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Malcikova J, Pavlova S, Baliakas P, Chatzikonstantinou T, Tausch E, Catherwood M, Rossi D, Soussi T, Tichy B, Kater AP, Niemann CU, Davi F, Gaidano G, Stilgenbauer S, Rosenquist R, Stamatopoulos K, Ghia P, Pospisilova S. ERIC recommendations for TP53 mutation analysis in chronic lymphocytic leukemia-2024 update. Leukemia 2024; 38:1455-1468. [PMID: 38755420 PMCID: PMC11217004 DOI: 10.1038/s41375-024-02267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
In chronic lymphocytic leukemia (CLL), analysis of TP53 aberrations (deletion and/or mutation) is a crucial part of treatment decision-making algorithms. Technological and treatment advances have resulted in the need for an update of the last recommendations for TP53 analysis in CLL, published by ERIC, the European Research Initiative on CLL, in 2018. Based on the current knowledge of the relevance of low-burden TP53-mutated clones, a specific variant allele frequency (VAF) cut-off for reporting TP53 mutations is no longer recommended, but instead, the need for thorough method validation by the reporting laboratory is emphasized. The result of TP53 analyses should always be interpreted within the context of available laboratory and clinical information, treatment indication, and therapeutic options. Methodological aspects of introducing next-generation sequencing (NGS) in routine practice are discussed with a focus on reliable detection of low-burden clones. Furthermore, potential interpretation challenges are presented, and a simplified algorithm for the classification of TP53 variants in CLL is provided, representing a consensus based on previously published guidelines. Finally, the reporting requirements are highlighted, including a template for clinical reports of TP53 aberrations. These recommendations are intended to assist diagnosticians in the correct assessment of TP53 mutation status, but also physicians in the appropriate understanding of the lab reports, thus decreasing the risk of misinterpretation and incorrect management of patients in routine practice whilst also leading to improved stratification of patients with CLL in clinical trials.
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Affiliation(s)
- Jitka Malcikova
- Department of Internal Medicine, Hematology and Oncology, and Institute of Medical Genetics and Genomics, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Sarka Pavlova
- Department of Internal Medicine, Hematology and Oncology, and Institute of Medical Genetics and Genomics, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Panagiotis Baliakas
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Eugen Tausch
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Mark Catherwood
- Haematology Department, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Thierry Soussi
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Hematopoietic and Leukemic Development, UMRS_938, Sorbonne University, Paris, France
| | - Boris Tichy
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Frederic Davi
- Sorbonne Université, Paris, France
- Department of Hematology, Hôpital Pitié-Salpêtière, AP-HP, Paris, France
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Stephan Stilgenbauer
- Division of CLL, Department of Internal Medicine III, Ulm University, Ulm, Germany
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milan, Italy.
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Sarka Pospisilova
- Department of Internal Medicine, Hematology and Oncology, and Institute of Medical Genetics and Genomics, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic.
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
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2
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Santisteban-Espejo A, Bernal-Florindo I, Montero-Pavon P, Perez-Requena J, Atienza-Cuevas L, Fernandez-Valle MDC, Villalba-Fernandez A, Garcia-Rojo M. Pathogenic Variants Associated with Epigenetic Control and the NOTCH Pathway Are Frequent in Classic Hodgkin Lymphoma. Int J Mol Sci 2024; 25:2457. [PMID: 38473705 DOI: 10.3390/ijms25052457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Classic Hodgkin lymphoma (cHL) constitutes a B-cell neoplasm derived from germinal center lymphocytes. Despite high cure rates (80-90%) obtained with the current multiagent protocols, a significant proportion of cHL patients experience recurrences, characterized by a lower sensitivity to second-line treatments. The genomic background of chemorefractory cHL is still poorly understood, limiting personalized treatment strategies based on molecular features. In this study, using a targeted next-generation sequencing (NGS) panel specifically designed for cHL research, we compared chemosensitive and chemorefractory diagnostic tissue samples of cHL patients. Furthermore, we longitudinally examined paired diagnosis-relapsesamples of chemorefractory cHL in order to define patterns of dynamic evolution and clonal selection. Pathogenic variants in NOTCH1 and NOTCH2 genes frequently arise in cHL. Mutations in genes associated with epigenetic regulation (CREBBP and EP300) are particularly frequent in relapsed/refractory cHL. The appearance of novel clones characterized by mutations previously not identified at diagnosis is a common feature in cHL cases showing chemoresistance to frontline treatments. Our results expand current molecular and pathogenic knowledge of cHL and support the performance of molecular studies in cHL prior to the initiation of first-line therapies.
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Affiliation(s)
- Antonio Santisteban-Espejo
- Department of Pathology, Puerta del Mar University Hospital, 11009 Cadiz, Spain
- Department of Medicine and Surgery, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain
| | - Irene Bernal-Florindo
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain
- Department of Pathology, Jerez de la Frontera University Hospital, 11407 Cadiz, Spain
| | - Pedro Montero-Pavon
- Department of Pathology, Jerez de la Frontera University Hospital, 11407 Cadiz, Spain
| | - Jose Perez-Requena
- Department of Pathology, Puerta del Mar University Hospital, 11009 Cadiz, Spain
| | | | | | | | - Marcial Garcia-Rojo
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain
- Department of Pathology, Jerez de la Frontera University Hospital, 11407 Cadiz, Spain
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3
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Tomacinschii V, Mosquera Orgueira A, Santos CA, Robu M, Buruiana S, Fraga Rodriguez MF. The implication of next-generation sequencing in the diagnosis and clinical management of non-Hodgkin lymphomas. Front Oncol 2023; 13:1275327. [PMID: 38023160 PMCID: PMC10663367 DOI: 10.3389/fonc.2023.1275327] [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: 08/09/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Next generation sequencing (NGS) is a technology that broadens the horizon of knowledge of several somatic pathologies, especially in oncological and oncohematological pathology. In the case of NHL, the understanding of the mechanisms of tumorigenesis, tumor proliferation and the identification of genetic markers specific to different lymphoma subtypes led to more accurate classification and diagnosis. Similarly, the data obtained through NGS allowed the identification of recurrent somatic mutations that can serve as therapeutic targets that can be inhibited and thus reducing the rate of resistant cases. The article's purpose is to offer a comprehensive overview of the best ways of integrating of next-generation sequencing technologies for diagnosis, prognosis, classification, and selection of optimal therapy from the perspective of tailor-made medicine.
