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Kinoshita H, Bollard CM, Toner K. CD19 CAR-T cell therapy for relapsed or refractory diffuse large B cell lymphoma: Why does it fail? Semin Hematol 2023; 60:329-337. [PMID: 38336529 PMCID: PMC10964476 DOI: 10.1053/j.seminhematol.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 02/12/2024]
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy is an effective treatment for relapsed or refractory diffuse large B cell lymphoma (DLBCL) with 3 CD19 targeting products now FDA-approved for this indication. However, up to 60% of patients ultimately progress or relapse following CAR-T cell therapy. Mechanisms of resistance to CAR-T cell therapy in patients with DLBCL are likely multifactorial and have yet to be fully elucidated. Determining patient, tumor and therapy-related factors that may predict an individual's response to CAR-T cell therapy requires ongoing analysis of data from clinical trials and real-world experience in this population. In this review we will discuss the factors identified to-date that may contribute to failure of CAR-T cell therapy in achieving durable remissions in patients with DLBCL.
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MESH Headings
- Humans
- Receptors, Chimeric Antigen
- Receptors, Antigen, T-Cell/therapeutic use
- Neoplasm Recurrence, Local/etiology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Immunotherapy, Adoptive
- Antigens, CD19/therapeutic use
- Cell- and Tissue-Based Therapy
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Affiliation(s)
- Hannah Kinoshita
- Cell Enhancement and Technologies for Immunotherapy, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University, Washington, DC
| | - Catherine M Bollard
- Cell Enhancement and Technologies for Immunotherapy, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University, Washington, DC
| | - Keri Toner
- Cell Enhancement and Technologies for Immunotherapy, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University, Washington, DC
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Liu C, Shi P, Li Z, Li B, Li Z. A nomogram for predicting the rapid progression of diffuse large B-cell lymphoma established by combining baseline PET/CT total metabolic tumor volume, lesion diffusion, and TP53 mutations. Cancer Med 2023; 12:16734-16743. [PMID: 37366281 PMCID: PMC10501242 DOI: 10.1002/cam4.6295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES This study aimed to integrate positron emission tomography/computed tomography (PET/CT) metrics and genetic mutations to optimize the risk stratification for diffuse large B-cell lymphoma (DLBCL) patients. METHODS The data of 94 primary DLBCL patients with baseline PET/CT examination completed in the Shandong Cancer Hospital and Institute (Jinan, China) were analyzed to establish a training cohort. An independent cohort of 45 DLBCL patients with baseline PET/CT examination from other hospitals was established for external validation. The baseline total metabolic tumor volume (TMTV) and the largest distance between two lesions (Dmax) standardized by patient body surface area (SDmax) were calculated. The pretreatment pathological tissues of all patients were sequenced by a lymphopanel including 43 genes. RESULTS The optimal TMTV cutoff was 285.3 cm3 and the optimal SDmax cutoff was 0.135 m-1 . TP53 status was found as an independent predictive factor significantly affecting complete remission (p = 0.001). TMTV, SDmax, and TP53 status were the main factors of the nomogram and could stratify the patients into four distinct subgroups based on their predicted progression-free survival (PFS). The calibration curve demonstrated satisfactory agreement between the predicted and actual 1-year PFS of the patients. The receiver operating characteristic curves showed this nomogram based on PET/CT metrics and TP53 mutations had a better predictive ability than the clinic risk scores. Similar results were identified upon external validation. CONCLUSIONS The nomogram based on imaging factors and TP53 mutations could lead to a more accurate selection of DLBCL patients with rapid progression, to increase tailor therapy.
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Affiliation(s)
- Cong Liu
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjinChina
- Department of Radiation OncologyTianjin Medical UniversityTianjinChina
- Department of Internal Medicine‐Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Pengyue Shi
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Zhenjiang Li
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Baosheng Li
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjinChina
- Department of Radiation OncologyTianjin Medical UniversityTianjinChina
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Zengjun Li
- Department of Hematology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
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Wang Y, Yang Y, Wang Q, Wang C, Xu X, Wang D, Bai F, Li P, Huang X. Sellar B lymphoblastic lymphoma mimics pituitary apoplexy with newly discovered gene mutations in TP53 and PAX5: A case report. Front Oncol 2023; 13:1087232. [PMID: 36824134 PMCID: PMC9941690 DOI: 10.3389/fonc.2023.1087232] [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: 11/02/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
Lymphoblastic lymphoma (LBL) is a rare tumor that accounts for approximately 2-4% of all non-Hodgkin lymphomas, and less than 20% of LBLs are derived from B cells. B- Lymphoblastic lymphoma (B-LBL) often presents as bone marrow and peripheral blood lesions, and is very rare to present as a seller mass. We report a case of sellar B lymphoblastic lymphoma mimicking pituitary apoplexy, and review its diagnosis and treatment process, combined with the literature to deepen the understanding of sellar tumors.
