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Kirkegaard MK, Minderman M, Sjö LD, Pals ST, Eriksen PRG, Heegaard S. Prevalence and prognostic value of MYD88 and CD79B mutations in ocular adnexal large B-cell lymphoma: a reclassification of ocular adnexal large B-cell lymphoma. Br J Ophthalmol 2023; 107:576-581. [PMID: 34706861 DOI: 10.1136/bjophthalmol-2021-319580] [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: 05/02/2021] [Accepted: 10/10/2021] [Indexed: 11/04/2022]
Abstract
AIMS To (1) reclassify ocular adnexal large B-cell lymphomas (OA-LBCLs) per 2016 WHO lymphoma classification and (2) determine the prevalence of MYD88 and CD79B mutations and their association with clinical parameters among OA-LBCLs. METHODS This study is a retrospective analysis of all OA-LBCLs diagnosed in Denmark between 1980 and 2018. Medical records and tissue samples were retrieved. Thirty-four OA-LBCLs were included. Fluorescence in situ hybridisation and Epstein-Barr-encoded RNA in situ hybridisation were used for the reclassification. Mutational status was established by allele-specific PCR and confirmed by Sanger sequencing. Primary endpoints were overall survival, disease-specific survival (DSS) and progression-free survival (PFS). RESULTS Two LBCL subtypes were identified: diffuse large B-cell lymphoma (DLBCL) (27 of 32; 84%) and high-grade B-cell lymphoma (HGBL) with MYC and BCL2 and/or BCL6 rearrangements (5 of 32; 16%). cMYC/BCL2 double-expressor DLBCLs had a poorer DSS than non-double-expressor DLBCLs (5-year DSS, 25% vs 78%) (HR 0.23; 95% CI 0.06 to 0.85; p=0.014). MYD88 mutations were present in 10 (29%) of 34 lymphomas and carried a poorer PFS than wild-type cases (5-year PFS, 0% vs 43%) (HR 0.78; 95% CI 0.61 to 0.98; p=0.039). CD79B mutations were present in 3 (9%) of 34 cases. CONCLUSION OA-LBCL consists mainly of two subtypes: DLBCL and HGBL with MYC and BCL2 and/or BCL6 rearrangements. MYD88 mutations are important drivers of OA-LBCL. MYD88 mutations, as well as cMYC/BCL2 double-expressor DLBCL, appear to be associated with a poor prognosis. Implementing MYD88 mutational analysis in routine diagnostics may improve OA-LBCL prognostication.
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Affiliation(s)
| | - Marthe Minderman
- Department of Pathology, Amsterdam University Medical Centers loc. AMC, Amsterdam, The Netherlands
| | - Lene Dissing Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steven T Pals
- Department of Pathology, Amsterdam University Medical Centers loc. AMC, Amsterdam, The Netherlands
- Department of Pathology, Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Patrick R G Eriksen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Eye Section, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Screening Strategy for Detecting Double-Hit Lymphoma in a Resource-Limited Setting. Appl Immunohistochem Mol Morphol 2021; 30:49-55. [PMID: 34456240 DOI: 10.1097/pai.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
AIM High-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements [double-hit lymphomas (DHL)] are aggressive lymphomas. Current literature recommends fluorescent in-situ hybridization analysis (FISH) in all cases of diffuse large B-cell lymphoma (DLBCL) to identify cases of DHL. However, this approach is not feasible in a resource-limited setting. We analyzed cases of de novo high-grade B-cell non-Hodgkin lymphoma using histomorphology, immunohistochemistry and FISH to identify which cases need to undergo FISH testing in a resource-limited setting. MATERIALS AND METHODS Cases of de novo high-grade B-cell non-Hodgkin lymphoma that included DLBCL, not otherwise specified and B-cell lymphoma unclassifiable (BCLU) with features intermediate between DLBCL and Burkitt lymphoma diagnosed over a period of 5 years were analyzed by Hans algorithm, MYC, BCL2, and Ki67. MYC, BCL2, and BCL6 break apart FISH was tested in selected cases. RESULTS One hundred and nine cases were obtained, of which 102 had DLBCL morphology and 7 had BCLU/blastoid morphology. BCL2 expression was noted in 48 cases (44%), MYC in 33 cases (30.3%) and MYC/BCL2 co-expression in 24 cases (22%). FISH testing could be done in 42 consecutive cases, of which 5 cases had MYC and BCL2 co-rearrangement (11.9%) (double-hit) and 2 cases showed rearrangement for only MYC (4.7%) (single-hit). Single-hit lymphoma/DHL showed significant independent positive correlation with BCLU/blastoid morphology, CD10 expression, germinal center B-cell phenotype, and MYC/BCL2 co-expression. The sensitivity and specificity of each parameters include BCLU/blastoid morphology (42% vs. 94%), CD10 positive (50% vs. 88%), germinal center B-cell phenotype (57% vs. 82%), MYC/BCL2 co-expression (85% vs. 80%). Selected candidates for FISH (any one of the above parameters) using this strategy showed a sensitivity and specificity of 100% and 68%, respectively (P=0.001). CONCLUSION We propose a highly sensitive screening strategy for detection of MYC/BCL2 rearrangement in high-grade B-cell lymphoma in a resource-limited setting (pending validation in a larger cohort).