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Affiliation(s)
- Victor Tomacinschii
- Department of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
- Department of Hematology, Public Medical Sanitary Institution (PMSI) Institute of Oncology, Chisinau, Moldova
| | - Adrian Mosquera Orgueira
- University Hospital of Santiago de Compostela, Servizo Galego de Saude (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Aliste Santos
- University Hospital of Santiago de Compostela, Servizo Galego de Saude (SERGAS), Santiago de Compostela, Spain
| | - Maria Robu
- Department of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Sanda Buruiana
- Department of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Maximo Francisco Fraga Rodriguez
- University Hospital of Santiago de Compostela, Servizo Galego de Saude (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Forensic Sciences, Pathology, Ginecology and Obstetrics and Pediatrics, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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4
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Donzel M, Pesce F, Trecourt A, Groussel R, Bachy E, Ghesquières H, Fontaine J, Benzerdjeb N, Mauduit C, Traverse-Glehen A. Molecular Characterization of Primary Mediastinal Large B-Cell Lymphomas. Cancers (Basel) 2023; 15:4866. [PMID: 37835560 PMCID: PMC10571533 DOI: 10.3390/cancers15194866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Since the description of primary mediastinal large B-cell lymphoma (PMBL) as a distinct entity from diffuse large B-cell lymphomas (DLBCL), numerous studies have made it possible to improve their definition. Despite this, this differential diagnosis can be challenging in daily practice. However, in some centers, PMBL may be treated according to a particular regimen, distinct from those used in DLBCL, emphasizing the importance of accurate identification at diagnosis. This study aimed to describe the histological and molecular characteristics of PMBL to improve the accuracy of their diagnosis. Forty-nine cases of PMBL were retrospectively retrieved. The mean age at diagnosis was 39 years (21-83), with a sex ratio of 0.88. All cases presented a fibrous background with diffuse growth of intermediate to large cells with an eosinophil (26/49, 53%) or retracted cytoplasm (23/49, 47%). "Hodgkin-like" cells were observed in 65% of cases (32/49, 65%). The phenotype was: BCL6+ (47/49, 96%), MUM1+ (40/49, 82%), CD30+ (43/49, 88%), and CD23+ (37/49, 75%). Genomic DNAs were tested by next generation sequencing of 33 cases using a custom design panel. Pathogenic variants were found in all cases. The most frequent mutations were: SOCS1 (30/33, 91%), TNFAIP3 (18/33, 54.5%), ITPKB (17/33, 51.5%), GNA13 (16/33, 48.5%), CD58 (12/33, 36.4%), B2M (12/33; 36.4%), STAT6 (11/33, 33.3%) as well as ARID1A (10/33, 30.3%), XPO1 (9/33, 27.3%), CIITA (8/33, 24%), and NFKBIE (8/33, 24%). The present study describes a PMBL cohort on morphological, immunohistochemical, and molecular levels to provide pathologists with daily routine tools. These data also reinforce interest in an integrated histomolecular diagnosis to allow a precision diagnosis as early as possible.
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Affiliation(s)
- Marie Donzel
- Hospices Civils de Lyon, Institut de Pathologie Multisite, Hôpital Lyon Sud, 69310 Lyon, France (N.B.)
- UFR Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre International de Recherche en Infectiologie (CIRI), UFR Lyon-1, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS), UMR5308, Ecole Normale Supérieure de Lyon, 69342 Lyon, France
| | | | - Alexis Trecourt
- Hospices Civils de Lyon, Institut de Pathologie Multisite, Hôpital Lyon Sud, 69310 Lyon, France (N.B.)
- UFR Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | | | - Emmanuel Bachy
- UFR Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre International de Recherche en Infectiologie (CIRI), UFR Lyon-1, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS), UMR5308, Ecole Normale Supérieure de Lyon, 69342 Lyon, France
- Hospices Civils de Lyon, Service d’Hématologie, Hôpital Lyon Sud, 69310 Lyon, France
| | - Hervé Ghesquières
- UFR Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre International de Recherche en Infectiologie (CIRI), UFR Lyon-1, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS), UMR5308, Ecole Normale Supérieure de Lyon, 69342 Lyon, France
- Hospices Civils de Lyon, Service d’Hématologie, Hôpital Lyon Sud, 69310 Lyon, France
| | - Juliette Fontaine
- Hospices Civils de Lyon, Institut de Pathologie Multisite, Hôpital Lyon Sud, 69310 Lyon, France (N.B.)
| | - Nazim Benzerdjeb
- Hospices Civils de Lyon, Institut de Pathologie Multisite, Hôpital Lyon Sud, 69310 Lyon, France (N.B.)
- UFR Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Claire Mauduit
- Hospices Civils de Lyon, Institut de Pathologie Multisite, Hôpital Lyon Sud, 69310 Lyon, France (N.B.)
- Centre International de Recherche en Infectiologie (CIRI), UFR Lyon-1, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS), UMR5308, Ecole Normale Supérieure de Lyon, 69342 Lyon, France
- Institut National de la Santé et de la Recherche Médicale, Centre Méditerranéen de Médecine Moléculaire (C3M), Unité 1065, Equipe 10, 06000 Nice, France
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon, Institut de Pathologie Multisite, Hôpital Lyon Sud, 69310 Lyon, France (N.B.)
- UFR Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre International de Recherche en Infectiologie (CIRI), UFR Lyon-1, Institut National de la Santé et de la Recherche Médicale (INSERM) U1111, Centre National de la Recherche Scientifique (CNRS), UMR5308, Ecole Normale Supérieure de Lyon, 69342 Lyon, France
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5
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Darlington M, Sujobert P, Kosmider O, Luque Paz D, Kaltenbach S, Figeac M, Hayette S, Mezaour N, Coquerelle S, Alary AS, Bidet A, Le Bris Y, Delabesse E, Davi F, Preudhomme C, Durand-Zaleski I, Macintyre E, Alame M, Baran-Marzak F, Berger MG, Bories D, Caye-Eude A, Cayuela JM, Cornillet-Lefebvre P, Delhommeau F, Estienne-Felix MH, Etancelin P, Flandrin-Gresta P, Lippert E, Marzac C, Miguet L, Pastoret C, Raynaud S, Rizzo D. Targeted High-throughput Sequencing for Hematological Malignancies: A GBMHM Survey of Practice and Cost Evaluation in France. Hemasphere 2023; 7:e943. [PMID: 37637995 PMCID: PMC10455455 DOI: 10.1097/hs9.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
The objective of this study was to assess the clinical impact and financial costs of next-generation sequencing (NGS) in 5 categories of pediatric and adult hematological cancers. NGS prescriptions were prospectively collected from 26 laboratories, with varied technical and reporting practice (all or only significant targets). Impact was defined by the identification of (1) an actionable mutation, (2) a mutation with prognostic and/or theranostic value, and/or (3) a mutation allowing nosological refinement, reported by local investigators. A microcosting study was undertaken in 4 laboratories, identifying the types and volumes of resources required for each procedural step. Individual index prescriptions for 3961 patients were available for impact analysis on the management of myeloid disorders (two thirds) and, mainly mature B, lymphoid disorders (one third). NGS results were considered to impact the management for 73.4% of prescriptions: useful for evaluation of prognostic risk in 34.9% and necessary for treatment adaptation (actionable) in 19.6%, but having no immediate individual therapeutic impact in 18.9%. The average overall cost per sample was 191 € for the restricted mature lymphoid amplicon panel. Capture panel costs varied from 369 € to 513 €. Unit costs varied from 0.5 € to 5.7 € per kb sequenced, from 3.6 € to 11.3 € per target gene/hot-spot sequenced and from 4.3 € to 73.8 € per target gene/hot-spot reported. Comparable costs for the Amplicon panels were 5-8 € per kb and 10.5-14.7 € per target gene/hot-spot sequenced and reported, demonstrating comparable costs with greater informativity/flexibility for capture strategies. Sustainable funding of precision medicine requires a transparent discussion of its impact on care pathways and its financial aspects.
