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Viscovo M, Clemmensen MDL, Fosso F, Maiolo E, Autore F, Laurenti L, Hohaus S, Chiusolo P. PlentiPlex™ MYD88 Waldenström lymphoma qPCR assay: A highly sensitive method for detection of MYD88 L265P mutation. Int J Lab Hematol 2024; 46:665-669. [PMID: 38390807 DOI: 10.1111/ijlh.14255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Agarose gel-based conventional and real-time allele-specific polymerase chain reaction (AS-PCR) assays are currently used for sensitive detection and quantification of MYD88 L265P mutation. Visual inspection of an agarose gel can often be ambiguous. We propose a new allele-specific quantification PCR (AS-qPCR) assay, PlentiPlex™ MYD88 Waldenström lymphoma qPCR assay, that uses Intercalating Nucleic Acid (INA®) technology for increased affinity and specificity. METHODS This study compares PlentiPlex™ MYD88 Waldenström lymphoma qPCR assay with conventional AS-PCR. We included a total of 102 peripheral and bone marrow blood samples from 94 patients with a lymphoproliferative disorder. Droplet digital PCR (ddPCR) was used as a third method in case of discrepancy. RESULTS A positive percent agreement of 100% (95% CI 0.92-1.0) and a negative percent agreement of 98% (95% CI 0.90-1.0) were found between the conventional AS-PCR and the AS-qPCR methods. Including the ddPCR results to validate the discrepant cases, the sensitivity and specificity of PlentiPlex™ MYD88 Waldenström lymphoma qPCR Assay were 1.0 (95% CI 0.97-1.0) and 1.0 (95% CI 0.96-1.0), respectively. CONCLUSION Our data demonstrate that PlentiPlex™ MYD88 Waldenström lymphoma qPCR assay is a fast, highly sensitive, and specific method for the detection of MYD88 L265P compared with conventional AS-PCR.
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Affiliation(s)
- Marcello Viscovo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | | | - Federica Fosso
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCC, Rome, Italy
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCC, Rome, Italy
| | - Francesco Autore
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCC, Rome, Italy
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCC, Rome, Italy
| | - Stefan Hohaus
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCC, Rome, Italy
| | - Patrizia Chiusolo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A Gemelli IRCC, Rome, Italy
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Bibas M, Sarosiek S, Castillo JJ. Waldenström Macroglobulinemia - A State-of-the-Art Review: Part 1: Epidemiology, Pathogenesis, Clinicopathologic Characteristics, Differential Diagnosis, Risk Stratification, and Clinical Problems. Mediterr J Hematol Infect Dis 2024; 16:e2024061. [PMID: 38984103 PMCID: PMC11232678 DOI: 10.4084/mjhid.2024.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
Waldenström macroglobulinemia (WM) is an infrequent variant of lymphoma, classified as a B-cell malignancy identified by the presence of IgM paraprotein, infiltration of clonal, small lymphoplasmacytic B cells in the bone marrow, and the MYD88 L265P mutation, which is observed in over 90% of cases. The direct invasion of the malignant cells into tissues like lymph nodes and spleen, along with the immune response related to IgM, can also lead to various health complications, such as cytopenias, hyperviscosity, peripheral neuropathy, amyloidosis, and Bing-Neel syndrome. Chemoimmunotherapy has historically been considered the preferred treatment for WM, wherein the combination of rituximab and nucleoside analogs, alkylating drugs, or proteasome inhibitors has exhibited notable efficacy in inhibiting tumor growth. Recent studies have provided evidence that Bruton Tyrosine Kinase inhibitors (BTKI), either used independently or in conjunction with other drugs, have been shown to be effective and safe in the treatment of WM. The disease is considered to be non-curable, with a median life expectancy of 10 to 12 years.
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Affiliation(s)
- Michele Bibas
- Department of Clinical Research, Hematology. National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCSS Rome Italy
| | - Shayna Sarosiek
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jorge J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Boccon-Gibod C, Sourdeau E, Morel P, Chapiro E, Nguyen-Khac F, Bravetti C, Davi F, Morel V, Gauthier N, Grenier A, Boussen I, Choquet S, Leblond V, Le Garff-Tavernier M, Baron M, Roos-Weil D. Circulating tumor cells in Waldenström macroglobulinemia. Leukemia 2024; 38:903-907. [PMID: 38332185 DOI: 10.1038/s41375-024-02156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Clémentine Boccon-Gibod
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
| | - Elise Sourdeau
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | | | - Elise Chapiro
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Florence Nguyen-Khac
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Clotilde Bravetti
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Frédéric Davi
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Véronique Morel
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Nicolas Gauthier
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Adrien Grenier
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Inès Boussen
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Sylvain Choquet
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Véronique Leblond
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Magali Le Garff-Tavernier
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Marine Baron
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Damien Roos-Weil
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France.
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Guérémy A, Boucraut J, Boudjarane J, Grapperon AM, Fortanier E, Farnault L, Gabert J, Vely F, Lacroix R, Kouton L, Attarian S, Delmont E. Clinical, biological, electrophysiological and therapeutic profile of patients with anti-MAG neuropathy according to MYD88 L265P and CXCR4 mutations and underlying haemopathy. J Neurol 2024; 271:1320-1330. [PMID: 37979093 DOI: 10.1007/s00415-023-12068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Anti-MAG neuropathies are associated with an IgM monoclonal gammopathy of undetermined significance (MGUS) or with a malignant haemopathy. Our objective was to determine whether the presence of a haemopathy or somatic mutations of MYD88 and CXCR4 genes influences disease presentation and response to rituximab (RTX). METHODS We included 79 patients (mean age 74 years, disease duration 9.68 years) who had a bone marrow aspiration with morphologic and immunophenotypic analysis. MYD88L265P and CXCR4 mutations were analysed in peripheral B cells. Information collected included: inflammatory neuropathy cause and treatment sensory sum score (ISS), MRC testing, overall neuropathy limitation scale (ONLS), Rash-built Overall Disability Score (RODS), ataxia score, anti-MAG titres, peak IgM dosage, neurofilament light chain levels, motor and sensory amplitudes, motor unit index (MUNIX) and motor unit size index (MUSIX) sum scores. Efficacy of RTX was evaluated at 12 months in 26 patients. RESULTS Malignant haematological disorders were discovered in 17 patients (22%): 13 Waldenstrom macroglobulinemia, 3 marginal zone lymphoma and one mantle cell lymphoma. MYD88L265P mutation was detected in 29/60 (48%) patients and CXCR4 in 1 single patient. Disease severity, biological and electrophysiological data and response to RTX were comparable in patients with MGUS/lymphoma and patients with/without MYD88L265P mutation. ISS was lower and MUSIX higher in patients improved by RTX. CONCLUSIONS MYD88L265P mutation and underlying haemopathies are not predictive of a more severe disease. However, in cases of resistant and progressive neuropathy, they provide an opportunity to prescribe newly available drugs such as Bruton tyrosine kinase inhibitors.
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Affiliation(s)
- Alexandre Guérémy
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - José Boucraut
- APHM, Hôpital de La Timone, Service d'Immunologie, Marseille-Immunopole, Marseille, France
- AMU, Institut de Neurosciences des Systèmes (INS, UMR1106), Marseille, France
| | - John Boudjarane
- Laboratory of Constitutional Cytogenetics, Department of Medical Genetics, La Timone Hospital Marseille, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Etienne Fortanier
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Laure Farnault
- Haematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, Marseille, France
- APHM Head of Biochemistry and Molecular Biology, Hopital Nord chemin des Bourrely, 13015, Marseille, France
| | - Jean Gabert
- INT Bd Jean Moulin Aix-Marseille University UMR7289, Marseille, France
- Aix-Marseille University, CNRS, INSERM, CIML, Marseille, France
| | - Frédéric Vely
- APHM, Hôpital de La Timone, Service d'Immunologie, Marseille-Immunopole, Marseille, France
- Aix-Marseille University, CNRS, INSERM, CIML, Marseille, France
| | - Romaric Lacroix
- Center for CardioVascular and Nutrition Research (C2VN), Faculty of Medical and Paramedical Sciences, Aix-Marseille University, National Institute of Health and Medical Research (INSERM), National Research Institute for Agriculture, Food and Environment (INRAE), 13005, Marseille, France
- Laboratoire d'Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Ludivine Kouton
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France.
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Montesdeoca S, García-Gisbert N, Calvo X, Arenillas L, Román D, Fernández-Rodríguez C, Navarro R, Costan B, Vela MDC, Camacho L, Abella E, Colomo L, Salido M, Puiggros A, Florensa L, Espinet B, Bellosillo B, Ferrer del Álamo A. Leukemic Involvement Is a Common Feature in Waldenström Macroglobulinemia at Diagnosis. Cancers (Basel) 2023; 15:4152. [PMID: 37627180 PMCID: PMC10452547 DOI: 10.3390/cancers15164152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Waldenström Macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with bone marrow (BM) involvement and IgM monoclonal gammopathy. To date, no studies have focused specifically on peripheral blood (PB) involvement. In this study, 100 patients diagnosed with WM according to the World Health Organization (WHO) criteria were included based on the demonstration of MYD88mut in BM and the availability of PB multiparametric flow cytometry (MFC) analysis. Leukemic involvement by MFC was detected in 50/100 patients. A low percentage of mature small lymphocytes in PB smears was observed in only 15 cases. MYD88mut by AS-qPCR was detected in PB in 65/100 cases. In cases with leukemic expression by MFC, MYD88mut was detected in all cases, and IGH was rearranged in 44/49 cases. In 21/50 patients without PB involvement by MFC, molecular data were consistent with circulating disease (MYD88mut by AS-qPCR 3/50, IGH rearranged 6/50, both 12/50). Therefore, PB involvement by standard techniques was detected in 71/100 patients. MYD88mut was detected in PB by dPCR in 9/29 triple negative cases. Overall, 80% of the patients presented PB involvement by any technique. Our findings support the role of PB MFC in the evaluation of patients with IgM monoclonal gammopathy and provide reliable information on correlation with molecular features. The development of a feasible MFC assay may stand as an objective tool in the classification of mature B cell neoplasms presenting with IgM monoclonal gammopathy.
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Affiliation(s)
- Sara Montesdeoca
- Laboratori d’Hematologia, Servei Diagnòstic de Laboratori, Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain;
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
| | - Nieves García-Gisbert
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Xavier Calvo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Leonor Arenillas
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - David Román
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Concepción Fernández-Rodríguez
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Rosa Navarro
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Beatriz Costan
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - María del Carmen Vela
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Laura Camacho
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Eugènia Abella
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Servei d’Hematologia Clínica, Hospital del Mar, 08003 Barcelona, Spain
| | - Lluís Colomo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Marta Salido
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Anna Puiggros
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Lourdes Florensa
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Blanca Espinet
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Beatriz Bellosillo
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Ana Ferrer del Álamo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
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Bustoros M, Gribbin C, Castillo JJ, Furman R. Biomarkers of Progression and Risk Stratification in Asymptomatic Waldenström Macroglobulinemia. Hematol Oncol Clin North Am 2023; 37:e1-e13. [PMID: 37574332 DOI: 10.1016/j.hoc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Waldenström macroglobulinemia is an indolent IgM-secreting B-cell lymphoplasmacytic lymphoma that is preceded by an asymptomatic stage. Clinical and molecular features have been used in risk models to predict progression rates in different asymptomatic subgroups. Risk models used both disease-specific and nonspecific biomarkers for asymptomatic patients. Recently, models that incorporate continuous variables rather than distinct cutoffs have emerged to more accurately predict the risk of progression. Integrating genetic alterations to the clinical models is a promising approach that could improve risk stratification and management of asymptomatic patients.
