105, F-13284, Marseille, France
| | - Gilles Salles
- INSERM1052, CNRS 5286, Centre de Recherche en Cancerologie de Lyon, Faculté de Médecine Lyon-Sud Charles Mérieux, Hospices Civils De Lyon, Laboratoire d'hématologie, F-69495 Pierre Bénite cedex
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18
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Kim Y, Won C, Chang S, Lee M, Choi J, Lee W. Expression of programmed death-1 in cutaneous extranodal natural killer/T-cell lymphoma and its effect on clinical findings and biological behaviour. J Eur Acad Dermatol Venereol 2017; 31:821-827. [DOI: 10.1111/jdv.14165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Y.J. Kim
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - C.H. Won
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S.E. Chang
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - M.W. Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - J.H. Choi
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - W.J. Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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19
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Morscio J, Tousseyn T. Recent insights in the pathogenesis of post-transplantation lymphoproliferative disorders. World J Transplant 2016; 6:505-516. [PMID: 27683629 PMCID: PMC5036120 DOI: 10.5500/wjt.v6.i3.505] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/30/2016] [Accepted: 08/18/2016] [Indexed: 02/05/2023] Open
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is an aggressive complication of solid organ and hematopoietic stem cell transplantation that arises in up to 20% of transplant recipients. Infection or reactivation of the Epstein-Barr virus (EBV), a ubiquitous human herpesvirus, in combination with chronic immunosuppression are considered as the main predisposing factors, however insight in PTLD biology is fragmentary. The study of PTLD is complicated by its morphological heterogeneity and the lack of prospective trials, which also impede treatment optimization. Furthermore, the broad spectrum of underlying disorders and the graft type represent important confounding factors. PTLD encompasses different malignant subtypes that resemble histologically similar lymphomas in the general population. Post-transplant diffuse large B-cell lymphoma (PT-DLBCL), Burkitt lymphoma (PT-BL) and plasmablastic lymphoma (PT-PBL) occur most frequently. However, in many studies various EBV+ and EBV- PTLD subtypes are pooled, complicating the interpretation of the results. In this review, studies of the gene expression pattern, the microenvironment and the genetic profile of PT-DLBCL, PT-BL and PT-PBL are summarized to better understand the mechanisms underlying post-transplantation lymphomagenesis. Based on the available findings we propose stratification of PTLD according to the histological subtype and the EBV status to facilitate the interpretation of future studies and the establishment of clinical trials.
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20
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Le KS, Thibult ML, Just-Landi S, Pastor S, Gondois-Rey F, Granjeaud S, Broussais F, Bouabdallah R, Colisson R, Caux C, Ménétrier-Caux C, Leroux D, Xerri L, Olive D. Follicular B Lymphomas Generate Regulatory T Cells via the ICOS/ICOSL Pathway and Are Susceptible to Treatment by Anti-ICOS/ICOSL Therapy. Cancer Res 2016; 76:4648-60. [PMID: 27246829 DOI: 10.1158/0008-5472.can-15-0589] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
Abstract
The prognosis of follicular lymphoma (FL) patients is suspected to be influenced by tumor-infiltrating regulatory T cells (Treg). The mechanism of Treg enrichment in FL and their impact on malignant FL B cells remains to be elucidated. We analyzed 46 fresh lymph node biopsy samples, including FL (n = 20), diffuse large B-cell lymphoma (n = 10), classical Hodgkin lymphoma (n = 9), and reactive lymphadenitis (n = 7). Using multicolor flow cytometry and cell sorting, we observed an accumulation of CD25(high)CD127(low/neg) Tregs in FL tissues. These Tregs comprised activated ICOS(+) Tregs that were able to suppress not only conventional T cells, but also FL B cells. These FL B cells were able to express ICOSL in vitro and to generate CD25(high)FoxP3(high) Tregs expressing ICOS. Treg generation was associated with ICOS/ICOSL engagement and was abrogated by antagonist anti-ICOS and anti-ICOSL antibodies. Interactions between Tregs and FL B cells resulted in ICOSL downregulation on FL B cells. Our results highlight a key role for Tregs in FL pathogenesis and suggest that targeting the ICOS/ICOSL pathway may be a promising immunotherapy for FL treatment. Cancer Res; 76(16); 4648-60. ©2016 AACR.