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Tsai CC, Su YC, Bamodu OA, Chen BJ, Tsai WC, Cheng WH, Lee CH, Hsieh SM, Liu ML, Fang CL, Lin HT, Chen CL, Yeh CT, Lee WH, Ho CL, Lai SW, Tzeng HE, Hsieh YY, Chang CL, Zheng YM, Liu HW, Yen Y, Whang-Peng J, Chao TY. High-Grade B-Cell Lymphoma (HGBL) with MYC and BCL2 and/or BCL6 Rearrangements Is Predominantly BCL6-Rearranged and BCL6-Expressing in Taiwan. Cancers (Basel) 2021; 13:cancers13071620. [PMID: 33807449 PMCID: PMC8059140 DOI: 10.3390/cancers13071620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary This study highlights the epidemiological, cytogenetic and clinical difference between patients with multiple hit diffuse large B-cell lymphoma in Taiwan and those from western countries. Unlike in the West, the majority of patients with multiple hit lymphoma in Taiwan harbor a BCL6 rearrangement. Almost three in every five BCL6-rearranged double hit lymphoma cases in Taiwan are non-GCB phenotype, indicating, at least in part, that the preferential screening for double hit with BCL6 rearrangement may be a clinically-informative modality for patients with non-GCB phenotype DLBCL in Taiwan. This also suggests the need for a different treatment approach than is obtained in the West where BCL6 double hit lymphomas are seemingly GCB. Consistent with our present findings, mandatory screening for BCL6-rearrangement in suspected DLBCL cases in Taiwan may aid early diagnosis, therapy decision, and clinical outcome forecast. Abstract This study investigated the epidemiological and clinical peculiarities of BCL2 and BCL6 rearrangement in patients with high grade B-cell lymphoma (HGBL) from Taiwan, compared with data from Western countries. Two hundred and eighty-two DLBCL cases from Taipei Medical University-affiliated hospitals (n = 179) and Tri-Service General Hospital (n = 103) were enrolled for this study. From the 282, 47 (16.7%) had MYC translocation; 24 of these harbored concurrent BCL2 and/or BCL6 translocation (double-hit, DH or triple-hit, TH). Twelve DH-HGBL cases had simultaneous MYC and BCL6 translocations, 8 harbored MYC and BCL2 rearrangement, while the remaining 4 patients exhibited TH. Together, 66.7% of DH/TH-HGBL patients were BCL6 rearrangement positive. Among these BCL6-rearranged DH/TH-HGBL patients, only 6 (37.5%) overexpressed MYC and BCL6 proteins simultaneously, indicating that MYC-BCL6 co-overexpression may not be plausible surrogate biomarker for screening BCL6-rearranged DH-HGBL. By the end of year 5, all patients with TH-HGBL, BCL2 DH-HGBL and all but one BCL6 DH-HGBL cases had expired or were lost to follow-up. Progression-free survival (PFS) was longer for the non-DH/TH-HGBL group compared with the DH/TH-HGBL group. While the patients with BCL2 DH-HGBL were lost to follow-up by day 800, their remaining TH-HGBL and BCL6 DH-HGBL peers exhibited very poor PFS, regardless of age strata. More so, patients with BCL6 rearrangement were 5.5-fold more likely associated with extranodal involvement compared with their BCL2-rearranged peers. Moreover, ~60.0% of the BCL6-rearranged DH-HGBL cases were non-GCB, suggesting that including screening for BCL6 rearrangement in patients with the non-GCB phenotype may aid medical decision-making and therapeutic strategy. Contrary to contemporary data from western countries, 2 in every 3 patients with DH/TH-HGBL in Taiwan harbor BCL6 rearrangement. Consistent with present findings, we recommend mandatory screening for BCL6 rearrangement in patients with aggressive HGBL in Taiwan.
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Affiliation(s)
- Cheng-Chih Tsai
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
| | - Yung-Cheng Su
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei City 115, Taiwan
| | - Oluwaseun Adebayo Bamodu
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
- Department of Medical Research and Education, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Bo-Jung Chen
- Department of Pathology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (B.-J.C.); (C.-H.L.); (M.-L.L.); (W.-H.L.)
| | - Wen-Chiuan Tsai
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan;
| | - Wei-Hong Cheng
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
| | - Chii-Hong Lee
- Department of Pathology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (B.-J.C.); (C.-H.L.); (M.-L.L.); (W.-H.L.)
- Department of Anatomic Pathology, Taipei Institute of Pathology, Taipei City 103, Taiwan
| | - Shu-Min Hsieh
- Department of Clinical Pathology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan;
| | - Mei-Ling Liu
- Department of Pathology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (B.-J.C.); (C.-H.L.); (M.-L.L.); (W.-H.L.)
| | - Chia-Lang Fang
- Department of Pathology, Taipei Medical University Hospital, Taipei City 110, Taiwan; (C.-L.F.); (C.-L.C.)
| | - Huan-Tze Lin
- Division of Hematology and Oncology, Department of Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan; (H.-T.L.); (H.-E.T.)
| | - Chi-Long Chen
- Department of Pathology, Taipei Medical University Hospital, Taipei City 110, Taiwan; (C.-L.F.); (C.-L.C.)
