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Balikó A, Szakács Z, Kajtár B, Ritter Z, Gyenesei A, Farkas N, Kereskai L, Vályi-Nagy I, Alizadeh H, Pajor L. Clinicopathological analysis of diffuse large B-cell lymphoma using molecular biomarkers: a retrospective analysis from 7 Hungarian centers. Front Oncol 2023; 13:1224733. [PMID: 37746254 PMCID: PMC10514474 DOI: 10.3389/fonc.2023.1224733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background The clinical and genetic heterogeneity of diffuse large B-cell lymphoma (DLBCL) presents distinct challenges in predicting response to therapy and overall prognosis. The main objective of this study was to assess the application of the immunohistochemistry- and interphase fluorescence in situ hybridization (FISH)-based molecular markers in the diagnosis of DLBCL and its prognostic value in patients treated with rituximab-based immunochemotherapy. Methods This is a multicenter, retrospective study, which analyzed data from 7 Hungarian hematology centers. Eligible patients were adults, had a histologically confirmed diagnosis of DLBCL, were treated with rituximab-based immunochemotherapy in the first line, and had available clinicopathological data including International Prognostic Index (IPI). On the specimens, immunohistochemistry and FISH methods were performed. Germinal center B-cell like (GCB) and non-GCB subtypes were classified by the Hans algorithm. Outcomes included overall survival (OS), event-free survival (EFS), and EFS at 2 years (EFS24). For survival analysis, we used Kaplan-Meier curves with the log-rank test and multivariate Cox regression. Results A total of 247 DLBCL cases were included. Cases were positive for MYC, BCL2, BCL6, and MUM1 expression in 52.1%, 66.2%, 72.6%, and 77.8%, respectively. BCL6 translocation, BCL2 gene copy number (GCN) gain, IGH::MYC translocation, MYC GCN gain, IGH::BCL2 translocation, and BCL6 GCN gain were detected in 21.4%, 14.1%, 7.3%, 1.8%, 7.3%, and 0.9%, respectively. At a median follow-up of 52 months, 140 patients (56.7%) had disease progression or relapse. The Kaplan-Meier estimate for EFS24 was 56.2% (CI: 50.4-62.8%). In univariate analysis, only IPI and BCL6 expression were significant predictors of both OS and EFS, whereas MUM1 predicted EFS only. In multivariate analysis, the IPI score was a significant independent negative, whereas MIB-1 and BCL6 protein expressions were significant independent positive predictors of both OS and EFS. Conclusion In our study, we found that only IPI, BCL6 protein expression and MIB-1 protein expression are independent predictors of survival outcomes in DLBCL. We did not find any difference in survival by GCB vs. non-GCB subtypes. These findings may improve prognostication in DLBCL and can contribute to designing further research in the area.
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Affiliation(s)
- Anett Balikó
- Tolna County Balassa János Hospital, Szekszárd, ;Hungary
- PhD Doctoral School – Interdisciplinary Medical Sciences (D93), Medical School, University of Pécs, Pécs, ;Hungary
| | - Zsolt Szakács
- First Department of Medicine, Medical School, University of Pécs, Pécs, ;Hungary
| | - Béla Kajtár
- Department of Pathology, Medical School, University of Pécs, Pécs, ;Hungary
| | - Zsombor Ritter
- Department of Medical Imaging, Medical School, University of Pécs, Pécs, ;Hungary
| | - Attila Gyenesei
- Szentágothai Research Centre, University of Pécs, Pécs, ;Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, ;Hungary
| | - László Kereskai
- Department of Pathology, Medical School, University of Pécs, Pécs, ;Hungary
| | - István Vályi-Nagy
- South-Pest Hospital Centre – National Institute for Infectology and Haematology, Budapest, ;Hungary
| | - Hussain Alizadeh
- First Department of Medicine, Medical School, University of Pécs, Pécs, ;Hungary
| | - László Pajor
- Department of Pathology, Medical School, University of Pécs, Pécs, ;Hungary
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2
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Baptista MJ, Tapia G, Muñoz‐Marmol A, Muncunill J, Garcia O, Montoto S, Gribben JG, Calaminici M, Martinez A, Veloza L, Martínez‐Trillos A, Aldamiz T, Menarguez J, Terol M, Ferrandez A, Alcoceba M, Briones J, González‐Barca E, Climent F, Muntañola A, Moraleda J, Provencio M, Abrisqueta P, Abella E, Colomo L, García‐Ballesteros C, Garcia‐Caro M, Sancho J, Ribera J, Mate J, Navarro J. Genetic and phenotypic characterisation of HIV-associated aggressive B-cell non-Hodgkin lymphomas, which do not occur specifically in this population: diagnostic and prognostic implications. Histopathology 2022; 81:826-840. [PMID: 36109172 PMCID: PMC9828544 DOI: 10.1111/his.14798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Abstract
The frequency of aggressive subtypes of B-cell non-Hodgkin lymphoma (B-NHL), such as high-grade B-cell lymphomas (HGBL) with MYC and BCL2 and/or BCL6 rearrangement (HGBL-DH/TH) or Burkitt-like lymphoma (BL) with 11q aberration, is not well known in the HIV setting. We aimed to characterise HIV-associated aggressive B-NHL according to the 2017 WHO criteria, and to identify genotypic and phenotypic features with prognostic impact. Seventy-five HIV-associated aggressive B-NHL were studied by immunohistochemistry (CD10, BCL2, BCL6, MUM1, MYC, and CD30), EBV-encoded RNAs (EBERs), and fluorescence in situ hybridisation (FISH) to evaluate the status of the MYC, BCL2, and BCL6 genes and chromosome 11q. The 2017 WHO classification criteria and the Hans algorithm, for the cell-of-origin classification of diffuse large B-cell lymphomas (DLBCL), were applied. In DLBCL cases, the frequencies of MYC and BCL6 rearrangements (14.9 and 27.7%, respectively) were similar to those described in HIV-negative patients, but BCL2 rearrangements were infrequent (4.3%). MYC expression was identified in 23.4% of DLBCL cases, and coexpression of MYC and BCL2 in 13.0%, which was associated with a worse prognosis. As for BL cases, the expression of MUM1 (30.4%) conferred a worse prognosis. Finally, the prevalence of HGBL-DH/TH and BL-like with 11q aberration are reported in the HIV setting. The phenotypic and genotypic characteristics of HIV-associated aggressive B-NHL are similar to those of the general population, except for the low frequency of BCL2 rearrangements in DLBCL. MYC and BCL2 coexpression in DLBCL, and MUM-1 expression in BL, have a negative prognostic impact on HIV-infected individuals.
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Affiliation(s)
- Maria Joao Baptista
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Ana‐María Muñoz‐Marmol
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Josep Muncunill
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Olga Garcia
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Silvia Montoto
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - John G Gribben
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - Maria Calaminici
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - Antonio Martinez
- Department of Pathology, Hospital Clinic, IDIBAPSUniversity of BarcelonaBarcelonaSpain
| | - Luis Veloza
- Department of Pathology, Hospital Clinic, IDIBAPSUniversity of BarcelonaBarcelonaSpain
| | | | - Teresa Aldamiz
- Department of Infectious DiseasesHospital Gregorio MarañónMadridSpain
| | | | - María‐José Terol
- Department of Hematology and OncologyHospital Clínic Universitari de ValènciaValenciaSpain
| | - Antonio Ferrandez
- Department of PathologyHospital Clínic Universitari de ValènciaValenciaSpain
| | - Miguel Alcoceba
- Department of HematologyHospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Centro de Investigación del Cáncer‐IBMCC (USAL‐CSIC)SalamancaSpain
| | - Javier Briones
- Department of Hematology, Hospital de la Santa Creu i Sant PauJosep Carreras Leukaemia Research Institute (IJC)BarcelonaSpain
| | - Eva González‐Barca
- Department of HematologyICO‐Hospital Duran i ReynalsL'Hospitalet de LlobregatSpain
| | - Fina Climent
- Department of PathologyHospital Universitari de Bellvitge‐IDIBELL, L'Hospitalet de LlobregatBadalonaSpain
| | - Ana Muntañola
- Department of Clinical HematologyHospital Universitari Mutua de TerrassaTerrassaSpain
| | - José‐María Moraleda
- Department of HematologyHospital Clinico Universitario Virgen de la ArrixacaMurciaSpain
| | - Mariano Provencio
- Department of Medical OncologyHospital Universitario Puerta De HierroMajadahondaSpain
| | - Pau Abrisqueta
- Department of HematologyHospital Vall d'HebrónBarcelonaSpain
| | | | - Lluis Colomo
- Department of PathologyHospital del MarBarcelonaSpain
| | | | | | - Juan‐Manuel Sancho
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Josep‐Maria Ribera
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - José‐Luis Mate
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - José‐Tomas Navarro
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
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The New Treatment Methods for Non-Hodgkin Lymphoma in Pediatric Patients. Cancers (Basel) 2022; 14:cancers14061569. [PMID: 35326719 PMCID: PMC8945992 DOI: 10.3390/cancers14061569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
One of the most common cancer malignancies is non-Hodgkin lymphoma, whose incidence is nearly 3% of all 36 cancers combined. It is the fourth highest cancer occurrence in children and accounts for 7% of cancers in patients under 20 years of age. Today, the survivability of individuals diagnosed with non-Hodgkin lymphoma varies by about 70%. Chemotherapy, radiation, stem cell transplantation, and immunotherapy have been the main methods of treatment, which have improved outcomes for many oncological patients. However, there is still the need for creation of novel medications for those who are treatment resistant. Additionally, more effective drugs are necessary. This review gathers the latest findings on non-Hodgkin lymphoma treatment options for pediatric patients. Attention will be focused on the most prominent therapies such as monoclonal antibodies, antibody–drug conjugates, chimeric antigen receptor T cell therapy and others.