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Affiliation(s)
- Kieu-Suong Le
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France. Aix Marseille Université, Marseille, France
| | - Marie-Laure Thibult
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France. Institut Paoli - Calmettes, Marseille, France
| | | | - Sonia Pastor
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France
| | - Françoise Gondois-Rey
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France
| | - Samuel Granjeaud
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France
| | | | | | - Renaud Colisson
- Centre de Recherche en Cancérologie de Lyon, Inserm U1052/CNRS 5286, Lyon, France
| | - Christophe Caux
- Centre de Recherche en Cancérologie de Lyon, Inserm U1052/CNRS 5286, Lyon, France
| | | | | | - Luc Xerri
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France. Aix Marseille Université, Marseille, France. Institut Paoli - Calmettes, Marseille, France
| | - Daniel Olive
- Centre de recherche en Cancérologie de Marseille, Inserm U1068/CNRS U7258, Marseille, France. Aix Marseille Université, Marseille, France. Institut Paoli - Calmettes, Marseille, France.
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21
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Leich E, Hoster E, Wartenberg M, Unterhalt M, Siebert R, Koch K, Klapper W, Engelhard M, Puppe B, Horn H, Staiger AM, Stuhlmann-Laeisz C, Bernd HW, Feller AC, Hummel M, Lenze D, Stein H, Hartmann S, Hansmann ML, Möller P, Hiddemann W, Dreyling M, Ott G, Rosenwald A. Similar clinical features in follicular lymphomas with and without breaks in the BCL2 locus. Leukemia 2015; 30:854-60. [PMID: 26621338 DOI: 10.1038/leu.2015.330] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 01/18/2023]
Abstract
Approximately 15% of follicular lymphomas (FLs) lack breaks in the BCL2 locus. The aim of this study was to better define molecular and clinical features of BCL2-breakpoint/t(14;18)-negative FLs. We studied the presence of BCL2, BCL6 and MYC breaks by fluorescence in situ hybridization and the expression of BCL2, MUM1, CD10, P53 and Ki67 in large clinical trial cohorts of 540 advanced-stage FL cases and 116 early-stage disease FL patients treated with chemotherapy regimens and radiation, respectively. A total of 86% and 53% of advanced- and early-stage FLs were BCL2-breakpoint-positive, respectively. BCL2 was expressed in almost all FLs with BCL2 break and also in 86% and 69% of BCL2-breakpoint-negative advanced- and early-stage FLs, respectively. CD10 expression was significantly reduced in BCL2-breakpoint-negative FLs of all stages and MUM1 and Ki67 expression were significantly increased in BCL2-break-negative early-stage FLs. Patient characteristics did not differ between FLs with and without BCL2 breaks and neither did survival times in advanced-stage FLs. These results suggest that the molecular profile differs to some extent between FLs with and without BCL2 breaks and support the notion that FLs with and without BCL2 breaks belong to the same lymphoma entity.