- Department of Pathology, School of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Chi-Tai Yeh
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
- Department of Medical Research and Education, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Wei-Hwa Lee
- Department of Pathology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (B.-J.C.); (C.-H.L.); (M.-L.L.); (W.-H.L.)
| | - Ching-Liang Ho
- Division of Hematology-Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.H.); (S.-W.L.)
| | - Shiue-Wei Lai
- Division of Hematology-Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.H.); (S.-W.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Huey-En Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Medical University Hospital, Taipei City 110, Taiwan; (H.-T.L.); (H.-E.T.)
- Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei City 110, Taiwan;
| | - Yao-Yu Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
| | - Chia-Lun Chang
- Department of Medicine, Division of Hematology and Oncology, Taipei Medical University-Wan-Fang Hospital, Taipei City 116, Taiwan; (C.-L.C.); (Y.-M.Z.); (J.W.-P.)
| | - Yu-Mei Zheng
- Department of Medicine, Division of Hematology and Oncology, Taipei Medical University-Wan-Fang Hospital, Taipei City 116, Taiwan; (C.-L.C.); (Y.-M.Z.); (J.W.-P.)
| | - Hui-Wen Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
| | - Yun Yen
- Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei City 110, Taiwan;
| | - Jacqueline Whang-Peng
- Department of Medicine, Division of Hematology and Oncology, Taipei Medical University-Wan-Fang Hospital, Taipei City 116, Taiwan; (C.-L.C.); (Y.-M.Z.); (J.W.-P.)
- Taipei Cancer Center, Taipei Medical University, Taipei City 110, Taiwan
| | - Tsu-Yi Chao
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (C.-C.T.); (Y.-C.S.); (O.A.B.); (W.-H.C.); (C.-T.Y.); (Y.-Y.H.); (H.-W.L.)
- Division of Hematology-Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan; (C.-L.H.); (S.-W.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei City 110, Taiwan
- Correspondence: ; Tel.: +886-2-2249-0088 (ext. 8402); Fax: +886-2-6639-7181
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Yuan D, Li G, Yu L, Jiang Y, Shi Y, Chen Q, Ma X, Pham LV, Young KH, Deng M, Fang Z, Xu B. CS2164 and Venetoclax Show Synergistic Antitumoral Activities in High Grade B-Cell Lymphomas With MYC and BCL2 Rearrangements. Front Oncol 2021; 11:618908. [PMID: 33777762 PMCID: PMC7988232 DOI: 10.3389/fonc.2021.618908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/25/2021] [Indexed: 01/03/2023] Open
Abstract
High-grade B-cell lymphoma with concurrent MYC and BCL2 rearrangements (HGBL-DHL) is a rare, aggressive mature B-cell malignancy with a high likelihood of treatment failure following front-line immunochemotherapies. Patients with HGBL-DHL who develop a relapsed or refractory disease have little effective therapeutic strategies and show very poor clinical outcomes, thus calling for development of novel therapies for this specific patient population. In this study, we investigated the preclinical anti-lymphoma efficacies and potential mechanism of action of a novel treatment approach, combining the BCL2 inhibitor venetoclax with CS2164, a new orally active multitarget inhibitor, in HGBL-DHL models. This combination therapy exhibited a robust synergistic cytotoxicity against HGBL-DHL cells, evidenced by cooperatively inducing loss of cell viability and promoting cell apoptosis. Moreover, coadministration of CS2164 and venetoclax resulted in significant superior suppression of HGBL-DHL cell growth and remarkably abrogated tumor burden in a HGBL-DHL-xenografted mouse model. The synergistic lethality of CS2164 and venetoclax in HGBL-DHL cells was associated with induction of DNA damage and impairment of DNA repair ability. Of importance, the combined treatment almost abolished the expression of both BCL2 and MYC, two hallmark proteins of HGBL-DHL, and substantially blunted the activity of PI3K/AKT/mTOR signaling cascade. In addition, MCL1 and BCL-XL, two well-characterized contributors for venetoclax resistance, were significantly lessened in the presence of CS2164 and venetoclax, thus leading to the accumulation of proapoptotic proteins BAX and PUMA and then initiating the intrinsic apoptosis pathway. Taken together, these findings suggest that the regimen of CS2164 and venetoclax is highly effective to eliminate HGBL-DHL cells in the preclinical setting, warranting further clinical investigations of this regimen for the treatment of unfavorable HGBL-DHL patients.