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4
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Tourneret A, Alame M, Rigau V, Bauchet L, Fabbro M, De Oliveira L, Cacheux V, Costes V, Lacheretz-Szablewski V. BCL2 and BCL6 atypical/unbalanced gene rearrangements in diffuse large B-cell lymphoma are indicators of an aggressive clinical course. J Clin Pathol 2020; 74:650-656. [PMID: 32912960 DOI: 10.1136/jclinpath-2020-206767] [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: 05/18/2020] [Revised: 07/08/2020] [Accepted: 08/10/2020] [Indexed: 11/03/2022]
Abstract
AIMS Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin's lymphoma that represents a heterogeneous group of disease that is differentially characterised by clinical, molecular and cytogenetic features. MYC, BCL2 and BCL6 gene rearrangements have been identified as prognostic factors in DLBCL, especially for MYC. Nevertheless the frequency and effect of atypical/unbalanced BCL6, BCL2 and MYC translocations in DLBCL is not fully documented. Here, we aimed to analyse those atypical/unbalanced rearrangements in DLBCL and to assess their prognostic impact. METHODS We collected tumour tissue and clinical data from 97 DLBCL and used interphase fluorescence in situ hybridisation (FISH) with break-apart probe to characterise BCL6, BCL2 and MYC gene pattern. RESULTS 19 of 97 (19,6%) cases of DLBCL had atypical/ unbalanced gene rearrangements (14 involving BCL6 gene, 5 involving BCL2 gene and none involving MYC gene). Compared with patients with simple gene rearrangement and patients without cytogenetic abnormality, patients with atypical/unbalanced gene rearrangement were in an unfavourable risk group by the International Prognostic Index (p=0039), died of disease (p=0012), harboured relapse or progression (p=0011) and had shorter overall (p=0,04), relapse free (p=0029) and event free (p=0026) survival. CONCLUSIONS We showed that patients with DLBCL with BCL2 or BCL6 atypical/unbalanced rearrangements constituted a group of patients with poor outcome. We also underlined the importance of FISH analyses, easily feasible in routine practise, at diagnosis of DLBCL to detect the rather frequent and clinically significant atypical/unbalanced aberrations of these genes.
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Affiliation(s)
- Alicia Tourneret
- Université de Montpellier, Montpellier, France.,Département de Pathologie, CHU Montpellier, Montpellier, France
| | - Melissa Alame
- Université de Montpellier, Montpellier, France.,Département d'Hematologie Biologique, CHU Montpellier, Montpellier, France
| | - Valerie Rigau
- Université de Montpellier, Montpellier, France.,Département de Pathologie, CHU Montpellier, Montpellier, France
| | - Luc Bauchet
- Université de Montpellier, Montpellier, France.,Département de Neurochirurgie, CHU Montpellier, Montpellier, France
| | | | | | - Valere Cacheux
- Université de Montpellier, Montpellier, France.,Département d'Hematologie Biologique, CHU Montpellier, Montpellier, France
| | - Valerie Costes
- Université de Montpellier, Montpellier, France.,Département de Pathologie, CHU Montpellier, Montpellier, France
| | - Vanessa Lacheretz-Szablewski
- Université de Montpellier, Montpellier, France .,Département de Pathologie, CHU Montpellier, Montpellier, France
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5
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Salam DSDA, Thit EE, Teoh SH, Tan SY, Peh SC, Cheah SC. C-MYC, BCL2 and BCL6 Translocation in B-cell Non-Hodgkin Lymphoma Cases. J Cancer 2020; 11:190-198. [PMID: 31892985 PMCID: PMC6930405 DOI: 10.7150/jca.36954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022] Open
Abstract
C-MYC, BCL2 and BCL6 genes are the most commonly oncogenes involved in B-Cell lymphomas. Translocations of these oncogenes are associated with an aggressive clinical course. This study aims to elucidate the patterns of BCL6, BCL2 and C-MYC gene aberrations among Malaysian B-cell Non-Hodgkin Lymphoma (NHL) using fluorescence in situ hybridization (FISH). Eighty-one B-cell NHL tissue blocks were retrieved between the year 2011 to 2015 and investigated using immunohistochemistry and interphase FISH dual colour break-apart probes of BCL2, BCL6, C-MYC and IgH. A significant difference was detected between the nodal and extranodal sites in all the BCL2 (p=0.01), C-MYC (p=0.03) and IgH (p=0.006) cases except for BCL6 (p=0.2). Our study showed that BCL6 had the highest gene translocation while BCL2/BCL6 had the most mixed aberrations of gain copies and translocation, however no mixed aberrations of gain copies and translocation was found in C-MYC. None of the mixed gain copies and translocation was found in any of the germinal centre B-cell (GCB) subtype of Diffuse Large B-cell Lymphoma, however, five were found in BCL6 and IgH gene in the non-GCB subtype; while mixed gain copies and translocation cases of BCL2 gene was found in the Follicular Lymphoma cases only. The study found interesting findings of BCL2, C-MYC and IgH gene aberrations between nodal and extranodal sites. This information might benefit future study in predicting prognosis and determine effective therapeutic strategies in the multi-ethnic populations of Malaysia as well as the Asian population.
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Affiliation(s)
| | - Ei Ei Thit
- Advanced Molecular Pathology Laboratory, SingHealth Tissue Repository, Singapore
| | - Siew Hoon Teoh
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | | | | | - Shiau-Chuen Cheah
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
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6
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Li S, Wang Z, Lin L, Wu Z, Yu Q, Gao F, Zhang J, Xu Y. BCL6 Rearrangement Indicates Poor Prognosis in Diffuse Large B-cell Lymphoma Patients: A Meta-analysis of Cohort Studies. J Cancer 2019; 10:530-538. [PMID: 30719149 PMCID: PMC6360306 DOI: 10.7150/jca.25732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/03/2018] [Indexed: 12/19/2022] Open
Abstract
BCL6 (3q27) rearrangement is the most frequent chromosomal abnormality in diffuse large B-cell lymphoma (DLBCL). Previously, studies on the association between BCL6 rearrangement and DLBCL outcome remain controversial. Here we systematically reviewed literatures to identify the prognostic significance of BCL6 rearrangement in DLBCL. Meta-analytic methods are used to obtain pooled estimates of the association between BCL6 rearrangement and prognosis in DLBCL patients treated with different chemotherapy regimens. A total of 22 studies are enrolled in the cohort, involving 3037 patients. BCL6 rearrangement is verified to be negatively associated with overall survival (OS) (HR=1.36, p=0.000), but not with progression-free survival (PFS). Moreover, the subgroup analyses show that BCL6 rearrangement is prognostic only in DLBCLs treated with rituximab-containing regimens.
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Affiliation(s)
- Shu Li
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhan Wang
- Center for Orthopaedic Research, Orthopaedics Research Institute of Zhejiang University, Department of Orthopaedics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Liming Lin
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Zhaoxing Wu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Qingfeng Yu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.,Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Feiqiong Gao
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jiawei Zhang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yang Xu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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7
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PROGNOSTIC VALUE OF IMMUNOHISTOCHEMICAL MARKERS IN PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA. EUREKA: HEALTH SCIENCES 2018. [DOI: 10.21303/2504-5679.2018.00564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a potentially curable disease, but standard treatment is not effective enough for all patients. That is why so important to identify high risk patients who need more aggressive therapy at the time of diagnosis. Nowadays prognosis for patients with DLBCL is based on International prognostic index (IPI). However, this index consists of only clinical parameters and does not include the biological characteristics of the tumour. Immunohistochemistry (IHC) markers could also play a prognostic role. There are some publications regarding predictive and prognostic role of expression of Bcl-2, Bcl-6, MUM1, CD10 and CD30, but their results are controversial. The aim of our study was to analyze prognostic role of these markers, to compare survival of patients with positive and negative expression of these markers and to build a prognostic model which include biological parameters for identifying high risk patients. There were statistically significant differences in EFS between the group of patients with negative and positive expression of CD10 (51.5 % versus 72.5 %, р=0.01) and in OS between the group of patients with negative and positive expression of Bcl-6 (61.1 % versus 79.6 %, р=0.03). Six-factors nonlinear neural network prediction model (MLP_6) was built. The sensitivity of the model is 63.2 % (95 % CІ 49.3 % – 75.6 %), specificity – 85.2 % (95 % CІ 79.1 % – 90.1 %). Prognostic factors include negative IHC expression of Bcl-6, CD10, non-GCB molecular subtype (according to algorithm Hans), gender (male), advanced Ann-Arbor stages, >2extranodal involvement. Our nonlinear neural network prediction model could improve prognostic role of IPI by adding of biological tumour characteristics (IHC expression of CD10, Bcl-6, molecular subtype by IHC algorithm).
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8
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Mondello P, Steiner N, Willenbacher W, Cerchione C, Nappi D, Mauro E, Ferrero S, Cuzzocrea S, Mian M. Bendamustine plus Rituximab Versus R-CHOP as First-Line Treatment for Patients with Follicular Lymphoma Grade 3A: Evidence from a Multicenter, Retrospective Study. Oncologist 2018; 23:454-460. [PMID: 29317554 DOI: 10.1634/theoncologist.2017-0037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Rituximab plus bendamustine (R-B) has been demonstrated to improve outcomes and reduce toxicity compared with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma (FL). Nevertheless, in clinical practice, many centers still prefer R-CHOP to R-B in patients with FL grade 3A (FL3A). Therefore, we retrospectively assessed patients with FL3A treated with either R-CHOP or R-B in five European cancer centers and compared their outcomes. MATERIALS AND METHODS We retrospectively assessed 132 patients affected by FL grade 3A treated with either R-B or R-CHOP in the first line and evaluated outcome and toxicity according to the type of treatment. This study included 101 patients who were a subgroup of a previously published cohort. RESULTS R-B was less toxic and achieved a similar percentage of complete remissions compared with R-CHOP (97% vs. 96%, p = .3). During follow-up, 10 (16%) patients relapsed after R-B and 29 (41%) after R-CHOP (p = .001), leading to a median progression-free survival (PFS) of 15 versus 11.7 years, respectively (p = .03). Furthermore, R-B overcame the negative prognostic impact of BCL2 expression (15 vs. 4.8 years; p = .001). However, median overall survival was similar between both groups (not reached for both; p = .8). CONCLUSION R-B as a first-line treatment of FL3A is better tolerated than R-CHOP and seems to induce more profound responses, leading to a significantly lower relapse rate and prolonged PFS. Therefore, R-B is a valid treatment option for FL grade 3A. IMPLICATIONS FOR PRACTICE Rituximab plus bendamustine (R-B) has shown to be less toxic and more effective than rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) in follicular lymphoma grade 3A. Although both regimens can induce a complete remission in >95% of patients, relapses occur more frequently after R-CHOP than R-B, leading to a significantly longer progression-free survival in the latter. R-B is also able to overcome the impact of negative prognosticators, such as BCL2 expression. However, because of the indolent course of this disease and efficient salvage treatments, overall survival was similar in both treatment groups. Therefore, R-B is a valid treatment option in this patient setting.