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Affiliation(s)
- E Leich
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - E Hoster
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany
| | - M Wartenberg
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - M Unterhalt
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - R Siebert
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - K Koch
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Engelhard
- Department for Radiotherapy, University Hospital Essen, Essen, Germany
| | - B Puppe
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - H Horn
- Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart and University of Tübingen, Tübingen, Germany
| | - A M Staiger
- Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart and University of Tübingen, Tübingen, Germany
| | - C Stuhlmann-Laeisz
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - H W Bernd
- Institute of Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A C Feller
- Institute of Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - M Hummel
- Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany
| | - D Lenze
- Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany
| | - H Stein
- Pathodiagnostik Berlin, Berlin, Germany
| | - S Hartmann
- Institute of Pathology, University Hospital Frankfurt am, Frankfurt, Germany
| | - M L Hansmann
- Institute of Pathology, University Hospital Frankfurt am, Frankfurt, Germany
| | - P Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | - W Hiddemann
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - M Dreyling
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
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22
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Nelson LS, Mansfield JR, Lloyd R, Oguejiofor K, Salih Z, Menasce LP, Linton KM, Rose CJ, Byers RJ. Automated prognostic pattern detection shows favourable diffuse pattern of FOXP3(+) Tregs in follicular lymphoma. Br J Cancer 2015; 113:1197-205. [PMID: 26439683 PMCID: PMC4647874 DOI: 10.1038/bjc.2015.291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/30/2015] [Accepted: 07/11/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Histopathological prognostication relies on morphological pattern recognition, but as numbers of biomarkers increase, human prognostic pattern-recognition ability decreases. Follicular lymphoma (FL) has a variable outcome, partly determined by FOXP3 Tregs. We have developed an automated method, hypothesised interaction distribution (HID) analysis, to analyse spatial patterns of multiple biomarkers which we have applied to tumour-infiltrating lymphocytes in FL. METHODS A tissue microarray of 40 patient samples was used in triplex immunohistochemistry for FOXP3, CD3 and CD69, and multispectral imaging used to determine the numbers and locations of CD3(+), FOXP3/CD3(+) and CD69/CD3(+) T cells. HID analysis was used to identify associations between cellular pattern and outcome. RESULTS Higher numbers of CD3(+) (P=0.0001), FOXP3/CD3(+) (P=0.0031) and CD69/CD3(+) (P=0.0006) cells were favourable. Cross-validated HID analysis of cell pattern identified patient subgroups with statistically significantly different survival (35.5 vs 142 months, P=0.00255), a more diffuse pattern associated with favourable outcome and an aggregated pattern with unfavourable outcome. CONCLUSIONS A diffuse pattern of FOXP3 and CD69 positivity was favourable, demonstrating ability of HID analysis to automatically identify prognostic cellular patterns. It is applicable to large numbers of biomarkers, representing an unsupervised, automated method for identification of undiscovered prognostic cellular patterns in cancer tissue samples.
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Affiliation(s)
- Lilli S Nelson
- Medical School, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | | | - Roslyn Lloyd
- Perkin-Elmer, 68 Elm Street, Hopkinton, Massachusetts 01748, USA
| | - Kenneth Oguejiofor
- Institute of Cancer Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - Zena Salih
- Department of Medical Oncology, The Christie Foundation NHS Trust, 550 Wilmslow Rd, Manchester M20 4BX, UK
| | - Lia P Menasce
- Department of Histopathology, The Christie Foundation NHS Trust, 550 Wilmslow Rd, Manchester M20 4BX, UK
| | - Kim M Linton
- Institute of Cancer Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.,Department of Medical Oncology, The Christie Foundation NHS Trust, 550 Wilmslow Rd, Manchester M20 4BX, UK
| | - Chris J Rose
- Institute of Population Health, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.,Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK
| | - Richard J Byers
- Institute of Cancer Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.,Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.,Department of Histopathology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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23
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Lectins from opportunistic bacteria interact with acquired variable-region glycans of surface immunoglobulin in follicular lymphoma. Blood 2015; 125:3287-96. [PMID: 25784678 DOI: 10.1182/blood-2014-11-609404] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/10/2015] [Indexed: 12/13/2022] Open
Abstract
B-cell antigen receptor (BCR) expression is a key feature of most B-cell lymphomas, but the mechanisms of BCR signal induction and the involvement of autoantigen recognition remain unclear. In follicular lymphoma (FL) B cells, BCR expression is retained despite a chromosomal translocation that links the antiapoptotic gene BCL2 to the regulatory elements of immunoglobulin genes, thereby disrupting 1 heavy-chain allele. A remarkable feature of FL-BCRs is the acquisition of potential N-glycosylation sites during somatic hypermutation. The introduced glycans carry mannose termini, which create potential novel binding sites for mannose-specific lectins. Here, we investigated the effect of N-linked variable-region glycosylation for BCR interaction with cognate antigen and with lectins of different origins. N-glycans were found to severely impair BCR specificity and affinity to the initial cognate antigen. In addition, we found that lectins from Pseudomonas aeruginosa and Burkholderia cenocepacia bind and stimulate FL cells. Human exposure to these bacteria can occur by contact with soil and water. In addition, they represent opportunistic pathogens in susceptible hosts. Understanding the role of bacterial lectins might elucidate the pathogenesis of FL and establish novel therapeutic approaches.