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Affiliation(s)
- Delin Yuan
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Genhong Li
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Lian Yu
- Department of Hematology and Rheumatology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, China
| | - Yuelong Jiang
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Yuanfei Shi
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Qiulin Chen
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Xiaomei Ma
- Department of Hematology and Rheumatology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, China
| | - Lan V Pham
- Biology, Tumor Dependency, Phamacyclics, Abbvie Company, San Francisco, CA, United States
| | - Ken H Young
- Division of Hematopathology, Department of Pathology, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Manman Deng
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Zhihong Fang
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
| | - Bing Xu
- Department of Hematology, The First Affiliated Hospital of Xiamen University and Institute of Hematology, School of Medicine, Xiamen University, Xiamen, China.,Department of Hematology, Key Laboratory of Xiamen for Diagnosis and Treatment of Hematological Malignancy, Xiamen, China
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Kim H, Kim HJ, Kim SH. Diagnostic Approach for Double-Hit and Triple-Hit Lymphoma Based on Immunophenotypic and Cytogenetic Characteristics of Bone Marrow Specimens. Ann Lab Med 2021; 40:361-369. [PMID: 32311849 PMCID: PMC7169621 DOI: 10.3343/alm.2020.40.5.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/16/2019] [Accepted: 03/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND High-grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6 (BCL2/BCL6), also known as double-hit lymphoma (DHL) and/or triple-hit lymphoma (THL), is a new entity of B-cell lymphoma in the 2017 WHO Classification. We retrospectively investigated D/THL and their clinico-laboratory features among cases of large B-cell lymphoma involving the bone marrow (BM), including diffuse large B-cell lymphoma, Burkitt lymphoma, and B-cell lymphomas with medium to large lymphoid cells, by additional FISH analysis of BM aspirates. METHODS A total of 111 patients diagnosed with aggressive B-cell lymphomas or B-cell lymphoma involving the BM with medium to large-sized malignant lymphocytes were reviewed from January 2000 to January 2018. Patients with available BM aspirates were evaluated by immunophenotyping by flow cytometry, chromosome, and FISH analysis for MYC and/or BCL2/BCL6 rearrangements. RESULTS In total, 23/111 (20.7%) showed MYC rearrangement, and eight (7.2%) were reclassified as D/THL on BM after FISH analysis for MYC and BCL2/BCL6. The detection of CD5(-)/CD10(+) based on flow cytometry was strongly associated with D/THL. A complex karyotype with aberrations related to regions in MYC and BCL2/BCL6 was significantly associated with D/THL. When the MYC FISH results of 28 BM aspirates and formalin-fixed paraffin-embedded tissue specimens were compared, 14% were discrepant. CONCLUSIONS Immunophenotypic and cytogenetic characteristics facilitate the diagnosis of D/THL in the cases with BM-involving aggressive B-cell lymphomas.
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Affiliation(s)
- Heyjin Kim
- Department of Laboratory Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Betts EV, Rashidi HH, Olson KA. Educational Case: Gastric High-Grade B-Cell Lymphoma With MYC and BCL2 Gene Rearrangement (Double-Hit Lymphoma). Acad Pathol 2020; 7:2374289520903415. [PMID: 32083169 PMCID: PMC7005970 DOI: 10.1177/2374289520903415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/06/2019] [Accepted: 01/01/2020] [Indexed: 11/18/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Elham Vali Betts
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Hooman H Rashidi
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kristin A Olson
- Department of Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma). Am J Clin Oncol 2019; 42:304-316. [PMID: 29419530 DOI: 10.1097/coc.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.
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Adams CM, Clark-Garvey S, Porcu P, Eischen CM. Targeting the Bcl-2 Family in B Cell Lymphoma. Front Oncol 2019; 8:636. [PMID: 30671383 PMCID: PMC6331425 DOI: 10.3389/fonc.2018.00636] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/05/2018] [Indexed: 12/21/2022] Open
Abstract
Although lymphoma is a very heterogeneous group of biologically complex malignancies, tumor cells across all B cell lymphoma subtypes share a set of underlying traits that promote the development and sustain malignant B cells. One of these traits, the ability to evade apoptosis, is essential for lymphoma development. Alterations in the Bcl-2 family of proteins, the key regulators of apoptosis, is a hallmark of B cell lymphoma. Significant efforts have been made over the last 30 years to advance knowledge of the biology, molecular mechanisms, and therapeutic potential of targeting Bcl-2 family members. In this review, we will highlight the complexities of the Bcl-2 family, including our recent discovery of overexpression of the anti-apoptotic Bcl-2 family member Bcl-w in lymphomas, and describe recent advances in the field that include the development of inhibitors of anti-apoptotic Bcl-2 family members for the treatment of B cell lymphomas and their performance in clinical trials.