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Affiliation(s)
- Patrizia Mondello
- Department of Human Pathology, University of Messina, Messina, Italy
- Department of Biological and Environmental Sciences, University of Messina, Messina, Italy
- Department of Medicine, Division of Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, USA
| | - Normann Steiner
- Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Internal Medicine V: Hematology & Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudio Cerchione
- Haematology Division, "Federico II" University Hospital, Naples, Italy
| | - Davide Nappi
- Haematology Division, "Federico II" University Hospital, Naples, Italy
| | - Endri Mauro
- Department of Internal Medicine, Pordenone General Hospital, Pordenone, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Division of Hematology AOU "Città della Salute e della Scienza di Torino,", Turin, Italy
| | - Salvatore Cuzzocrea
- Department of Biological and Environmental Sciences, University of Messina, Messina, Italy
| | - Michael Mian
- Haematology Division, "Federico II" University Hospital, Naples, Italy
- Department of Hematology & CBMT, Ospedale di Bolzano, Bolzano, Italy
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9
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Tzankov A, Went P, Dirnhofer S. Prognostic Significance of in situ Phenotypic Marker Expression in Diffuse Large B-cell Lymphomas. Biomark Insights 2017. [DOI: 10.1177/117727190700200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Diffuse large B-cell lymphomas (DLBCL) are the most common lymphoid malignancies, and encompass all malignant lymphomas characterized by large neoplastic cells and B-cell derivation. In the last decade, DLBCL has been subjected to intense clinical, phenotypic and molecular studies, and were found to represent a heterogeneous group of tumors. These studies suggested new disease subtypes and variants with distinct clinical characteristics, morphologies, immunophenotypes, genotypes or gene expression profiles, associated with distinct prognoses or unique sensitivities to particular therapy regimens. Unfortunately, the reliability and reproducibility of the molecular results remains unclear due to contradictory reports in the literature resulting from small sample sizes, referral and selection biases, and variable methodologies and cut-off levels used to determine positivity. Here, we review phenotypic studies on the prognostic significance of protein expression profiles in DLBCL and reconsider our own retrospective data on 301 primary DLBCL cases obtained on a previously validated tissue microarray in light of powerful statistical methods of determining optimal cut-off values of phenotypic factors for prediction of outcome.
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Affiliation(s)
| | - Philip Went
- Department of Pathology, University Hospital Basel, Switzerland
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Di Rocco A, De Angelis F, Ansuinelli M, Foà R, Martelli M. Is now the time for molecular driven therapy for diffuse large B-cell lymphoma? Expert Rev Hematol 2017; 10:761-774. [PMID: 28712322 DOI: 10.1080/17474086.2017.1356714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Recent genetic and molecular discoveries regarding alterations in diffuse large B-cell lymphoma (DLBCL) deeply changed the approach to this lymphoproliferative disorder. Novel additional predictors of outcomes and new therapeutic strategies are being introduced to improve outcomes. Areas covered: This review aims to analyse the recent molecular discoveries in DLBCL, the rationale of novel molecular driven treatments and their impact on DLBCL prognosis, especially in ABC-DLBCL and High Grade B Cell Lymphoma. Pre-clinical and clinical evidences are reviewed to critically evaluate the novel DLBCL management strategies. Expert commentary: New insights in DLBCL molecular characteristics should guide the therapeutic approach; the results of the current studies which are investigating safety and efficacy of novel 'X-RCHOP' will probably lead, in future, to a cell of origin (COO) based upfront therapy. Moreover, it is necessary to identify early patients with DLBCL who carried MYC, BCL2 and/or BCL6 rearrangements double hit lymphomas (DHL) because they should not receive standard R-CHOP but high intensity treatment as reported in many retrospective studies. New prospective trials are needed to investigate the more appropriate treatment of DHL.
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Affiliation(s)
- Alice Di Rocco
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Federico De Angelis
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Michela Ansuinelli
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Robin Foà
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
| | - Maurizio Martelli
- a Department of Cellular Biotechnologies and Hematology , Sapienza University of Rome , Rome , Italy
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Tohidirad M, Estiar MA, Rezamand A, Ghorbian S, Andalib S, Jahanzad I, Bahrami T, Sakhinia E. BCL-1 Gene Rearrangements in Iranian Non-Hodgkin Lymphoma Patients. Glob J Health Sci 2016; 8:53396. [PMID: 27045402 PMCID: PMC5016351 DOI: 10.5539/gjhs.v8n8p108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/27/2015] [Indexed: 12/05/2022] Open
Abstract
In the present study, our aim was to assess the incidence of BCL-1 gene rearrangements in formalin-fixed paraffin embedded (FFPE) tissue in patients with non-Hodgkin lymphomas (NHL). The BIOMED-2 protocol was applied to assess the BCL-1 gene rearrangements in NHL patients. PCR amplification was carried out on FFPE in 100 patients with B-cell lymphoma including 89 cases with diffused large B-cell lymphoma (DLBCL) (15 cases under 18 years old) and 11 cases with mantle cell lymphoma (MCL). Out of the 100 patients, 19 cases (19%) were identified to have concurrent translocation involving BCL-1. The significant association was seen between BCL-1 gene rearrangements and the lymphomas in patients older than 55 years (P<0.05). Out of 100 cases, 80 cases were positive and 20 cases were negative regarding CD20. No significant association was found between DLBCL lymphoma in patients under 18 years old and BCL-1 gene rearrangements (P>0.05). In addition, the positive and negative expressions of LCA/CD45 marker were 76% (76/100) and 26% (26/100), respectively. Our findings revealed that BCL-1 gene rearrangement assays using BIOMED-2 protocol can be considered as a valuable approach in detection of the lymphomas.
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Affiliation(s)
- Manoush Tohidirad
- Department of Basic Science, East Azarbayjan Science and Research Branch, Islamic Azad University, Tabriz, Iran Department of Basic Science, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
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Abstract
High-grade B-cell lymphomas (HGBCLs) are a heterogeneous group of neoplasms that include subsets of diffuse large B-cell lymphoma, Burkitt lymphoma, and lymphomas with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Morphologically indistinguishable HGBCLs may demonstrate variable clinical courses and responses to therapy. The morphologic evaluation and classification of these neoplasms must be followed by further genetic and immunophenotypic work-up. These additional diagnostic modalities lead to a comprehensive stratification of HGBCL that determines the prognosis and optimal therapy. This article reviews the well-established and emerging biomarkers that are most relevant to the clinical management of HGBCL.
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MESH Headings
- Biomarkers, Tumor/metabolism
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/pathology
- Gene Rearrangement
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Grading
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Proto-Oncogene Proteins c-myc/metabolism
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Affiliation(s)
- Amir Behdad
- Division of Hematopathology, Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, 251 East Huron, Feinberg 7-210, Chicago, IL 60611, USA.
| | - Nathanael G Bailey
- Division of Hematopathology, Department of Pathology, University of Michigan, 5242 Med Sci I, 1301 Catherine Street, Ann Arbor, MI 48109, USA
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Jarosova M, Kriegova E, Schneiderova P, Fillerova R, Prochazka V, Mikesova M, Flodr P, Indrak K, Papajik T. A Novel Non-Immunoglobulin (non-Ig)/BCL6 Translocation in Diffuse Large B-Cell Lymphoma Involving Chromosome 10q11.21 Loci and Review on Clinical Consequences of BCL6 Rearrangements. Pathol Oncol Res 2015; 22:233-43. [DOI: 10.1007/s12253-015-9972-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/19/2015] [Indexed: 11/30/2022]
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Ikegami K, Nakamura S, Esaki M, Yanai S, Hirahashi M, Oda Y, Takeshita M, Matsumoto T, Kitazono T. Prognostic value of chromosomal translocations in small-bowel diffuse large B-cell lymphoma. Histopathology 2015; 68:199-209. [DOI: 10.1111/his.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/01/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Koji Ikegami
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Shotaro Nakamura
- Division of Gastroenterology; Department of Internal Medicine; Iwate Medical University; Morioka Japan
| | - Motohiro Esaki
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Shunichi Yanai
- Division of Gastroenterology; Department of Internal Medicine; Iwate Medical University; Morioka Japan
| | - Minako Hirahashi
- Department of Anatomical Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Morishige Takeshita
- Department of Pathology; Faculty of Medicine; Fukuoka University; Fukuoka Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology; Department of Internal Medicine; Iwate Medical University; Morioka Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
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15
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Translocation of the proto-oncogene Bcl-6 in human glioblastoma multiforme. Cancer Lett 2014; 353:41-51. [DOI: 10.1016/j.canlet.2014.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 01/13/2023]
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Immunohistochemical and molecular characteristics with prognostic significance in diffuse large B-cell lymphoma. PLoS One 2014; 9:e98169. [PMID: 24887414 PMCID: PMC4041883 DOI: 10.1371/journal.pone.0098169] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/29/2014] [Indexed: 12/22/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma with marked biologic heterogeneity. We analyzed 100 cases of DLBCL to evaluate the prognostic value of immunohistochemical markers derived from the gene expression profiling-defined cell origin signature, including MYC, BCL2, BCL6, and FOXP1 protein expression. We also investigated genetic alterations in BCL2, BCL6, MYC and FOXP1 using fluorescence in situ hybridization and assessed their prognostic significance. BCL6 rearrangements were detected in 29% of cases, and BCL6 gene alteration (rearrangement and/or amplification) was associated with the non-germinal center B subtype (non-GCB). BCL2 translocation was associated with the GCB phenotype, and BCL2 protein expression was associated with the translocation and/or amplification of 18q21. MYC rearrangements were detected in 15% of cases, and MYC protein expression was observed in 29% of cases. FOXP1 expression, mainly of the non-GCB subtype, was demonstrated in 37% of cases. Co-expression of the MYC and BCL2 proteins, with non-GCB subtype predominance, was observed in 21% of cases. We detected an association between high FOXP1 expression and a high proliferation rate as well as a significant positive correlation between MYC overexpression and FOXP1 overexpression. MYC, BCL2 and FOXP1 expression were significant predictors of overall survival. The co-expression of MYC and BCL2 confers a poorer clinical outcome than MYC or BCL2 expression alone, whereas cases negative for both markers had the best outcomes. Our study confirms that DLBCL, characterized by the co-expression of MYC and BCL2 proteins, has a poor prognosis and establishes a significant positive correlation with MYC and FOXP1 over-expression in this entity.