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Affiliation(s)
- Yi Wang
- Department of Neurosurgery, First Hospital of Shanxi Medical University; and The First School of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yajun Yang
- Department of Neurosurgery, First Hospital of Shanxi Medical University; and The First School of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qiuxia Wang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Ce Wang
- Department of Neurosurgery, First Hospital of Shanxi Medical University; and The First School of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinjuan Xu
- Department of Neurosurgery, Shanxi Cardiovascular Disease Hospital, Taiyuan, Shanxi, China
| | - Dongao Wang
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Feirong Bai
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Panpan Li
- Department of Neurosurgery, First Hospital of Shanxi Medical University; and The First School of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xintao Huang
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Xintao Huang,
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Porpaczy E, Wohlfarth P, Königsbrügge O, Rabitsch W, Skrabs C, Staber P, Worel N, Müllauer L, Simonitsch-Klupp I, Kornauth C, Rohrbeck J, Jaeger U, Schiefer AI. Influence of TP53 Mutation on Survival of Diffuse Large B-Cell Lymphoma in the CAR T-Cell Era. Cancers (Basel) 2021; 13:cancers13225592. [PMID: 34830747 PMCID: PMC8616128 DOI: 10.3390/cancers13225592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary The genetic landscape of diffuse large B-cell lymphoma (DLBCL) is heterogenous. So far, detailed studies about TP53 mutations in DLBCL treated with anti-CD19 chimeric antigen receptor T-cell (CAR T cells) therapy are still missing. Chemotherapy resistance is one of the challenges in TP53 mutated tumors. New immunomodulatory agents, such as different inhibitors or CAR T cells, have shown durable responses in refractory/relapsed DLBCL in recent years. Although our CAR T cell treated cohort was small, we aimed to investigate the influence of TP53 mutations on overall survival of patients treated with CAR T cells compared to DLBCL patients without CAR T-cell therapy. Identification of risk factors for treatment failure may aid in choosing the most promising treatment in every setting. Abstract Refractory/relapsed diffuse large B-cell lymphoma (DLBCL) is associated with poor outcome. The clinical behavior and genetic landscape of DLBCL is heterogeneous and still not fully understood. TP53 mutations in DLBCL have been identified as markers of poor prognosis and are often associated with therapeutic resistance. Chimeric antigen receptor T-cell therapy is an innovative therapeutic concept and represents a game-changing therapeutic option by supporting the patient’s own immune system to kill the tumor cells. We investigated the impact of TP53 mutations on the overall survival of refractory/relapsed DLBCL patients treated with comparable numbers of therapy lines. The minimum number of therapy lines was 2 (median 4), including either anti-CD19 CAR T-cell therapy or conventional salvage therapy. A total of 170 patients with DLBCL and high-grade B-cell lymphoma with MYC, BCL2, and/or BCL6 rearrangements (DHL/THL), diagnosed and treated in our hospital between 2000 and 2021, were included. Twenty-nine of them received CAR T-cell therapy. TP53 mutations were found in 10/29 (35%) and 31/141 (22%) of patients in the CAR T-cell and conventional groups, respectively. Among the 141 patients not treated with CAR T cells, TP53 mutation was an independent prognostic factor for overall survival (OS) (median 12 months with TP53 vs. not reached without TP53 mutation, p < 0.005), but in the CAR T cell treated group, this significance could not be shown (median OS 30 vs. 120 months, p = 0.263). The findings from this monocentric retrospective study indicate that TP53 mutation status does not seem to affect outcomes in DLBCL patients treated with CAR T-cell therapy. Detailed evaluation in large cohorts is warranted.
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Affiliation(s)
- Edit Porpaczy
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria; (E.P.); (O.K.); (C.S.); (P.S.); (U.J.)
| | - Philipp Wohlfarth
- Department of Internal Medicine I, Hematopoietic Stem Cell Transplantation Unit, Medical University of Vienna, 1090 Vienna, Austria; (P.W.); (W.R.)
| | - Oliver Königsbrügge
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria; (E.P.); (O.K.); (C.S.); (P.S.); (U.J.)
| | - Werner Rabitsch
- Department of Internal Medicine I, Hematopoietic Stem Cell Transplantation Unit, Medical University of Vienna, 1090 Vienna, Austria; (P.W.); (W.R.)
| | - Cathrin Skrabs
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria; (E.P.); (O.K.); (C.S.); (P.S.); (U.J.)
| | - Philipp Staber
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria; (E.P.); (O.K.); (C.S.); (P.S.); (U.J.)
| | - Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Leonhard Müllauer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (I.S.-K.); (C.K.); (J.R.)
| | - Ingrid Simonitsch-Klupp
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (I.S.-K.); (C.K.); (J.R.)
| | - Christoph Kornauth
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (I.S.-K.); (C.K.); (J.R.)
| | - Johannes Rohrbeck
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (I.S.-K.); (C.K.); (J.R.)
| | - Ulrich Jaeger
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, 1090 Vienna, Austria; (E.P.); (O.K.); (C.S.); (P.S.); (U.J.)
| | - Ana-Iris Schiefer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (I.S.-K.); (C.K.); (J.R.)