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Affiliation(s)
- Clare M Adams
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sean Clark-Garvey
- Internal Medicine Residency Program, Department of Internal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Christine M Eischen
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
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Unexpected favorable outcome in a patient with high grade B-cell lymphoma with abnormalities of MYC, BCL6 and BCL2 loci. Cancer Genet 2018; 222-223:25-31. [PMID: 29666005 DOI: 10.1016/j.cancergen.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/18/2018] [Accepted: 01/24/2018] [Indexed: 11/21/2022]
Abstract
High grade B-cell lymphoma (HGBCL) by WHO 2016 classification requires rearrangements of MYC and BCL2 and/or BCL6, practically covering the so called "double-hit" or "triple hit" lymphomas. We report a case of HGBCL "triple-hit" lymphoma in a 64-year old female. Cytogenetic and fluorescence in situ hybridization (FISH) studies revealed complex karyotype including rearrangement of MYC to a novel, non-IG partner on chromosome 18, and rearrangement of BCL2, BCL6 and IGH as well as ins(3)(q21q27.3q25.1) among other abnormalities. FISH studies showed five copies of MYC and 3-8 copies of BCL2. Gene expression analysis by RNA sequencing showed that MYC, BCL2 and MECOM genes were overexpressed whereas BCL6 was under-expressed. BCL6 was fused to MBNL1 gene due to complex structural rearrangement. MYC was expressed in >70% of cells and BCL2 was diffusely but highly expressed by immunohistochemistry. No pathogenic mutations were identified by sequencing a 26-gene panel including TP53. The patient has unexpectedly been in complete remission for 12 months after diagnosis after intensive chemotherapy including DA-EPOCH regimen despite having HGBCL. The prognostication of HGBCL patients may further be improved by the sub-categorization of these lymphomas on the basis of more detailed genomic markers than merely the WHO 2016 classification.
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10
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Deb D, Rajaram S, Larsen JE, Dospoy PD, Marullo R, Li LS, Avila K, Xue F, Cerchietti L, Minna JD, Altschuler SJ, Wu LF. Combination Therapy Targeting BCL6 and Phospho-STAT3 Defeats Intratumor Heterogeneity in a Subset of Non-Small Cell Lung Cancers. Cancer Res 2017; 77:3070-3081. [PMID: 28377453 DOI: 10.1158/0008-5472.can-15-3052] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/31/2017] [Accepted: 03/20/2017] [Indexed: 02/07/2023]
Abstract
Oncogene-specific changes in cellular signaling have been widely observed in lung cancer. Here, we investigated how these alterations could affect signaling heterogeneity and suggest novel therapeutic strategies. We compared signaling changes across six human bronchial epithelial cell (HBEC) strains that were systematically transformed with various combinations of TP53, KRAS, and MYC-oncogenic alterations commonly found in non-small cell lung cancer (NSCLC). We interrogated at single-cell resolution how these alterations could affect classic readouts (β-CATENIN, SMAD2/3, phospho-STAT3, P65, FOXO1, and phospho-ERK1/2) of key pathways commonly affected in NSCLC. All three oncogenic alterations were required concurrently to observe significant signaling changes, and significant heterogeneity arose in this condition. Unexpectedly, we found two mutually exclusive altered subpopulations: one with STAT3 upregulation and another with SMAD2/3 downregulation. Treatment with a STAT3 inhibitor eliminated the upregulated STAT3 subpopulation, but left a large surviving subpopulation with downregulated SMAD2/3. A bioinformatics search identified BCL6, a gene downstream of SMAD2/3, as a novel pharmacologically accessible target of our transformed HBECs. Combination treatment with STAT3 and BCL6 inhibitors across a panel of NSCLC cell lines and in xenografted tumors significantly reduced tumor cell growth. We conclude that BCL6 is a new therapeutic target in NSCLC and combination therapy that targets multiple vulnerabilities (STAT3 and BCL6) downstream of common oncogenes, and tumor suppressors may provide a potent way to defeat intratumor heterogeneity. Cancer Res; 77(11); 3070-81. ©2017 AACR.
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Affiliation(s)
- Dhruba Deb
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satwik Rajaram
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California
| | - Jill E Larsen
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Patrick D Dospoy
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rossella Marullo
- Division of Hematology and Medical Oncology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Long Shan Li
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kimberley Avila
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fengtian Xue
- Departments of Pharmaceutical Sciences and Anesthesiology, University of Maryland, Baltimore, Maryland
| | - Leandro Cerchietti
- Division of Hematology and Medical Oncology, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - John D Minna
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas. .,Departments of Pharmacology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven J Altschuler
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California.
| | - Lani F Wu
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, California.