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Bakhirev AG, Vasef MA, Zhang QY, Reichard KK, Czuchlewski DR. Fluorescence Immunophenotyping and Interphase Cytogenetics (FICTION) Detects BCL6 Abnormalities, Including Gene Amplification, in Most Cases of Nodular Lymphocyte-Predominant Hodgkin Lymphoma. Arch Pathol Lab Med 2014; 138:538-42. [DOI: 10.5858/arpa.2012-0663-oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.— BCL6 translocations are a frequent finding in B-cell lymphomas of diverse subtypes, including some cases of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). However, reliable analysis of BCL6 rearrangements using fluorescence in situ hybridization is difficult in NLPHL because of the relative paucity of neoplastic cells. Combined immunofluorescence microscopy and fluorescence in situ hybridization, or fluorescence immunophenotyping and interphase cytogenetics as a tool for the investigation of neoplasms (FICTION), permits targeted analysis of neoplastic cells.
Objective.—To better define the spectrum of BCL6 abnormalities in NLPHL using FICTION analysis.
Design.—We performed an optimized FICTION analysis of 24 lymph nodes, including 11 NLPHL, 5 follicular hyperplasia with prominent progressive transformation of germinal centers, and 8 follicular hyperplasia without progressive transformation of germinal centers.
Results.— BCL6 rearrangement was identified in 5 of 11 cases of NLPHL (46%). In addition, BCL6 gene amplification, with large clusters of BCL6 signals in the absence of chromosome 3 aneuploidy, was detected in 3 of 11 cases of NLPHL (27%). One NLPHL showed extra copies of BCL6 present in conjunction with multiple copies of chromosome 3. Altogether, we detected BCL6 abnormalities in 9 of 11 cases of NLPHL (82%). None of the progressive transformation of germinal centers or follicular hyperplasia cases showed BCL6 abnormalities by FICTION.
Conclusions.—To our knowledge, this is the first report of BCL6 gene amplification in NLPHL. Our optimized protocol for FICTION permits detection of cytogenetic abnormalities in most NLPHL cases and may represent a useful ancillary diagnostic technique.
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Affiliation(s)
- Alexei G. Bakhirev
- From the Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque. Dr Reichard is now with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mohammad A. Vasef
- From the Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque. Dr Reichard is now with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Qian-Yun Zhang
- From the Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque. Dr Reichard is now with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kaaren K. Reichard
- From the Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque. Dr Reichard is now with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - David R. Czuchlewski
- From the Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque. Dr Reichard is now with the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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18
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Pham-Ledard A, Prochazkova-Carlotti M, Andrique L, Cappellen D, Vergier B, Martinez F, Grange F, Petrella T, Beylot-Barry M, Merlio JP. Multiple genetic alterations in primary cutaneous large B-cell lymphoma, leg type support a common lymphomagenesis with activated B-cell-like diffuse large B-cell lymphoma. Mod Pathol 2014; 27:402-11. [PMID: 24030746 DOI: 10.1038/modpathol.2013.156] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/12/2013] [Accepted: 07/14/2013] [Indexed: 12/14/2022]
Abstract
Primary cutaneous large B-cell lymphoma, leg type has been individualized from nodal diffuse large B-cell lymphoma. The objective of this study was to screen primary cutaneous large B-cell lymphoma, leg type for genetic alterations recently described in nodal diffuse large B-cell lymphoma. Skin biopsies from 23 patients were analyzed for IRF4, BCL2, BCL6, and MYC expression. FISH testing was performed for BCL2, BCL6, MYC with separation probes and for CDKN2A and PRDM1/BLIMP1 deletion. Multiple sequential FISH analyses with up to six probes were performed to define samples with multiple cytogenetic alterations. MYD88 mutations were studied by Sanger sequencing. All cases but one displayed at least one genetic alteration (96%). Nine patients exhibited a single genetic mutation and 12 combined several alterations (52%). We observed a split for BCL2, BCL6, or MYC in 1/23, 6/23, and 3/23 of cases, respectively. No double-hit lymphoma was observed. CDKN2A deletion was detected by FISH in only 5/23 cases. BLIMP1 and/or 6q deletion was observed at a higher rate in 10/20 of cases. No correlation between rearrangement and immunohistochemical expression was found for BCL2 or MYC. FISH tracking of sequential hybridizations showed that several alterations were carried by the same nuclei. The p.L265P MYD88 mutation was found in 11/18 (61%) of cases. Contrary to most cutaneous lymphomas that rarely harbor primary genetic alteration of their nodal histological equivalent, primary cutaneous large B-cell lymphoma, leg type seems to be a 'cutaneous counterpart' of activated B-cell-like diffuse large B-cell lymphoma with a similar cytogenetic profile and a high rate of MYD88 oncogenic L265P mutation. This also suggests a common lymphomagenesis with NF-κB activation, strong IRF4 expression and terminal B-cell differentiation blockage. Our data support the use of therapies targeting NF-κB, as most patients displayed disease progression and resistance to conventional therapies.
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Affiliation(s)
- Anne Pham-Ledard
- 1] EA2406 Histology and Molecular Pathology of Tumors, University of Bordeaux, Bordeaux, France [2] Dermatology Department, CHU Bordeaux, Bordeaux, France
| | | | - Laetitia Andrique
- EA2406 Histology and Molecular Pathology of Tumors, University of Bordeaux, Bordeaux, France
| | - David Cappellen
- 1] EA2406 Histology and Molecular Pathology of Tumors, University of Bordeaux, Bordeaux, France [2] Tumor Bank and Tumor Biology Laboratory, CHU Bordeaux, Bordeaux, France
| | | | - Fabian Martinez
- Tumor Bank and Tumor Biology Laboratory, CHU Bordeaux, Bordeaux, France
| | | | | | - Marie Beylot-Barry
- 1] EA2406 Histology and Molecular Pathology of Tumors, University of Bordeaux, Bordeaux, France [2] Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - Jean-Philippe Merlio
- 1] EA2406 Histology and Molecular Pathology of Tumors, University of Bordeaux, Bordeaux, France [2] Tumor Bank and Tumor Biology Laboratory, CHU Bordeaux, Bordeaux, France
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19
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BCL2, BCL6, IGH, TP53, and MYC protein expression and gene rearrangements as prognostic markers in diffuse large B-cell lymphoma: a study of 44 Turkish patients. Cancer Genet 2014; 207:87-93. [PMID: 24674866 DOI: 10.1016/j.cancergen.2014.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/15/2014] [Accepted: 02/01/2014] [Indexed: 01/13/2023]
Abstract
The purpose of this study was to determine the frequency of BCL2, BCL6, IGH, TP53, and MYC protein expression and rearrangements of the respective genes in diffuse large B-cell lymphoma (DLBCL) patients and to assess their prognostic values. Samples from 44 patients with DLBCL were evaluated using fluorescence in situ hybridization and immunohistochemical analyses. BCL6 was the most rearranged gene (63.6%), followed by MYC (31.8%), TP53 (22.7%), and BCL2 (18.2%). Multiple rearrangements were detected in 40.9% of the cases. BCL6 was the most expressed protein (78.6%), followed by TP53 (69.04%), BCL2 (59.5%) and MYC (14.3%). Expression of multiple proteins was detected in 67.4% of the cases. BCL2 (P = .003) expression had a significant negative influence on overall survival,whereas BCL6 (P = .014) expression had a significant positive influence. Our results with a different pattern of gene rearrangements and associated protein overexpression indicate the molecular genetic complexity of DLBCLs, which reflects the morphologic, biologic, and clinical heterogeneity of these lymphomas.
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Cui J, Liu Q, Cheng Y, Chen S, Sun Q. An intravascular large B-cell lymphoma with a t(3;14)(q27;q32) translocation. J Clin Pathol 2013; 67:279-81. [DOI: 10.1136/jclinpath-2013-201980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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21
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Bodoor K, Matalka I, Hayajneh R, Haddad Y, Gharaibeh W. Evaluation of BCL-6, CD10, CD138 and MUM-1 expression in diffuse large B-cell lymphoma patients: CD138 is a marker of poor prognosis. Asian Pac J Cancer Prev 2013; 13:3037-46. [PMID: 22994707 DOI: 10.7314/apjcp.2012.13.7.3037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The diffuse large B-cell lymphoma (DLBCL) encompasses two major groups of tumors with uneven survival outcomes--germinal center B-cell (GCB) and non-germinal center B-cell (non-GCB). In the present study, we investigated the expression of GCB markers (BCL-6 and CD10) and non-GCB markers (CD138 and MUM-1) in an effort to evaluate their prognostic value. Paraffin-embedded tumor biopsies of 46 Jordanian DLBCL patients were analyzed, retrospectively, by immunohistochemistry to investigate the expression of BCL-6, CD10, CD138 and MUM-1. In addition, survival curves were calculated with reference to marker expression, age, sex and nodal involvement. Positive expression of BCL-6, CD10, CD138 and MUM-1 was shown in 78%, 61%, 39% and 91% of the cases, respectively, that of BCL-6 being associated with better overall survival (p = 0.02), whereas positive CD138 was linked with poor overall survival (p = 0.01). The expression of CD10 and MUM-1 had no impact on the overall survival. Among the clinical characteristics studied, diagnosis at an early age, nodal involvement and maleness were associated with a higher overall survival for DLBCL patients. Our results underline the importance of BCL-6 as a marker of better prognosis and CD138 as a marker of poor prognosis for DLBCL patients.
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Affiliation(s)
- Khaldon Bodoor
- Department of Biology, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan.