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24
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Abstract
The diagnosis of B-cell non-Hodgkin lymphomas has changed significantly over the past few decades as new immunophenotypic markers, molecular subtype classification schemes, and novel biomarkers have emerged. Meanwhile, there has been an increasing emphasis on individualizing treatment approaches in accordance with a biologic heterogeneity that has been uncovered within many of the individual B-cell lymphoma entities. The application of high-throughput genomic sequencing to B-cell lymphomas has yielded large amounts of valuable information. The data encompass discoveries essential to an understanding of pathogenesis, clonal or tumoral evolution, and identification of biomarkers that may be useful for prognostic or therapeutic considerations. The following review discusses several of the more common, primarily tissuebased B-cell lymphomas, with a focus on pathologic classification and certain phenotypic characteristics or genetic lesions that apply to refinement of diagnosis and therapy.
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MESH Headings
- Biomarkers, Tumor
- High-Throughput Nucleotide Sequencing
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/pathology
- Mutation
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Affiliation(s)
- Sarah L Ondrejka
- Cleveland Clinic-Robert J. Tomsich Pathology and Laboratory Medicine Institute, 9500 Euclid Ave, L3, Cleveland, OH, 44195, USA
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25
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Harris NL. Indolent lymphoma: follicular lymphoma and the microenvironment-insights from the microscope. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:158-162. [PMID: 25696849 DOI: 10.1182/asheducation-2014.1.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Follicular lymphomas (FLs) are neoplasms of germinal center (GC) B cells, which retain many of the morphologic, immunophenotypic, genetic, and functional features of normal GC B cells. Both normal GCs and neoplastic follicles of FL also contain non-neoplastic cells (microenvironment) that influence and are influenced by the GC and FL B cells and are likely important for tumor cell survival. Many insights into the nature of the GC/FL microenvironment have come from morphologic and immunophenotypic analysis, both before and after the discoveries from gene expression profiling. This chapter reviews what we have learned from the microscope and highlights the pitfalls involved in trying to enumerate cells in the microenvironment for clinical prognostication.
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Affiliation(s)
- Nancy Lee Harris
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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26
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Pinheiro D, Chang YM, Bryant H, Szladovits B, Dalessandri T, Davison LJ, Yallop E, Mills E, Leo C, Lara A, Stell A, Polton G, Garden OA. Dissecting the regulatory microenvironment of a large animal model of non-Hodgkin lymphoma: evidence of a negative prognostic impact of FOXP3+ T cells in canine B cell lymphoma. PLoS One 2014; 9:e105027. [PMID: 25119018 PMCID: PMC4132014 DOI: 10.1371/journal.pone.0105027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 07/19/2014] [Indexed: 02/06/2023] Open
Abstract
The cancer microenvironment plays a pivotal role in oncogenesis, containing a number of regulatory cells that attenuate the anti-neoplastic immune response. While the negative prognostic impact of regulatory T cells (Tregs) in the context of most solid tissue tumors is well established, their role in lymphoid malignancies remains unclear. T cells expressing FOXP3 and Helios were documented in the fine needle aspirates of affected lymph nodes of dogs with spontaneous multicentric B cell lymphoma (BCL), proposed to be a model for human non-Hodgkin lymphoma. Multivariable analysis revealed that the frequency of lymph node FOXP3+ T cells was an independent negative prognostic factor, impacting both progression-free survival (hazard ratio 1.10; p = 0.01) and overall survival (hazard ratio 1.61; p = 0.01) when comparing dogs showing higher than the median FOXP3 expression with those showing the median value of FOXP3 expression or less. Taken together, these data suggest the existence of a population of Tregs operational in canine multicentric BCL that resembles thymic Tregs, which we speculate are co-opted by the tumor from the periphery. We suggest that canine multicentric BCL represents a robust large animal model of human diffuse large BCL, showing clinical, cytological and immunophenotypic similarities with the disease in man, allowing comparative studies of immunoregulatory mechanisms.