- Correspondence:
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Mansouri L, Thorvaldsdottir B, Laidou S, Stamatopoulos K, Rosenquist R. Precision diagnostics in lymphomas - Recent developments and future directions. Semin Cancer Biol 2021; 84:170-183. [PMID: 34699973 DOI: 10.1016/j.semcancer.2021.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/03/2023]
Abstract
Genetics is an integral part of the clinical diagnostics of lymphomas that improves disease subclassification and patient risk-stratification. With the introduction of high-throughput sequencing technologies, a rapid, in-depth portrayal of the genomic landscape in major lymphoma entities was achieved. Whilst a few lymphoma entities were characterized by a predominant gene mutation (e.g. Waldenström's macroglobulinemia and hairy cell leukemia), the vast majority demonstrated a very diverse genetic landscape with a high number of recurrent gene mutations (e.g. chronic lymphocytic leukemia and diffuse large B cell lymphoma), indeed reflecting the great clinical heterogeneity among lymphomas. These studies have allowed better understanding of the ontogeny and evolution of different lymphomas, while also identifying new genetic markers that can complement lymphoma diagnostics and improve prognostication. However, despite these efforts, there is still a limited number of gene mutations with predictive impact that can guide treatment selection. In this review, we will highlight clinically relevant diagnostic, prognostic and predictive markers in lymphomas that are used today in routine diagnostics. We will also discuss how comprehensive genomic characterization using broad sequencing panels, allowing for the simultaneous detection of different types of genetic aberrations, may aid future development of precision diagnostics in lymphomas. This may in turn pave the way for the implementation of tailored precision therapy strategies at the individual patient level.
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Affiliation(s)
- Larry Mansouri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Birna Thorvaldsdottir
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Stamatia Laidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Kostas Stamatopoulos
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Solna, Sweden.
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CXCR4 PET/MRI for follow-up of gastric mucosa-associated lymphoid tissue lymphoma after first-line H. pylori eradication. Blood 2021; 139:240-244. [PMID: 34525196 PMCID: PMC8759531 DOI: 10.1182/blood.2021013239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022] Open
Abstract
[68Ga]Pentixafor is a novel PET tracer that targets the chemokine receptor CXCR4, which is overexpressed in MALT lymphoma. In gastric MALT lymphoma after H pylori eradication, [68Ga]Pentixafor–PET shows high accuracy for detection of residual disease.
Posttreatment evaluation of gastric mucosa-associated lymphoid tissue (MALT) lymphoma currently relies on esophagogastroduodenoscopy with histological assessment of biopsies. Overexpression of the G protein–coupled C-X-C chemokine receptor type 4 (CXCR4) has been previously observed in MALT lymphoma. The aim of this prospective study was to evaluate positron emission tomography (PET) with the novel CXCR4 tracer [68Ga]Pentixafor as a potential alternative to follow up biopsies for assessment of residual disease (noncomplete remission [CR]) after first-line Helicobacter pylori eradication. Forty-six post–H pylori eradication [68Ga]Pentixafor–PET/magnetic resonance imaging (MRI) examinations of 26 gastric MALT lymphoma patients, and 20 [68Ga]Pentixafor–PET/MRI examinations of 20 control group patients without lymphoma, were analyzed. In the MALT lymphoma group, time-matched gastric biopsies were used as reference standard and showed CR in 6 cases. Pooled examination-based accuracy, sensitivity, specificity, and positive and negative predictive values of [68Ga]Pentixafor–PET for detection of residual gastric MALT lymphoma at follow-up were 97.0%, 95.0%, 100.0%, 100.0%, and 92.9%, respectively. Maximum and mean PET standardized uptake values showed moderate correlation with immunohistochemistry-based CXCR4+ cell counts, with correlation coefficients of r = 0.51 and r = 0.52 (P = .008 and P = .006). In summary, CXCR4 imaging with [68Ga]Pentixafor–PET may represent a promising test for assessment of residual gastric MALT lymphomas after H pylori eradication.