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Kojima M, Nishikii H, Takizawa J, Aoki S, Noguchi M, Chiba S, Ando K, Nakamura N. MYC rearrangements are useful for predicting outcomes following rituximab and chemotherapy: multicenter analysis of Japanese patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2013; 54:2149-54. [PMID: 23363269 DOI: 10.3109/10428194.2013.771398] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, and it has several morphologic and clinicopathologic variants. The prognosis of DLBCL can vary according to specific genetic and immunophenotypic abnormalities. The aim of this study was to investigate the prognostic impact of previously identified prognostic factors, such as activated B cell-like immunophenotype, CD5, BCL2 and MYC rearrangement (MYC-R), in patients treated with rituximab. We retrospectively analyzed the prognosis of 100 patients with DLBCL (median age, 66.5 years) treated with rituximab-containing chemotherapy. The 3-year overall survival (OS) and progression-free survival (PFS) were 66% and 62%. Outcomes were significantly worse in patients with MYC-R in 3-year OS (50% vs. 67.8%, p = 0.043) and PFS (30% vs. 57.8%, p = 0.003), and multivariate analysis showed that this finding was independent of the International Prognostic Index (IPI). Immunostaining by Muris algorithm had the highest predictive power among the three algorithms. However, other previously reported prognostic factors, such as BCL2 and CD5, were not good predictors of outcomes in these patients. In conclusion, our data suggest that fluorescence in situ hybridization (FISH) analysis for MYC-R can predict outcomes in response to rituximab-containing chemotherapy in Japanese patients with DLBCL.
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Affiliation(s)
- Minoru Kojima
- Division of Hematology/Oncology, Department of Internal Medicine
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Abstract
Over the last 30 years there has been a massive change in both the clinical and pathologic aspects of malignant lymphomas. Pathologists are now able to evaluate cellular phenotypes and lineages of tumor cells using a wide variety of biomarkers and molecular techniques. The ability to identify tumor cell phenotypes has revolutionized the classification of lymphomas, leading to an internationally agreed system based on the reliable recognition of specific clinico-pathologic entities. The World Health Organization classification combines clinical features, histomorphology, immunohistochemistry, and molecular and genetic marker data to precisely categorize lymphomas. On the clinical front the increasing use of needle core biopsies has made it easier and quicker to obtain tissue samples, and the development of (18)F-fluorodeoxyglucose positron emission tomography has revolutionized the assessment of patients both at presentation and after treatment. To improve overall outcomes for lymphoma patients there have been advances in the UK organization of cancer services. Cancer networks have been established, often with network multidisciplinary team meetings, and new diagnoses of lymphoma are reviewed on a network basis by pathologists specializing in the field. National and supranational quality control systems are in place for immunohistochemistry and for molecular techniques and multicenter clinical trials provide information about the efficacy of treatment regimens. The outcome of these advances is that a patient presenting in 2012 with suspected lymphoma can expect to be biopsied rapidly, to receive an accurate pathologic diagnosis by an expert hematopathologist, which will include prognostic marker information, and to have comprehensive disease assessment and discussion by a multidisciplinary team before embarking on the most appropriate treatment for his or her clinical situation.
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MYC status in concert with BCL2 and BCL6 expression predicts outcome in diffuse large B-cell lymphoma. Blood 2013; 121:2253-63. [PMID: 23335369 DOI: 10.1182/blood-2012-06-435842] [Citation(s) in RCA: 396] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
MYC rearrangements occur in 5% to 10% of diffuse large B-cell lymphomas (DLBCL) and confer an increased risk to cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (CHOP) and rituximab (R)-CHOP treated patients. We investigated the prognostic relevance of MYC-, BCL2- and BCL6-rearrangements and protein expression in a prospective randomized trial. Paraffin-embedded tumor samples from 442 de novo DLBCL treated within the RICOVER study of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL) were investigated using immunohistochemistry and fluorescence in situ hybridization (FISH) to detect protein expression and breaks of MYC, BCL2, and BCL6. Rearrangements of MYC, BCL2, and BCL6 were detected in 8.8%, 13.5%, and 28.7%, respectively. Protein overexpression of MYC (>40%) was encountered in 31.8% of tumors; 79.6% and 82.8% of tumors expressed BCL2 and BCL6, respectively. MYC translocations, MYChigh, BCL2high, and BCL6low protein expressions were associated with inferior survival. In multivariate Cox regression modeling, protein expression patterns of MYC, BCL2 and BCL6, and MYC rearrangements were predictive of outcome and provided prognostic information independent of the International Prognostic Index (IPI) for overall survival and event-free survival. A combined immunohistochemical or FISH/immunohistochemical score predicts outcome in DLBCL patients independent of the IPI and identifies a subset of 15% of patients with dismal prognosis in the high-risk IPI group following treatment with R-CHOP. Registered at http://www.cancer.gov/clinicaltrials: RICOVER trial of the DSHNHL is NCT 00052936.
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Pfreundschuh M. Growing Importance ofMYC/BCL2Immunohistochemistry in Diffuse Large B-Cell Lymphomas. J Clin Oncol 2012; 30:3433-5. [DOI: 10.1200/jco.2012.44.4729] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Michael Pfreundschuh
- German High-Grade Non-Hodgkin Lymphoma Study Group; Saarland University Medical School, Homburg, Germany
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26
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Kobayashi T, Tsutsumi Y, Sakamoto N, Nagoshi H, Yamamoto-Sugitani M, Shimura Y, Mizutani S, Matsumoto Y, Nishida K, Horiike S, Asano N, Nakamura S, Kuroda J, Taniwaki M. Double-hit Lymphomas Constitute a Highly Aggressive Subgroup in Diffuse Large B-cell Lymphomas in the Era of Rituximab. Jpn J Clin Oncol 2012; 42:1035-42. [DOI: 10.1093/jjco/hys148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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27
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Abdel-Ghafar AAA, El Din El Telbany MAS, Mahmoud HM, El-Sakhawy YN. Immunophenotyping of chronic B-cell neoplasms: flow cytometry versus immunohistochemistry. Hematol Rep 2012; 4:e3. [PMID: 22567217 PMCID: PMC3343452 DOI: 10.4081/hr.2012.e3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 11/04/2011] [Accepted: 12/22/2011] [Indexed: 11/23/2022] Open
Abstract
Morphological differentiation between benign and malignant lymphoproliferative disorders (LPDs) can be challenging. Immunophenotyping (IPT) by either technique, flow cytometry or immunohistochemistry (IHC), is an important step in solving such difficulty. Thirty-five newly diagnosed patients with chronic B-cell neoplasms (11 chronic lymphocytic leukemia, 22 non Hodgkin lymphoma and 2 hairy cell leukemia) were included in this study with age range from 20 to 70 years. Monoclonal antibodies surface expression using lymphoproliferative disorders panel (CD45, CD19, CD5, CD10, CD11c, CD20, CD22, CD23, CD38, CD79b, FMC7, CD103, CD25, kappa and lambda light chains) by flow cytometry was done on bone marrow samples. CD20, CD5, CD23, Bcl-2, Bcl-6, kappa and lambda light chain immunostaining were performed on fixed bone marrow trephine biopsy specimen. The sensitivity of IHC was 81.8% in chronic lymphocytic leukemia (CLL) and 100% in non Hodgkin lymphoma (NHL) as regards CD20, 100% in both groups as regards CD5, 46% in CLL and 66.7% in NHL as regards CD23, 33.3% in CLL and 50% in NHL as regards kappa chain, 20% in CLL and 33.3% in NHL as regards lambda chain. We found that IHC and flow cytometry are equally effective in diagnosing CLL; however, IHC might be slightly more sensitive than flow cytometry in detecting bone marrow infiltration in NHL and hairy cell leukemia (HCL).
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Akyurek N, Uner A, Benekli M, Barista I. Prognostic significance ofMYC,BCL2, andBCL6rearrangements in patients with diffuse large B-cell lymphoma treated with cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab. Cancer 2011; 118:4173-83. [DOI: 10.1002/cncr.27396] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/04/2011] [Accepted: 11/16/2011] [Indexed: 01/12/2023]
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Mahmoud HM, El-Sakhawy YN. Significance of Bcl-2 and Bcl-6 immunostaining in B-Non Hodgkin's lymphoma. Hematol Rep 2011; 3:e26. [PMID: 22593817 PMCID: PMC3269794 DOI: 10.4081/hr.2011.e26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 09/20/2011] [Accepted: 10/24/2011] [Indexed: 12/19/2022] Open
Abstract
The determination of prognosis for B-Non-Hodgkin's lymphoma (NHL) is known to be related to the multiple differences in tumor cell biology. Bcl-2 and Bcl-6 are two markers linked to germinal center B cells. Both markers are thought to have an effect on prognosis of mature B-cell neoplasms. Forty-four patients with chronic B-cell neoplasm were included; Bcl-2 and Bcl-6 expression by immunohistochemistry was examined. Bcl-2 protein was positive in 36.4% (16 of 44) of cases (62.5% of follicular lymphoma, 16.7% of mantle cell lymphoma and 30% of diffuse large B-cell lymphoma); the positive group implying a bad prognostic effect of the marker in NHL. Bcl-6 was positive in 13.6% (6 of 44) of cases (11.1% of mantle cell lymphoma and 40% of diffuse large B-cell lymphoma) and its positivity implies a better disease course. Bcl-2 and Bcl-6 can be used as prognostic marker in NHL.
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Abstract
An increasing number of neoplasms are associated with variably specific genetic abnormalities. This is best exemplified by hematological malignancies, in which there is a growing list of entities that are defined by their genetic lesion(s); this is not (yet) the case in mature B-cell lymphomas. However, enhanced insights into the pathogenesis of this large and diverse group of lymphomas have emerged with the ongoing unraveling of a plethora of fascinating genetic abnormalities. The purpose of this review is to synthesize well-recognized data and nascent discoveries in our understanding of the genetic basis of a spectrum of mature B-cell lymphomas, and how this may be applied to contemporary clinical practice. Despite the explosion of new and exciting knowledge in this arena, with the potential for enhanced diagnostic and prognostic strategies, it is essential to remain cognizant of the limitations (and complexity) of genetic investigations, so that assays can be developed and used both judiciously and rationally.