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Affiliation(s)
- Meryl Darlington
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
| | - Olivier Kosmider
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
| | - Damien Luque Paz
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
| | - Sophie Kaltenbach
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
| | - Martin Figeac
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
| | - Sandrine Hayette
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
| | - Nadia Mezaour
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Séverine Coquerelle
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Anne-Sophie Alary
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
| | - Audrey Bidet
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
| | - Yannick Le Bris
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
| | - Eric Delabesse
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
| | - Frédéric Davi
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
| | - Claude Preudhomme
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
| | | | - Elizabeth Macintyre
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Université Paris Cité, CNRS, Inserm, France
| | - Mélissa Alame
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Fanny Baran-Marzak
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Marc G. Berger
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Dominique Bories
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Aurélie Caye-Eude
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Jean-Michel Cayuela
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Pascale Cornillet-Lefebvre
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - François Delhommeau
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Marie-Hélène Estienne-Felix
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Pascaline Etancelin
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Pascale Flandrin-Gresta
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Eric Lippert
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Christophe Marzac
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Laurent Miguet
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Cédric Pastoret
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - Sophie Raynaud
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
| | - David Rizzo
- DRCI‑URC Eco Ile‑de‑France, Assistance Publique-Hôpitaux de Paris (AP-HP), France
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d’hématologie biologique, France
- Hôpital Cochin, Hématologie Biologique, AP-HP, Université, Paris Cité, France
- Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, France
- Hématologie Biologique, AP-HP, Necker-Enfants Malades Hospital, Paris, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, France
- CHU de Lille, Equipe bioinfo du Plateau Commun de Biologie Moléculaire, Lille, France
- Department of Hematology Biology, Molecular Hematology, Bordeaux University Hospital, Haut-Levêque Hospital, Pessac, France
- Hématologie Biologique, Nantes University Hospital and CRCI2NA Nantes-Angers, France
- Hématologie Biologique, CHU Toulouse, Inserm 1037, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, France
- AP-HP, Hôpital Pitié-Salpêtrière, Department of Biological Hematology, Sorbonne University, Paris
- Université Paris Cité, CNRS, Inserm, France
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6
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Lee TD, Aisner DL, David MP, Eno CC, Gagan J, Gocke CD, Guseva NV, Haley L, Jajosky AN, Jones D, Mansukhani MM, Mroz P, Murray SS, Newsom KJ, Paulson V, Roy S, Rushton C, Segal JP, Senaratne TN, Siddon AJ, Starostik P, Van Ziffle JAG, Wu D, Xian RR, Yohe S, Kim AS. Current clinical practices and challenges in molecular testing: a GOAL Consortium Hematopathology Working Group report. Blood Adv 2023; 7:4599-4607. [PMID: 37236162 PMCID: PMC10425685 DOI: 10.1182/bloodadvances.2023010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
While molecular testing of hematologic malignancies is now standard of care, there is variability in practice and testing capabilities between different academic laboratories, with common questions arising on how to best meet clinical expectations. A survey was sent to hematopathology subgroup members of the Genomics Organization for Academic Laboratories consortium to assess current and future practice and potentially establish a reference for peer institutions. Responses were received from 18 academic tertiary-care laboratories regarding next-generation sequencing (NGS) panel design, sequencing protocols and metrics, assay characteristics, laboratory operations, case reimbursement, and development plans. Differences in NGS panel size, use, and gene content were reported. Gene content for myeloid processes was reported to be generally excellent, while genes for lymphoid processes were less well covered. The turnaround time (TAT) for acute cases, including acute myeloid leukemia, was reported to range from 2 to 7 calendar days to 15 to 21 calendar days, with different approaches to achieving rapid TAT described. To help guide NGS panel design and standardize gene content, consensus gene lists based on current and future NGS panels in development were generated. Most survey respondents expected molecular testing at academic laboratories to continue to be viable in the future, with rapid TAT for acute cases likely to remain an important factor. Molecular testing reimbursement was reported to be a major concern. The results of this survey and subsequent discussions improve the shared understanding of differences in testing practices for hematologic malignancies between institutions and will help provide a more consistent level of patient care.
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Affiliation(s)
- Thomas D. Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Dara L. Aisner
- Department of Pathology, University of Colorado, Aurora, CO
| | - Marjorie P. David
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Celeste C. Eno
- Department of Pathology and Lab Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jeffrey Gagan
- Department of Pathology, University of Texas Southwestern, Dallas, TX
| | - Christopher D. Gocke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Lisa Haley
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Audrey N. Jajosky
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Daniel Jones
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Mahesh M. Mansukhani
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - Pawel Mroz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Sarah S. Murray
- Department of Pathology, University of California San Diego, La Jolla, CA
| | - Kimberly J. Newsom
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Vera Paulson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Somak Roy
- Department of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Chase Rushton
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | | | - T. Niroshini Senaratne
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Alexa J. Siddon
- Departments of Laboratory Medicine & Pathology, Yale School of Medicine, New Haven, CT
| | - Petr Starostik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | | | - David Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Rena R. Xian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sophia Yohe
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Annette S. Kim
- Department of Pathology, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA
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7
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Böck J, Maurus K, Gerhard-Hartmann E, Brändlein S, Kurz KS, Ott G, Anagnostopoulos I, Rosenwald A, Zamò A. Targeted panel sequencing in the routine diagnosis of mature T- and NK-cell lymphomas: report of 128 cases from two German reference centers. Front Oncol 2023; 13:1231601. [PMID: 37664054 PMCID: PMC10468607 DOI: 10.3389/fonc.2023.1231601] [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: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Diagnosing any of the more than 30 types of T-cell lymphomas is considered a challenging task for many pathologists and currently requires morphological expertise as well as the integration of clinical data, immunophenotype, flow cytometry and clonality analyses. Even considering all available information, some margin of doubt might remain using the current diagnostic procedures. In recent times, the genetic landscape of most T-cell lymphomas has been elucidated, showing a number of diagnostically relevant mutations. In addition, recent data indicate that some of these genetic alterations might bear prognostic and predictive value. Extensive genetic analyses, such as whole exome or large panel sequencing are still expensive and time consuming, therefore limiting their application in routine diagnostic. We therefore devoted our effort to develop a lean approach for genetic analysis of T-cell lymphomas, focusing on maximum efficiency rather than exhaustively covering all possible targets. Here we report the results generated with our small amplicon-based panel that could be used routinely on paraffin-embedded and even decalcified samples, on a single sample basis in parallel with other NGS-panels used in our routine diagnostic lab, in a relatively short time and with limited costs. We tested 128 available samples from two German reference centers as part of our routine work up (among which 116 T-cell lymphomas), which is the largest routine diagnostic series reported to date. Our results showed that this assay had a very high rate of technical success (97%) and could detect mutations in the majority (79%) of tested T-cell lymphoma samples.