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Mayerhoefer ME, Raderer M, Lamm W, Pichler V, Pfaff S, Weber M, Kiesewetter B, Hacker M, Kazianka L, Staber PB, Wester HJ, Rohrbeck J, Simonitsch-Klupp I, Haug A. CXCR4 PET imaging of mantle cell lymphoma using [ 68Ga]Pentixafor: comparison with [ 18F]FDG-PET. Theranostics 2021; 11:567-578. [PMID: 33391493 PMCID: PMC7738870 DOI: 10.7150/thno.48620] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022] Open
Abstract
For PET imaging of mantle cell lymphoma (MCL), [18F]FDG (2-deoxy-2-[18F]fluoro-D-glucose) is the currently recommended radiotracer, although uptake is variable and bone marrow evaluation is limited. In this prospective study, we evaluated the novel CXCR4 (G-protein-coupled C-X-C chemokine receptor type 4) tracer [68Ga]Pentixafor in MCL patients, and compared it to [18F]FDG. Methods: MCL patients underwent [68Ga]Pentixafor-PET/MRI, and, if required for routine purposes, also [18F]FDG-PET/MRI, before treatment. PET was evaluated separately for 23 anatomic regions (12 lymph node stations and 11 organs/tissues), using MRI as the main reference standard. Standardized uptake values (SUVmax and SUVmean) and tumor-to-background ratios (TBRblood and TBRliver) were calculated. General Estimation Equations (GEE) were used to compare [68Ga]Pentixafor-PET and [18F]FDG-PET sensitivities and positive predictive values (PPV). For bone marrow involvement, where biopsy served as the main reference standard, and splenic involvement, receiver operating characteristic curves were used to determine the optimal SUV and TBR cut-off values, and areas under the curve (AUC) were calculated. Results: Twenty-two MCL patients were included. [68Ga]Pentixafor-PET sensitivity (100%) was significantly higher than for [18F]FDG-PET (75.2%) (P<0.001), and PPV was slightly, but not significantly lower (94.0%.vs. 96.5%; P=0.21). SUVs and TBRs were significantly higher for [68Ga]Pentixafor-PET than for [18F]FDG-PET (P<0.001 in all cases); the greatest difference was observed for mean TBRblood, with 4.9 for [68Ga]Pentixafor-PET and 2.0 for [18F]FDG-PET. For bone marrow involvement, [68Ga]Pentixafor-PET SUVmean showed an AUC of 0.92; and for splenic involvement, TBRblood showed an AUC of 0.81. Conclusion: [68Ga]Pentixafor-PET may become an alternative to [18F]FDG-PET in MCL patients, showing clearly higher detection rates and better tumor-to-background contrast.
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Affiliation(s)
- Marius E. Mayerhoefer
- Dept. of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Markus Raderer
- Dept. of Internal Medicine I, Division of Oncology, Medical University of Vienna
| | - Wolfgang Lamm
- Dept. of Internal Medicine I, Division of Oncology, Medical University of Vienna
| | - Verena Pichler
- Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Sarah Pfaff
- Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Michael Weber
- Dept. of Biomedical Imaging and Image-guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Austria
| | - Barbara Kiesewetter
- Dept. of Internal Medicine I, Division of Oncology, Medical University of Vienna
| | - Markus Hacker
- Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
| | - Lukas Kazianka
- Dept. of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna
| | - Philipp B. Staber
- Dept. of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna
| | - Hans-Juergen Wester
- Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | | | | | - Alexander Haug
- Dept. of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Austria
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Vanura K. Sex as decisive variable in lymphoid neoplasms-an update. ESMO Open 2020; 6:100001. [PMID: 33399069 PMCID: PMC7808098 DOI: 10.1016/j.esmoop.2020.100001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/09/2020] [Accepted: 10/31/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- K Vanura
- Department of Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria.
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Deng M, Xu-Monette ZY, Pham LV, Wang X, Tzankov A, Fang X, Zhu F, Visco C, Bhagat G, Dybkaer K, Chiu A, Tam W, Zu Y, Hsi ED, You H, Huh J, Ponzoni M, Ferreri AJM, Møller MB, Parsons BM, Hagemeister F, van Krieken JH, Piris MA, Winter JN, Li Y, Xu B, Liu P, Young KH. Aggressive B-cell Lymphoma with MYC/TP53 Dual Alterations Displays Distinct Clinicopathobiological Features and Response to Novel Targeted Agents. Mol Cancer Res 2020; 19:249-260. [PMID: 33154093 DOI: 10.1158/1541-7786.mcr-20-0466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/09/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the major type of aggressive B-cell lymphoma. High-grade B-cell lymphoma (HGBCL) with MYC/BCL2 double-hit (DH) represents a distinct entity with dismal prognosis after standard immunochemotherapy in the current WHO lymphoma classification. However, whether TP53 mutation synergizes with MYC abnormalities (MYC rearrangement and/or Myc protein overexpression) contributing to HGBCL-like biology and prognosis is not well investigated. In this study, patients with DLBCL with MYC/TP53 abnormalities demonstrated poor clinical outcome, high-grade morphology, and distinct gene expression signatures. To identify more effective therapies for this distinctive DLBCL subset, novel MYC/TP53/BCL-2-targeted agents were investigated in DLBCL cells with MYC/TP53 dual alterations or HGBCL-MYC/BCL2-DH. A BET inhibitor INCB057643 effectively inhibited cell viability and induced apoptosis in DLBCL/HGBCL cells regardless of MYC/BCL2/TP53 status. Combining INCB057643 with a MDM2-p53 inhibitor DS3032b significantly enhanced the cytotoxic effects in HGBCL-DH without TP53 mutation, while combining with the BCL-2 inhibitor venetoclax displayed potent therapeutic synergy in DLBCL/HGBCL cells with and without concurrent TP53 mutation. Reverse-phase protein arrays revealed the synergistic molecular actions by INCB057643, DS3032b and venetoclax to induce cell-cycle arrest and apoptosis and to inhibit AKT/MEK/ERK/mTOR pathways, as well as potential drug resistance mechanisms mediated by upregulation of Mcl-1 and RAS/RAF/MEK/ERK pathways. In summary, these findings support subclassification of DLBCL/HGBCL with dual MYC/TP53 alterations, which demonstrates distinct pathobiologic features and dismal survival with standard therapy, therefore requiring additional targeted therapies. IMPLICATIONS: The clinical and pharmacologic studies suggest recognizing DLBCL with concomitant TP53 mutation and MYC abnormalities as a distinctive entity necessary for precision oncology practice. VISUAL OVERVIEW: http://mcr.aacrjournals.org/content/molcanres/19/2/249/F1.large.jpg.