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Affiliation(s)
- Mark Bustoros
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA.
| | - Caitlin Gribbin
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard Furman
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY, USA
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7
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Awata-Shiraiwa M, Yokohama A, Kanai Y, Gotoh N, Kasamatsu T, Handa H, Saitoh T, Murakami H, Hirato J, Ikota H, Tsukamoto N. Waldenström Macroglobulinemia and Non-IgM-Type Lymphoplasmacytic Lymphoma Are Genetically Similar. Acta Haematol 2023; 146:384-390. [PMID: 36917966 DOI: 10.1159/000530100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Waldenström macroglobulinemia (WM) represents a subset of lymphoplasmacytic lymphoma (LPL) with the immunoglobulin (Ig)M paraprotein. MYD88 L265P and CXCR4 mutations are common mutations in WM patients, and mutations in ARID1A and KMT2D (MLL2) have also been reported. However, little information has been accumulated on genetic changes in LPL with other paraproteins like IgG. METHODS We therefore aimed to evaluate genetic differences between WM and LPL with non-IgM paraprotein (non-IgM-type LPL) using targeted next-generation sequencing (NGS) in 20 Japanese patients (10 with WM, 10 with non-IgM-type LPL). RESULTS Mutations were detected in ARID1A (10%), CXCR4 (20%), MYD88 (90%), and KMT2D (0%) for WM patients and in ARID1A (10%), CXCR4 (20%), MYD88 (70%), and KMT2D (10%) for non-IgM-type LPL patients. No significant differences were identified. No mutations were detected in NOTCH2, PRDM1, CD274 (PD-L1), PDCD1LG2 (PD-L2), RAG2, MYBBP1A, TP53, or CD79B. DISCUSSION Mutant allele frequency in MYD88 L265P did not differ significantly between WM and non-IgM-type LPL. Most mutations detected by NGS were subclonal following MYD88 L265P, although one non-IgM-type LPL patient harbored only CXCR4 S338X mutation. Our NGS analyses reveal genetic characteristics in LPL patients and suggest genetic similarities between these two subsets of LPL, WM and non-IgM-type.
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Affiliation(s)
- Maaya Awata-Shiraiwa
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
- Gunma University of Health and Welfare, Maebashi, Japan
| | - Akihiko Yokohama
- Blood Transfusion Service, Gunma University Hospital, Maebashi, Japan
| | - Yukihiro Kanai
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Nanami Gotoh
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Tetsuhiro Kasamatsu
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Hiroshi Handa
- Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takayuki Saitoh
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Hirokazu Murakami
- Department of Laboratory Sciences, Gunma University Graduate School of Health Sciences, Maebashi, Japan
- Gunma University of Health and Welfare, Maebashi, Japan
| | - Junko Hirato
- Clinical Department of Pathology, Public Tomioka General Hospital, Tomioka, Japan
| | - Hayato Ikota
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Japan
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8
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Moreno DF, López-Guerra M, Paz S, Oliver-Caldés A, Mena MP, Correa JG, Battram AM, Osuna M, Rivas-Delgado A, Rodríguez-Lobato LG, Cardús O, Tovar N, Cibeira MT, Jiménez-Segura R, Bladé J, Rosiñol L, Colomer D, Fernández de Larrea C. Prognostic impact of MYD88 and CXCR4 mutations assessed by droplet digital polymerase chain reaction in IgM monoclonal gammopathy of undetermined significance and smouldering Waldenström macroglobulinaemia. Br J Haematol 2023; 200:187-196. [PMID: 36210485 PMCID: PMC10092069 DOI: 10.1111/bjh.18502] [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: 07/08/2022] [Revised: 09/09/2022] [Accepted: 09/25/2022] [Indexed: 01/14/2023]
Abstract
Waldenström macroglobulinaemia (WM) is characterized by recurrent somatic mutations in MYD88 and CXCR4 genes. However, limitations arise when analysing these mutations in IgM monoclonal gammopathy of undetermined significance (MGUS) or smouldering WM (SWM) given the lower tumour load. Here, we used droplet digital polymerase chain reaction (ddPCR) to analyse MYD88 L265P and CXCR4 S338* mutations (C1013G and C1013A) in unsorted bone marrow (BM) or cell-free DNA (cfDNA) samples from 101 IgM MGUS and 69 SWM patients. ddPCR was more sensitive to assess MYD88 L265P compared to allele-specific PCR, especially in IgM MGUS (64% vs 39%). MYD88 mutation burden correlated with other laboratory biomarkers, particularly BM infiltration (r = 0.8; p < 0.001). CXCR4 C1013G was analysed in MYD88-mutated samples with available genomic DNA and was detected in 19/54 (35%) and 18/42 (43%) IgM MGUS and SWM cases respectively, also showing correlation with BM involvement (r = 0.9; p < 0.001). ddPCR also detected 8 (38%) and 10 (63%) MYD88-mutated cfDNA samples in IgM MGUS and SWM respectively. Moreover, high BM mutation burden (≥8% MYD88 and ≥2% CXCR4) was associated with an increased risk of progression to symptomatic WM. We show the clinical applicability of ddPCR to assess MYD88 and CXCR4 in IgM MGUS and SWM and provide a molecular-based risk classification.
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Affiliation(s)
- David F Moreno
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mónica López-Guerra
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Sara Paz
- Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aina Oliver-Caldés
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mari-Pau Mena
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan G Correa
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Anthony M Battram
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Miguel Osuna
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Rivas-Delgado
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Oriol Cardús
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Natalia Tovar
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - María Teresa Cibeira
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Raquel Jiménez-Segura
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Joan Bladé
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Laura Rosiñol
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Dolors Colomer
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Carlos Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
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9
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Dogliotti I, Jiménez C, Varettoni M, Talaulikar D, Bagratuni T, Ferrante M, Pérez J, Drandi D, Puig N, Gilestro M, García-Álvarez M, Owen R, Jurczak W, Tedeschi A, Leblond V, Kastritis E, Kersten MJ, D’Sa S, Kaščák M, Willenbacher W, Roccaro AM, Poulain S, Morel P, Kyriakou C, Fend F, Vos JMI, Dimopoulos MA, Buske C, Ferrero S, García-Sanz R. Diagnostics in Waldenström's macroglobulinemia: a consensus statement of the European Consortium for Waldenström's Macroglobulinemia. Leukemia 2023; 37:388-395. [PMID: 36435884 PMCID: PMC9898035 DOI: 10.1038/s41375-022-01762-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022]
Abstract
The diagnosis of Waldenström's macroglobulinemia (WM), an IgM-associated lymphoplasmacytic lymphoma, can be challenging due to the different forms of disease presentation. Furthermore, in recent years, WM has witnessed remarkable progress on the diagnostic front, as well as a deeper understanding of the disease biology, which has affected clinical practice. This, together with the increasing variety of tools and techniques available, makes it necessary to have a practical guidance for clinicians to perform the initial evaluation of patients with WM. In this paper, we present the consensus recommendations and laboratory requirements for the diagnosis of WM developed by the European Consortium of Waldenström's Macroglobulinemia (ECWM), for both clinical practice as well as the research/academical setting. We provide the procedures for multiparametric flow cytometry, fluorescence in situ hybridization and molecular tests, and with this offer guidance for a standardized diagnostic work-up and methodological workflow of patients with IgM monoclonal gammopathy of uncertain significance, asymptomatic and symptomatic WM.
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Affiliation(s)
- Irene Dogliotti
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.
| | - Marzia Varettoni
- grid.419425.f0000 0004 1760 3027Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Dipti Talaulikar
- grid.1001.00000 0001 2180 7477Canberra Health Services, College of Medicine, Biology and Environment Australian National University, Canberra ACT, Australia
| | - Tina Bagratuni
- grid.5216.00000 0001 2155 0800Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martina Ferrante
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - José Pérez
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Daniela Drandi
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Noemí Puig
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Milena Gilestro
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - María García-Álvarez
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Roger Owen
- grid.415967.80000 0000 9965 1030The Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Wojciech Jurczak
- grid.418165.f0000 0004 0540 2543Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Alessandra Tedeschi
- grid.416200.1ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy
| | - Veronique Leblond
- grid.462844.80000 0001 2308 1657Département d’Hématologie Hôpital Pitié-Salpêtrière APHP, UPMC Université Paris, Paris, France
| | - Efstathios Kastritis
- grid.5216.00000 0001 2155 0800Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Marie José Kersten
- grid.509540.d0000 0004 6880 3010Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Shirley D’Sa
- grid.439749.40000 0004 0612 2754Centre for Waldenströms Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Michal Kaščák
- grid.412684.d0000 0001 2155 4545Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Wolfgang Willenbacher
- grid.410706.4Department of Haematology and Oncology, Internal Medicine V, Innsbruck University Hospital & Syndena GmbH, Connect to Cure, Innsbruck, Austria
| | - Aldo M. Roccaro
- grid.412725.7Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stephanie Poulain
- grid.410463.40000 0004 0471 8845Laboratory of Hematology, Biology and Pathology Center, CHU of Lille, INSERM UMR-S 1277, Team 4, Oncolille, Lille, France
| | - Pierre Morel
- grid.134996.00000 0004 0593 702XService d’Hematologie Clinique et Therapie Cellulaire, Centre Hospitalier Universitaire d’Amiens-Picardie, Amiens, France
| | - Charalampia Kyriakou
- grid.439749.40000 0004 0612 2754Centre for Waldenströms Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Falko Fend
- grid.411544.10000 0001 0196 8249Institute of Pathology and Comprehensive Cancer Centre, Eberhard-Karls-University, University Hospital Tübingen, Tübingen, Germany
| | - Josephine M. I. Vos
- grid.509540.d0000 0004 6880 3010Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Meletios A. Dimopoulos
- grid.5216.00000 0001 2155 0800Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christian Buske
- grid.410712.10000 0004 0473 882XInstitute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - Simone Ferrero
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy ,Hematology Division 1U, “AOU Città della Salute e della Scienza di Torino”, Torino, Italy
| | - Ramón García-Sanz
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
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10
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Drandi D, Ferrante M, Borriero M, Ferrero S. MYD88 L265P Mutation Detection by ddPCR: Recommendations for Screening and Minimal Residual Disease Monitoring : ddPCR for Highly Sensitive Detection of MYD88 L265P Mutation. Methods Mol Biol 2023; 2621:57-72. [PMID: 37041440 DOI: 10.1007/978-1-0716-2950-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
MYD88L265P is a gain-of-function mutation, arising from the missense alteration c.794T>C, that frequently occurs in B-cell malignancies such as Waldenstrom macroglobulinemia and less frequently in IgM monoclonal gammopathy of undetermined significance (IgM-MGUS) or other lymphomas. MYD88L265P has been recognized as a relevant diagnostic flag, but also as a valid prognostic and predictive biomarker, as well as an investigated therapeutic target. Up until now, allele-specific quantitative PCR (ASqPCR) has been widely used for MYD88L265P detection providing a higher level of sensitivity than Sanger sequencing. However, the recently developed droplet digital PCR (ddPCR) shows a deeper sensitivity, compared to ASqPCR, that is necessary for screening low infiltrated samples. Actually, ddPCR could represent an improvement in daily laboratory practice since it allows mutation detection in unselected tumor cells, allowing to bypass the time-consuming and costly B-cell selection procedure. ddPCR accuracy has been recently proved to be suitable also for mutation detection in "liquid biopsy" samples that might be used as a noninvasive and patient-friendly alternative to bone marrow aspiration especially during the disease monitoring. The relevance of MYD88L265P, both in daily management of patients and in prospective clinical trials investigating the efficacy of novel agents, makes crucial to find a sensitive, accurate, and reliable molecular technique for mutation detection. Here, we propose a protocol for MYD88L265P detection by ddPCR.