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An Aggressive Primary Cutaneous Follicle Center Lymphoma With c-MYC Translocation and CDKN2A (9p21) Deletion: A Case Report and Review of the Literature. Am J Dermatopathol 2017; 39:e44-e49. [DOI: 10.1097/dad.0000000000000738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Roth CG, Gillespie-Twardy A, Marks S, Agha M, Raptis A, Hou JZ, Farah R, Lin Y, Qian Y, Pantanowitz L, Boyiadzis M. Flow Cytometric Evaluation of Double/Triple Hit Lymphoma. Oncol Res 2016; 23:137-46. [PMID: 26931436 PMCID: PMC7838659 DOI: 10.3727/096504015x14500972666761] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
“Double” or “triple” hit lymphomas (D/THL) with recurrent translocations involving MYC/8q24 and BCL2/18q21 and/or BCL6/3q27 are characterized by a poor prognosis, but their identification is hampered by the clinicopathologic overlap with other disease categories. Cases with circulating blastic-appearing cells may initially cause concern for lymphoblastic leukemia a diagnostic dilemma, which has not been well studied. There is only limited literature regarding the flow cytometric (FC) D/THL phenotype and its clinical correlates. The FC features of 20 D/THL (11 BCL2+/MYC+, 5 BCL6+/MYC+, 4 BCL2+/BCL6+/MYC+) were evaluated, compared to 20 B-lymphoblastic leukemias (B-LBL), and correlated with overall survival. Most (89%, 17/19) D/THL were CD10+, 47% (9/19) lacked surface light chain, and a significant subset underexpressed CD45 (47%, 9/19), CD20 (42% 8/19), and/or CD19 (39%, 7/18), which did not vary by genetic subgroup. Compared to B-LBL, D/THL less frequently underexpressed CD45 (p = 0.0001) and CD20 (p = 0.0004). Lower levels of BCL2 expression were noted in the BCL6+/MYC+ and BCL2+/BCL6+/MYC+ subgroups versus BCL2+/MYC+ cases (p = 0.0014). Of the flow cytometric parameters assessed, dim CD45 expression correlated with inferior survival (p = 0.01). Although there is some overlap with B-LBL, D/THL demonstrates a characteristic immunophenotype which may have prognostic significance and warrants further investigation.
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Affiliation(s)
- Christine G Roth
- Department of Pathology, Division of Hematopathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Haberl S, Haferlach T, Stengel A, Jeromin S, Kern W, Haferlach C. MYC rearranged B-cell neoplasms: Impact of genetics on classification. Cancer Genet 2016; 209:431-439. [PMID: 27810071 DOI: 10.1016/j.cancergen.2016.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 12/12/2022]
Abstract
A cohort comprising 156 patients with B-cell neoplasms harboring an MYC rearrangement was analyzed with respect to phenotypic presentation, molecular markers (TP53, MYC and ID3) and additional cytogenetic abnormalities (concomitantly occurring BCL2, BCL6 and/or CCND1 rearrangements; double, triple or quadruple hit lymphomas = multiple hit lymphomas). MYC translocations occurred as single hit (only MYC rearranged, 63%) or multiple hit lymphoma (37%) and presented as acute leukemia (AL) (14%), Burkitt lymphoma (30%), chronic lymphocytic leukemia (CLL) (21%) or other mature B-cell neoplasms (35%). Multiple hit lymphomas more frequently showed a complex karyotype compared to single hit lymphomas (62% vs. 28%, p < 0.001). Single hit Burkitt lymphomas presented with specific characteristics, by translocation of MYC to an immunoglobulin locus, predominantly a non-complex karyotype (23% vs. 67%, p = 0.012) and a significantly higher ID3 and TP53 mutation frequency (ID3mut: 49% vs. 0%, p = 0.002; TP53mut: 69% vs. 33%, p = 0.045). Additionally, MYC rearranged CLL presented as outstanding group by often showing a non-complex karyotype (85%), absence of ID3 mutations, a high frequency of SF3B1 mutations, and a frequent involvement of non-immunoglobulin loci as MYC-partner genes (61%). Consequently, genetic characteristics distinguish different subgroups of MYC rearranged B-cell neoplasms and therefore may contribute to a new classification system.
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14
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Nowakowski GS, Czuczman MS. ABC, GCB, and Double-Hit Diffuse Large B-Cell Lymphoma: Does Subtype Make a Difference in Therapy Selection? Am Soc Clin Oncol Educ Book 2016:e449-57. [PMID: 25993209 DOI: 10.14694/edbook_am.2015.35.e449] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Personalized therapy for the treatment of patients with cancer is rapidly approaching and is an achievable goal in the near future. A substantial number of novel targets have been developed into therapeutic agents. There is a substantial variability to antitumor activity by novel therapeutics because of the unique heterogeneity and biology that exists both between and within lymphoma subtypes. Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). Approximately 40% of patients have refractory disease or disease that will relapse after an initial response, and the majority of patients with relapsed DLBCL will succumb to the disease. There are two major biologically distinct molecular subtypes of DLBCL: germinal center B-cell (GCB) and activated B-cell (ABC). ABC DLBCL is associated with substantially worse outcomes when treated with standard chemoimmunotherapy. In addition to GCB and ABC subtypes, double-hit lymphomas (approximately 5% to 10% of patients) and double-expressor lymphomas, which overexpress MYC and BCL2 protein, are aggressive DLBCLs and are also associated with a poor prognosis. Double-hit lymphomas have concurrent chromosomal rearrangements of MYC plus BCL2 (or less likely, BCL6). Advances in molecular characterization techniques and the development of novel agents targeting specific subtypes of DLBCL have provided a foundation for personalized therapy of DLBCL based on molecular subtype. A number of early clinical trials evaluating combinations of novel targeted agents with standard chemotherapy (R-CHOP) have been completed and have demonstrated the feasibility of this approach with encouraging efficacy. As such, molecular classification of DLBCL is not only important for prognostication, but moves to center stage for personalization of therapy for DLBCL.