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Affiliation(s)
- Manman Deng
- Duke University Medical Center, Division of Hematopathology and Department of Pathology, Durham, North Carolina.,Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zijun Y Xu-Monette
- Duke University Medical Center, Division of Hematopathology and Department of Pathology, Durham, North Carolina
| | - Lan V Pham
- Phamacyclics, an Abbvie Company, San Francisco, California
| | - Xudong Wang
- Duke University Medical Center, Division of Hematopathology and Department of Pathology, Durham, North Carolina
| | | | - Xiaosheng Fang
- Duke University Medical Center, Division of Hematopathology and Department of Pathology, Durham, North Carolina
| | - Feng Zhu
- Duke University Medical Center, Division of Hematopathology and Department of Pathology, Durham, North Carolina
| | - Carlo Visco
- Department of Medicine and Division of Hematology, University of Verona, Verona, Italy
| | - Govind Bhagat
- Columbia University Medical Center and New York Presbyterian Hospital, New York, New York
| | | | | | - Wayne Tam
- Weill Medical College of Cornell University, New York, New York
| | - Youli Zu
- The Methodist Hospital, Houston, Texas
| | | | - Hua You
- Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Jooryung Huh
- Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | | | | | | | | | - Fredrick Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Han van Krieken
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Miguel A Piris
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Jane N Winter
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yong Li
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Phillip Liu
- Applied Technology Group, Incyte Research Institute, Wilmington, Delaware.
| | - Ken H Young
- Duke University Medical Center, Division of Hematopathology and Department of Pathology, Durham, North Carolina. .,Duke Cancer Institute, Durham, North Carolina
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Cucco F, Barrans S, Sha C, Clipson A, Crouch S, Dobson R, Chen Z, Thompson JS, Care MA, Cummin T, Caddy J, Liu H, Robinson A, Schuh A, Fitzgibbon J, Painter D, Smith A, Roman E, Tooze R, Burton C, Davies AJ, Westhead DR, Johnson PWM, Du MQ. Distinct genetic changes reveal evolutionary history and heterogeneous molecular grade of DLBCL with MYC/BCL2 double-hit. Leukemia 2020; 34:1329-1341. [PMID: 31844144 PMCID: PMC7192846 DOI: 10.1038/s41375-019-0691-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
Using a Burkitt lymphoma-like gene expression signature, we recently defined a high-risk molecular high-grade (MHG) group mainly within germinal centre B-cell like diffuse large B-cell lymphomas (GCB-DLBCL), which was enriched for MYC/BCL2 double-hit (MYC/BCL2-DH). The genetic basis underlying MHG-DLBCL and their aggressive clinical behaviour remain unknown. We investigated 697 cases of DLBCL, particularly those with MYC/BCL2-DH (n = 62) by targeted sequencing and gene expression profiling. We showed that DLBCL with MYC/BCL2-DH, and those with BCL2 translocation, harbour the characteristic mutation signatures that are associated with follicular lymphoma and its high-grade transformation. We identified frequent MYC hotspot mutations that affect the phosphorylation site (T58) and its adjacent amino acids, which are important for MYC protein degradation. These MYC mutations were seen in a subset of cases with MYC translocation, but predominantly in those of MHG. The mutations were more frequent in double-hit lymphomas with IG as the MYC translocation partner, and were associated with higher MYC protein expression and poor patient survival. DLBCL with MYC/BCL2-DH and those with BCL2 translocation alone are most likely derived from follicular lymphoma or its precursor lesion, and acquisition of MYC pathogenic mutations may augment MYC function, resulting in aggressive clinical behaviour.
