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Zinzani PL, Muñoz J, Trotman J. Current and future therapies for follicular lymphoma. Exp Hematol Oncol 2024; 13:87. [PMID: 39175100 PMCID: PMC11340193 DOI: 10.1186/s40164-024-00551-1] [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: 06/06/2024] [Accepted: 08/02/2024] [Indexed: 08/24/2024] Open
Abstract
Follicular lymphoma (FL) is an indolent, germinal center B cell-derived lymphoid neoplasm, for which recent advances in treatment have substantially improved patient survival. However, FL remains an incurable and heterogeneous disease, with groups of patients experiencing early disease progression, histologic transformation, or a high risk of treatment-related toxicity. Additionally, FL is a continually relapsing disease, and response rates and disease-control intervals decrease with each subsequent line of therapy. In this review, we explore the current treatment landscape for relapsed or refractory FL and promising therapies in development, highlighting the efficacy and potential risks of each treatment. We provide a real-world perspective on the unmet needs of patients with FL. Novel therapeutic approaches in development offer a wide array of options for clinicians when treating relapsed or refractory FL. A nuanced approach is required to address the needs of individual patients, taking into consideration both the risks and benefits of each treatment option, as well as patient preferences.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia Seràgnoli, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Javier Muñoz
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA.
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
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2
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Kim M, Hwang HS, Son EM, Cho H, Yoon DH, Suh C, Park CS, Go H, Huh J. Clinicopathological and prognostic significance of BCL2, BCL6, MYC, and IRF4 copy number gains and translocations in follicular lymphoma: a study by FISH analysis. Leuk Lymphoma 2020; 61:3342-3350. [PMID: 32921221 DOI: 10.1080/10428194.2020.1815017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BCL2 translocation is the genetic hallmark of follicular lymphoma (FL). Besides BCL2 translocation, copy number (CN) gains and translocations of BCL6, MYC, and IRF4 have also been detected in FL, but there is little information regarding their prognostic significance. This retrospective study used fluorescence in situ hybridization (FISH) to analyze BCL2, BCL6, MYC, and IRF4 translocations and CN gains in 105 FL cases. Genetic translocations were detected for BCL2 (n = 64; 72.7%), BCL6 (n = 14; 15.9%), and MYC (n = 2; 2.3%); no case showed IRF4 translocation. Overall, 23 (26.1%), 30 (34.1%), 12 (13.8%), and 10 (11.0%) cases showed CN gains in BCL2, BCL6, MYC, and IRF4, respectively. BCL6 CN gain was a prognostic factor for worse overall survival, demonstrating a trend toward significance in multivariate analysis (HR =8.769, p = 0.056). BCL6 CN gain in FL might be associated with aggressive biologic behavior.
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Affiliation(s)
- Meejeong Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Son
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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3
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High-grade B-cell lymphoma: a term re-purposed in the revised WHO classification. Pathology 2020; 52:68-77. [DOI: 10.1016/j.pathol.2019.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 12/24/2022]
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4
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Zhu Z, Li T, Zhang X, Zhang Z, Zhu D, Lin P, Tu S, Ren W. Molecular and clinical progress in follicular lymphoma lacking the t(14;18) translocation (Review). Int J Oncol 2019; 56:7-17. [PMID: 31789408 DOI: 10.3892/ijo.2019.4917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/25/2019] [Indexed: 11/05/2022] Open
Abstract
Although the majority of patients with follicular lymphoma (FL) harbor the t(14;18)(q32;q21) IGH/BCL2 gene rearrangement that leads to the overexpression of BCL2 protein, approximately 20% of FL cases lack t(14;18)(q32;q21). It is considered that BCL2 overexpression underscores the development of the majority of cases of FL and their transformation to more aggressive lymphoma [known as transformed FL (tFL)]. However, FL cases lacking the t(14;18)(q32;q21) translocation exhibit symptoms analogous to their t(14;18)‑positive counterparts. An important goal of recent research on FL has been to clarify the distinctions between the two different forms of FL. Numerous studies have shed light onto the genetic and molecular features of t(14;18)‑negative FL and the related clinical manifestations. In this review, we summarize the current knowledge of t(14;18)‑negative FL occurring in the lymph nodes with an emphasis on the underlying molecular and clinical features. In addition, novel treatment directions are discussed.