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Affiliation(s)
- Dammy Pinheiro
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Yu-Mei Chang
- Research Office, The Royal Veterinary College, London, United Kingdom
| | - Hannah Bryant
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Balazs Szladovits
- Department of Pathology and Pathogen Biology, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Tim Dalessandri
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
| | - Lucy J. Davison
- Henry Wellcome Building, Centre for Cellular and Molecular Physiology, University of Oxford, Oxford, United Kingdom
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth Yallop
- Clinical Investigation Centre, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Emily Mills
- Clinical Investigation Centre, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Chiara Leo
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Ana Lara
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Anneliese Stell
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Gerry Polton
- Oncology Service, North Downs Specialist Referrals, Bletchingley, Surrey, United Kingdom
| | - Oliver A. Garden
- Department of Clinical Sciences and Services, Immune Regulation Laboratory, The Royal Veterinary College, London, United Kingdom
- Department of Clinical Sciences and Services, Queen Mother Hospital for Animals, The Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
- * E-mail:
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27
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The prognostic impact of variant histology in nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG). Blood 2013; 122:4246-52; quiz 4292. [DOI: 10.1182/blood-2013-07-515825] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Key PointsHistopathologic variants of nodular lymphocyte–predominant Hodgkin lymphoma are associated with advanced stage and increased relapse rate. A prognostic score combining histopathologic and clinical features can allocate patients to 3 defined risk groups.
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28
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Westin JR, Chu F, Zhang M, Fayad LE, Kwak LW, Fowler N, Romaguera J, Hagemeister F, Fanale M, Samaniego F, Feng L, Baladandayuthapani V, Wang Z, Ma W, Gao Y, Wallace M, Vence LM, Radvanyi L, Muzzafar T, Rotem-Yehudar R, Davis RE, Neelapu SS. Safety and activity of PD1 blockade by pidilizumab in combination with rituximab in patients with relapsed follicular lymphoma: a single group, open-label, phase 2 trial. Lancet Oncol 2013; 15:69-77. [PMID: 24332512 DOI: 10.1016/s1470-2045(13)70551-5] [Citation(s) in RCA: 433] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Endogenous or iatrogenic antitumour immune responses can improve the course of follicular lymphoma, but might be diminished by immune checkpoints in the tumour microenvironment. These checkpoints might include effects of programmed cell death 1 (PD1), a co-inhibitory receptor that impairs T-cell function and is highly expressed on intratumoral T cells. We did this phase 2 trial to investigate the activity of pidilizumab, a humanised anti-PD1 monoclonal antibody, with rituximab in patients with relapsed follicular lymphoma. METHODS We did this open-label, non-randomised trial at the University of Texas MD Anderson Cancer Center (Houston, TX, USA). Adult (≥18 years) patients with rituximab-sensitive follicular lymphoma relapsing after one to four previous therapies were eligible. Pidilizumab was administered at 3 mg/kg intravenously every 4 weeks for four infusions, plus eight optional infusions every 4 weeks for patients with stable disease or better. Starting 17 days after the first infusion of pidilizumab, rituximab was given at 375 mg/m(2) intravenously weekly for 4 weeks. The primary endpoint was the proportion of patients who achieved an objective response (complete response plus partial response according to Revised Response Criteria for Malignant Lymphoma). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00904722. FINDINGS We enrolled 32 patients between Jan 13, 2010, and Jan 20, 2012. Median follow-up was 15.4 months (IQR 10.1-21.0). The combination of pidilizumab and rituximab was well tolerated, with no autoimmune or treatment-related adverse events of grade 3 or 4. The most common adverse events of grade 1 were anaemia (14 patients) and fatigue (13 patients), and the most common adverse event of grade 2 was respiratory infection (five patients). Of the 29 patients evaluable for activity, 19 (66%) achieved an objective response: complete responses were noted in 15 (52%) patients and partial responses in four (14%). INTERPRETATION The combination of pidilizumab plus rituximab is well tolerated and active in patients with relapsed follicular lymphoma. Our results suggest that immune checkpoint blockade is worthy of further study in follicular lymphoma. FUNDING National Institutes of Health, Leukemia and Lymphoma Society, Cure Tech, and University of Texas MD Anderson Cancer Center.