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Durnick DK, Law ME, Maurer MJ, Natkunam Y, Levy R, Lossos IS, Kurtin PJ, McPhail ED. Expression of LMO2 is associated with t(14;18)/IGH-BCL2 fusion but not BCL6 translocations in diffuse large B-cell lymphoma. Am J Clin Pathol 2010; 134:278-81. [PMID: 20660332 DOI: 10.1309/ajcpatup1d0hgcug] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) can be separated for prognostic purposes using gene expression profiling (GEP) into 2 subgroups: germinal center B-cell (GCB) and activated B-cell phenotypes. However, GEP is impractical for routine clinical use, and immunophenotyping is an imperfect surrogate. Therefore, we studied the relationship between expression of the purported germinal center marker LMO2 and the presence of IGH-BCL2 fusions, BCL6 translocations, and LMO2 translocations. In addition, we investigated the usefulness of LMO2 expression as a marker of GCB subtype in DLBCL. Immunohistochemical and fluorescence in situ hybridization studies were successfully performed on 101 cases of de novo DLBCL that had been incorporated into a tissue microarray. There was a statistically significant association between IGH-BCL2 fusion and LMO2 protein expression (P = .02) but not between BCL6 translocations and LMO2 expression. LMO2 translocations were not identified. Although uncommon, all cases that had both IGH-BCL2 fusion and BCL6 translocations expressed LMO2. The findings suggest LMO2 as a potential marker for the GCB phenotype.
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Barrans S, Crouch S, Smith A, Turner K, Owen R, Patmore R, Roman E, Jack A. Rearrangement of MYC Is Associated With Poor Prognosis in Patients With Diffuse Large B-Cell Lymphoma Treated in the Era of Rituximab. J Clin Oncol 2010; 28:3360-5. [DOI: 10.1200/jco.2009.26.3947] [Citation(s) in RCA: 448] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Rearrangement of MYC occurs in a proportion of diffuse large B-cell lymphomas (DLBCL), where they may be associated with an adverse clinical outcome. The aim of this study was to determine the frequency of MYC translocations in DLBCL and their prognostic impact in the era of cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (CHOP-R) therapy. Patients and Methods Three hundred three patients with previously untreated DLBCL, with no evidence of underlying follicular lymphoma, were investigated using immunohistochemistry and interphase fluorescent in situ hybridization for MYC, BCL6, and t(14;18)/BCL2 rearrangements. All patients (median age, 71.1 years; range, 23 to 96 years) were treated when CHOP-R was standard therapy for DLBCL and observed for a maximum of 4 years. Overall survival (OS) at 3 years was 49% (95% CI, 42% to 56%). Results MYC rearrangements were demonstrated in 35 (14%) of 245 biopsies with data available. Of these, 26 (74%) also had a t(14;18), 10 (26%) were BCL6 and MYC rearranged, and seven had all three abnormalities. Only age, International Prognostic Index, and MYC rearrangement retained prognostic significance in the final model. OS was significantly worse for patients with rearrangement of MYC (survival probability at 2 years = 0.35 in v 0.61 in the nonrearranged group). Conclusion The presence of a MYC rearrangement is a strongly adverse prognostic factor in CHOP-R–treated patients and can be used in combination with patients' age and IPI to accurately predict clinical outcome. In DLBCL, rearrangement of MYC is rarely found as the sole genetic abnormality and the poor prognosis of these patients is likely to reflect a synergistic effect alongside deregulation of BCL6 or BCL2.
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Affiliation(s)
- Sharon Barrans
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Simon Crouch
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Alex Smith
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Kathryn Turner
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Roger Owen
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Russell Patmore
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Eve Roman
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Andrew Jack
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
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Primary diffuse large B-cell lymphoma of the oral cavity: germinal center classification. Head Neck Pathol 2010; 4:181-91. [PMID: 20533006 PMCID: PMC2923304 DOI: 10.1007/s12105-010-0184-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 05/20/2010] [Indexed: 02/03/2023]
Abstract
Primary lymphomas of the oral cavity are rare and the most frequent type is diffuse large B-cell lymphoma (DLBCL). Recently, several reports have highlighted the value of classifying DLBCL into prognostically important subgroups, namely germinal center B-cell like (GCB) and non-germinal center B-cell like (non-GCB) lymphomas based on gene expression profiles and by immunohistochemical expression of CD10, BCL6 and MUM-1. GCB lymphomas tend to exhibit a better prognosis than non-GCB lymphomas. Studies validating this classification have been done for DLBCL of the breast, CNS, testes and GI tract. Therefore we undertook this study to examine if primary oral DLBCLs reflect this trend. We identified 13 cases (age range 38-91 years) from our archives dating from 2003-09. IHC was performed using antibodies against germinal center markers (CD10, BCL6), activated B-cell markers (MUM1, BCL2) and Ki-67 (proliferation marker). Cases were sub-classified as GCB subgroup if CD10 and/or BCL6 were positive and MUM-1, was negative and as non-GCB subgroup if CD10 was negative and MUM-1 was positive. Immunoreactivity was noted in 2/13 cases for CD10, in 12/13 for BCL6, in 8/13 for MUM-1, and in 6/13 for BCL2. Therefore, 8/13 (58%) were sub-classified as non-GCB DLBCLs and 5/13 (42%) as GCB subgroup. All tumors showed frequent labeling with Ki-67 (range 40-95%). Four of the 8 patients with non-GCB subgroup succumbed to their disease, with the mean survival rate of 16 months. Two patients in this group are alive, one with no evidence of disease and another with disease. No information was available for the other 3 patients in this group. Four of the 5 patients in the GCB subgroup were alive with no evidence of disease and one patient succumbed to complications of therapy and recurrent disease after 18 months. In conclusion, our analysis shows that primary oral DLBCL predominantly belongs to the non-GCB subgroup, which tends to exhibit a poorer prognosis. These findings could allow pathologists to provide a more accurate insight into the potential aggressive behavior and poorer prognosis of these lymphomas.
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Ennishi D, Asai H, Maeda Y, Shinagawa K, Ikeda K, Yokoyama M, Terui Y, Takeuchi K, Yoshino T, Matsuo K, Hatake K, Tanimoto M. Statin-independent prognosis of patients with diffuse large B-cell lymphoma receiving rituximab plus CHOP therapy. Ann Oncol 2010; 21:1217-1221. [DOI: 10.1093/annonc/mdp490] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Copie-Bergman C, Gaulard P, Leroy K, Briere J, Baia M, Jais JP, Salles GA, Berger F, Haioun C, Tilly H, Emile JF, Banham AH, Mounier N, Gisselbrecht C, Feugier P, Coiffier B, Molina TJ. Immuno–Fluorescence In Situ Hybridization Index Predicts Survival in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP: A GELA Study. J Clin Oncol 2009; 27:5573-9. [DOI: 10.1200/jco.2009.22.7058] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the prognostic value of cell of origin immunohistochemical markers and BCL2, BCL6, and c-MYC translocations in a homogeneous cohort of patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Patients and Methods Patients with CD20+ DLBCL were enrolled in the randomized LNH98-5 and 01-5B Groupe d'Etude des Lymphomes de l'Adulte trials. Paraffin-embedded tumor samples of 119 patients treated with R-CHOP were analyzed by immunohistochemistry for CD10, BCL6, MUM1/IRF4, LMO2, and forkhead box protein P1 (FOXP1) expression and for BCL2, BCL6, and c-MYC breakpoints by fluorescence in situ hybridization (FISH) on tissue microarray. Results LMO2 expression and BCL2 breakpoint were associated with the germinal center (GC) subtype defined by Hans' algorithm, respectively (P < .0001; P = .0002) whereas FOXP1 expression and BCL6 breakpoint were associated with the non-germinal center (non-GC) subtype (P = .008 and P = .0001, respectively). The immunohistochemical markers analyzed independently, GC/non-GC phenotype and BCL2 breakpoint did not predict overall survival (OS). BCL6 breakpoint was significantly associated with an unfavorable impact on OS (P = .04). Interestingly, an immunoFISH index, defined by positivity for at least two of three non-GC markers (FOXP1, MUM1/IRF4, BCL6 breakpoint) was significantly associated with a shorter 5-year OS rate (44%; 95% CI, 28 to 60 v 78%; 95% CI, 59 to 89; P = .01) which was independent (P = .04) of the age-adjusted International Prognostic Index (P = .04) in multivariate analysis. Conclusion Our study demonstrates that combining immunohistochemistry with FISH allows construction of an immunoFISH index that significantly predicts survival in elderly DLBCL patients treated with R-CHOP.
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Affiliation(s)
- Christiane Copie-Bergman
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Philippe Gaulard
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Karen Leroy
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Josette Briere
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Maryse Baia
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Jean-Philippe Jais
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Gilles A. Salles
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Françoise Berger
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Corinne Haioun
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Herve Tilly
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Jean-François Emile
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Alison H. Banham
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Nicolas Mounier
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Christian Gisselbrecht
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Pierre Feugier
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Bertrand Coiffier
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
| | - Thierry J. Molina
- From the Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier; L'Institut National de la Santé et de la Recherche Médicale, Unité 955, Institut Mondor de Recherche Biomédicale; Université Paris 12, Faculté de médecine, Créteil; Université Paris Diderot and Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Necker; Université Paris Descartes; Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu,
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Shustik J, Han G, Farinha P, Johnson NA, Ben Neriah S, Connors JM, Sehn LH, Horsman DE, Gascoyne RD, Steidl C. Correlations between BCL6 rearrangement and outcome in patients with diffuse large B-cell lymphoma treated with CHOP or R-CHOP. Haematologica 2009; 95:96-101. [PMID: 19797725 DOI: 10.3324/haematol.2009.007203] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND BCL6 gene rearrangement is the most frequent chromosomal abnormality in diffuse large B-cell lymphoma, a malignancy characterized by genetic heterogeneity and wide variability in clinical outcome. The prognostic significance of BCL6 rearrangement has not been evaluated in the context of rituximab therapy for diffuse large B-cell lymphoma. We analyzed the effect of the BCL6 rearrangement on survival in patients with diffuse large B-cell lymphoma treated with CHOP and CHOP plus rituximab (R-CHOP). DESIGN AND METHODS BCL6 rearrangement status was analyzed by fluorescence in situ hybridization with break-apart probes in 164 patients with diffuse large B-cell lymphoma treated with CHOP (n=65) or R-CHOP (n=99). Cell-of-origin immunophenotype including BCL6 protein expression were determined by immunohistochemistry on a tissue microarray. RESULTS BCL6 rearrangement was detected in 19.5% of cases. The presence of the gene rearrangement was associated with a non-germinal center B-cell immunophenotype (P=0.006), and showed no correlation with BCL6 protein expression. A trend toward inferior overall survival was observed in association with the BCL6 rearrangement among patients treated with R-CHOP (P=0.08), but not among patients treated with CHOP (P=0.64). However, BCL6 rearrangement also correlated with a high International Prognostic Index score (P=0.02), and did not demonstrate independent prognostic value by multivariate analysis. CONCLUSIONS The introduction of rituximab may have altered the prognostic impact of BCL6 gene rearrangement in patients with diffuse large B-cell lymphoma. However, prospective analysis within large randomized clinical trials will be needed to clarify the prognostic significance of this biomarker in the rituximab era.
