1
|
Impact of Tumour Epstein–Barr Virus Status on Clinical Outcome in Patients with Classical Hodgkin Lymphoma (cHL): A Review of the Literature and Analysis of a Clinical Trial Cohort of Children with cHL. Cancers (Basel) 2022; 14:cancers14174297. [PMID: 36077832 PMCID: PMC9454639 DOI: 10.3390/cancers14174297] [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: 07/03/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The Epstein–Barr virus (EBV) contributes to different forms of human cancer, including a subset of classical Hodgkin lymphoma (cHL), a B-cell lymphoma with unusual histological features. Although the pathogenesis of EBV-associated cHL remains to be elucidated, biological investigations point to an important aetiological role for the virus in the development of this tumour. This is even more relevant now considering the potential opportunities that exist to treat EBV-associated disorders, for example, with immunotherapeutics or small molecule inhibitors targeting viral proteins. For this reason, we believe it is now timely to review the association between EBV and cHL and in particular to re-evaluate the impact of EBV status on clinical outcomes in cHL patients. Herein, we also report the impact of EBV on clinical outcomes in a cohort of children and adolescents with cHL. Abstract In this study, we have re-evaluated how EBV status influences clinical outcome. To accomplish this, we performed a literature review of all studies that have reported the effect of EBV status on patient outcome and also explored the effect of EBV positivity on outcome in a clinical trial of children with cHL from the UK. Our literature review revealed that almost all studies of older adults/elderly patients have reported an adverse effect of an EBV-positive status on outcome. In younger adults with cHL, EBV-positive status was either associated with a moderate beneficial effect or no effect, and the results in children and adolescents were conflicting. Our own analysis of a series of 166 children with cHL revealed no difference in overall survival between EBV-positive and EBV-negative groups (p = 0.942, log rank test). However, EBV-positive subjects had significantly longer event-free survival (p = 0.0026). Positive latent membrane protein 1 (LMP1) status was associated with a significantly lower risk of treatment failure in a Cox regression model (HR = 0.21, p = 0.005). In models that controlled for age, gender, and stage, EBV status had a similar effect size and statistical significance. This study highlights the age-related impact of EBV status on outcome in cHL patients and suggests different pathogenic effects of EBV at different stages of life.
Collapse
|
2
|
Prognostic value of Bcl2 and p53 in Hodgkin lymphoma: A systematic review and meta-analysis. Pathol Res Pract 2021; 219:153370. [PMID: 33618247 DOI: 10.1016/j.prp.2021.153370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/21/2022]
Abstract
AIMS Several studies suggested that high expression of Bcl2 and/or p53 in Hodgkin/Reed-Sternberg cells is an unfavorable prognostic factor in Hodgkin lymphoma (HL). However, results in this field appear contrasting. We aimed to assess the prognostic value of p53 and Bcl2 in HL through a systematic review and meta-analysis. METHODS Electronic databases were searched from January 2000 to December 2020 for all studies assessing the prognostic value of p53 and Bcl2 in HL. The association of high p53 or Bcl2 expression with overall survival (OS), progression-free survival (PFS) and response to treatment was assessed by using hazard ratio (HR) and odds ratio (OR). RESULTS Eighteen studies were included. Bcl2 overexpression was significantly associated with decreased PFS (HR = 2.202; p < 0.0001), while the associations with decreased OS (HR = 1.565; p = 0.257) and refractoriness to treatment (OR = 0.482; p = 0.068) were non-significant. p53 overexpression was not significantly associated with refractoriness to treatment (OR = 0.904; p = 0.155); the analysis of OS and PFS was not feasible, but published data suggested the absence of a significant association. CONCLUSIONS In HL, Bcl2 overexpression is associated with decreased PFS, while a significant prognostic value could not be demonstrated for p53. Defining optimal criteria for interpreting Bcl2 and p53 immunostaining is necessary to draw definitive conclusions.