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Affiliation(s)
- Daniela Drandi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, Torino, Italy.
| | - Martina Ferrante
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, Torino, Italy
| | - Michela Borriero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, Torino, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, Torino, Italy
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11
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Lim JH, Wang JQ, Webb F, Saxena K, Tuipulotu DE, Pandey A, Man SM, Talaulikar D. Plasma cells arise from differentiation of clonal lymphocytes and secrete IgM in Waldenström Macroglobulinaemia. iScience 2022; 25:104856. [PMID: 35992066 PMCID: PMC9389254 DOI: 10.1016/j.isci.2022.104856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/16/2022] [Accepted: 07/25/2022] [Indexed: 10/25/2022] Open
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12
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Ababneh O, Abushukair H, Qarqash A, Syaj S, Al Hadidi S. The Use of Bruton Tyrosine Kinase Inhibitors in Waldenström’s Macroglobulinemia. Clin Hematol Int 2022; 4:21-29. [PMID: 35950210 PMCID: PMC9358782 DOI: 10.1007/s44228-022-00007-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 01/04/2023] Open
Abstract
The use of Bruton Tyrosine Kinase (BTK) inhibitors in Waldenström’s Macroglobulinemia (WM) is evolving. Ibrutinib, a first-generation BTK inhibitor, is currently approved for use in frontline and relapsed/refractory disease. Second-generation BTK inhibitors are being used and studied to improve clinical outcomes and/or safety profile. Zanubrutinib, one such second-generation inhibitor, was recently approved in treatment-naive and refractory/relapsed patients. Here, we review the use of BTK inhibitors in WM in front-line and refractory or relapsed settings. We also highlight common adverse events, the emergence of BTK inhibitors resistance, and future directions of their use.
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Affiliation(s)
- Obada Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Aref Qarqash
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
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13
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Alcoceba M, García-Álvarez M, Medina A, Maldonado R, González-Calle V, Chillón MC, Sarasquete ME, González M, García-Sanz R, Jiménez C. MYD88 Mutations: Transforming the Landscape of IgM Monoclonal Gammopathies. Int J Mol Sci 2022; 23:5570. [PMID: 35628381 PMCID: PMC9141891 DOI: 10.3390/ijms23105570] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023] Open
Abstract
The MYD88 gene has a physiological role in the innate immune system. Somatic mutations in MYD88, including the most common L265P, have been associated with the development of certain types of lymphoma. MYD88L265P is present in more than 90% of patients with Waldenström's macroglobulinemia (WM) and IgM monoclonal gammopathy of undetermined significance (IgM-MGUS). The absence of MYD88 mutations in WM patients has been associated with a higher risk of transformation into aggressive lymphoma, resistance to certain therapies (BTK inhibitors), and shorter overall survival. The MyD88 signaling pathway has also been used as a target for specific therapies. In this review, we summarize the clinical applications of MYD88 testing in the diagnosis, prognosis, follow-up, and treatment of patients. Although MYD88L265P is not specific to WM, few tumors present a single causative mutation in a recurrent position. The role of the oncogene in the pathogenesis of WM is still unclear, especially considering that the mutation can be found in normal B cells of patients, as recently reported. This may have important implications for early lymphoma detection in healthy elderly individuals and for the treatment response assessment based on a MYD88L265P analysis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca (HUS/IBSAL), CIBERONC and Cancer Research Institute of Salamanca-IBMCC (USAL-CSIC), 37007 Salamanca, Spain; (M.A.); (M.G.-Á.); (A.M.); (R.M.); (V.G.-C.); (M.C.C.); (M.E.S.); (M.G.); (C.J.)
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14
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Tao Y, Pan ZK, Wang S, Wang L, Zhao WL. [Exploring the detection of MYD88 mutation in patients with Waldenström macroglobulinemia by different methods and specimens]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:388-392. [PMID: 35680596 PMCID: PMC9250951 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Indexed: 11/05/2022]
Abstract
Objective: To improve the positivity rate and accuracy of MYD88 mutation detection in patients with Waldenström macroglobulinemia (WM) . Methods: MYD88 mutation status was retrospectively evaluated in 66 patients diagnosed with WM in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to June 2021. The positivity rate and accuracy of the different methods and specimens for MYD88 mutation detection were analyzed. Results: MYD88 mutations were detected in 51 of 66 patients with WM, with an overall positivity rate of 77%. The positivity rate of the next-generation sequencing (NGS) or allele-specific polymerase chain reaction (AS-PCR) was significantly higher than that of the first-generation Sanger sequencing (84% vs 71% vs 46%, P<0.05) . For the different specimens, the positivity rate for the lymph nodes or bone marrow was significantly higher than that of peripheral blood (79% vs 84% vs 52%, P<0.05) . The positivity rate of the MYD88 mutation in the lymph nodes, bone marrow, and peripheral blood determined by NGS was 86%, 90%, and 67%, respectively. The positivity rate in the lymph nodes, bone marrow, and peripheral blood detected by AS-PCR was 78%, 81%, and 53%, respectively. Thirty-nine patients with WM underwent ≥ 2 MYD88 mutation detections. The final MYD88 mutational status for each patient was used as the standard to determine the accuracy of the different methods and in different specimens. The accuracy of MYD88 mutation detection in the lymph nodes (n=18) and bone marrow (n=13) by NGS was significantly higher than that in the peripheral blood (n=4) (100% vs 100% vs 75%, P<0.05) . There was no statistically significant difference in the accuracy of MYD88 mutation detection by AS-PCR in the lymph nodes (n=15) , bone marrow (n=11) , or peripheral blood (n=16) (93% vs 91% vs 88%, P>0.05) . Conclusions: In the detection of the MYD88 mutation in patients diagnosed with WM, NGS or AS-PCR is more sensitive than Sanger sequencing. Lymph nodes and bone marrow specimens are better than peripheral blood specimens.
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Affiliation(s)
- Y Tao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Z K Pan
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - S Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - L Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - W L Zhao
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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15
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Drandi D, Decruyenaere P, Ferrante M, Offner F, Vandesompele J, Ferrero S. Nucleic Acid Biomarkers in Waldenström Macroglobulinemia and IgM-MGUS: Current Insights and Clinical Relevance. Diagnostics (Basel) 2022; 12:diagnostics12040969. [PMID: 35454017 PMCID: PMC9028641 DOI: 10.3390/diagnostics12040969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/13/2022] Open
Abstract
Waldenström Macroglobulinemia (WM) is an indolent lymphoplasmacytic lymphoma, characterized by the production of excess immunoglobulin M monoclonal protein. WM belongs to the spectrum of IgM gammopathies, ranging from asymptomatic IgM monoclonal gammopathy of undetermined significance (IgM-MGUS), through IgM-related disorders and asymptomatic WM to symptomatic WM. In recent years, its complex genomic and transcriptomic landscape has been extensively explored, hereby elucidating the biological mechanisms underlying disease onset, progression and therapy response. An increasing number of mutations, cytogenetic abnormalities, and molecular signatures have been described that have diagnostic, phenotype defining or prognostic implications. Moreover, cell-free nucleic acid biomarkers are increasingly being investigated, benefiting the patient in a minimally invasive way. This review aims to provide an extensive overview of molecular biomarkers in WM and IgM-MGUS, considering current shortcomings, as well as potential future applications in a precision medicine approach.
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Affiliation(s)
- Daniela Drandi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10126 Torino, Italy; (M.F.); (S.F.)
- Correspondence: (D.D.); (P.D.)
| | - Philippe Decruyenaere
- Department of Hematology, Ghent University Hospital, 9000 Ghent, Belgium;
- OncoRNALab, Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium;
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
- Correspondence: (D.D.); (P.D.)
| | - Martina Ferrante
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10126 Torino, Italy; (M.F.); (S.F.)
| | - Fritz Offner
- Department of Hematology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Jo Vandesompele
- OncoRNALab, Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium;
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Simone Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10126 Torino, Italy; (M.F.); (S.F.)
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16
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Pratt G, El-Sharkawi D, Kothari J, D'Sa S, Auer R, McCarthy H, Krishna R, Miles O, Kyriakou C, Owen R. Diagnosis and management of Waldenström macroglobulinaemia-A British Society for Haematology guideline. Br J Haematol 2022; 197:171-187. [PMID: 35020191 DOI: 10.1111/bjh.18036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022]
Abstract
SCOPE The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with Waldenström macroglobulinaemia. In individual patients, circumstances may dictate an alternative approach. METHODOLOGY This guideline was compiled according to the British Society for Haematology (BSH) process at http://www.b-s-h.org.uk/guidelines/proposing-and-writing-a-new-bsh-guideline/. Recommendations are based on a review of the literature using Medline, Pubmed, Embase, Central, Web of Science searches from beginning of 2013 (since the publication of the previous guidelines) up to November 2021. The following search terms were used: Waldenström('s) macroglobulin(a)emia OR lymphoplasmacytic lymphoma, IgM(-related) neuropathy OR cold h(a)emagglutinin disease OR cold agglutinin disease OR cryoglobulin(a)emia AND (for group a only) cytogenetic OR molecular OR mutation OR MYD88 OR CXCR4, management OR treatment OR transfusion OR supportive care OR plasma exchange OR plasmapheresis OR chemotherapy OR bendamustine OR bortezomib OR ibrutinib OR fludarabine OR dexamethasone OR cyclophosphamide OR rituximab OR everolimus, bone marrow transplantation OR stem cell transplantation. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haemato-Oncology Task Force, the BSH Guidelines Committee and the Haemato-Oncology sounding board of BSH. It was also on the members section of the BSH website for comment. It has also been reviewed by UK Charity WMUK; these organisations do not necessarily approve or endorse the contents.