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Affiliation(s)
- Francesco Cucco
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK
| | - Chulin Sha
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | | | - Simon Crouch
- Department of Health Sciences, University of York, York, UK
| | - Rachel Dobson
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Zi Chen
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - Matthew A Care
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Thomas Cummin
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Josh Caddy
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Hongxiang Liu
- Haematopathology and Oncology Diagnostics Service, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Anne Robinson
- Haematopathology and Oncology Diagnostics Service, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jude Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute, London, UK
| | - Daniel Painter
- Department of Health Sciences, University of York, York, UK
| | | | - Eve Roman
- Department of Health Sciences, University of York, York, UK
| | - Reuben Tooze
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK
| | - Catherine Burton
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK
| | - Andrew J Davies
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Peter W M Johnson
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK.
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11
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Pfajfer L, Mair NK, Jiménez-Heredia R, Genel F, Gulez N, Ardeniz Ö, Hoeger B, Bal SK, Madritsch C, Kalinichenko A, Chandra Ardy R, Gerçeker B, Rey-Barroso J, Ijspeert H, Tangye SG, Simonitsch-Klupp I, Huppa JB, van der Burg M, Dupré L, Boztug K. Mutations affecting the actin regulator WD repeat–containing protein 1 lead to aberrant lymphoid immunity. J Allergy Clin Immunol 2018; 142:1589-1604.e11. [DOI: 10.1016/j.jaci.2018.04.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/12/2018] [Accepted: 04/06/2018] [Indexed: 11/28/2022]
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12
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Peroja P, Pedersen M, Mantere T, Nørgaard P, Peltonen J, Haapasaari KM, Böhm J, Jantunen E, Turpeenniemi-Hujanen T, Rapakko K, Karihtala P, Soini Y, Vasala K, Kuittinen O. Mutation of TP53, translocation analysis and immunohistochemical expression of MYC, BCL-2 and BCL-6 in patients with DLBCL treated with R-CHOP. Sci Rep 2018; 8:14814. [PMID: 30287880 PMCID: PMC6172218 DOI: 10.1038/s41598-018-33230-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive lymphoma with diverse outcomes. Concurrent translocation of MYC and BCL-2 and/or BCL-6, and concurrent immunohistochemical (IHC) high expression of MYC and BCL-2, have been linked to unfavorable treatment responses. TP53-mutated DLBCL has also been linked to worse outcome. Our aim was to evaluate the aforementioned issues in a cohort of 155 patients uniformly treated with R-CHOP-like therapies. We performed direct sequencing of TP53 exons 5, 6, 7 and 8 as well as fluorescence in-situ hybridization (FISH) of MYC, BCL-2 and BCL-6, and IHC of MYC, BCL-2 and BCL-6. In multivariate analysis, TP53 mutations in L3 and loop-sheet helix (LSH) associated with a risk ratio (RR) of disease-specific survival (DSS) of 8.779 (p = 0.022) and a RR of disease-free survival (DFS) of 10.498 (p = 0.011). In IHC analysis BCL-2 overexpression was associated with inferior DFS (p = 0.002) and DSS (p = 0.002). DLBCL with BCL-2 and MYC overexpression conferred inferior survival in all patients (DSS, p = 0.038 and DFS, p = 0.011) and in patients with non-GC phenotype (DSS (p = 0.013) and DFS (p = 0.010). Our results imply that in DLBCL, the location of TP53 mutations and IHC analysis of BCL-2 and MYC might have a role in the assessment of prognosis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols
- Cyclophosphamide
- Doxorubicin
- Female
- Gene Expression Profiling
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prednisone
- Proto-Oncogene Proteins c-bcl-2/analysis
- Proto-Oncogene Proteins c-bcl-6/analysis
- Proto-Oncogene Proteins c-myc/analysis
- Rituximab
- Sequence Analysis, DNA
- Survival Analysis
- Translocation, Genetic
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
- Vincristine
- Young Adult
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Affiliation(s)
- Pekka Peroja
- Department of Oncology and Radiotherapy, Cancer and Translational Medicine Research Unit, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Mette Pedersen
- Department of Pathology, Herlev and Gentofte University Hospital, University of Copenhagen, Herlev, Denmark
| | - Tuomo Mantere
- Laboratory of Genetics, Northern Finland Laboratory Centre NordLab Oulu, Oulu, Finland
| | - Peter Nørgaard
- Department of Pathology, Herlev and Gentofte University Hospital, University of Copenhagen, Herlev, Denmark
| | - Jenni Peltonen
- Department of Oncology and Radiotherapy, Cancer and Translational Medicine Research Unit, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | | | - Jan Böhm
- Department of Pathology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Esa Jantunen
- Department of Medicine, University of Eastern Finland/Clinical Medicine, Kuopio University Hospital, Siun Sote -North Carelia Central, Kuopio, Finland
| | - Taina Turpeenniemi-Hujanen
- Department of Oncology and Radiotherapy, Cancer and Translational Medicine Research Unit, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Katrin Rapakko
- Laboratory of Genetics, Northern Finland Laboratory Centre NordLab Oulu, Oulu, Finland
| | - Peeter Karihtala
- Department of Oncology and Radiotherapy, Cancer and Translational Medicine Research Unit, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland.