Collapse
|
3
|
Stachowicz-Stencel T, Synakiewicz A. Biomarkers for pediatric cancer detection: latest advances and future perspectives. Biomark Med 2020; 14:391-400. [PMID: 32270691 DOI: 10.2217/bmm-2019-0613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cancer is one of the major health problems of the modern world. With the development of novel biochemistry and analytical instrumentation, precancer diagnosis has become a major focus of clinical and preclinical research. Finding appropriate biomarkers is crucial to make an early diagnosis, before the disease fully develops. With the improvement of precancer studies, cancer biomarkers prove their usefulness in providing important data on the cancer type and the status of patients' progression at a very early stage of the disease. Due to the constant evolution of pediatric cancer diagnosis, which includes highly advanced molecular techniques, the authors have decided to focus on selected groups of neoplastic disease and these include brain tumors, neuroblastoma, osteosarcoma and Hodgkin lymphoma.
Collapse
Affiliation(s)
- Teresa Stachowicz-Stencel
- Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland 7 Debinki Street, 80-952 Gdansk, Poland
| | - Anna Synakiewicz
- Department of Pediatrics, Hematology & Oncology, Medical University of Gdansk, Poland 7 Debinki Street, 80-952 Gdansk, Poland
| |
Collapse
|
4
|
Lorenzetti MA, Mosna MJ, De Matteo EN, García Lombardi M, Colli SL, Preciado MV. Overexpression of survivin in pediatric Hodgkin lymphoma tumor cells: Characterization of protein expression and splice-variants transcription profile. Exp Mol Pathol 2019; 108:24-31. [PMID: 30876863 DOI: 10.1016/j.yexmp.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 01/30/2023]
Abstract
Survivin is abundantly expressed during fetal development but absent in most differentiated adult tissues; an exception being components of the immune system, such as B and T lymphocytes. Beyond acting as a master regulator of the cell cycle, survivin acts as an inhibitor of apoptosis and is overexpressed in almost all carcinoma types; however, its expression in lymphomas is lesser-explored. Survivin's role in carcinogenesis was subjected to its sub-cellular localization and splice transcripts expression, namely wild-type survivin, survivin-∆Ex3 and survivin-2B. To assess survivin's expression and sub-cellular localization in Epstein Barr virus positive and negative biopsies from treatment naïve pediatric patients with Hodgkin lymphoma (HL), samples were stained for survivin protein by immunofluorescence. The proportion of survivin+ cells was calculated, survivin sub-cellular localization assessed and its fluorescence intensity quantified. Transcription profile of survivin mRNA variants was studied by RT-qPCR. Survivin was overexpressed in the nucleus of tumor cells, and also in a greater proportion of tumor cells, in comparison with the non-tumoral infiltrating cells. Although a higher expression of survivin was observed in advanced clinical stages, no correlation was found between the expression level of survivin and a proliferation marker, or event-free survival. Instead, survivin was related to apoptosis inhibition in tumor cells. Additionally, survivin's transcriptional variants displayed similar expression levels. Present results suggest that although survivin is overexpressed in Hodgkin's tumor cells, it may not play a central role in the progression of classic HL, or act as a suitable progression biomarker, as suggested for most carcinomas.
Collapse
Affiliation(s)
- Mario Alejandro Lorenzetti
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, División Patología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.