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Affiliation(s)
- Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jaimal Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shirley D'Sa
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Helen McCarthy
- University Hospitals Dorset NHS Foundation Trust, Dorset, UK
| | - Rajesh Krishna
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Oliver Miles
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Charalampia Kyriakou
- University College London Hospitals NHS Foundation Trust, London, UK
- London North West University Healthcare NHS Trust, London, UK
| | - Roger Owen
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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17
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Demos MG, Hunter ZR, Xu L, Tsakmaklis N, Kofides A, Munshi M, Liu X, Guerrera ML, Leventoff CR, White TP, Flynn CA, Meid K, Patterson CJ, Yang G, Branagan AR, Sarosiek S, Castillo JJ, Treon SP, Gustine JN. Cell-free DNA analysis for detection of MYD88 L265P and CXCR4 S338X mutations in Waldenström macroglobulinemia. Am J Hematol 2021; 96:E250-E253. [PMID: 33819355 DOI: 10.1002/ajh.26184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Maria G. Demos
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Zachary R. Hunter
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Lian Xu
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Amanda Kofides
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Manit Munshi
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Xia Liu
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Maria Luisa Guerrera
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Carly R. Leventoff
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Timothy P. White
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Catherine A. Flynn
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Kirsten Meid
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Christopher J. Patterson
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Guang Yang
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Andrew R. Branagan
- Department of Medicine Harvard Medical School Boston Massachusetts USA
- Division of Medical Oncology Massachusetts General Hospital Boston Massachusetts USA
| | - Shayna Sarosiek
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Jorge J. Castillo
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Steven P. Treon
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Department of Medicine Harvard Medical School Boston Massachusetts USA
| | - Joshua N. Gustine
- Bing Center for Waldenström's Macroglobulinemia Dana‐Farber Cancer Institute Boston Massachusetts USA
- Boston University School of Medicine Boston Massachusetts USA
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18
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Halting the FGF/FGFR axis leads to antitumor activity in Waldenström macroglobulinemia by silencing MYD88. Blood 2021; 137:2495-2508. [PMID: 33197938 DOI: 10.1182/blood.2020008414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/30/2020] [Indexed: 01/12/2023] Open
Abstract
The human fibroblast growth factor/fibroblast growth factor receptor (FGF/FGFR) axis deregulation is largely involved in supporting the pathogenesis of hematologic malignancies, including Waldenström macroglobulinemia (WM). WM is still an incurable disease, and patients succumb because of disease progression. Therefore, novel therapeutics designed to specifically target deregulated signaling pathways in WM are required. We aimed to investigate the role of FGF/FGFR system blockade in WM by using a pan-FGF trap molecule (NSC12). Wide-transcriptome profiling confirmed inhibition of FGFR signaling in NSC12-treated WM cells; unveiling a significant inhibition of MYD88 was also confirmed at the protein level. Importantly, the NSC12-dependent silencing of MYD88 was functionally active, as it led to inhibition of MYD88-driven pathways, such as BTK and SYK, as well as the MYD88-downstream target HCK. Of note, both canonical and noncanonical NF-κB cascades were downregulated in WM cells upon NSC12 treatment. Functional sequelae exerted by NSC12 in WM cells were studied, demonstrating significant inhibition of WM cell growth, induction of WM cell apoptosis, halting MAPK, JAK/STAT3, and PI3K-Akt pathways. Importantly, NSC12 exerted an anti-WM effect even in the presence of bone marrow microenvironment, both in vitro and in vivo. Our studies provide the evidence for using NSC12 as a specific FGF/FGFR system inhibitor, thus representing a novel therapeutic strategy in WM.
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19
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Ferrante M, Furlan D, Zibellini S, Borriero M, Candido C, Sahnane N, Uccella S, Genuardi E, Alessandria B, Bianchi B, Mora B, Grimaldi D, Defrancesco I, Jiménez C, Cavallo F, Ferrero D, Dogliotti I, Merli M, Varettoni M, Ferrero S, Drandi D. MYD88 L265P Detection in IgM Monoclonal Gammopathies: Methodological Considerations for Routine Implementation. Diagnostics (Basel) 2021; 11:diagnostics11050779. [PMID: 33926007 PMCID: PMC8146978 DOI: 10.3390/diagnostics11050779] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
In IgM monoclonal gammopathies MYD88L265P is a prognostic and predictive biomarker of therapy response. MYD88L265P detection is mainly performed by allele-specific quantitative PCR (ASqPCR), however recently, droplet digital PCR (ddPCR) has been proved to be suitable for MYD88L265P screening and minimal residual disease monitoring (MRD). This study compared ASqPCR and ddPCR to define the most sensitive method for MYD88L265P detection in bone marrow (BM), peripheral blood (PB) sorted or unsorted CD19+ cells, and in plasma cell-free DNA (cfDNA). Overall, the analysis showed a good concordance rate (74%) between the two methods, especially in BM samples, while discordances (26%) were mostly in favor of ddPCR (ddPCR+ vs. ASqPCR-) and were particularly evident in samples with low mutational burden, such as PB and cfDNA. This study highlights ddPCR as a feasible approach for MYD88L265P detection across different specimen types (including cfDNA). Interestingly, its high sensitivity makes CD19+ selection dispensable. On the other hand, our results showed that MYD88L265P detection on PB samples, especially with ASqPCR, is suboptimal for screening and MRD analysis. Finally, significantly different MYD88L265P mutational levels observed between Waldenström Macroglobulinemia and IgM monoclonal gammopathy of undetermined significance patients suggest the need for further studies in order to identify possible correlations between mutational levels and risk of progression to Waldenström.
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Affiliation(s)
- Martina Ferrante
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Daniela Furlan
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (D.F.); (S.U.)
| | - Silvia Zibellini
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Michela Borriero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Chiara Candido
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Nora Sahnane
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Silvia Uccella
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (D.F.); (S.U.)
| | - Elisa Genuardi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Beatrice Alessandria
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Benedetta Bianchi
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Barbara Mora
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Daniele Grimaldi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
| | - Irene Defrancesco
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), 37001 Salamanca, Spain;
| | - Federica Cavallo
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
- Hematology, A.O.U. Città della Salute e della Scienza, University of Torino, 10100 Torino, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
- Hematology, A.O.U. Città della Salute e della Scienza, University of Torino, 10100 Torino, Italy
| | - Irene Dogliotti
- Stem Cell Transplant Unit, University Hospital AOU Città della Salute e della Scienza, 10100 Torino, Italy;
| | - Michele Merli
- University Hospital “Ospedale di Circolo e Fondazione Macchi”-ASST Sette Laghi, University of Insubria, 21100 Varese, Italy; (N.S.); (B.B.); (B.M.); (M.M.)
| | - Marzia Varettoni
- Division of Hematology, IRCCS Foundation, Policlinico San Matteo, 27100 Pavia, Italy; (S.Z.); (C.C.); (I.D.); (M.V.)
| | - Simone Ferrero
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
- Hematology, A.O.U. Città della Salute e della Scienza, University of Torino, 10100 Torino, Italy
- Correspondence: ; Tel.: +39-388-064-3900
| | - Daniela Drandi
- Department of Molecular Biotechnology and Health Sciences, Hematology Division, University of Torino, 10100 Torino, Italy; (M.F.); (M.B.); (E.G.); (B.A.); (D.G.); (F.C.); (D.F.); (D.D.)
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20
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Branagan AR, Lei M, Treon SP, Castillo JJ. Clinical application of genomics in Waldenström macroglobulinemia. Leuk Lymphoma 2021; 62:1805-1815. [PMID: 33569985 DOI: 10.1080/10428194.2021.1881514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Waldenström Macroglobulinemia (WM) is an incurable hematologic malignancy characterized by lymphoplasmacytic infiltration of the bone marrow and the presence of monoclonal immunoglobulin (IgM). Although a portion of WM patients may experience a relatively indolent course, patients may experience IgM-related morbidity and/or disease-related mortality. This underscores the need for novel approaches to improve response and survival rates. Significant progress had been made in our understanding of the genomics and biology of WM. The discovery of the highly recurrent somatic mutations in the MYD88 gene detected in 90-95% and the CXCR4 gene detected in 30-40% of WM patients has provided an opportunity to develop novel targeted approaches. Mutational status has important implications in predicting response to therapies such as BTK inhibitors. Treatment of WM should be guided by many factors including performance status, comorbidities, goals of therapy, and toxicities. In this review, we describe how current genomics may be utilized to optimize WM treatment selection. As the therapeutic landscape of WM continues to expand with more targeted approaches, the genomics in WM will likely play a greater role in individualizing treatment.
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Affiliation(s)
- Andrew R Branagan
- Department of Hematologic Oncology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mathew Lei
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Steven P Treon
- Harvard Medical School, Boston, MA, USA.,Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jorge J Castillo
- Harvard Medical School, Boston, MA, USA.,Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
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21
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Gertz MA. Waldenström macroglobulinemia: 2021 update on diagnosis, risk stratification, and management. Am J Hematol 2021; 96:258-269. [PMID: 33368476 DOI: 10.1002/ajh.26082] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 02/06/2023]
Abstract
DISEASE OVERVIEW Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, lymphadenopathy, and rarely hyperviscosity. DIAGNOSIS Presence of IgM monoclonal protein associated with ≥10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis. The L265P mutation in MYD88 is detectable in more than 90% of patients and is found in the majority of IgM MGUS patients. RISK STRATIFICATION Age, hemoglobin level, platelet count, β2 microglobulin, LDH and monoclonal IgM concentrations are characteristics that are predictive of outcomes. RISK-ADAPTED THERAPY Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Rituximab-monotherapy is inferior to regimens that combine it with bendamustine, an alkylating agent, a proteosome inhibitor, or ibrutinib. Purine nucleoside analogues are active but usage is declining in favor of less toxic alternatives. The preferred Mayo Clinic induction is rituximab and bendamustine. MANAGEMENT OF REFRACTORY DISEASE Bortezomib, fludarabine, thalidomide, everolimus, Bruton Tyrosine Kinase inhibitors, carfilzomib, lenalidomide, and bendamustine have all been shown to have activity in relapsed WM. Given WM's natural history, reduction of therapy toxicity is an important part of treatment selection.
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Affiliation(s)
- Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Schmidt K, Sack U, Graf R, Winkler W, Popp O, Mertins P, Sommermann T, Kocks C, Rajewsky K. B-Cell-Specific Myd88 L252P Expression Causes a Premalignant Gammopathy Resembling IgM MGUS. Front Immunol 2020; 11:602868. [PMID: 33343574 PMCID: PMC7747680 DOI: 10.3389/fimmu.2020.602868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 12/20/2022] Open
Abstract
A highly recurrent somatic L265P mutation in the TIR domain of the signaling adapter MYD88 constitutively activates NF-κB. It occurs in nearly all human patients with Waldenström’s macroglobulinemia (WM), a B cell malignancy caused by IgM-expressing cells. Here, we introduced an inducible leucine to proline point mutation into the mouse Myd88 locus, at the orthologous position L252P. When the mutation was introduced early during B cell development, B cells developed normally. However, IgM-expressing plasma cells accumulated with age in spleen and bone, leading to more than 20-fold elevated serum IgM titers. When introduced into germinal center B cells in the context of an immunization, the Myd88L252P mutation caused prolonged persistence of antigen-specific serum IgM and elevated numbers of antigen-specific IgM plasma cells. Myd88L252P-expressing B cells switched normally, but plasma cells expressing other immunoglobulin isotypes did not increase in numbers, implying that IgM expression may be required for the observed cellular expansion. In order to test whether the Myd88L252P mutation can cause clonal expansions, we introduced it into a small fraction of CD19-positive B cells. In this scenario, five out of five mice developed monoclonal IgM serum paraproteins accompanied by an expansion of clonally related plasma cells that expressed mostly hypermutated VDJ regions. Taken together, our data suggest that the Myd88L252P mutation is sufficient to promote aberrant survival and expansion of IgM-expressing plasma cells which in turn can cause IgM monoclonal gammopathy of undetermined significance (MGUS), the premalignant condition that precedes WM.
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Affiliation(s)
- Kristin Schmidt
- Immune Regulation and Cancer, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Ulrike Sack
- Immune Regulation and Cancer, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Robin Graf
- Immune Regulation and Cancer, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Wiebke Winkler
- Biology of Malignant Lymphomas, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Oliver Popp
- Proteomics, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Philipp Mertins
- Proteomics, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Thomas Sommermann
- Immune Regulation and Cancer, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Christine Kocks
- Immune Regulation and Cancer, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Transgenics, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Klaus Rajewsky
- Immune Regulation and Cancer, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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23
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CXCR4 S338X clonality is an important determinant of ibrutinib outcomes in patients with Waldenström macroglobulinemia. Blood Adv 2020; 3:2800-2803. [PMID: 31570491 DOI: 10.1182/bloodadvances.2019000635] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023] Open
Abstract
Key Points
CXCR4 S338X clonality ≥25% is associated with lower very good partial response and shorter progression-free survival to ibrutinib. CXCR4 S338X clonality assessment represents a novel biomarker to predict outcomes to ibrutinib in Waldenström macroglobulinemia patients.