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Affiliation(s)
- Grzegorz S Nowakowski
- From the Division of Hematology, Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY
| | - Myron S Czuczman
- From the Division of Hematology, Mayo Clinic, Rochester, MN; Roswell Park Cancer Institute, Buffalo, NY
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15
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Cheema FN, Agloria M, Koshy N, Hildebrandt GC. Double hit lymphoma - a case of unusual response after sequential aggressive chemotherapy and review of the literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:117-21. [PMID: 25336995 PMCID: PMC4196880 DOI: 10.4137/ccrep.s11393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/24/2013] [Accepted: 02/28/2013] [Indexed: 11/05/2022]
Abstract
Lymphomas with recurrent chromosomal breakpoints activating multiple oncogenes, including MYC, BCL2, and BCL6 are often referred to as "Dual Hit" or "Double Hit" lymphomas (DHL). In the updated classification for malignant lymphomas by the World Health Organization (WHO), the novel category of "B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma (DLBCL) and Burkitt's lymphoma (BL)" was proposed in an attempt to create a (temporary) container for aggressive mature B-cell lymphomas that should not be diagnosed as either BL or DLBCL. DHL make up an important part of this novel WHO category, the other part representing heterogeneous cases of aggressive B-cell lymphoma that have features of BL. DHL are highly aggressive lymphomas with generally poor response to first line and salvage treatment. Limited data is available to guide therapeutic decisions, and despite aggressive measures including high dose (HD) chemotherapy followed by autologous hematopoietic cell transplantation (AHCT), outcome is unsatisfyingly poor. Herein, we report a case of a patient with DHL and review the relevant literature.
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Affiliation(s)
- Faisal N Cheema
- Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Maliha Agloria
- Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Nebu Koshy
- Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Gerhard C Hildebrandt
- Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ; Division of Hematology and Hematologic Malignancies, University of Utah School of Medicine, Salt Lake City, UT, USA
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16
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Barlow JH, Nussenzweig A. Replication initiation and genome instability: a crossroads for DNA and RNA synthesis. Cell Mol Life Sci 2014; 71:4545-59. [PMID: 25238783 DOI: 10.1007/s00018-014-1721-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 08/28/2014] [Indexed: 12/16/2022]
Abstract
Nuclear DNA replication requires the concerted action of hundreds of proteins to efficiently unwind and duplicate the entire genome while also retaining epigenetic regulatory information. Initiation of DNA replication is tightly regulated, rapidly firing thousands of origins once the conditions to promote rapid and faithful replication are in place, and defects in replication initiation lead to proliferation defects, genome instability, and a range of developmental abnormalities. Interestingly, DNA replication in metazoans initiates in actively transcribed DNA, meaning that replication initiation occurs in DNA that is co-occupied with tens of thousands of poised and active RNA polymerase complexes. Active transcription can induce genome instability, particularly during DNA replication, as RNA polymerases can induce torsional stress, formation of secondary structures, and act as a physical barrier to other enzymes involved in DNA metabolism. Here we discuss the challenges facing mammalian DNA replication, their impact on genome instability, and the development of cancer.
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18
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Rambaldi A, Boschini C, Gritti G, Delaini F, Oldani E, Rossi A, Barbui AM, Caracciolo D, Ladetto M, Gueli A, Crescenzo A, Passera R, Devizzi L, Patti C, Gianni AM, Tarella C. The lymphocyte to monocyte ratio improves the IPI-risk definition of diffuse large B-cell lymphoma when rituximab is added to chemotherapy. Am J Hematol 2013; 88:1062-7. [PMID: 23940056 DOI: 10.1002/ajh.23566] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/19/2013] [Accepted: 08/04/2013] [Indexed: 12/21/2022]
Abstract
The peripheral blood lymphocyte to monocyte ratio (LMR) at diagnosis can be clinically relevant in patients with diffuse large B-cell lymphoma (DLBCL). We reviewed the outcome of 1,057 DLBCL patients followed from 1984 to 2012 at four centers. LMR was analyzed as a clinical biomarker by receiver-operating characteristic (ROC) analysis and Harrell's C-statistics. Patients were characterized by a median age of 61 years, International Prognostic Index (IPI) score of >2 in 39%, and were treated with a rituximab-containing chemotherapy in 66%. LMR proved strongly predictive for survival in patients treated with rituximab-based programs, but not in those receiving chemotherapy alone. Additionally, an LMR value of ≤2.6 (as determined by ROC analysis) was associated with a worst performance status, a higher lactate dehydrogenase (LDH) level, an advanced clinical stage, and a higher IPI score (P = 0.000). In patients treated with rituximab-supplemented chemotherapy programs, an LMR value of <2.6 was found in most of the primary refractory patients (75%) which proved as the best cutoff to predict both response and survival (P = 0.018). Finally, multivariate analysis and Harrell's C-statistics confirmed the IPI-independent role of LMR on survival (P = 0.0000). In conclusion, LMR is a potent predictor of clinical response and survival in DLBCL treated with rituximab-containing chemotherapy.