| | - María Jimena Mosna
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, División Patología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Elena Noemí De Matteo
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, División Patología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Sandra Lorena Colli
- División Patología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - María Victoria Preciado
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, División Patología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| |
Collapse
|
5
|
Méhes G, Matolay O, Beke L, Czenke M, Jóna Á, Miltényi Z, Illés Á, Bedekovics J. Hypoxia-related carbonic anhydrase IX expression is associated with unfavourable response to first-line therapy in classical Hodgkin's lymphoma. Histopathology 2019; 74:699-708. [PMID: 30636023 DOI: 10.1111/his.13808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
AIMS The present study evaluates the impact of hypoxia-related carbonic anhydrase IX and XII isoenzyme expression as a basic adaptive mechanism to neutralise intracellular acidosis in classical Hodgkin's lymphoma (cHL). METHODS AND RESULTS Eighty-one primary biopsies and 15 relapsed tissue samples diagnosed with cHL were analysed for necrosis, CAIX and CAXII expression and cell proliferation to compare hypoxia-related histological and functional data with survival characteristics. Variable, but highly selective cell membrane CAIX expression could be demonstrated in Hodgkin-Reed-Sternberg (HRS) cells in 39 of 81 samples (48.1%), while virtually no staining presented in their microenvironment. In contrast, CAXII expression in HRS cells could be demonstrated in only 18 of 77 samples (23.4%), with significant stromal positivity (50 of 77, 64.9%). The CAIX+ positive phenotype was strongly associated with lymphocyte depletion (four of four, 100%) and nodular sclerosis (29 of 51, 56.9%) subtypes. CAIX/Ki-67 dual immunohistochemistry demonstrated suppressed cell proliferation in CAIX+ positive compared to CAIX- negative HRS cells (P < 0.001). Seventy-two months' progression-free survival (PFS) was significantly lower for the CAIX positive group (0.192) compared with the CAIX negative group (0.771) (P < 0.001), while the overall survival (OS) did not differ (P = 0.097). CONCLUSION Hypoxic stress-related adaptation - highlighted by CAIX expression - results in cellular quiescence in HRS cells, potentially contributing to the short-term failure of the standard chemotherapy in cHL.
Collapse
Affiliation(s)
- Gábor Méhes
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Orsolya Matolay
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Livia Beke
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marianna Czenke
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ádám Jóna
- Hematology Division, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsofia Miltényi
- Hematology Division, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Árpád Illés
- Hematology Division, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Bedekovics
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
6
|
Kılıç Bağır E, Açıkalın A, Ergin M, Sezgin G, Küpeli S, Seydaoğlu G. Pediatrik lenfomalarda histopatolojik subtip ve Ebstein-Barr virus ilişkisi: immünohistokimyasal ve in situ hibridizasyon çalışması. CUKUROVA MEDICAL JOURNAL 2018. [DOI: 10.17826/cumj.368637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
7
|
Nagpal P, Akl MR, Ayoub NM, Tomiyama T, Cousins T, Tai B, Carroll N, Nyrenda T, Bhattacharyya P, Harris MB, Goy A, Pecora A, Suh KS. Pediatric Hodgkin lymphoma: biomarkers, drugs, and clinical trials for translational science and medicine. Oncotarget 2016; 7:67551-67573. [PMID: 27563824 PMCID: PMC5341896 DOI: 10.18632/oncotarget.11509] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/18/2016] [Indexed: 01/09/2023] Open
Abstract
Hodgkin lymphoma (HL) is a lymphoid malignancy that is typically derived from germinal-center B cells. EBV infection, mutations in NF-κB pathway genes, and genetic susceptibility are known risk factors for developing HL. CD30 and NF-κB have been identified as potential biomarkers in pediatric HL patients, and these molecules may represent therapeutic targets. Although current risk adapted and response based treatment approaches yield overall survival rates of >95%, treatment of relapse or refractory patients remains challenging. Targeted HL therapy with the antibody-drug conjugate Brentuximab vedotin (Bv) has proven to be superior to conventional salvage chemotherapy and clinical trials are being conducted to incorporate Bv into frontline therapy that substitutes Bv for alkylating agents to minimize secondary malignancies. The appearance of secondary malignancies has been a concern in pediatric HL, as these patients are at highest risk among all childhood cancer survivors. The risk of developing secondary leukemia following childhood HL treatment is 10.4 to 174.8 times greater than the risk in the general pediatric population and the prognosis is significantly poorer than the other hematological malignancies with a mortality rate of nearly 100%. Therefore, identifying clinically valuable biomarkers is of utmost importance to stratify and select patients who may or may not need intensive regimens to maintain optimal balance between maximal survival rates and averting late effects. Here we discuss epidemiology, risk factors, staging, molecular and genetic prognostic biomarkers, treatment for low and high-risk patients, and the late occurrence of secondary malignancies in pediatric HL.