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Affiliation(s)
- Zunmin Zhu
- Institute of Hematology, Henan Renmin Hospital, Zhengzhou, Henan 475000, P.R. China
| | - Tao Li
- Laboratory of Hematology, The First Affiliated Hospital of Zhenzhou University, Zhengzhou, Henan 475000, P.R. China
| | - Xuran Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, P.R. China
| | - Zhengqiang Zhang
- Immunology Laboratory of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan 450008, P.R. China
| | - Dandan Zhu
- Zhengzhou Shenyou Biotechnology, Zhengzhou, Henan 450000, P.R. China
| | - Pei Lin
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shichun Tu
- Scintillon Institute for Biomedical and Bioenergy Research, San Diego, CA 92121, USA
| | - Weihong Ren
- Department of Laboratory Medicine, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, P.R. China
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5
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Henrich M, Bauknecht A, Hecht W, Reinacher M. Lack of Bcl-2 expression in feline follicular lymphomas. J Vet Diagn Invest 2019; 31:809-817. [PMID: 31585524 DOI: 10.1177/1040638719877916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Bcl-2, an anti-apoptotic protein, is commonly overexpressed in follicular lymphomas in humans. This is usually the result of a chromosomal translocation that transposes the Bcl-2 gene into the immunoglobulin gene locus. The immunohistochemical assessment of this overexpression can be used as a tool for the differentiation of follicular lymphoma and follicular hyperplasia. In cats, little information about the expression of Bcl-2 in follicular lymphoma exists. We investigated 18 follicular lymphomas histologically and immunohistochemically for the expression of Bcl-2, CD3, CD45R, and feline leukemia virus. Clonality was assessed by PCR for antigen receptor gene rearrangements. Although the histology resembled that of their human counterparts, diffuse expression of Bcl-2 within the follicles of the feline lymphomas, as seen in human cases, was not present. Only single cells within the follicles, comparable to the reactive controls, were positive for Bcl-2 expression. The mean survival time of 4.6 y confirmed the indolent character of the tumor. None of the clinical parameters assessed were statistically significant predictors of survival. Furthermore, a statistically significant difference in survival of animals with or without anti-neoplastic therapy was also not demonstrable.
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Affiliation(s)
- Manfred Henrich
- Institut fuer Veterinaer-Pathologie, Justus-Liebig-Universitaet Giessen, Giessen, Hessen, Germany
| | - Anna Bauknecht
- Institut fuer Veterinaer-Pathologie, Justus-Liebig-Universitaet Giessen, Giessen, Hessen, Germany
| | - Werner Hecht
- Institut fuer Veterinaer-Pathologie, Justus-Liebig-Universitaet Giessen, Giessen, Hessen, Germany
| | - Manfred Reinacher
- Institut fuer Veterinaer-Pathologie, Justus-Liebig-Universitaet Giessen, Giessen, Hessen, Germany
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Choi SM, Betz BL, Perry AM. Follicular Lymphoma Diagnostic Caveats and Updates. Arch Pathol Lab Med 2018; 142:1330-1340. [PMID: 30221980 DOI: 10.5858/arpa.2018-0217-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Follicular lymphoma is a common small B-cell lymphoma, likely to be encountered by any practicing pathologist, regardless of specialty. Although the features of typical follicular lymphoma are well known and in most instances easily identifiable, there are lesser-appreciated morphologic appearances that can raise alternative diagnostic possibilities. The limited tissue available in core needle biopsies can make it additionally challenging to thoroughly evaluate those features in the context of architecture. Furthermore, ancillary testing including immunohistochemistry and molecular/genetic analysis do not always show classic findings and may pose additional challenges to interpretation. OBJECTIVES.— To review the morphologic features of follicular lymphoma with a discussion of morphologic variants and mimics; to discuss pitfalls of ancillary testing and provide the practicing pathologist with an appropriate context for interpretation of immunohistochemical and molecular/genetic studies when follicular lymphoma is part of the differential diagnosis; and to propose diagnostic strategies when there is limited tissue for evaluation. DATA SOURCES.— We used examples of follicular lymphoma from our institution as well as a review of the literature, with a focus on the diagnostic aspects that are broadly relevant to a general pathology practice. CONCLUSIONS.— Follicular lymphoma can occasionally present with atypical morphologic, immunohistochemical, or molecular/genetic features. In particular, those findings can be difficult to interpret in the setting of a limited tissue sample. Awareness of those possibilities will help guide the pathologist to a more accurate and precise diagnosis.