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24
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Immunoglobulin M Paraproteinaemias. Cancers (Basel) 2020; 12:cancers12061688. [PMID: 32630470 PMCID: PMC7352433 DOI: 10.3390/cancers12061688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022] Open
Abstract
Monoclonal paraproteinaemia is an increasingly common reason for referral to haematology services. Paraproteinaemias may be associated with life-threatening haematologic malignancies but can also be an incidental finding requiring only observation. Immunoglobulin M (IgM) paraproteinaemias comprise 15–20% of monoclonal proteins but pose unique clinical challenges. IgM paraproteins are more commonly associated with lymphoplasmacytic lymphoma than multiple myeloma and can occur in a variety of other mature B-cell neoplasms. The large molecular weight of the IgM multimer leads to a spectrum of clinical manifestations more commonly seen with IgM paraproteins than others. The differential diagnosis of B-cell and plasma cell dyscrasias associated with IgM gammopathies can be challenging. Although the discovery of MYD88 L265P and other mutations has shed light on the molecular biology of IgM paraproteinaemias, clinical and histopathologic findings still play a vital role in the diagnostic process. IgM secreting clones are also associated with a number of “monoclonal gammopathy of clinical significance” entities. These disorders pose a novel challenge from both a diagnostic and therapeutic perspective. In this review we provide a clinical overview of IgM paraproteinaemias while discussing the key advances which may affect how we manage these patients in the future.
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25
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Detection of the MYD88L265P and CXCR4S338X mutations by cell-free DNA in Waldenström macroglobulinemia. Ann Hematol 2020; 99:1763-1769. [DOI: 10.1007/s00277-020-04139-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
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26
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Anderson KJ, Ósvaldsdóttir ÁB, Atzinger B, Traustadóttir GÁ, Jensen KN, Lárusdóttir AE, Bergthórsson JT, Hardardóttir I, Magnúsdóttir E. The BLIMP1-EZH2 nexus in a non-Hodgkin lymphoma. Oncogene 2020; 39:5138-5151. [PMID: 32533097 DOI: 10.1038/s41388-020-1347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 01/12/2023]
Abstract
Waldenström's macroglobulinemia (WM) is a non-Hodgkin lymphoma, resulting in antibody-secreting lymphoplasmacytic cells in the bone marrow and pathologies resulting from high levels of monoclonal immunoglobulin M (IgM) in the blood. Despite the key role for BLIMP1 in plasma cell maturation and antibody secretion, its potential effect on WM cell biology has not yet been explored. Here we provide evidence of a crucial role for BLIMP1 in the survival of cells from WM cell line models and further demonstrate that BLIMP1 is necessary for the expression of the histone methyltransferase EZH2 in both WM and multiple myeloma cell lines. The effect of BLIMP1 on EZH2 levels is post-translational, at least partially through the regulation of proteasomal targeting of EZH2. Chromatin immunoprecipitation analysis and transcriptome profiling suggest that the two factors co-operate in regulating genes involved in cancer cell immune evasion. Co-cultures of natural killer cells and cells from a WM cell line further suggest that both factors participate in immune evasion by promoting escape from natural killer cell-mediated cytotoxicity. Together, the interplay of BLIMP1 and EZH2 plays a vital role in promoting the survival of WM cell lines, suggesting a role for the two factors in Waldenström's macroglobulinaemia.
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Affiliation(s)
- Kimberley Jade Anderson
- Department of Anatomy, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland.,Department of Biomedical Science, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland
| | - Árný Björg Ósvaldsdóttir
- Department of Anatomy, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland.,Department of Biomedical Science, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland
| | - Birgit Atzinger
- Department of Anatomy, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland.,Department of Biomedical Science, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland
| | - Gunnhildur Ásta Traustadóttir
- Department of Anatomy, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland.,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland
| | - Kirstine Nolling Jensen
- The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,Department of Biochemistry and Molecular Biology, Faculty of Medicine, Vatnsmýrarvegur 16, University of Iceland, 101, Reykjavík, Iceland.,Department of Immunology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavík, Iceland
| | - Aðalheiður Elín Lárusdóttir
- Department of Anatomy, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland.,Department of Biomedical Science, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland
| | - Jón Thór Bergthórsson
- Department of Biomedical Science, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,Department of Laboratory Haematology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavík, Iceland
| | - Ingibjörg Hardardóttir
- The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,Department of Biochemistry and Molecular Biology, Faculty of Medicine, Vatnsmýrarvegur 16, University of Iceland, 101, Reykjavík, Iceland.,Department of Immunology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavík, Iceland
| | - Erna Magnúsdóttir
- Department of Anatomy, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavik, Iceland. .,Department of Biomedical Science, Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland. .,The University of Iceland Biomedical Center, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.
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27
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Treon SP, Xu L, Guerrera ML, Jimenez C, Hunter ZR, Liu X, Demos M, Gustine J, Chan G, Munshi M, Tsakmaklis N, Chen JG, Kofides A, Sklavenitis-Pistofidis R, Bustoros M, Keezer A, Meid K, Patterson CJ, Sacco A, Roccaro A, Branagan AR, Yang G, Ghobrial IM, Castillo JJ. Genomic Landscape of Waldenström Macroglobulinemia and Its Impact on Treatment Strategies. J Clin Oncol 2020; 38:1198-1208. [PMID: 32083995 DOI: 10.1200/jco.19.02314] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Next-generation sequencing has revealed recurring somatic mutations in Waldenström macroglobulinemia (WM), including MYD88 (95%-97%), CXCR4 (30%-40%), ARID1A (17%), and CD79B (8%-15%). Deletions involving chromosome 6q are common in patients with mutated MYD88 and include genes that modulate NFKB, BCL2, Bruton tyrosine kinase (BTK), and apoptosis. Patients with wild-type MYD88 WM show an increased risk of transformation and death and exhibit many mutations found in diffuse large B-cell lymphoma. The discovery of MYD88 and CXCR4 mutations in WM has facilitated rational drug development, including the development of BTK and CXCR4 inhibitors. Responses to many agents commonly used to treat WM, including the BTK inhibitor ibrutinib, are affected by MYD88 and/or CXCR4 mutation status. The mutation status of both MYD88 and CXCR4 can be used for a precision-guided treatment approach to WM.
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Affiliation(s)
- Steven P Treon
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Lian Xu
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Maria Luisa Guerrera
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Cristina Jimenez
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Zachary R Hunter
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Xia Liu
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Maria Demos
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Joshua Gustine
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Gloria Chan
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Manit Munshi
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Jiaji G Chen
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Amanda Kofides
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Romanos Sklavenitis-Pistofidis
- Department of Medicine, Harvard Medical School, Boston, MA.,Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA.,Clinical Research Development and Phase I Unit, CREA Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Mark Bustoros
- Department of Medicine, Harvard Medical School, Boston, MA.,Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA
| | - Andrew Keezer
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | - Kirsten Meid
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
| | | | - Antonio Sacco
- Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA.,Clinical Research Development and Phase I Unit, CREA Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Aldo Roccaro
- Clinical Research Development and Phase I Unit, CREA Laboratory, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Andrew R Branagan
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Guang Yang
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Irene M Ghobrial
- Department of Medicine, Harvard Medical School, Boston, MA.,Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA
| | - Jorge J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
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28
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de Groen RAL, Schrader AMR, Kersten MJ, Pals ST, Vermaat JSP. MYD88 in the driver's seat of B-cell lymphomagenesis: from molecular mechanisms to clinical implications. Haematologica 2019; 104:2337-2348. [PMID: 31699794 PMCID: PMC6959184 DOI: 10.3324/haematol.2019.227272] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
More than 50 subtypes of B-cell non-Hodgkin lymphoma (B-NHL) are recognized in the most recent World Health Organization classification of 2016. The current treatment paradigm, however, is largely based on 'one-size-fits-all' immune-chemotherapy. Unfortunately, this therapeutic strategy is inadequate for a significant number of patients. As such, there is an indisputable need for novel, preferably targeted, therapies based on a biologically driven classification and risk stratification. Sequencing studies identified mutations in the MYD88 gene as an important oncogenic driver in B-cell lymphomas. MYD88 mutations constitutively activate NF-κB and its associated signaling pathways, thereby promoting B-cell proliferation and survival. High frequencies of the hotspot MYD88(L265P) mutation are observed in extranodal diffuse large B-cell lymphoma and Waldenström macroglobulinemia, thereby demonstrating this mutation's potential as a disease marker. In addition, the presence of mutant MYD88 predicts survival outcome in B-NHL subtypes and it provides a therapeutic target. Early clinical trials targeting MYD88 have shown encouraging results in relapsed/refractory B-NHL. Patients with these disorders can benefit from analysis for the MYD88 hotspot mutation in liquid biopsies, as a minimally invasive method to demonstrate treatment response or resistance. Given these clear clinical implications and the crucial role of MYD88 in lymphomagenesis, we expect that analysis of this gene will increasingly be used in routine clinical practice, not only as a diagnostic classifier, but also as a prognostic and therapeutic biomarker directing precision medicine. This review focuses on the pivotal mechanistic role of mutated MYD88 and its clinical implications in B-NHL.
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Affiliation(s)
| | | | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam.,Cancer Center Amsterdam, Amsterdam
| | - Steven T Pals
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Cancer Center Amsterdam, Amsterdam.,Department of Pathology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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29
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Polyatskin IL, Artemyeva AS, Krivolapov YA. [Revised WHO classification of tumors of hematopoietic and lymphoid tissues, 2017 (4th edition):lymphoid tumors]. Arkh Patol 2019; 81:59-65. [PMID: 31317932 DOI: 10.17116/patol20198103159] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The paper is devoted to changes in the 4th edition of the WHO classification of lymphoid tumors in the 2017 revision, to the principles of the structure and features of the classification. It discusses changes in the identification of new clinical and morphological categories and in the abolition of some previously existing ones. New information about lymphoid tumors, their immunophenotypic and molecular characteristics of classification importance are briefly outlined. The absolute need for molecular genetic studies for the diagnosis of certain lymphoproliferative diseases is underlined. The characteristics of lymphoid pretumor states are given.