| | - Ylermi Soini
- Department of Pathology, University of Oulu and Medical Research Center, Oulu, Finland
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Kaija Vasala
- Department of Oncology and Radiotherapy, Central Finland Central Hospital, Jyväskylä, Finland
| | - Outi Kuittinen
- University of Eastern Finland, Faculty of Health Medicine, Institute of Clinical Medicine Oncology, Kuopio University Hospital, Kuopio, Finland
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13
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Shi Y, Deng L, Song Y, Lin D, Lai Y, Zhou L, Yang L, Li X. CD3+/CD8+ T-cell density and tumoral PD-L1 predict survival irrespective of rituximab treatment in Chinese diffuse large B-cell lymphoma patients. Int J Hematol 2018; 108:254-266. [DOI: 10.1007/s12185-018-2466-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 10/16/2022]
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14
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Kiesewetter B, Simonitsch-Klupp I, Kornauth C, Dolak W, Lukas J, Mayerhoefer ME, Raderer M. Immunohistochemical expression of cereblon and MUM1 as potential predictive markers of response to lenalidomide in extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma). Hematol Oncol 2017; 36:62-67. [PMID: 28833354 DOI: 10.1002/hon.2472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/20/2017] [Accepted: 07/27/2017] [Indexed: 02/06/2023]
Abstract
Lenalidomide is an active agent for the treatment of MALT lymphoma. Recently, high expression levels of cereblon (CRBN) and MUM1 have been associated with better response rates in multiple myeloma treated with lenalidomide. However, there are no data on CRBN and MUM1 expression in MALT lymphoma. In the current study, we have systematically investigated a potential correlation of CRBN/MUM1 immunohistochemical expression and response to lenalidomide-based therapy in a series of 46 patients with MALT lymphoma treated at the Medical University Vienna 2009 to 2014. In total, 28% (13/46) of biopsy specimens derived from gastric tissues, while 72% (33/46) originated from extragastric MALT lymphoma. In terms of CRBN, 54% showed high expression (CRBN+, ≥50% positive cells); the remaining 46% were classified as low expression (CRBN-). In contrast to other reports, there was a non-significant trend towards worse response rates in CRBN+ (68% versus 86%, P = 0.161). Relapse rates (P = 0.592) and PFS (P = 0.306) did not differ between CRBN+/CRBN-, but all 3 patients progressing on lenalidomide were CRBN+ and both patients completely lacking CRBN expression responded to treatment. Concerning MUM1, 62% were MUM1-negative (MUM1-) and 38% positive (MUM1+). There was no difference in response to lenalidomide by MUM1-status (MUM1+ 71% versus MUM1- 79%, P = 0.546) and also relapse rates (P = 0.828) and PFS (P = 0.681) did not differ. Interestingly, a subgroup analysis of gastric lymphoma revealed a significantly better PFS for CRBN- and MUM1- patients, respectively (both P < 0.05). To conclude, there was no significant difference in response to lenalidomide between patients with low or high expression of CRBN/MUM1 in a general population of MALT lymphoma, and immunohistochemical CRBN/MUM1 assessment cannot be recommended in the clinical routine.
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Affiliation(s)
- Barbara Kiesewetter
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | | | | | - Werner Dolak
- Department of Medicine III, Clinical Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Julius Lukas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
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15
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Rosenquist R, Rosenwald A, Du MQ, Gaidano G, Groenen P, Wotherspoon A, Ghia P, Gaulard P, Campo E, Stamatopoulos K. Clinical impact of recurrently mutated genes on lymphoma diagnostics: state-of-the-art and beyond. Haematologica 2017; 101:1002-9. [PMID: 27582569 DOI: 10.3324/haematol.2015.134510] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/03/2016] [Indexed: 12/14/2022] Open
Abstract
Similar to the inherent clinical heterogeneity of most, if not all, lymphoma entities, the genetic landscape of these tumors is markedly complex in the majority of cases, with a rapidly growing list of recurrently mutated genes discovered in recent years by next-generation sequencing technology. Whilst a few genes have been implied to have diagnostic, prognostic and even predictive impact, most gene mutations still require rigorous validation in larger, preferably prospective patient series, to scrutinize their potential role in lymphoma diagnostics and patient management. In selected entities, a predominantly mutated gene is identified in almost all cases (e.g. Waldenström's macroglobulinemia/lymphoplasmacytic lymphoma and hairy-cell leukemia), while for the vast majority of lymphomas a quite diverse mutation pattern is observed, with a limited number of frequently mutated genes followed by a seemingly endless tail of genes with mutations at a low frequency. Herein, the European Expert Group on NGS-based Diagnostics in Lymphomas (EGNL) summarizes the current status of this ever-evolving field, and, based on the present evidence level, segregates mutations into the following categories: i) immediate impact on treatment decisions, ii) diagnostic impact, iii) prognostic impact, iv) potential clinical impact in the near future, or v) should only be considered for research purposes. In the coming years, coordinated efforts aiming to apply targeted next-generation sequencing in large patient series will be needed in order to elucidate if a particular gene mutation will have an immediate impact on the lymphoma classification, and ultimately aid clinical decision making.