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Affiliation(s)
- Jesse Shustik
- Division of Medical Oncology, Laboratory Medicine, BC Cancer Agency, University of British Columbia, Vancouver, Canada
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Alacacioglu I, Ozcan MA, Ozkal S, Piskin O, Turgut N, Demirkan F, Ozsan GH, Kargi A, Undar B. Prognostic significance of immunohistochemical classification of diffuse large B-cell lymphoma. ACTA ACUST UNITED AC 2009; 14:84-9. [PMID: 19298719 DOI: 10.1179/102453309x385205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM To evaluate the clinical significance of immunoperoxidase staining for CD10, bcl-6, mum-1 and bcl-2 to subdivide DLBCL into prognostic subgroups, we analysed 50 DLBCL cases using immunohistochemical methods. METHODS AND RESULTS Fifty DLBCL patients were evaluated retrospectively. The expression of CD10 was associated with better OS (p=0.04) whereas expression of mum-1 was associated with worse OS (p=0.009). There were no significance of OS in case of expression of bcl-6 (p=0.05) and bcl-2 (p=0.3). They were subclassified using CD10, mum-1, bcl-6 as germinal center B-cell like (GCB) lymphoma (30%) and non-GCB lymphoma (70%). The OS and EFS (event free survival) were longer in GCB group (p=0.002) and 5-year OS for GCB group was 92% compared with only 44% for the non-GCB group (p=0.02). The OS of the GCB group also was longer compared to that of the non-GCB group in low IPI subgroup (p=0.01). CONCLUSION The existence of survival differences between GCB a non-GCB group also in the patients with low IPI score, showed the importance of prognostic classification in the risk-adaptive treatment approaches. The classification as GCB and non-GCB based immunostains may enable to define more accurate prognostic groups in DLBCL.
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Affiliation(s)
- Inci Alacacioglu
- Division of Hematology, Dokuz Eylul University Faculty of Medicine, Balcova, Izmir, Turkey
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Most primary adrenal lymphomas are diffuse large B-cell lymphomas with non-germinal center B-cell phenotype, BCL6 gene rearrangement and poor prognosis. Mod Pathol 2009; 22:1210-7. [PMID: 19525926 DOI: 10.1038/modpathol.2009.87] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Primary adrenal lymphoma is extremely rare, accounting for <1% of non-Hodgkin lymphomas, and lymphoma-associated chromosomal translocations have yet to be reported in this entity. We performed a retrospective study of 10 cases in immunocompetent patients including 4 males and 6 females with a median age of 68 years. The most common presenting symptoms were abdominal pain and fever; unexpectedly, clinically evident adrenal insufficiency was detected only in one patient. The mean tumor size at diagnosis was 8.5 cm. Half of the patients had bilateral involvement. All cases presented with stage IE disease without regional nodal involvement. Histologically, eight cases were diffuse large B-cell lymphoma, all of which carried a non-germinal center B-cell phenotype. Fluorescence in situ hybridization revealed BCL6 gene rearrangement in 5 (83%) of 6 diffuse large B-cell lymphomas investigated. The remaining cases were one case each of plasmablastic lymphoma and extranodal NK/T-cell lymphoma, nasal type, the first and third case of primary adrenal lymphoma of these particular lymphoma subtypes in the English literature, respectively. At a median follow-up of 4.5 months, 7 patients died of lymphoma, 1 died of an unrelated disease, 1 was alive with disease, and 1 was alive without disease. The prognosis of these patients was poor as compared with those with nodal diffuse large B-cell lymphoma. We speculate that the poor outcome of primary adrenal lymphoma might be related to the bulky tumor size at presentation, non-germinal center B-cell phenotype, and frequent BCL-6 gene rearrangement.
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Chang KC, Huang GC, Jones D, Tsao CJ, Lee JYY, Su IJ. Distribution and Prognosis of WHO Lymphoma Subtypes in Taiwan Reveals a Low Incidence of Germinal-Center Derived Tumors. Leuk Lymphoma 2009; 45:1375-84. [PMID: 15359636 DOI: 10.1080/10428194042000198849] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To assess the distribution of lymphomas in Taiwan according to the WHO (World Health Organization) classification, 175 recently diagnosed cases of malignant lymphomas were studied and the clinicopathologic data were analyzed. B-cell lymphomas accounted for 57.1% of cases, T-cell lymphomas 38.9%, and Hodgkin's lymphoma 4%. Extranodal lymphomas predominated (55.4%). The most common subtype of B-cell lymphoma was diffuse large B-cell lymphoma (33.1%). All tumor types believed to be derived from germinal center (GC) B-cells including follicular lymphoma (4.6%), Burkitt lymphoma (1.7%), Hodgkin lymphoma (4.0%), and GC-like diffuse large B-cell lymphoma (as defined by combined expression of bc1-6 and CD10) were rather uncommon as compared to frequencies seen in series from Western countries. The common T-cell lymphomas included nasal and extranasal NK/T cell lymphoma (7.4%), mycosis fungoides (7.4%), and unspecified peripheral T-cell lymphoma (6.9%). Adult T-cell leukemia/lymphoma was very uncommon and accounts for only 0.6%. The proportional increase in T-cell lymphomas that were unrelated to type I human T-cell lymphotropic virus (HTLV-1) may be linked to differential Epstein-Barr virus (EBV) oncogenesis. The survival data revealed that mantle cell lymphoma, NK/T-cell lymphoma, unspecified peripheral T-cell lymphoma, and subcutaneous panniculitis-like T-cell lymphoma had an aggressive course. Our results confirm the utility of the WHO classification scheme for prognostic stratification and further highlight the distinctive distribution pattern of malignant lymphoma in Taiwan including the higher relative incidence of T cell lymphomas and the rarity of germinal center-derived B-cell tumors.
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Affiliation(s)
- Kong-Chao Chang
- Department of Pathology, and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Julen O, Dellacasa I, Pelte MF, Borish B, Bouchardy C, Capanna F, Vlastos G, Dubuisson JB, Vlastos AT. Primary breast lymphomas. Rare Tumors 2009; 1:e14. [PMID: 21139885 PMCID: PMC2994446 DOI: 10.4081/rt.2009.e14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/01/2009] [Indexed: 11/24/2022] Open
Abstract
The diagnosis, prognostic factors, and optimal management of primary breast lymphomas (PBL) is difficult. Seven patients recorded at the Geneva Cancer Registry between 1973–1998 were reviewed. Five patient had diffuse large B-cell lymphoma, one a follicular lymphoma and one a MALT-lymphoma. All patients had clinical and radiological findings consistent with breast cancer and underwent mastectomy, which is not indicated in PBL. Diagnosis should be established prior to operative interventions, as fine needle aspiration missed the diagnosis for one patient and intra-operative frozen sections for 3 patients in our study. Five-year and 10-year overall survivals were 57% and 15%, respectively. Of the 3 patients who died from PBL, 2 had tumors that were Bcl-2 positive but Bcl-6 negative. All 3 surviving patients have positive Bcl-2 and Bcl-6 immunostaining, which could be important prognostic factors if confirmed by a larger study.
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Affiliation(s)
- Olivier Julen
- Department of Gynecology and Obstetrics, Geneva University Hospital
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42
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Nyvold CG, Bendix K, Brandsborg M, Pulczynski S, Silkjaer T, Hokland P. Multiplex PCR for the detection of BCL-1/IGH and BCL-2/IGH gene rearrangements--clinical validation in a prospective study of blood and bone marrow in 258 patients with or suspected of non-Hodgkin's lymphoma. Acta Oncol 2009; 46:21-30. [PMID: 17438702 DOI: 10.1080/02841860600681551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We have designed a multiplex PCR, which allows for fast and high throughput demonstration of the BCL-1/IGH and BCL-2/IGH fusion DNA observed primarily in mantle cell- and follicular non-Hodgkin's lymphoma (NHL). Blood (PB) and/or bone marrow (BM) from 258 patients suspected of NHL have prospectively been evaluated. Eleven patients (4%) were found t(11;14)+ and 37 patients (14%) t(14;18)+. Comparing these results to standard diagnostic methods of PB and/or BM identified PCR+ samples that were normal by morphology (BCL-1/IGH: 1/11; BCL-2/IGH: 17/37). Equally important, patients who were not clonal in PB and/or BM by flow cytometry were identified as PCR+ (BCL-1/IGH: 3/11; BCL-2/IGH: 23/37). We conclude that this multiplex approach allows for easy and sensitive molecular determination of molecular lesions in NHL, which have diagnostic and prognostic importance.
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Abstract
Diffuse Large B cell lymphoma (DLBCL) is characterized by a markedly heterogeneous clinical course and response to therapy that is not appreciated with standard histopathologic and immunophenotypic evaluations. Analysis of global gene expression using DNA microarrays has the potential to improve the classification of lymphomas. Molecular profiling may allow the description of specific disease subtypes with similar clinical behavior and outcome. In addition, gene expression profiling has led to the discovery of new putative genes and a better understanding of aberrant signaling pathways. These insights may lead to the discovery of new targeted therapies. This review describes the progress that has been made in our understanding of DLBCL as a result of gene expression profiling.