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Affiliation(s)
- I L Polyatskin
- N.N.Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - A S Artemyeva
- N.N.Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Yu A Krivolapov
- I.I. Mechnikov North-Western State Medical University, Saint-Petersburg, Russia
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30
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Pathak S, Rowczenio DM, Owen RG, Doody GM, Newton DJ, Taylor C, Taylor J, Cargo C, Hawkins PN, Krause K, Lachmann HJ, Savic S. Exploratory Study of
MYD
88
L265P, Rare
NLRP
3
Variants, and Clonal Hematopoiesis Prevalence in Patients With Schnitzler Syndrome. Arthritis Rheumatol 2019; 71:2121-2125. [DOI: 10.1002/art.41030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/27/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | | | | | | | - Jan Taylor
- St. James's University Hospital Leeds UK
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31
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Nakamura A, Ohwada C, Takeuchi M, Takeda Y, Tsukamoto S, Mimura N, Nagisa OH, Sugita Y, Tanaka H, Wakita H, Aotsuka N, Matsue K, Yokote K, Ohara O, Nakaseko C, Sakaida E. Detection of MYD88 L265P mutation by next-generation deep sequencing in peripheral blood mononuclear cells of Waldenström's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance. PLoS One 2019; 14:e0221941. [PMID: 31483817 PMCID: PMC6726192 DOI: 10.1371/journal.pone.0221941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/19/2019] [Indexed: 01/17/2023] Open
Abstract
We investigated the feasibility of using next-generation sequencing (NGS) technique using molecular barcoding technology to detect MYD88 L265P mutation in unselected peripheral blood mononuclear cells (PBMCs) in 52 patients with Waldenström's macroglobulinemia [1] and 21 patients with IgM-monoclonal gammopathy of undetermined significance (MGUS). The NGS technique successfully detected the MYD88 L265P in unselected PBMCs at a sensitivity of 0.02%, which was ×5 higher than that of AS-PCR. All the results between paired BM and PB samples from 2 IgM MGUS and 4 untreated WM patients matched completely. MYD88 L265P mutation was detected in 14/21 (66.7%), 14/19 (73.7%), and 10/33 (30.3%) with the median mutant allele burden of 0.36% (range, 0.06-2.85%), 0.48% (range, 0.02-32.3%), and 0.16% (range, 0.02-33.8%), in IgM-MGUS, untreated WM, and previously treated WM, respectively. Multiple linear regression analysis identified an absolute peripheral lymphocyte count as the positive predictor of PB mutant allele burden (R2 = 0,72, P<0.0001). Our non-invasive, simple NGS method has the potential to detect MYD88 L265P mutations in PBMCs of IgM MGUS and WM patients, which may especially utilized for monitoring minimal residual tumor burden after treatment.
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Affiliation(s)
- Ayako Nakamura
- Department of Hematology, Chiba University Hospital, Chiba, Japan
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
- Hematology and Oncology, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Chikako Ohwada
- Department of Hematology, Chiba University Hospital, Chiba, Japan
- * E-mail:
| | | | - Yusuke Takeda
- Department of Hematology, Chiba University Hospital, Chiba, Japan
| | | | - Naoya Mimura
- Department of Hematology, Chiba University Hospital, Chiba, Japan
- Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan
| | | | - Yasumasa Sugita
- Department of Hematology, Oami Municipal Hospital, Oami-Shirasato, Japan
| | - Hiroaki Tanaka
- Department of Hematology, Asahi General Hospital, Asahi, Japan
| | - Hisashi Wakita
- Hematology and Oncology, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Nobuyuki Aotsuka
- Hematology and Oncology, Japanese Red Cross Narita Hospital, Narita, Japan
| | - Kosei Matsue
- Department of Hematology/Oncology, Kameda General Hospital, Kamogawa, Japan
| | - Koutaro Yokote
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Osamu Ohara
- Department of Technology Development, Kazusa DNA Research Institute, Kisarazu, Japan
- Future Medicine Education and Research Organization, Chiba University, Chiba, Japan
| | - Chiaki Nakaseko
- Department of Hematology, Chiba University Hospital, Chiba, Japan
- Department of Hematology, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Chiba, Japan
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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32
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Gertz MA. Waldenström macroglobulinemia: 2019 update on diagnosis, risk stratification, and management. Am J Hematol 2019; 94:266-276. [PMID: 30328142 DOI: 10.1002/ajh.25292] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 12/30/2022]
Abstract
DISEASE OVERVIEW Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with immunoglobulin M (IgM) monoclonal protein. Clinical features include anemia, thrombocytopenia, hepatosplenomegaly, lymphadenopathy, and rarely hyperviscosity. DIAGNOSIS Presence of IgM monoclonal protein associated with ≥10% clonal lymphoplasmacytic cells in bone marrow confirms the diagnosis. The L265P mutation in MYD88 is detectable in >90% of patients and is found in the majority of IgM monoclonal gammopathy of undetermined significance patients. RISK STRATIFICATION Age, hemoglobin level, platelet count, β2 microglobulin, and monoclonal IgM concentrations are characteristics that are predictive of outcomes. RISK-ADAPTED THERAPY Not all patients who fulfill WM criteria require therapy; these patients can be observed until symptoms develop. Rituximab-monotherapy is inferior to regimens that combine it with bendamustine, an alkylating agent, a proteosome inhibitor, or ibrutinib. Purine nucleoside analogs are active but usage is declining for less toxic alternatives. The preferred Mayo Clinic induction is rituximab and bendamustine. Potential for stem cell transplantation should be considered in selected younger patients. MANAGEMENT OF REFRACTORY DISEASE Bortezomib, fludarabine, thalidomide, everolimus, ibrutinib, carfilzomib, lenalidomide, and bendamustine have all been shown to have activity in relapsed WM. Given WM's natural history, reduction of therapy toxicity is an important part of treatment selection.
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Affiliation(s)
- Morie A. Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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33
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Onsets of progression and second treatment determine survival of patients with symptomatic Waldenström macroglobulinemia. Blood Adv 2018; 2:3102-3111. [PMID: 30455359 DOI: 10.1182/bloodadvances.2018021287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022] Open
Abstract
Few reports assess prognosis during follow-up of patients with symptomatic Waldenström macroglobulinemia (WM). In 121 WM patients treated between 1993 and 2016, we analyzed the prognostic role during the clinical course of the initial International Prognostic Scoring System for WM (IPSSWM). Then, we assessed onset of response, progression, and second treatment initiation coded as time-dependent covariates. High-risk IPSSWM was an adverse prognostic factor for survival after first treatment initiation (SAFTI). Nevertheless, the corresponding Dxy concordance index obtained in multiple landmark analyses decreased from 0.24 to 0.08 during the first 6 years, in accordance with a departure from the proportional hazard assumption. By contrast with onset of response (whatever its level), onset of progression and initiation of second-line treatment retained prognostic value for SAFTI (P = .02 and P = .006, respectively). These findings were confirmed in cause-specific Cox models for deaths related to WM, but not for unrelated deaths. Time to progression after first-line treatment and time to initiation of second-line treatment had no prognostic value for survival after these 2 events. These results were confirmed in an independent series of 119 patients homogeneously treated with chemoimmunotherapy. Finally, after second-line and third-line treatment, onset of progression had significant prognostic value for subsequent risk of related death only. Thus, taking initial IPSSWM and delayed response to treatment into account, only onset of progression and second treatment initiation provided additional prognostic information for SAFTI. Therefore, progression-free survival or time to next treatment may be satisfactory surrogate end points of SAFTI in WM.
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34
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Treon SP, Xu L, Liu X, Hunter ZR, Yang G, Castillo JJ. Genomic Landscape of Waldenström Macroglobulinemia. Hematol Oncol Clin North Am 2018; 32:745-752. [DOI: 10.1016/j.hoc.2018.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Kastritis E, Leblond V, Dimopoulos MA, Kimby E, Staber P, Kersten MJ, Tedeschi A, Buske C. Waldenström's macroglobulinaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv41-iv50. [PMID: 29982402 DOI: 10.1093/annonc/mdy146] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- E Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Leblond
- Department of Hematology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, UPMC GRC11-GRECHY, Paris, France
| | - M A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - E Kimby
- Division of Hematology, Department of Medicine at Huddinge, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - P Staber
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Vienna General Hospital, Vienna, Austria
| | - M J Kersten
- Department of Hematology, Academic Medical Center
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - A Tedeschi
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
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36
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New Molecular Technologies for Minimal Residual Disease Evaluation in B-Cell Lymphoid Malignancies. J Clin Med 2018; 7:jcm7090288. [PMID: 30231510 PMCID: PMC6162632 DOI: 10.3390/jcm7090288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022] Open
Abstract
The clearance of malignant clonal cells significantly correlates with clinical outcomes in many hematologic malignancies. Accurate and high throughput tools for minimal residual disease (MRD) detection are needed to overcome some drawbacks of standard molecular techniques; such novel tools have allowed for higher sensitivity analyses and more precise stratification of patients, based on molecular response to therapy. In this review, we depict the recently introduced digital PCR and next-generation sequencing technologies, describing their current application for MRD monitoring in lymphoproliferative disorders. Moreover, we illustrate the feasibility of these new technologies to test less invasive and more patient-friendly tissues sources, such as "liquid biopsy".
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37
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Bagratuni T, Ntanasis-Stathopoulos I, Gavriatopoulou M, Mavrianou-Koutsoukou N, Liacos C, Patseas D, Kanellias N, Migkou M, Ziogas DC, Eleutherakis-Papaiakovou E, Roussou M, Fotiou D, Terpos E, Kastritis E, Dimopoulos MA. Detection of MYD88 and CXCR4 mutations in cell-free DNA of patients with IgM monoclonal gammopathies. Leukemia 2018; 32:2617-2625. [PMID: 30026568 PMCID: PMC6286389 DOI: 10.1038/s41375-018-0197-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/29/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
Liquid biopsyis being integrated into cancer diagnostics with profound therapeutic implications. However, its role in Waldenström's Macroglobulinemia (WM) and IgM monoclonal gammopathies is still unclear. In this study, we evaluated the role of peripheral blood (PB) cell-free DNA (cfDNA) in characterizing the mutational status of MYD88 and CXCR4 of patients with IgM monoclonal gammopathies. Paired bone marrow (BM) tumor DNA (tDNA) and PB cfDNA samples from 98 patients (9 MGUS, 45 with WM in remission, 44 with smoldering WM, newly diagnosed or relapsed WM) and 10 controls with non-IgM monoclonal gammopathies were analyzed. Regarding MYD88L265P mutation, 76 patients had paired tDNA and cfDNA informative samples. Among patients with WM in remission, 65% harbored the MYD88L265P mutation, whereas the corresponding percentage among smoldering/newly diagnosed or relapsed WM was 92%. The overall concordance rate was 94% (72/76). For CXCR4 mutations, 65 patients had paired informative tDNA and cfDNA samples. The overall concordance rate was 90% (59/65). All controls had wild-type MYD88 and CXCR4. In conclusion, PB cfDNA is a useful, minimally invasive, cost-effective, and time-effective tool for the identification of the presence of MYD88 and CXCR4 mutations in patients with IgM monoclonal gammopathies avoiding unnecessary BM assessment.
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Affiliation(s)
- Tina Bagratuni
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nefeli Mavrianou-Koutsoukou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christine Liacos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Patseas
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kanellias
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Magdalini Migkou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios C Ziogas
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Roussou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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38
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Yosef A, Touloukian EZ, Nambudiri VE. Ibrutinib in the management of Waldenstrom macroglobulinemia. J Oncol Pharm Pract 2018; 25:434-441. [PMID: 29996737 DOI: 10.1177/1078155218786037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bruton tyrosine kinase plays a critical role in hastening cell proliferation. Bruton tyrosine kinase inhibitors are a class of immunotheraputic agents that disrupt this signaling pathway. Ibrutinib, a novel Bruton tyrosine kinase inhibitor approved by the Food and Drug Administration (FDA) for the treatment of Waldenstrom macroglobulinemia in patients who have failed treatment with other agents, has emerged as an important therapeutic agent in the management of Waldenstrom macroglobulinemia and other plasma cell dyscrasias. Ibrutinib has shown to increase progression free survival and improve overall mortality. We present a review of ibrutinib, beginning with an overview of the Bruton tyrosine kinase pathway and clinically relevant gene mutations impacting treatment and prognosis for patients with Waldenstrom macroglobulinemia, followed by evidence supporting therapeutic indications for ibrutinib, and detailing its safety and efficacy evidence, current clinical guidelines, adverse effects and their management, and finally challenges of drug resistance. We also present findings on newly developed Bruton tyrosine kinase inhibitors in the therapeutic pipeline to provide readers insight into this rapidly evolving corner of oncology pharmacy practice.