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Affiliation(s)
- Julia Böck
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Katja Maurus
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | | | | | - Katrin S. Kurz
- Department of Clinical Pathology, Robert-Bosch-Hospital, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Hospital, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | | | | | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany
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8
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Sesboue C, Galtier J, Jeanneau M, Chauvel A, Laharanne E, Amintas S, Merlio JP, Bouabdallah K, Gros FX, de Leval L, Gros A, Parrens M. Combined Reverse-Transcriptase Multiplex Ligation-Dependent Probe Amplification and Next-Generation Sequencing Analyses to Assign Unclassified BCL2 -/BCL6 - Nonrearranged Small B-Cell Lymphoid Neoplasms as Follicular or Nodal Marginal Zone Lymphoma. Mod Pathol 2023; 36:100043. [PMID: 36853790 DOI: 10.1016/j.modpat.2022.100043] [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: 04/28/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 01/11/2023]
Abstract
Distinguishing between follicular lymphoma (FL) and nodal marginal zone lymphoma (NMZL) can be difficult when morphologic and phenotypic features are unusual and characteristic cytogenetic rearrangements are absent. We evaluated the diagnostic contribution of ancillary techniques-including fluorescence in situ hybridization (FISH)-detected 1p36 deletion; reverse-transcriptase, multiplex, ligation-dependent probe amplification (RT-MLPA); and next-generation sequencing (NGS)-for tumors that remain unclassified according to standard criteria. After review, 50 CD5-negative small B-cell lymphoid neoplasms without BCL2 and BCL6 FISH rearrangements were diagnosed as FLs (n = 27), NMZLs (n = 5), or unclassified (n = 18) based on the 2016 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. FISH helped identify the 1p36 deletion in 3 FLs and 1 unclassified tumor. Most classified FLs had an RT-MLPA germinal center B-cell (GCB) signature (93%) or were noncontributive (7%). Classified NMZLs had an RT-MLPA activated B-cell signature (20%), had an unassigned signature (40%), or were noncontributive (40%). Among unclassified tumors, the RT-MLPA GCB signature was associated with mutations most commonly found in FLs (CREBBP, EZH2, STAT6, and/or TNFRSF14) (90%). An RT-MLPA-detected GCB signature and/or NGS-detected gene mutations were considered as FL identifiers for 13 tumors. An activated B-cell signature or NOTCH2 mutation supported NMZL diagnosis in 3 tumors. Combining the RT-MLPA and NGS findings successfully discriminated 89% of unclassified tumors in favor of one or the other diagnosis. NGS-detected mutations may be of therapeutic interest. Herein, we detected 3 EZH2 and 8 CREBBP mutations that might be eligible for targeted therapies.
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Affiliation(s)
- Come Sesboue
- Pathology Department, University Hospital of Bordeaux, Pessac, France.
| | - Jean Galtier
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Pessac, France
| | - Marie Jeanneau
- Pathology Department, University Hospital of Bordeaux, Pessac, France
| | - Annick Chauvel
- Pathology Department, University Hospital of Bordeaux, Pessac, France
| | - Elodie Laharanne
- Tumor Bank and Tumor Biology Laboratory, University Hospital of Bordeaux, Pessac, France; BRIC INSERM U1312, Trio 2, University of Bordeaux, Bordeaux, France
| | - Samuel Amintas
- Tumor Bank and Tumor Biology Laboratory, University Hospital of Bordeaux, Pessac, France; BRIC INSERM U1312, BioGo, University of Bordeaux, Bordeaux, France
| | - Jean-Philippe Merlio
- Tumor Bank and Tumor Biology Laboratory, University Hospital of Bordeaux, Pessac, France; BRIC INSERM U1312, Trio 2, University of Bordeaux, Bordeaux, France
| | - Krimo Bouabdallah
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Pessac, France
| | - François-Xavier Gros
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Pessac, France
| | | | - Audrey Gros
- Tumor Bank and Tumor Biology Laboratory, University Hospital of Bordeaux, Pessac, France; BRIC INSERM U1312, Trio 2, University of Bordeaux, Bordeaux, France
| | - Marie Parrens
- Pathology Department, University Hospital of Bordeaux, Pessac, France; BRIC INSERM U1312, Trio 2, University of Bordeaux, Bordeaux, France
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9
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Santisteban-Espejo A, Bernal-Florindo I, Perez-Requena J, Atienza-Cuevas L, Catalina-Fernandez I, Fernandez-Valle MDC, Romero-Garcia R, Garcia-Rojo M. Identification of prognostic factors in classic Hodgkin lymphoma by integrating whole slide imaging and next generation sequencing. Mol Omics 2022; 18:1015-1028. [PMID: 36382626 DOI: 10.1039/d2mo00195k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Digital pathology and genomics are increasingly used to improve our understanding of lymphoid neoplasms. Algorithms for quantifying cell populations in the lymph node and genetics can be integrated to identify new biomarkers with prognostic impact in classic Hodgkin lymphoma (cHL). In 16 cHL patients, we have performed whole slide imaging (WSI) analysis and quantification of CD30+, CD20+, CD3+ and MUM1+ cells in whole tissue slides, and Next Generation Sequencing (NGS) in formalin fixed paraffin-embedded (FFPE) tissue, using a widely used NSG panel (Oncomine® Focus Assay) to define genetic variants underlying tumor development. The different cell populations could be successfully identified in scanned slides of cHL, supporting the inclusion of WSI in the histopathological evaluation of cHL as an adequate method for the quantification of different cell populations. We also performed genetic profiling in FFPE samples of cHL leading to the identification of copy number variations in the Neurofibromin 1 gene (17q11.2) and the Androgen Receptor gene (Xq12) accompanied by chromosomal gains and losses in CDK4, KRAS and FGFR2 genes. Progression-free survival (PFS) was statistically significantly higher in cHL patients with amplification in the NF1 gene combined with CD3+ cells above 28.6% (p = 0.006) and MUM1+ cells above 21.8% (p < 0.001). Moreover, patients with MUM1+ cells above 21.8% showed a statistically significantly higher PFS when combined with amplification of the AR gene (p < 0.001) and wild-type KRAS (p < 0.001). The integration of WSI analysis and DNA sequencing could be useful to improve our understanding of the biology of cHL and define risk subgroups.