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Affiliation(s)
- Sarah M Choi
- From the Department of Pathology, University of Michigan, Ann Arbor
| | - Bryan L Betz
- From the Department of Pathology, University of Michigan, Ann Arbor
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Xia QY, Wang XT, Ye SB, Wang X, Li R, Shi SS, Fang R, Zhang RS, Ma HH, Lu ZF, Shen Q, Bao W, Zhou XJ, Rao Q. Novel gene fusion of PRCC-MITF defines a new member of MiT family translocation renal cell carcinoma: clinicopathological analysis and detection of the gene fusion by RNA sequencing and FISH. Histopathology 2018; 72:786-794. [PMID: 29148086 DOI: 10.1111/his.13439] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
AIMS MITF, TFE3, TFEB and TFEC belong to the same microphthalmia-associated transcription factor family (MiT). Two transcription factors in this family have been identified in two unusual types of renal cell carcinoma (RCC): Xp11 translocation RCC harbouring TFE3 gene fusions and t(6;11) RCC harbouring a MALAT1-TFEB gene fusion. The 2016 World Health Organisation classification of renal neoplasia grouped these two neoplasms together under the category of MiT family translocation RCC. RCCs associated with the other two MiT family members, MITF and TFEC, have rarely been reported. Herein, we identify a case of MITF translocation RCC with the novel PRCC-MITF gene fusion by RNA sequencing. METHODS AND RESULTS Histological examination of the present tumour showed typical features of MiT family translocation RCCs, overlapping with Xp11 translocation RCC and t(6;11) RCC. However, this tumour showed negative results in TFE3 and TFEB immunochemistry and split fluorescence in-situ hybridisation (FISH) assays. The other MiT family members, MITF and TFEC, were tested further immunochemically and also showed negative results. RNA sequencing and reverse transcription-polymerase chain reaction confirmed the presence of a PRCC-MITF gene fusion: a fusion of PRCC exon 5 to MITF exon 4. We then developed FISH assays covering MITF break-apart probes and PRCC-MITF fusion probes to detect the MITF gene rearrangement. CONCLUSIONS This study both proves the recurring existence of MITF translocation RCC and expands the genotype spectrum of MiT family translocation RCCs.
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Affiliation(s)
- Qiu-Yuan Xia
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao-Tong Wang
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Sheng-Bing Ye
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xuan Wang
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Rui Li
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Shan-Shan Shi
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ru Fang
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ru-Song Zhang
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Heng-Hui Ma
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhen-Feng Lu
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qin Shen
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wei Bao
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiao-Jun Zhou
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Qiu Rao
- Department of Pathology, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Zhang X, Takata K, Cui W, Miyata-Takata T, Sato Y, Noujima-Harada M, Yoshino T. Protocadherin γ A3 is expressed in follicular lymphoma irrespective of BCL2 status and is associated with tumor cell growth. Mol Med Rep 2016; 14:4622-4628. [PMID: 27748813 PMCID: PMC5102029 DOI: 10.3892/mmr.2016.5808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/18/2016] [Indexed: 01/24/2023] Open
Abstract
Protocadherin genes (PCDHs) have been suggested to act as tumor suppressor genes in various tumor types. Previous studies have demonstrated the upregulation of certain PCDH-γ subfamily genes in nodal and duodenal follicular lymphoma (FL) using gene expression analyses. However, the mechanisms and associated molecular function of PCDH-γ subfamily gene upregulation in FL remain to be elucidated. The present study examined the expression of PCDHGA3, an upregulated PCDH-γ gene subfamily member, in B-cell lymphoma 2 (BCL2)-positive and -negative FL, and evaluated its association with tumor cell proliferation in an FL-derived cell line. Immunohistochemical analysis demonstrated that the majority of FL grade 1–2 samples (19/20; 95%) and over half of grade 3A FL samples (5/9; 56%) were PCDHGA3-positive, whereas only 1/17 reactive lymphoid hyperplasia samples was positive. Notably, this positivity was widely observed in samples of BCL2-negative FL (13/15; 87%) and FL with diffuse area (10/10; 100%). The FL-derived cell line FL18 exhibited strong PCDHGA3 expression, similar to the patient samples, and its proliferation was suppressed by PCDHGA3 gene knockdown. Genes expressed concomitantly with PCDHGA3 were selected from gene expression data, and TNFRSF6B, a member of the tumor necrosis factor receptor superfamily, was among the top five most strongly correlated genes. Coexpression of TNFRSF6B and PCDHGA3 was observed immunohistochemically in FL18 cells, suggesting potential cooperation in tumor cell maintenance. In conclusion, the results of the present study indicated that PCDHGA3 was expressed in FL irrespective of BCL2 status and grading and was associated with cell proliferation. Further studies involving molecular genetic analyses are required to elucidate the mechanisms underlying the activity of PCDHGA3 in FL.