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Affiliation(s)
- Amir Yosef
- Grand Strand Regional Medical Center, Myrtle Beach, USA
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39
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Fontanilles M, Marguet F, Bohers É, Viailly PJ, Dubois S, Bertrand P, Camus V, Mareschal S, Ruminy P, Maingonnat C, Lepretre S, Veresezan EL, Derrey S, Tilly H, Picquenot JM, Laquerrière A, Jardin F. Non-invasive detection of somatic mutations using next-generation sequencing in primary central nervous system lymphoma. Oncotarget 2018. [PMID: 28636991 PMCID: PMC5564634 DOI: 10.18632/oncotarget.18325] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose Primary central nervous system lymphomas (PCNSL) have recurrent genomic alterations. The main objective of our study was to demonstrate that targeted sequencing of circulating cell-free DNA (cfDNA) released by PCNSL at the time of diagnosis could identify somatic mutations by next-generation sequencing (NGS). Patients and Methods PlasmacfDNA and matched tumor DNA (tDNA) from 25 PCNSL patients were sequenced using an Ion Torrent Personal Genome Machine (Life Technologies®). First, patient-specific targeted sequencing of identified somatic mutations in tDNA was performed. Then, a second sequencing targeting MYD88 c.T778C was performed and compared to plasma samples from 25 age-matched control patients suffering from other types of cancer. Results According to the patient-specific targeted sequencing, eight patients (32% [95% CI 15-54%]) had detectable somatic mutations in cfDNA. Considering MYD88 sequencing, six patients had the specific c.T778C alteration detected in plasma. Using a control group, the sensitivity was 24% [9-45%] and the specificity was 100%. Tumor volume or deep brain structure involvement did not influence the detection of somatic mutations in plasma. Conclusion This pilot study provided evidence that somatic mutations can be detected by NGS in the cfDNA of a subset of patients suffering from PCNSL.
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Affiliation(s)
- Maxime Fontanilles
- Department of Hematology, Cancer Center Henri Becquerel, 76000 Rouen, France.,INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Florent Marguet
- INSERM U1245 and Hôpital Charles Nicolle, NeoVasc Team, University of Normandy, UNIVROUEN, CHU-Hôpitaux de Rouen, 76031 Rouen, France.,Department of Neuropathology, Hôpital Charles Nicolle, Normandy Center for Genomic and Personalized Medicine, CHU-Hôpitaux de Rouen, 76031 Rouen, France
| | - Élodie Bohers
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Pierre-Julien Viailly
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Sydney Dubois
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Philippe Bertrand
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Vincent Camus
- Department of Hematology, Cancer Center Henri Becquerel, 76000 Rouen, France.,INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Sylvain Mareschal
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Philippe Ruminy
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Catherine Maingonnat
- INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | - Stéphane Lepretre
- Department of Hematology, Cancer Center Henri Becquerel, 76000 Rouen, France
| | | | - Stéphane Derrey
- Department of Neurosurgery, Hôpital Charles Nicolle, CHU-Hôpitaux de Rouen, 76031 Rouen, France
| | - Hervé Tilly
- Department of Hematology, Cancer Center Henri Becquerel, 76000 Rouen, France.,INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
| | | | - Annie Laquerrière
- INSERM U1245 and Hôpital Charles Nicolle, NeoVasc Team, University of Normandy, UNIVROUEN, CHU-Hôpitaux de Rouen, 76031 Rouen, France.,Department of Neuropathology, Hôpital Charles Nicolle, Normandy Center for Genomic and Personalized Medicine, CHU-Hôpitaux de Rouen, 76031 Rouen, France
| | - Fabrice Jardin
- Department of Hematology, Cancer Center Henri Becquerel, 76000 Rouen, France.,INSERM U1245, Cancer Center Henri Becquerel, Institute of Research and Innovation in Biomedicine (IRIB), University of Normandy, UNIVROUEN, 76000 Rouen, France
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40
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Tanzima Nuhat S, Sakata-Yanagimoto M, Komori D, Hattori K, Suehara Y, Fukumoto K, Fujisawa M, Kusakabe M, Matsue K, Wakamatsu H, Shimadzu M, Chiba S. Droplet digital polymerase chain reaction assay and peptide nucleic acid-locked nucleic acid clamp method for RHOA mutation detection in angioimmunoblastic T-cell lymphoma. Cancer Sci 2018; 109:1682-1689. [PMID: 29493850 PMCID: PMC5980118 DOI: 10.1111/cas.13557] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 12/11/2022] Open
Abstract
Angioimmunoblastic T‐cell lymphoma (AITL) is a subtype of nodal peripheral T‐cell lymphoma (PTCL). Somatic RHOA mutations, most frequently found at the hotspot site c.50G > T, p.Gly17Val (G17V RHOA mutation) are a genetic hallmark of AITL. Detection of the G17V RHOA mutations assists prompt and appropriate diagnosis of AITL. However, an optimal detection method for the G17V RHOA mutation remains to be elucidated. We compared the sensitivity and concordance of next‐generation sequencing (NGS), droplet digital PCR (ddPCR) and peptide nucleic acid‐locked nucleic acid (PNA‐LNA) clamp method for detecting the G17V RHOA mutation. G17V RHOA mutations were identified in 27 of 67 (40.3%) PTCL samples using NGS. ddPCR and PNA‐LNA clamp method both detected G17V mutations in 4 samples in addition to those detected with NGS (31 of 67, 46.3%). Additionally, variant allele frequencies with ddPCR and those with NGS showed high concordance (P < .001). Three other RHOA mutations involving the p.Gly17 position (c.[49G > T;50G > T], p.Gly17Leu in PTCL198; c.[50G > T;51A > C], p.Gly17Val in PTCL216; and c.50G > A, p.Gly17Glu in PTCL223) were detected using NGS. These sequence changes could not appropriately be detected using the ddPCR assay and the PNA‐LNA clamp method although both indicated that the samples might have mutations. In total, 34 out of 67 PTCL samples (50.7%) had RHOA mutations at the p.Gly17 position. In conclusion, our results suggested that a combination of ddPCR/PNA‐LNA clamp methods and NGS are best method to assist the diagnosis of AITL by detecting RHOA mutations at the p.Gly17 position.
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Affiliation(s)
- Sharna Tanzima Nuhat
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | | | - Daisuke Komori
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Keiichiro Hattori
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Yasuhito Suehara
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Kota Fukumoto
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Manabu Fujisawa
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Manabu Kusakabe
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | | | | | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Life Science Centre of Tsukuba Advanced Research Alliance University of Tsukuba, Tsukuba, Japan
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41
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Drandi D, Genuardi E, Dogliotti I, Ferrante M, Jiménez C, Guerrini F, Schirico ML, Mantoan B, Muccio V, Lia G, Zaccaria GM, Omedè P, Passera R, Orsucci L, Benevolo G, Cavallo F, Galimberti S, Sanz RG, Boccadoro M, Ladetto M, Ferrero S. Highly sensitive MYD88L265P mutation detection by droplet digital polymerase chain reaction in Waldenström macroglobulinemia. Haematologica 2018; 103:1029-1037. [PMID: 29567768 PMCID: PMC6058774 DOI: 10.3324/haematol.2017.186528] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/23/2018] [Indexed: 12/14/2022] Open
Abstract
We here describe a novel method for MYD88L265P mutation detection and minimal residual disease monitoring in Waldenström macroglobulinemia, by droplet digital polymerase chain reaction, in bone marrow and peripheral blood cells, as well as in circulating cell-free DNA. Our method shows a sensitivity of 5.00×10−5, which is far superior to the widely used allele-specific polymerase chain reaction (1.00×10−3). Overall, 291 unsorted samples from 148 patients (133 with Waldenström macroglobulinemia, 11 with IgG lymphoplasmacytic lymphoma and 4 with IgM monoclonal gammopathy of undetermined significance) were analyzed: 194 were baseline samples and 97 were followup samples. One hundred and twenty-two of 128 (95.3%) bone marrow and 47/66 (71.2%) baseline peripheral blood samples scored positive for MYD88L265P. To investigate whether MYD88L265P detection by droplet digital polymerase chain reaction could be used for minimal residual disease monitoring, mutation levels were compared with IGH-based minimal residual disease analysis in 10 patients, and was found to be as informative as the classical, standardized, but not yet validated in Waldenström macroglobulinemia, IGH-based minimal residual disease assay (r2=0.64). Finally, MYD88L265P detection by droplet digital polymerase chain reaction on plasma circulating tumor DNA from 60 patients showed a good correlation with bone marrow findings (bone marrow median mutational value 1.92×10−2, plasma circulating tumor DNA value: 1.4×10−2, peripheral blood value: 1.03×10−3). This study indicates that droplet digital polymerase chain reaction assay of MYD88L265P is a feasible and sensitive tool for mutation screening and minimal residual disease monitoring in Waldenström macroglobulinemia. Both unsorted bone marrow and peripheral blood samples can be reliably tested, as can circulating tumor DNA, which represents an attractive, less invasive alternative to bone marrow for MYD88L265P detection.