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Affiliation(s)
- Antonio Santisteban-Espejo
- Pathology Department, Puerta del Mar University Hospital, Av. Ana de Viya, 21. 11009, Cadiz, Spain. .,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cadiz, Spain.,Department of Medicine, University of Cadiz, Cadiz, Spain
| | - Irene Bernal-Florindo
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cadiz, Spain.,Pathology Department, Jerez de la Frontera University Hospital, Cadiz, Spain
| | - Jose Perez-Requena
- Pathology Department, Puerta del Mar University Hospital, Av. Ana de Viya, 21. 11009, Cadiz, Spain.
| | - Lidia Atienza-Cuevas
- Pathology Department, Puerta del Mar University Hospital, Av. Ana de Viya, 21. 11009, Cadiz, Spain.
| | | | | | - Raquel Romero-Garcia
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cadiz, Spain
| | - Marcial Garcia-Rojo
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cadiz, Spain.,Pathology Department, Jerez de la Frontera University Hospital, Cadiz, Spain
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10
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Santisteban-Espejo A, Bernal-Florindo I, Perez-Requena J, Atienza-Cuevas L, Moran-Sanchez J, Fernandez-Valle MDC, Romero-Garcia R, Garcia-Rojo M. The Need for Standardization in Next-Generation Sequencing Studies for Classic Hodgkin Lymphoma: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12040963. [PMID: 35454013 PMCID: PMC9027849 DOI: 10.3390/diagnostics12040963] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
Classic Hodgkin lymphoma (cHL) constitutes a B cell-derived neoplasm defined by a scarce tumoral population, termed Hodgkin and Reed–Sternberg (HRS) cells, submerged into a histologically heterogeneous microenvironment. The paucity of HRS cells has historically hampered genetic studies, rendering the identification of the recurrent genetic lesions and molecular pathways deregulated in this lymphoma difficult. The advent of high-throughput sequencing methods such as next-generation sequencing (NGS) could sensibly optimize the identification of the mutational landscape of cHL. However, there is no current consensus either in the design of panels for targeted NGS or in its most relevant clinical applications. In this work, we systematically review the current state of NGS studies of cHL, stressing the need for standardization both in the candidate genes to be analyzed and the bioinformatic pipelines. As different institutions have developed and implemented their own customized NGS-based protocols, to compare and systematically review the major findings of this ongoing research area could be of added value for centers that routinely perform diagnostic, monitoring and genotyping strategies in cHL samples. The results of this systematic review should contribute to the interdepartmental harmonization and achievement of a consensus in the current clinical applications of NGS studies of cHL.
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Affiliation(s)
- Antonio Santisteban-Espejo
- Department of Pathology, Puerta del Mar University Hospital, 11009 Cadiz, Spain; (A.S.-E.); (J.P.-R.); (L.A.-C.); (M.G.-R.)
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain;
- Department of Medicine, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain;
| | - Irene Bernal-Florindo
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain;
- Correspondence:
| | - Jose Perez-Requena
- Department of Pathology, Puerta del Mar University Hospital, 11009 Cadiz, Spain; (A.S.-E.); (J.P.-R.); (L.A.-C.); (M.G.-R.)
| | - Lidia Atienza-Cuevas
- Department of Pathology, Puerta del Mar University Hospital, 11009 Cadiz, Spain; (A.S.-E.); (J.P.-R.); (L.A.-C.); (M.G.-R.)
| | - Julia Moran-Sanchez
- Department of Medicine, Faculty of Medicine, University of Cadiz, 11003 Cadiz, Spain;
- Department of Hematology and Hemotherapy, Puerta del Mar University Hospital, 11009 Cadiz, Spain;
| | | | - Raquel Romero-Garcia
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain;
| | - Marcial Garcia-Rojo
- Department of Pathology, Puerta del Mar University Hospital, 11009 Cadiz, Spain; (A.S.-E.); (J.P.-R.); (L.A.-C.); (M.G.-R.)
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), 11009 Cadiz, Spain;
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11
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Sun KH(M, Wong YT(H, Cheung KM(C, Yuen C(M, Chan YT(T, Lai WY(J, Chao C(D, Fan WS(K, Chow YK(K, Law MF, Tam HC(T. Update on Molecular Diagnosis in Extranodal NK/T-Cell Lymphoma and Its Role in the Era of Personalized Medicine. Diagnostics (Basel) 2022; 12:diagnostics12020409. [PMID: 35204500 PMCID: PMC8871212 DOI: 10.3390/diagnostics12020409] [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: 01/11/2022] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 02/06/2023] Open
Abstract
Natural killer (NK)/T-cell lymphoma (NKTCL) is an aggressive malignancy with unique epidemiological, histological, molecular, and clinical characteristics. It occurs in two pathological forms, namely, extranodal NKTCL (ENKTCL) and aggressive NK leukemia, according to the latest World Health Organization (WHO) classification. Epstein–Barr virus (EBV) infection has long been proposed as the major etiology of lymphomagenesis. The adoption of high-throughput sequencing has allowed us to gain more insight into the molecular mechanisms of ENKTCL, which largely involve chromosome deletion and aberrations in Janus kinase (JAK)-signal transducer and activator of transcription (STAT), programmed cell death protein-1 (PD-1)/PD-ligand 1 (PD-L1) pathways, as well as mutations in tumor suppressor genes. The molecular findings could potentially influence the traditional chemoradiotherapy approach, which is known to be associated with significant toxicity. This article will review the latest molecular findings in NKTCL and recent advances in the field of molecular diagnosis in NKTCL. Issues of quality control and technical difficulties will also be discussed, along with future prospects in the molecular diagnosis and treatment of NKTCL.
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Affiliation(s)
- Ka-Hei (Murphy) Sun
- Division of Hematopathology, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong; (K.-H.S.); (C.Y.)
| | | | - Ka-Man (Carmen) Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
| | - Carmen (Michelle) Yuen
- Division of Hematopathology, Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Hong Kong; (K.-H.S.); (C.Y.)
| | - Yun-Tat (Ted) Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
| | - Wing-Yan (Jennifer) Lai
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
| | - Chun (David) Chao
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
| | - Wing-Sum (Katie) Fan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
| | - Yuen-Kiu (Karen) Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
| | - Man-Fai Law
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
- Correspondence:
| | - Ho-Chi (Tommy) Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong; (K.-M.C.); (Y.-T.C.); (W.-Y.L.); (C.C.); (W.-S.F.); (Y.-K.C.); (H.-C.T.)
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12
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CYCLON and NPM1 Cooperate within an Oncogenic Network Predictive of R-CHOP Response in DLBCL. Cancers (Basel) 2021; 13:cancers13235900. [PMID: 34885010 PMCID: PMC8656558 DOI: 10.3390/cancers13235900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/05/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary CYCLON is a nuclear protein, which has been associated with disease progression and treatment resistance in DLBCL, the most common form of aggressive B-cell lymphoma, but also represents a predictive factor of refractory disease and relapse for immuno-chemotherapy-treated DLBCL patients. The molecular mechanisms related to this unstructured protein remain largely uncharacterized. Here, we performed a mass-spectrometry-based identification of the CYCLON protein interactome that suggested it could exert nucleolar functions related to cell proliferation. Among the CYCLON oncogenic network, we performed an immunohistochemical evaluation of the multi-functional nucleolar protein NPM1 in a DLBCL cohort and showed that CYCLON/NPM1 concomitant expression delineates a poor prognosis subgroup of patients. Multivariate survival analyses demonstrated that specific sub-cellular localizations of CYCLON and NPM1 represent independent novel predictors specifically associated with refractory DLBCL. Abstract R-CHOP immuno-chemotherapy significantly improved clinical management of diffuse large B-cell lymphoma (DLBCL). However, 30–40% of DLBCL patients still present a refractory disease or relapse. Most of the prognostic markers identified to date fail to accurately stratify high-risk DLBCL patients. We have previously shown that the nuclear protein CYCLON is associated with DLBCL disease progression and resistance to anti-CD20 immunotherapy in preclinical models. We also recently reported that it also represents a potent predictor of refractory disease and relapse in a retrospective DLBCL cohort. However, only sparse data are available to predict the potential biological role of CYCLON and how it might exert its adverse effects on lymphoma cells. Here, we characterized the protein interaction network of CYCLON, connecting this protein to the nucleolus, RNA processing, MYC signaling and cell cycle progression. Among this network, NPM1, a nucleolar multi-functional protein frequently deregulated in cancer, emerged as another potential target related to treatment resistance in DLBCL. Immunohistochemistry evaluation of CYCLON and NPM1 revealed that their co-expression is strongly related to inferior prognosis in DLBCL. More specifically, alternative sub-cellular localizations of the proteins (extra-nucleolar CYCLON and pan-cellular NPM1) represent independent predictive factors specifically associated to R-CHOP refractory DLBCL patients, which could allow them to be orientated towards risk-adapted or novel targeted therapies.