Collapse
Affiliation(s)
- Poonam Nagpal
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mohamed R. Akl
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nehad M. Ayoub
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tatsunari Tomiyama
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Tasheka Cousins
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Betty Tai
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Nicole Carroll
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Themba Nyrenda
- Department of Research, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Michael B. Harris
- Department of Pediatrics, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andre Goy
- Clinical Divisions, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Andrew Pecora
- Clinical Divisions, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - K. Stephen Suh
- The Genomics and Biomarkers Program, The John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
- Department of Research, Hackensack University Medical Center, Hackensack, NJ, USA
| |
Collapse
|
8
|
Prevalence and Prognostic Significance of Epstein–Barr Virus Infection in Classical Hodgkin's Lymphoma: A Meta-analysis. Arch Med Res 2014; 45:417-31. [DOI: 10.1016/j.arcmed.2014.06.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
|
9
|
Effect of cytotoxic agents and retinoic acid on Myc-N protein expression in neuroblastoma. Appl Immunohistochem Mol Morphol 2010; 18:86-9. [PMID: 19550295 DOI: 10.1097/pai.0b013e3181aa432d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Neuroblastoma is an important pediatric tumor in which Myc-N amplification is a well-known poor prognostic indicator. It has a great diversity in clinical behavior. The effect of pharmacologic agents used in neuroblastoma treatment on Myc-N expression is still unclear. METHOD We analyzed Myc-N expression changes by immunocytochemistry in Myc-N-positive Kelly human neuroblastoma cell line using retinoic acid and cytotoxic drugs (cisplatin, vincristine, cyclophosphamide, etoposide, and doxorubicin) and their combinations compared with control conditions. First, concentration of drugs were determined as LD50 doses. Kelly cells and drugs were incubated for 24 hours in 5% CO2, 37 degrees C in 96-well plates. Myc-N expression was scored semiquantitatively as negative, mild, moderate, or high positive. RESULTS Myc-N amplification did not change with any agent or combination. It was higher than 20 copies in all conditions. Myc-N protein expression was high in control and doxorubicin group. It was moderate in retinoic acid, cyclophosphamide, retinoic acid combined with cyclophosphamide and retinoic acid combined with doxorubicin groups. The expression was mild in cisplatin, vincristine, etoposide, retinoic acid combined with etoposide, and retinoic acid combined with cisplatin groups. Myc-N expression was negative in retinoic acid combined with vincristine group. CONCLUSIONS Myc-N expression is reduced with cytotoxic agents and retinoic acid in neuroblastoma although Myc-N amplification remains the same. Retinoic acid combined with vincristine is the most effective combination to reduce Myc-N expression. Our results suggest that therapeutic applications of these agents as low dose maintenance therapy might be useful.
Collapse
|
10
|
Jayanthan A, Howard SC, Trippett T, Horton T, Whitlock JA, Daisley L, Lewis V, Narendran A. Targeting the Bcl-2 family of proteins in Hodgkin lymphoma:in vitrocytotoxicity, target modulation and drug combination studies of the Bcl-2 homology 3 mimetic ABT-737. Leuk Lymphoma 2009; 50:1174-82. [DOI: 10.1080/10428190902943069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
11
|
Expression and Methylation Pattern of p16 in Neuroblastoma Tumorigenesis. Pathol Oncol Res 2009; 16:1-6. [DOI: 10.1007/s12253-009-9178-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
|
12
|
Aktaş S, Kargı A, Olgun N, Diniz G, Erbay A, Vergin C. Prognostic Significance of Cell Proliferation and Apoptosis-Regulating Proteins in Epstein-Barr Virus Positive and Negative Pediatric Non-Hodgkin’s Lymphoma. Pathol Oncol Res 2008; 15:345-50. [DOI: 10.1007/s12253-008-9127-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 11/05/2008] [Indexed: 01/15/2023]
|
13
|
Staege MS, Banning-Eichenseer U, Weißflog G, Volkmer I, Burdach S, Richter G, Mauz-Körholz C, Föll J, Körholz D. Gene expression profiles of Hodgkin's lymphoma cell lines with different sensitivity to cytotoxic drugs. Exp Hematol 2008; 36:886-96. [DOI: 10.1016/j.exphem.2008.02.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 01/21/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
|