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Affiliation(s)
- Jason R Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fuliang Chu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Min Zhang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Fayad
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan Fowler
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jorge Romaguera
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Zhiqiang Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wencai Ma
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yanli Gao
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wallace
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis M Vence
- Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laszlo Radvanyi
- Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tariq Muzzafar
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - R Eric Davis
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Immunology Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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29
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Mitteldorf C, Bieri M, Wey N, Kerl K, Kamarachev J, Pfaltz M, Kutzner H, Roncador G, Tomasini D, Kempf W. Expression of programmed death-1 (CD279) in primary cutaneous B-cell lymphomas with correlation to lymphoma entities and biological behaviour. Br J Dermatol 2013; 169:1212-8. [DOI: 10.1111/bjd.12579] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 12/12/2022]
Affiliation(s)
- C. Mitteldorf
- Department of Dermatology; Klinikum Hildesheim GmbH; Hildesheim Germany
| | - M. Bieri
- Department of Pathology; University Hospital Zürich; Zürich Switzerland
| | - N. Wey
- Department of Pathology; University Hospital Zürich; Zürich Switzerland
| | - K. Kerl
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - J. Kamarachev
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - M. Pfaltz
- Department of Psychiatry and Psychotherapy; University Hospital Zürich; Zürich Switzerland
- Kempf und Pfaltz; Histologische Diagnostik; Research Unit; Seminarstrasse 1 CH-8042 Zürich Switzerland
| | - H. Kutzner
- Dermatopathologie Friedrichshafen Bodensee; Friedrichshafen Germany
| | - G. Roncador
- Centro Nacional de Investigaciones Oncologicas; Madrid Spain
| | - D. Tomasini
- Department of Dermatology; Hospital of Busto Arsizio; Busto Arsizio Italy
| | - W. Kempf
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
- Kempf und Pfaltz; Histologische Diagnostik; Research Unit; Seminarstrasse 1 CH-8042 Zürich Switzerland
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Smith SM. Dissecting follicular lymphoma: high versus low risk. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2013; 2013:561-567. [PMID: 24319232 DOI: 10.1182/asheducation-2013.1.561] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Progress in the management of follicular lymphoma (FL) has translated to improved outcomes, with most patients surviving a decade or more from the time of diagnosis. However, the disease remains quite heterogeneous and a substantial number of patients have more aggressive disease with short responses to therapy and/or transformation to higher-grade lymphomas. Given the lack of a single standard approach, it is important to understand sources of heterogeneity among patients that influence initial management, surveillance strategies, and overall prognosis. Most of the validated tools, such as the Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI-2, apply to the frontline setting, and there is an unmet need for prognostic tools in relapsed and refractory disease states. In particular, the number of prior treatment regimens may be less important than the duration of response to the most recent regimen and the type of prior therapy received. Furthermore, despite awareness of progressive genetic and epigenetic derangements and a growing appreciation of the microenvironment's role in FL outcomes, there is no validated means of incorporating biologic data into clinical prognostic indices. This review highlights the current state of knowledge regarding risk stratification in FL.
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Affiliation(s)
- Sonali M Smith
- 1Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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