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13
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Jajosky AN, Havens NP, Sadri N, Oduro KA, Moore EM, Beck RC, Meyerson HJ. Clinical Utility of Targeted Next-Generation Sequencing in the Evaluation of Low-Grade Lymphoproliferative Disorders. Am J Clin Pathol 2021; 156:433-444. [PMID: 33712839 DOI: 10.1093/ajcp/aqaa255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES We investigated the usefulness of a custom-designed 31-gene next-generation sequencing (NGS) panel implemented on a routine basis for the evaluation of low-grade lymphoproliferative disorders (LPDs). METHODS In total, 147 blood, bone marrow, and tissue specimens were sequenced, including 81% B-cell, 15% T-cell, and 3% natural killer (NK)-cell neoplasms. RESULTS Of the cases, 92 (63%) of 147 displayed at least one pathogenic variant while 41 (28%) of 147 had two or more. Low mutation rates were noted in monoclonal B-cell lymphocytoses and samples with small T- and NK-cell clones of uncertain significance. Pathogenic molecular variants were described in specific disorders and classified according to their diagnostic, prognostic, and potential therapeutic value. Diagnostically, in addition to confirming the diagnosis of 15 of 15 lymphoplasmacytic lymphomas, 10 of 12 T large granular lymphocytic leukemias, and 2 of 2 hairy cell leukemias (HCLs), the panel helped resolve the diagnosis of 10 (62.5%) of 16 challenging cases lacking a specified diagnosis based on standard morphology, phenotype, and genetic analysis. CONCLUSIONS Overall, implementation of this targeted lymphoid NGS panel as part of regular hematopathology practice was found to be a beneficial adjunct in the evaluation of low-grade LPDs.
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Affiliation(s)
- Audrey N Jajosky
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nathaniel P Havens
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Navid Sadri
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kwadwo A Oduro
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Erika M Moore
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose C Beck
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Howard J Meyerson
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
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14
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Plasticity of Mature B Cells Between Follicular and Classic Hodgkin Lymphomas: A Series of 22 Cases Expanding the Spectrum of Transdifferentiation. Am J Surg Pathol 2021; 46:58-70. [PMID: 34265801 DOI: 10.1097/pas.0000000000001780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Follicular lymphoma and classic Hodgkin lymphoma can be associated in composite and/or sequential lymphomas. Common IGH and BCL2 rearrangements have already been identified between both contingents of these entities, but mutation profiles have not yet been investigated. The main objective of this study was to analyze the transdifferentiation process that may occur between Hodgkin and follicular contingents in sequential and composite lymphomas to better characterize these entities. From 2004 to 2020, a retrospective multicentric study was performed, including 9 composite and 13 sequential lymphomas. Clinical data were retrospectively collected. Fluorescent in situ hybridization of BCL2 and BCL6 rearrangements, polymerase chain reaction of IGH and IGK rearrangements, next-generation sequencing of IGK rearrangement, and targeted next-generation sequencing (TNGS) on a panel of genes frequently mutated in lymphomas were performed on each contingent of composite and sequential lymphomas. For TNGS, each contingent was isolated by laser capture microdissection. Clinical presentation and evolution were more aggressive in sequential than composite lymphomas. By fluorescent in situ hybridization, common rearrangements of BCL6 and BCL2 were identified between both contingents. Similarly, a common clonal relationship was established by evaluating IGH and IGK rearrangement by polymerase chain reaction or next-generation sequencing. By TNGS, the same pathogenic variants were identified in both contingents in the following genes: CREBBP, KMT2D, BCL2, EP300, SF3B1, SOCS1, ARID1A, and BCOR. Specific pathogenic variants for each contingent were also identified: XPO1 for Hodgkin lymphoma contingent and FOXO1, TNFRSF14 for follicular lymphoma contingent. This study reinforces the hypothesis of a transdifferentiation process between Hodgkin and follicular contingent of sequential/composite lymphomas.
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15
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Extranucleolar CYCLON Staining Pattern Is Strongly Associated to Relapse/Refractory Disease in R-CHOP-treated DLBCL. Hemasphere 2021; 5:e598. [PMID: 34131636 PMCID: PMC8196088 DOI: 10.1097/hs9.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
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16
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Stance of MRD in Non-Hodgkin's Lymphoma and its upsurge in the novel era of cell-free DNA. Clin Transl Oncol 2021; 23:2206-2219. [PMID: 33991328 DOI: 10.1007/s12094-021-02635-4] [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: 02/12/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Cancer genomics has evolved over the years from understanding the pathogenesis of cancer to screening the future possibilities of cancer occurrence. Understanding the genetic profile of tumors holds a prognostic as well as a predictive value in this era of therapeutic surveillance, molecular remission, and precision medicine. Identifying molecular markers in tumors is the current standard of approach, and requires an efficient combination of an accessible sample type and a profoundly sensitive technique. Liquid biopsy or cell-free DNA has evolved as a novel sample type with promising results in recent years. Although cell-free DNA has significant role in various cancer types, this review focuses on its application in Non-Hodgkin's Lymphoma. Beginning with the current concept and clinical relevance of minimal residual disease in Non-Hodgkin's lymphoma, we discuss the literature on circulating DNA and its evolving application in the realm of cutting-edge technology.
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17
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Abstract
Twenty-five years after the Revised European American Classification of Lymphoid Neoplasms classification was published, its principle of an integrative approach to disease definition based on several parameters still prevails and has been adopted and expanded in the following World Health Organization classifications of tumors of the hematopoietic organs. The latest World Health Organization classification revised in 2017 comprises more than 80 entities of mature lymphoid neoplasms (B-cell, T-cell, and Hodgkin lymphomas), which are defined according to their morphology, immunophenotype, genetic lesions and molecular profiles, clinical features, and cellular derivation. The classification also recognizes both incipient and indolent lymphoid neoplasms with a low potential of progression. In this review, we highlight some of the new data and recent modifications introduced in the 2017 classification.