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Affiliation(s)
- Daniel Morgensztern
- Division of Hematology/Oncology, Department of Medicine, Washington University in St Louis, St Louis, MO, USA
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44
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Tzankov A, Schneider A, Hoeller S, Dirnhofer S. Prognostic importance of BCL6 rearrangements in diffuse large B-cell lymphoma with respect to Bcl6 protein levels and primary lymphoma site. Hum Pathol 2009; 40:1055-6; author reply 1056. [PMID: 19524106 DOI: 10.1016/j.humpath.2009.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 03/05/2009] [Indexed: 11/18/2022]
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45
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Tibiletti MG, Martin V, Bernasconi B, Del Curto B, Pecciarini L, Uccella S, Pruneri G, Ponzoni M, Mazzucchelli L, Martinelli G, Ferreri AJ, Pinotti G, Assanelli A, Scandurra M, Doglioni C, Zucca E, Capella C, Bertoni F. BCL2, BCL6, MYC, MALT 1, and BCL10 rearrangements in nodal diffuse large B-cell lymphomas: a multicenter evaluation of a new set of fluorescent in situ hybridization probes and correlation with clinical outcome. Hum Pathol 2009; 40:645-52. [DOI: 10.1016/j.humpath.2008.06.032] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 05/28/2008] [Accepted: 06/23/2008] [Indexed: 11/29/2022]
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Borovecki A, Korać P, Nola M, Ivanković D, Jaksić B, Dominis M. Prognostic significance of B-cell differentiation genes encoding proteins in diffuse large B-cell lymphoma and follicular lymphoma grade 3. Croat Med J 2009; 49:625-35. [PMID: 18925696 DOI: 10.3325/cmj.2008.5.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM To define prognostic significance of B-cell differentiation genes encoding proteins and BCL2 and BCL6 gene abnormalities in diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern. METHODS In 53 patients with diffuse large B-cell lymphoma and 20 patients with follicular lymphoma grade 3 with >75% follicular growth pattern the following was performed: 1) determination of protein expression of BCL6, CD10, MUM1/IRF4, CD138, and BCL2 by immunohistochemistry; 2) subclassification into germinal center B-cell-like (GCB) and activated B-cell-like (ABC) groups according to the results of protein expression; 3) detection of t(14;18)(q32;q21)/IgH-BCL2 and BCL6 abnormalities by fluorescent in situ hybridization in diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern as well as in GCB and ABC groups; and 4) assessment of the influence of the analyzed characteristics and clinical prognostic factors on overall survival. RESULTS Only BCL6 expression was more frequently found in follicular lymphoma grade 3 with >75% follicular growth pattern than in diffuse large B-cell lymphoma (P=0.030). There were no differences in BCL2 and BCL6 gene abnormalities between diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern. Diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients were equally distributed in GCB and ABC groups. t(14;18)(q32;q21) was more frequently recorded in GCB group, and t(14;18)(q32;q21) with BCL2 additional signals or only BCL2 and IgH additional signals in ABC group (P=0.004). The GCB and ABC groups showed no difference in BCL6 gene abnormalities. There was no overall survival difference between the diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients, however, GCB group had longer overall survival than ABC group (P=0.047). Multivariate analysis showed that BCL6, CD10, and BCL2 expression, BCL2 and BCL6 abnormalities, and International Prognostic Index were not significantly related to overall survival. CONCLUSION Diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients have very similar characteristics and their prognosis is more influenced by protein expression of B-cell differentiation stage genes than by tumor cells growth pattern, BCL2 and BCL6 abnormalities, and International Prognostic Index.
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Affiliation(s)
- Ana Borovecki
- Department of Clinical Pathology and Cytology, Merkur University Hospital, Zajceva 19, 10000 Zagreb, Croatia.
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Ennishi D, Yokoyama M, Terui Y, Asai H, Sakajiri S, Mishima Y, Takahashi S, Komatsu H, Ikeda K, Takeuchi K, Tanimoto M, Hatake K. Soluble interleukin-2 receptor retains prognostic value in patients with diffuse large B-cell lymphoma receiving rituximab plus CHOP (RCHOP) therapy. Ann Oncol 2008; 20:526-33. [PMID: 19074749 DOI: 10.1093/annonc/mdn677] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Soluble interleukin-2 receptor (SIL-2R) is known to be a prognostic parameter in patients with diffuse large B-cell lymphoma (DLBCL) receiving cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) therapy. However, its prognostic value has not been well known since the introduction of rituximab. PATIENTS AND METHODS We retrospectively evaluated the prognostic impact of SIL-2R in 228 DLBCL patients, comparing 141 rituximab-combined CHOP (RCHOP)-treated patients with 87 CHOP-treated patients as a historical control. RESULTS Patients with high serum SIL-2R showed significantly poorer event-free survival (EFS) and overall survival (OS) than patients with low SIL-2R in both the RCHOP group (2-year EFS, 66% versus 92%, P<0.001; OS, 82% versus 95%, P=0.005) and the CHOP group (2-year EFS, 40% versus 82%; OS, 61% versus 90%, both P<0.001). Multivariate analysis including the five parameters of International Prognostic Index (IPI) and two-categorized IPI revealed that SIL-2R was an independent prognostic factor for EFS and OS in the RCHOP group as well as in the CHOP group. CONCLUSIONS Our results demonstrate that SIL-2R retains its prognostic value in the rituximab era. The prognostic value of SIL-2R in DLBCL patients receiving rituximab-combined chemotherapy should be reassessed on a larger scale and by long-term follow-up.
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Affiliation(s)
- D Ennishi
- Department of Medical Oncology and Hematology, Cancer Institute Hospital, 3-10-6 Ariake Koto-ku, Tokyo, Japan
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A distinctive subtype of t(14;18)-negative nodal follicular non-Hodgkin lymphoma characterized by a predominantly diffuse growth pattern and deletions in the chromosomal region 1p36. Blood 2008; 113:1053-61. [PMID: 18978208 DOI: 10.1182/blood-2008-07-168682] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Follicular lymphoma (FL) is a morphologically and genetically well-characterized B-cell non-Hodgkin lymphoma that can show predominantly follicular, combined follicular and diffuse, or predominantly diffuse growth patterns. Although approximately 85% of FLs harbor the translocation t(14;18)(q32;q21) and consistently display a follicular growth pattern, predominantly diffuse FLs are less well characterized on the phenotypical, molecular, and clinical level. We studied 35 predominantly diffuse FL by immunohistochemistry, classical chromosome banding analysis, fluorescence in situ hybridization (FISH), and gene expression profiling. A total of 28 of 29 analyzable cases lacked t(14;18), and 27 of 29 cases revealed a unifying chromosomal aberration, a deletion in 1p36. Morphologically, 12 FLs were grade 1 and 23 were grade 2, and the immunophenotype with frequent expression of CD10, BCL6, and CD23 was in line with a germinal center B-cell phenotype. The gene expression profiles of 4 predominantly diffuse FLs fell into the spectrum of typical FL, with a unique enrichment of specific gene signatures. Remarkably, patients with diffuse FL frequently presented with low clinical stage and large but localized inguinal tumors. These results suggest that predominantly diffuse FL represent a distinct subtype of t(14;18)-negative nodal FL with a unifying genetic alteration (deletion of 1p36) and characteristic clinical features.
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Cady FM, O'Neill BP, Law ME, Decker PA, Kurtz DM, Giannini C, Porter AB, Kurtin PJ, Johnston PB, Dogan A, Remstein ED. Del(6)(q22) and BCL6 rearrangements in primary CNS lymphoma are indicators of an aggressive clinical course. J Clin Oncol 2008; 26:4814-9. [PMID: 18645192 DOI: 10.1200/jco.2008.16.1455] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Primary CNS lymphoma (PCNSL) is an aggressive lymphoma but clinically validated biologic markers that can predict natural history to tailor treatment according to risk are lacking. Several genetic changes including BCL6 rearrangements and deletion of 6q22, containing the putative tumor suppressor gene PTPRK, are potential risk predictors. Herein we determined the prevalence and survival impact of del(6)(q22) and BCL6, immunoglobulin heavy chain (IGH), and MYC gene rearrangements in a large PCNSL cohort treated in a single center. PATIENTS AND METHODS Interphase fluorescence in situ hybridization was performed using two-color probes for BCL6, MYC, IGH-BCL6, and del(6)(q22) on thin sections of 75 paraffin-embedded samples from 75 HIV-negative, immunocompetent patients newly diagnosed with PCNSL. Survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and proportional hazards regression adjusting for age, deep structure involvement, and high-dose methotrexate (HDMTX) treatment. RESULTS The prevalence of del(6)(q22) and BCL6, IGH, and MYC translocations was 45%,17%, 13%, and 3%, respectively. The presence of del(6)(q22) and/or a BCL6 translocation was associated with inferior overall survival (OS; P = .0097). The presence of either del(6)(q22) alone or a BCL6 translocation alone was also associated with inferior OS (P = .0087). Univariable results held after adjusting for age, deep structure involvement, and HDMTX. CONCLUSION Del (6)(q22) and BCL6 rearrangements are common in PCNSL and predict for decreased OS independent of deep structure involvement and HDMTX. Unlike systemic diffuse large B-cell lymphoma, del(6)(q22) is common and IGH translocations are infrequent and usually involve BCL6 rather than BCL2, suggesting a distinct pathogenesis.
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Affiliation(s)
- Francois M Cady
- Department of Pathology, CellNetix Pathology, Olympia, WA, USA
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A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 trial). Blood 2008; 112:2248-60. [PMID: 18612102 DOI: 10.1182/blood-2008-03-145128] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This prospective study aimed to develop reproducible diagnostic criteria for sporadic Burkitt lymphoma (BL), applicable to routine practice, and to evaluate the efficacy of dose-modified (dm) CODOX-M/IVAC in patients diagnosed using these criteria. The study was open to patients with an aggressive B-cell lymphoma with an MKI67 fraction approaching 100%. Immunophenotype and fluorescent in situ hybridization (FISH) were used to separate BL from other aggressive B-cell lymphomas. BL was characterized by the presence of a cMYC rearrangement as a sole cytogenetic abnormality occurring in patients with a germinal center phenotype with absence of BCL-2 expression and abnormal TP53 expression. A total of 128 patients were eligible for the study, of whom 58 were considered to have BL and 70 to have diffuse large B-cell lymphoma (DLBCL). There were 110 clinically fit patients who received dmCODOX-M (methotrexate, dose 3 g/m(2)) with or without IVAC according to risk group. The 2-year progression-free survival was 64% (95% confidence interval [CI] 51%-77%) for BL, 55% (95% CI 42%-66%) for DLBCL, 85% (95% CI 73%-97%) for low risk, and 49% (95% CI 38%-60%) for high-risk patients. The observed differences in outcome and other clinical features validate the proposed diagnostic criteria. Compared with the previous trial LY06 with full-dose methotrexate (6.7 g/m(2)), there was a reduction in toxicity with comparable outcomes. This study was registered at www.clinicaltrials.gov as NCT00040690.
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