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Affiliation(s)
- Daniela Drandi
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
| | - Irene Dogliotti
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1U, AOU Città della Salute e della Scienza di Torino, Italy
| | - Martina Ferrante
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
| | - Cristina Jiménez
- Hematology Department, University Hospital of Salamanca and Research Biomedical Institute of Salamanca, Spain
| | - Francesca Guerrini
- Division of Hematology, Department of Oncology, Santa Chiara Hospital, Pisa, Italy
| | - Mariella Lo Schirico
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
| | - Barbara Mantoan
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
| | - Vittorio Muccio
- Division of Hematology 1U, AOU Città della Salute e della Scienza di Torino, Italy
| | - Giuseppe Lia
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
| | - Gian Maria Zaccaria
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy.,Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Italy
| | - Paola Omedè
- Division of Hematology 1U, AOU Città della Salute e della Scienza di Torino, Italy
| | - Roberto Passera
- Biostatistics Unit, Division of Nuclear Medicine, AOU Città della Salute e della Scienza di Torino, Italy
| | - Lorella Orsucci
- Division of Hematology 2, AOU Città della Salute e della Scienza di Torino, Italy
| | - Giulia Benevolo
- Division of Hematology 2, AOU Città della Salute e della Scienza di Torino, Italy
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1U, AOU Città della Salute e della Scienza di Torino, Italy
| | - Sara Galimberti
- Division of Hematology, Department of Oncology, Santa Chiara Hospital, Pisa, Italy
| | - Ramón García Sanz
- Hematology Department, University Hospital of Salamanca and Research Biomedical Institute of Salamanca, Spain
| | - Mario Boccadoro
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1U, AOU Città della Salute e della Scienza di Torino, Italy
| | - Marco Ladetto
- Division of Hematology, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy.,Division of Hematology 1U, AOU Città della Salute e della Scienza di Torino, Italy
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Castillo JJ, Gustine JN, Meid K, Dubeau T, Severns P, Xu L, Yang G, Hunter ZR, Treon SP. Low levels of von Willebrand markers associate with high serum IgM levels and improve with response to therapy, in patients with Waldenström macroglobulinaemia. Br J Haematol 2018. [PMID: 29532913 DOI: 10.1111/bjh.15200] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Joshua N Gustine
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kirsten Meid
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Toni Dubeau
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Patricia Severns
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lian Xu
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Guang Yang
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Zachary R Hunter
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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43
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Castillo JJ, Gustine JN, Meid K, Xu L, Hunter ZR, Treon SP. Comparing apples to oranges: A commentary on the Mayo study of MYD88 significance in Waldenstrom's macroglobulinemia. Am J Hematol 2018; 93:E69-E71. [PMID: 29218718 DOI: 10.1002/ajh.24997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Jorge J. Castillo
- Department of Medicine; Harvard Medical School; and Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Joshua N. Gustine
- Department of Medicine; Harvard Medical School; and Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Kirsten Meid
- Department of Medicine; Harvard Medical School; and Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Lian Xu
- Department of Medicine; Harvard Medical School; and Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Zachary R. Hunter
- Department of Medicine; Harvard Medical School; and Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute; Boston Massachusetts
| | - Steven P. Treon
- Department of Medicine; Harvard Medical School; and Bing Center for Waldenstrom's Macroglobulinemia, Dana-Farber Cancer Institute; Boston Massachusetts
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44
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45
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Abeykoon JP, Paludo J, King RL, Ansell SM, Gertz MA, LaPlant BR, Halvorson AE, Gonsalves WI, Dingli D, Fang H, Rajkumar SV, Lacy MQ, He R, Kourelis T, Reeder CB, Novak AJ, McPhail ED, Viswanatha DS, Witzig TE, Go RS, Habermann TM, Buadi FK, Dispenzieri A, Leung N, Lin Y, Thompson CA, Hayman SR, Kyle RA, Kumar SK, Kapoor P. MYD88 mutation status does not impact overall survival in Waldenström macroglobulinemia. Am J Hematol 2018; 93:187-194. [PMID: 29080258 DOI: 10.1002/ajh.24955] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 12/22/2022]
Abstract
Waldenström macroglobulinemia (WM) is an immunoglobulin M-associated lymphoma, with majority of cases demonstrating MYD88 locus alteration, most commonly, MYD88L265P . Owing to low prevalence of the wild-type (WT) MYD88 genotype in WM, clinically relevant data in this patient population are sparse, with one study showing nearly a 10-fold increased risk of mortality in this subgroup compared to patients with MYD88L265P mutation. We studied a large cohort of patients with MYD88L265P and MYD88WT WM, evaluated at Mayo Clinic, Rochester, between 1995 and 2016, to specifically assess the impact of these genotypes on clinical course. Of 557 patients, MYD88L265P mutation status, as determined by allele-specific polymerase chain reaction, was known in 219, and 174 (79%) of those exhibited MYD88L265P , 157 of 174 patients had active disease. Of 45 (21%) patients with MYD88WT genotype, 44 had active disease. The estimated median follow-up was 7.0 years; median overall survival was 10.2 years (95% CI: 8.4-16.5) for MYD88L265P versus 13.9 years (95% CI: 6.4-29.3) for the MYD88WT (P = 0.86). The time-to-next therapy from frontline treatment and the presenting features were similar in the two patient populations. For patients with smoldering WM at diagnosis, the median time-to-progression to active disease was 2.8 years (95% CI: 2.2-3.8) in the MYD88L265P cohort and 1.9 years (95% CI: 0.7-3.1) in the MYD88WT cohort (P = 0.21). The frequency of transformation to high-grade lymphoma, or the development of therapy-elated myelodysplastic syndrome was higher in the MYD88WT cohort (16% versus 4% in the MYD88L265P , P = 0.009). In conclusion, MYD88L265P mutation does not appear to be a determinant of outcome, and its presence may not be a disease-defining feature in WM. Our findings warrant external validation, preferably through prospective studies.
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46
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Mazzucchelli M, Frustaci AM, Deodato M, Cairoli R, Tedeschi A. Waldenstrom's Macroglobulinemia: An Update. Mediterr J Hematol Infect Dis 2018; 10:e2018004. [PMID: 29326801 PMCID: PMC5760071 DOI: 10.4084/mjhid.2018.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022] Open
Abstract
Waldenstrom Macroglobulinemia is a rare lymphoproliferative disorder with distinctive clinical features. Diagnostic and prognostic characterisation in WM significantly changed with the discovery of two molecular markers: MYD88 and CXCR4. Mutational status of these latter influences both clinical presentation and prognosis and demonstrated therapeutic implications. Treatment choice in Waldenstrom disease is strictly guided by patients age and characteristics, specific goals of therapy, the necessity for rapid disease control, the risk of treatment-related neuropathy, disease features, the risk of immunosuppression or secondary malignancies and potential for future autologous stem cell transplantation. The therapeutic landscape has expanded during the last years and the approval of ibrutinib, the first drug approved for Waldenstrom Macroglobulinemia, represents a significant step forward for a better management of the disease.
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Affiliation(s)
- Maddalena Mazzucchelli
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Anna Maria Frustaci
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Marina Deodato
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Roberto Cairoli
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano
| | - Alessandra Tedeschi
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano
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Abstract
Waldenstrom Macroglobulinemia is a rare lymphoproliferative disorder with distinctive clinical features. Diagnostic and prognostic characterisation in WM significantly changed with the discovery of two molecular markers: MYD88 and CXCR4. Mutational status of these latter influences both clinical presentation and prognosis and demonstrated therapeutic implications. Treatment choice in Waldenstrom disease is strictly guided by patients age and characteristics, specific goals of therapy, the necessity for rapid disease control, the risk of treatment-related neuropathy, disease features, the risk of immunosuppression or secondary malignancies and potential for future autologous stem cell transplantation. The therapeutic landscape has expanded during the last years and the approval of ibrutinib, the first drug approved for Waldenstrom Macroglobulinemia, represents a significant step forward for a better management of the disease.
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Paludo J, Ansell SM. Advances in the understanding of IgM monoclonal gammopathy of undetermined significance. F1000Res 2017; 6:2142. [PMID: 29399323 PMCID: PMC5785715 DOI: 10.12688/f1000research.12880.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/12/2022] Open
Abstract
Among monoclonal gammopathies of undetermined significance (MGUSs), the immunoglobulin M (IgM) MGUS subtype stands as a unique entity and plays a pivotal role as a pre-malignant condition for multiple B-cell non-Hodgkin lymphomas, most notably Waldenström macroglobulinemia (WM). A relationship between IgM MGUS and WM has been proposed for decades. However, insight regarding the pathobiology of these two conditions improved significantly in recent years, strengthening the hypothesis that WM and IgM MGUS are different stages of the same disease. Therefore, the understanding of IgM MGUS and that of WM are interconnected and advances in one will likely impact the other. Furthermore, IgM MGUS has been more commonly recognized as the underlying etiology of IgM-related disorders. In this review, we explore recent advances in the understanding of the pathobiology of IgM MGUS and WM and the treatment of common IgM-related disorders.
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Affiliation(s)
- Jonas Paludo
- Department of Medicine, Division of Hematology, Mayo Clinic , Rochester, USA
| | - Stephen M Ansell
- Department of Medicine, Division of Hematology, Mayo Clinic , Rochester, USA
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Thieblemont C. Improved biological insight and influence on management in indolent lymphoma. Talk 3: update on nodal and splenic marginal zone lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:371-378. [PMID: 29222281 PMCID: PMC6142593 DOI: 10.1182/asheducation-2017.1.371] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Splenic marginal zone lymphoma (SMZL) and nodal marginal zone lymphoma (NMZL) are rare indolent chronic B-cell lymphomas. Prognosis is typically good with median survival around 10-15 years. Management is generally based on the presence of symptoms or high tumor burden. There are no standard treatments for these 2 entities, and therapeutic strategies are rapidly evolving. Clinical developments for these 2 entities are oriented by genomic studies, with largely overlapping mutational profiles involving the NOTCH, B-cell receptor (BcR) and nuclear factor κB (NF-κB) signaling, chromatin remodeling, and the cytoskeleton. Although new therapeutic options based on targeting signaling pathways and overcoming resistance are increasingly available, few specific prospective studies are performed for these rare subtypes, limiting the conclusions that can be drawn. Novel drugs targeting B-cell signaling have shown promise, including ibrutinib and copanlisib. The second-generation oral immunomodalator (IMiD) lenalidomide showed impressive results when combined with rituximab. Other potential solutions include targeting the NF-κB, JAK/STAT, BCL2, NOTCH, and Toll-like receptor signaling pathways; however, studies in these 2 MZL entities are yet to prove a definitive benefit. Molecular profiling is now a cornerstone of diagnostic, prognostic, and therapeutic strategies to offer patient- and disease-specific solutions. The development of a wider range of effective targeted therapies and prognostic biomarkers is keenly awaited and is expected to strongly affect the natural history of SMZL and NMZL.
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Affiliation(s)
- Catherine Thieblemont
- Hemato-Oncology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; Diderot University, Sorbonne Paris-Cité, Paris, France; and EA7324, Descartes University, Paris, France
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50
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Hiemcke-Jiwa LS, Minnema MC, Radersma-van Loon JH, Jiwa NM, de Boer M, Leguit RJ, de Weger RA, Huibers MMH. The use of droplet digital PCR in liquid biopsies: A highly sensitive technique for MYD88 p.(L265P) detection in cerebrospinal fluid. Hematol Oncol 2017; 36:429-435. [PMID: 29210102 DOI: 10.1002/hon.2489] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/12/2017] [Accepted: 11/06/2017] [Indexed: 12/28/2022]
Abstract
The gold standard for diagnosis of central nervous system lymphomas still regards a stereotactic brain biopsy, with the risk of major complications for the patient. As tumor cells can be detected in cerebrospinal fluid (CSF), CSF analysis can be used as an alternative. In this respect, mutation analysis in CSF can be of added value to other diagnostic parameters such a cytomorphology and clonality analysis. A well-known example of targeted mutation analysis entails MYD88 p.(L265P) detection, which is present in the majority of Bing Neel syndrome and primary central nervous system lymphoma (PCNSL) patients. Unfortunately, tumor yield in CSF can be very low. Therefore, use of the highly sensitive droplet digital PCR (ddPCR) might be a suitable analysis strategy for targeted mutation detection. We analyzed 26 formalin fixed paraffin embedded (FFPE) samples (8 positive and 18 negative for MYD88 p.(L265P) mutation) by ddPCR, of which the results were compared with next generation sequencing (NGS). Subsequently, 32 CSF samples were analyzed by ddPCR. ddPCR and NGS results on FFPE material showed 100% concordance. Among the 32 CSF samples, 9 belonged to patients with lymphoplasmacytic lymphoma (LPL) and clinical suspicion of Bing Neel syndrome, and 3 belonged to patients with PCNSL. Nine of these samples tested positive for MYD88 p.(L265P) (8 LPL and 1 PCNSL). This study shows that sensitive MYD88 mutation analysis by ddPCR in CSF is highly reliable and can be applied even when DNA input is low. Therefore, ddPCR is of added value to current diagnostic parameters, especially when the available amount of DNA is limited.
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Affiliation(s)
- Laura S Hiemcke-Jiwa
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique C Minnema
- Deparment of Hematology, University Medical Center Utrecht Cancer Center, Utrecht, The Netherlands
| | | | - N Mehdi Jiwa
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirthe de Boer
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roos J Leguit
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel A de Weger
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon M H Huibers
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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