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18
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Toth L, Vasef MA. Molecular Pathogenesis of Primary Gastrointestinal Tract Lymphomas. Semin Diagn Pathol 2021; 38:46-52. [PMID: 33985832 DOI: 10.1053/j.semdp.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022]
Abstract
Primary gastrointestinal lymphomas are rare though the incidence is significantly increased among adult patients in recent years. The majority of the patients present with symptoms overlapping with other gastrointestinal disorders and imaging findings are not specific. Therefore, histologic examination is necessary to establish the diagnosis. Insight into etiologies, molecular pathogenesis and critical signaling pathways in lymphomas including gastrointestinal lymphomas has significantly expanded within the last 3 decades. Given the increasing demand for incorporation of genetic data, the appropriate handling and processing of small endoscopic gastrointestinal biopsy samples of suspected lymphoma is becoming extremely crucial and at times challenging. The use of next generation sequencing with analysis of genes relevant to diagnosis, prognosis, and therapeutic targets continues to have a significant promising impact on management of patients in lymphoid malignancies. In particular, the identification of constitutively activated pathways and the emergence of novel targeted medications predict that more effective therapies will be identified for these disorders in the coming years.
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Affiliation(s)
- Laura Toth
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Mohammad A Vasef
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
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19
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Bommier C, Mauduit C, Fontaine J, Bourbon E, Sujobert P, Huet S, Baseggio L, Hayette S, Laurent C, Bachy E, Ghesquières H, Thieblemont C, Salles G, Traverse-Glehen A. Real-life targeted next-generation sequencing for lymphoma diagnosis over 1 year from the French Lymphoma Network. Br J Haematol 2021; 193:1110-1122. [PMID: 33764507 DOI: 10.1111/bjh.17395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
As the impact of targeted next-generation sequencing (TNGS) on daily diagnosis has not been evaluated, we performed TNGS (46 genes) on lymphomas of unclear subtype following expert haematopathological review. The potential impact on patient care and modifications of final diagnosis were divided into major and minor changes according to the European Society of Medical Oncology (ESMO) guidelines. Among 229 patients [19 primary central nervous system lymphomas (PCNSL), 48 large B-cell lymphomas (LBCLs), 89 small BCLs (SBCLs), seven Hodgkin lymphomas (HL), 66 T-cell lymphomas], the overall concordance rate of histological and TNGS diagnosis was 89·5%. TNGS confirmed the histological diagnosis in 144 cases (62·9%), changed the diagnosis in 24 cases (10·5%) and did not help to clarify diagnosis in 61 cases (26·7%). Modifications to the final diagnosis had a clinical impact on patient care in 8·3% of cases. Diagnostic modifications occurred in all types of lymphoma except in PCNSL and HL; the modification rate was 14·6% in SBCL and 12·5% in LBCL. While comparing informative and uninformative cases, no differences were found in terms of DNA amplification, quality or depth of sequencing and biopsy type. The present study highlights that TNGS may directly contribute to a more accurate diagnosis in difficult-to-diagnose lymphomas, thus improving the clinical management in routine practice.
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Affiliation(s)
- Côme Bommier
- Pathology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Haemato-oncology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Paris, France.,Université de Paris, Université Paris Descartes, Paris, France
| | - Claire Mauduit
- Pathology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Oullins, France.,Inserm U1065, C3M-Control of Gene Expression, Nice, France
| | - Juliette Fontaine
- Pathology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Oullins, France
| | - Estelle Bourbon
- Pathology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Oullins, France
| | - Pierre Sujobert
- Université Claude Bernard Lyon 1, Oullins, France.,Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Pierre-Bénite, France
| | - Sarah Huet
- Université Claude Bernard Lyon 1, Oullins, France.,Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Pierre-Bénite, France
| | - Lucile Baseggio
- Université Claude Bernard Lyon 1, Oullins, France.,Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Pierre-Bénite, France
| | - Sandrine Hayette
- Université Claude Bernard Lyon 1, Oullins, France.,Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Pierre-Bénite, France
| | - Camille Laurent
- Pathology Department, Institut Universitaire du Cancer-Oncopôle, Centre Hospitalier de Toulouse, Toulouse, France
| | - Emmanuel Bachy
- Université Claude Bernard Lyon 1, Oullins, France.,Haematology Department, Hospices Civils de Lyon, CHU Lyon-Sud, Pierre-Bénite, France
| | - Hervé Ghesquières
- Université Claude Bernard Lyon 1, Oullins, France.,Haematology Department, Hospices Civils de Lyon, CHU Lyon-Sud, Pierre-Bénite, France
| | - Catherine Thieblemont
- Haemato-oncology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
| | - Gilles Salles
- Université Claude Bernard Lyon 1, Oullins, France.,Haematology Department, Hospices Civils de Lyon, CHU Lyon-Sud, Pierre-Bénite, France
| | - Alexandra Traverse-Glehen
- Pathology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Oullins, France
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20
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Linking the KIR phenotype with STAT3 and TET2 mutations to identify chronic lymphoproliferative disorders of NK cells. Blood 2021; 137:3237-3250. [PMID: 33512451 DOI: 10.1182/blood.2020006721] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/16/2020] [Indexed: 01/27/2023] Open
Abstract
Distinguishing chronic lymphoproliferative disorders of NK cells (CLPD-NK) from reactive NK-cell expansion is challenging. We assessed the value of killer immunoglobulin-like receptor(KIR) phenotyping and targeted high-throughput sequencing in a cohort of 114 consecutive patients with NK cell proliferation, retrospectively assigned to a CLPD-NK group (n = 46) and a reactive NK group (n = 68). We then developed an NK-cell clonality score combining flow cytometry and molecular profiling with a positive predictive value of 93%. STAT3 and TET2 mutations were respectively identified in 27% and 34% of the patients with CLPD-NK, constituting a new diagnostic hallmark for this disease. TET2-mutated CLPD-NK preferentially exhibited a CD16low phenotype, more frequently displayed a lower platelet count, and was associated with other hematologic malignancies such as myelodysplasia. To explore the mutational clonal hierarchy of CLPD-NK, we performed whole-exome sequencing of sorted, myeloid, T, and NK cells and found that TET2 mutations were shared by myeloid and NK cells in 3 of 4 cases. Thus, we hypothesized that TET2 alterations occur in early hematopoietic progenitors which could explain a potential link between CLPD-NK and myeloid malignancies. Finally, we analyzed the transcriptome by RNA sequencing of 7 CLPD-NK and evidenced 2 groups of patients. The first group displayed STAT3 mutations or SOCS3 methylation and overexpressed STAT3 target genes. The second group, including 2 TET2-mutated cases, significantly underexpressed genes known to be downregulated in angioimmunoblastic T-cell lymphoma. Our results provide new insights into the pathogenesis of NK-cell proliferative disorders and, potentially, new therapeutic opportunities.