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Affiliation(s)
- Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | - Cristina Boschini
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | - Giuseppe Gritti
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | - Federica Delaini
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | - Elena Oldani
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | - Andrea Rossi
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | - Anna Maria Barbui
- Hematology and Bone Marrow Transplant Units of Azienda Ospedaliera Papa Giovanni XXIIIBergamo Italy
| | | | - Marco Ladetto
- Division of Hematology IUniversity of TorinoTorino Italy
| | - Angela Gueli
- Hematology and Cell Therapy Division and Molecular Biotechnology CenterMauriziano‐Umberto I Hospital and Dep. Onc. Sp. ‐ University of TorinoTorino Italy
| | - Alberto Crescenzo
- Hematology and Cell Therapy Division and Molecular Biotechnology CenterMauriziano‐Umberto I Hospital and Dep. Onc. Sp. ‐ University of TorinoTorino Italy
| | - Roberto Passera
- Division of Nuclear MedicineUniversity of TorinoTorino Italy
| | - Liliana Devizzi
- Medical OncologyFondazione IRCCS Istituto Nazionale TumoriMilano Italy
| | - Caterina Patti
- Hematology and Bone Marrow Transplant Units of Ospedali Riuniti Villa Sofia‐Cervello of Palermo Palermo Italy
| | | | - Corrado Tarella
- Division of Hematology IUniversity of TorinoTorino Italy
- Hematology and Cell Therapy Division and Molecular Biotechnology CenterMauriziano‐Umberto I Hospital and Dep. Onc. Sp. ‐ University of TorinoTorino Italy
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Wu D, Wood BL, Dorer R, Fromm JR. Utility of flow cytometry for immunophenotyping double-hit lymphomas. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:398. [DOI: 10.1002/cyto.b.21117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- David Wu
- Department of Laboratory Medicine; University of Washington Medical Center; Seattle WA
| | - Brent L. Wood
- Department of Laboratory Medicine; University of Washington Medical Center; Seattle WA
| | - Russell Dorer
- Department of Pathology; Virginia Mason Medical Center; Seattle WA
| | - Jonathan R. Fromm
- Department of Laboratory Medicine; University of Washington Medical Center; Seattle WA
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The Impact of MYC Rearrangements and “Double Hit” Abnormalities in Diffuse Large B-Cell Lymphoma. Curr Hematol Malig Rep 2013; 8:243-52. [DOI: 10.1007/s11899-013-0169-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Emadali A, Rousseaux S, Bruder-Costa J, Rome C, Duley S, Hamaidia S, Betton P, Debernardi A, Leroux D, Bernay B, Kieffer-Jaquinod S, Combes F, Ferri E, McKenna CE, Petosa C, Bruley C, Garin J, Ferro M, Gressin R, Callanan MB, Khochbin S. Identification of a novel BET bromodomain inhibitor-sensitive, gene regulatory circuit that controls Rituximab response and tumour growth in aggressive lymphoid cancers. EMBO Mol Med 2013; 5:1180-95. [PMID: 23828858 PMCID: PMC3944460 DOI: 10.1002/emmm.201202034] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 12/13/2022] Open
Abstract
Immuno-chemotherapy elicit high response rates in B-cell non-Hodgkin lymphoma but heterogeneity in response duration is observed, with some patients achieving cure and others showing refractory disease or relapse. Using a transcriptome-powered targeted proteomics screen, we discovered a gene regulatory circuit involving the nuclear factor CYCLON which characterizes aggressive disease and resistance to the anti-CD20 monoclonal antibody, Rituximab, in high-risk B-cell lymphoma. CYCLON knockdown was found to inhibit the aggressivity of MYC-overexpressing tumours in mice and to modulate gene expression programs of biological relevance to lymphoma. Furthermore, CYCLON knockdown increased the sensitivity of human lymphoma B cells to Rituximab in vitro and in vivo. Strikingly, this effect could be mimicked by in vitro treatment of lymphoma B cells with a small molecule inhibitor for BET bromodomain proteins (JQ1). In summary, this work has identified CYCLON as a new MYC cooperating factor that autonomously drives aggressive tumour growth and Rituximab resistance in lymphoma. This resistance mechanism is amenable to next-generation epigenetic therapy by BET bromodomain inhibition, thereby providing a new combination therapy rationale for high-risk lymphoma. The nuclear factor CYCLON is a new MYC cooperating factor that drives tumor growth and Rituximab resistance in lymphoma. This resistance mechanism can be targeted by next-generation epigenetic therapy by BET bromodomain inhibition downstream of MYC.
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Affiliation(s)
- Anouk Emadali
- CEA, iRTSV, Biologie à Grande Echelle, Grenoble, France
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Double-hit B-cell Lymphomas With BCL6 and MYC Translocations Are Aggressive, Frequently Extranodal Lymphomas Distinct From BCL2 Double-hit B-cell Lymphomas. Am J Surg Pathol 2013; 37:323-32. [DOI: 10.1097/pas.0b013e31826cebad] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Which treatment for high-risk patients with DLBCL? Lancet Oncol 2012; 13:1180-2. [PMID: 23168361 DOI: 10.1016/s1470-2045(12)70507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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