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Affiliation(s)
- Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Germany and Comprehensive Cancer Center Mainfranken (CCC MF), Germany
| | - Ming-Qing Du
- Division of Molecular Histopathology, Department of Pathology, University of Cambridge, UK
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Patricia Groenen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hopsital, Fulham Road, London, UK
| | - Paolo Ghia
- Division of Experimental Oncology and Department of Onco-Hematology, Università Vita-Salute San Raffaele and IRCCS Instituto Scientifico San Raffaele, Milan, Italy
| | - Philippe Gaulard
- Department of Pathology, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil INSERM U955, Université Paris-Est, Créteil, France
| | - Elias Campo
- Hemathopatology Section, Department of Pathology, Hospital Clinic and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain
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16
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Soon G, Ow GW, Chan HL, Ng SB, Wang S. Primary cardiac diffuse large B-cell lymphoma in immunocompetent patients: clinical, histologic, immunophenotypic, and genotypic features of 3 cases. Ann Diagn Pathol 2016; 24:40-6. [PMID: 27649953 DOI: 10.1016/j.anndiagpath.2016.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/18/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
Primary cardiac lymphoma (PCL) is a rare extranodal lymphoma that involves only the heart and/or pericardium. Primary cardiac lymphoma is much less common in immunocompetent patients compared with those who are immunosuppressed. Patients with PCL have variable clinical manifestations that may lead to misdiagnosis and delay in treatment. Modern radiologic imaging now allows for earlier detection of these tumors. This study describes the clinical, histologic/cytologic, immunophenotypic, and molecular genetic findings for 3 immunocompetent patients with primary cardiac diffuse large B-cell lymphoma. All 3 patients had different initial clinical presentations. The neoplastic cells in all 3 cases were large in size, morphologically resembling diffuse large B-cell lymphoma. Neoplastic cells in 2 cases had non-germinal center (GC)-like (non-GC-like) and 1 case had GC-like immunophenotype. Neoplastic cells in all 3 cases showed C-MYC and BCL2 immunohistochemical protein coexpression. Neoplastic cells in 1 case showed double-hit MYC and BCL2 gene rearrangements, whereas another 1 case showed MYC gene rearrangement without BCL2 gene rearrangement. Epstein-Barr virus-encoded RNA was negative in the neoplastic cells in all 3 cases. All 3 patients received rituximab-based chemotherapy. Two patients subsequently had disease relapse at other extranodal sites at 10 and 24 months, respectively, whereas 1 patient was alive without disease at 9 months after diagnosis. If there is sufficient diagnostic tissue in these rare tumors, molecular studies should ideally be performed for prognostication and further patient management.
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Affiliation(s)
- Gwyneth Soon
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Guan Wei Ow
- Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore
| | - Hian Li Chan
- Department of Haematology-Oncology, National University Hospital, National University Health System, Singapore
| | - Siok Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Shi Wang
- Department of Pathology, National University Hospital, National University Health System, Singapore.
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with considerable heterogeneity reflected in the 2008 World Health Organization classification. In recent years, genome-wide assessment of genetic and epigenetic alterations has shed light upon distinct molecular subsets linked to dysregulation of specific genes or pathways. Besides fostering our knowledge regarding the molecular complexity of DLBCL types, these studies have unraveled previously unappreciated genetic lesions, which may be exploited for prognostic and therapeutic purposes. Following the last World Health Organization classification, we have witnessed the emergence of new variants of specific DLBCL entities, such as CD30 DLBCL, human immunodeficiency virus-related and age-related variants of plasmablastic lymphoma, and EBV DLBCL arising in young patients. In this review, we will present an update on the clinical, pathologic, and molecular features of DLBCL incorporating recently gained information with respect to their pathobiology and prognosis. We will emphasize the distinctive features of newly described or emerging variants and highlight advances in our understanding of entities presenting a diagnostic challenge, such as T-cell/histiocyte-rich large B-cell lmphoma and unclassifiable large B-cell lymphomas. Furthermore, we will discuss recent advances in the genomic characterization of DLBCL, as they may relate to prognostication and tailored therapeutic intervention. The information presented in this review derives from English language publications appearing in PubMed throughout December 2015. For a complete outline of this paper, please visit: http://links.lww.com/PAP/A12.
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