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21
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de Lange K, de Boer EN, Bosga A, Alimohamed MZ, Johansson LF, Mulder AB, Vellenga E, van Diemen CC, Deelen P, van den Berg E, Sikkema-Raddatz B. Targeted RNA-Sequencing Enables Detection of Relevant Translocations and Single Nucleotide Variants and Provides a Method for Classification of Hematological Malignancies-RANKING. Clin Chem 2020; 66:1521-1530. [PMID: 33257979 DOI: 10.1093/clinchem/hvaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with hematological malignancies (HMs) carry a wide range of chromosomal and molecular abnormalities that impact their prognosis and treatment. Since no current technique can detect all relevant abnormalities, technique(s) are chosen depending on the reason for referral, and abnormalities can be missed. We tested targeted transcriptome sequencing as a single platform to detect all relevant abnormalities and compared it to current techniques. MATERIAL AND METHODS We performed RNA-sequencing of 1385 genes (TruSight RNA Pan-Cancer, Illumina) in bone marrow from 136 patients with a primary diagnosis of HM. We then applied machine learning to expression profile data to perform leukemia classification, a method we named RANKING. Gene fusions for all the genes in the panel were detected, and overexpression of the genes EVI1, CCND1, and BCL2 was quantified. Single nucleotide variants/indels were analyzed in acute myeloid leukemia (AML), myelodysplastic syndrome and patients with acute lymphoblastic leukemia (ALL) using a virtual myeloid (54 genes) or lymphoid panel (72 genes). RESULTS RANKING correctly predicted the leukemia classification of all AML and ALL samples and improved classification in 3 patients. Compared to current methods, only one variant was missed, c.2447A>T in KIT (RT-PCR at 10-4), and BCL2 overexpression was not seen due to a t(14; 18)(q32; q21) in 2% of the cells. Our RNA-sequencing method also identified 6 additional fusion genes and overexpression of CCND1 due to a t(11; 14)(q13; q32) in 2 samples. CONCLUSIONS Our combination of targeted RNA-sequencing and data analysis workflow can improve the detection of relevant variants, and expression patterns can assist in establishing HM classification.
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Affiliation(s)
- Kim de Lange
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Genomics Coordination Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eddy N de Boer
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke Bosga
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mohamed Z Alimohamed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Lennart F Johansson
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Genomics Coordination Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - André B Mulder
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Edo Vellenga
- Department of Hematology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Cleo C van Diemen
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Patrick Deelen
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Genomics Coordination Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Genetics, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Eva van den Berg
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Birgit Sikkema-Raddatz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Helpful Criteria When Implementing NGS Panels in Childhood Lymphoblastic Leukemia. J Pers Med 2020; 10:jpm10040244. [PMID: 33255984 PMCID: PMC7711852 DOI: 10.3390/jpm10040244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022] Open
Abstract
The development of Next-Generation Sequencing (NGS) has provided useful diagnostic, prognostic, and therapeutic strategies for individualized management of B-cell precursor acute lymphoblastic leukemia (BCP-ALL) patients. Consequently, NGS is rapidly being established in clinical practice. However, the technology’s complexity, bioinformatics analysis, and the different available options difficult a broad consensus between different laboratories in its daily routine introduction. This collaborative study among Spanish centers was aimed to assess the feasibility, pros, and cons of our customized panel and other commercial alternatives of NGS-targeted approaches. The custom panel was tested in three different sequencing centers. We used the same samples to assess other commercial panels (OncomineTM Childhood Cancer Research Assay; Archer®FusionPlex® ALL, and Human Comprehensive Cancer Panel GeneRead Panel v2®). Overall, the panels showed a good performance in different centers and platforms, but each NGS approach presented some issues, as well as pros and cons. Moreover, a previous consensus on the analysis and reporting following international guidelines would be preferable to improve the concordance in results among centers. Our study shows the challenges posed by NGS methodology and the need to consider several aspects of the chosen NGS-targeted approach and reach a consensus before implementing it in daily practice.
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Sorigue M, Cañamero E, Sancho JM. Precision medicine in follicular lymphoma: Focus on predictive biomarkers. Hematol Oncol 2020; 38:625-639. [PMID: 32700331 DOI: 10.1002/hon.2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023]
Abstract
Current care for patients with follicular lymphoma (FL) offers most of them long-term survival. Improving it further will require careful patient selection. This review focuses on predictive biomarkers (ie, those whose outcome correlations depend on the treatment strategy) in FL, because awareness of what patient subsets benefit most or least from each therapy will help in this task. The first part of this review aims to summarize what biomarkers are predictive in FL, the magnitude of the effect and the quality of the evidence. We find predictive biomarkers in the setting of (a) indication of active treatment, (b) front-line induction (use of anthracyline-based regimens, CHOP vs bendamustine, addition of rituximab), (c) post-(front-line)induction (rituximab maintenance, radioimmunotherapy), and (d) relapse (hematopoietic stem cell transplant) and targeted agents. The second part of this review discusses the challenges of precision medicine in FL, including (a) cost, (b) clinical relevance considerations, and (c) difficulties over the broad implementation of biomarkers. We then provide our view on what biomarkers may become used in the next few years. We conclude by underscoring the importance of assessing the potential predictiveness of available biomarkers to improve patient care but also that there is a long road ahead before reaching their broad implementation due to remaining scientific, technological, and economic hurdles.
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Affiliation(s)
- Marc Sorigue
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Eloi Cañamero
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
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24
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25
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de Groen RAL, Schrader AMR, Kersten MJ, Pals ST, Vermaat JSP. MYD88 in the driver's seat of B-cell lymphomagenesis: from molecular mechanisms to clinical implications. Haematologica 2019; 104:2337-2348. [PMID: 31699794 PMCID: PMC6959184 DOI: 10.3324/haematol.2019.227272] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
More than 50 subtypes of B-cell non-Hodgkin lymphoma (B-NHL) are recognized in the most recent World Health Organization classification of 2016. The current treatment paradigm, however, is largely based on 'one-size-fits-all' immune-chemotherapy. Unfortunately, this therapeutic strategy is inadequate for a significant number of patients. As such, there is an indisputable need for novel, preferably targeted, therapies based on a biologically driven classification and risk stratification. Sequencing studies identified mutations in the MYD88 gene as an important oncogenic driver in B-cell lymphomas. MYD88 mutations constitutively activate NF-κB and its associated signaling pathways, thereby promoting B-cell proliferation and survival. High frequencies of the hotspot MYD88(L265P) mutation are observed in extranodal diffuse large B-cell lymphoma and Waldenström macroglobulinemia, thereby demonstrating this mutation's potential as a disease marker. In addition, the presence of mutant MYD88 predicts survival outcome in B-NHL subtypes and it provides a therapeutic target. Early clinical trials targeting MYD88 have shown encouraging results in relapsed/refractory B-NHL. Patients with these disorders can benefit from analysis for the MYD88 hotspot mutation in liquid biopsies, as a minimally invasive method to demonstrate treatment response or resistance. Given these clear clinical implications and the crucial role of MYD88 in lymphomagenesis, we expect that analysis of this gene will increasingly be used in routine clinical practice, not only as a diagnostic classifier, but also as a prognostic and therapeutic biomarker directing precision medicine. This review focuses on the pivotal mechanistic role of mutated MYD88 and its clinical implications in B-NHL.
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Affiliation(s)
| | | | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam.,Cancer Center Amsterdam, Amsterdam
| | - Steven T Pals
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Cancer Center Amsterdam, Amsterdam.,Department of Pathology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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