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Affiliation(s)
- Xueyan Zhang
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Katsuyoshi Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Wei Cui
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Tomoko Miyata-Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Mai Noujima-Harada
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
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9
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Ho C, Kluk MJ. Molecular Pathology: Predictive, Prognostic, and Diagnostic Markers in Lymphoid Neoplasms. Surg Pathol Clin 2016; 9:489-521. [PMID: 27523974 DOI: 10.1016/j.path.2016.04.011] [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] [Indexed: 06/06/2023]
Abstract
Lymphoid neoplasms show great diversity in morphology, immunophenotypic profile, and postulated cells of origin, which also reflects the variety of genetic alterations within this group of tumors. This review discusses many of the currently known genetic alterations in selected mature B-cell and T-cell lymphoid neoplasms, and their significance as diagnostic, prognostic, and therapeutic markers. Given the rapidly increasing number of genetic alterations that have been described in this group of tumors, and that the clinical significance of many is still being studied, this is not an entirely exhaustive review of all of the genetic alterations that have been reported.
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Affiliation(s)
- Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Michael J Kluk
- Department of Pathology, Weill Cornell Medical College, 525 East 68th Street, Mailbox #79, F-540, New York, NY 10065, USA.
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Bogusz AM, Bagg A. Genetic aberrations in small B-cell lymphomas and leukemias: molecular pathology, clinical relevance and therapeutic targets. Leuk Lymphoma 2016; 57:1991-2013. [PMID: 27121112 DOI: 10.3109/10428194.2016.1173212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Small B-cell lymphomas and leukemias (SBCLs) are a clinically, morphologically, immunophenotypically and genetically heterogeneous group of clonal lymphoid neoplasms, including entities such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), mantle cell lymphoma (MCL), follicular lymphoma (FL), lymphoplasmacytic lymphoma (LPL), marginal zone lymphoma (MZL) and hairy cell leukemia (HCL). The pathogenesis of some of these lymphoid malignancies is characterized by distinct translocations, for example t(11;14) in the majority of cases of MCL and t(14;18) in most cases of FL, whereas other entities are associated with a variety of recurrent but nonspecific numeric chromosomal abnormalities, as exemplified by del(13q14), del(11q22), and +12 in CLL, and yet others such as LPL and HCL that lack recurrent or specific cytogenetic aberrations. The recent surge in next generation sequencing (NGS) technology has shed more light on the genetic landscape of SBCLs through characterization of numerous driver mutations including SF3B1 and NOTCH1 in CLL, ATM and CCND1 in MCL, KMT2D and EPHA7 in FL, MYD88 (L265P) in LPL, KLF2 and NOTCH2 in splenic MZL (SMZL) and BRAF (V600E) in HCL. The identification of distinct genetic lesions not only provides greater insight into the molecular pathogenesis of these disorders but also identifies potential valuable biomarkers for prognostic stratification, as well as specific targets for directed therapy. This review discusses the well-established and recently identified molecular lesions underlying the pathogenesis of SBCLs, highlights their clinical relevance and summarizes novel targeted therapies.
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Affiliation(s)
- Agata M Bogusz
- a Department of Pathology and Laboratory Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Adam Bagg
- a Department of Pathology and Laboratory Medicine, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
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11
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Alpatov R, Carstens B, Harding K, Jarrett C, Balakhani S, Lincoln J, Brzeskiewicz P, Guo Y, Ohene-Mobley A, LeRoux J, McDaniel V, Meltesen L, Minka D, Patel M, Manavi C, Swisshelm K. Rare double-hit with two translocations involving IGH both, with BCL2 and BCL3, in a monoclonal B-cell lymphoma/leukemia. Mol Cytogenet 2015; 8:101. [PMID: 26719766 PMCID: PMC4696310 DOI: 10.1186/s13039-015-0203-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/17/2015] [Indexed: 12/17/2022] Open
Abstract
Background Chronic Lymphocytic Leukemia (CLL) is a lymphoproliferative disease characterized by multiple recurring clonal cytogenetic anomalies and is the most common leukemia in adults. Chromosomal abnormalities associated with CLL include trisomy 12 and IGH;BCL3 rearrangement [t(14;19)(q32;q13)] that juxtaposes a proto-oncogenic gene BCL3 and an immunoglobulin heavy chain, a translocation that may be associated with shorter survival. In addition to the IGH;BCL3 rearrangement, other translocations involving 14q32 locus are involved in various lymphoproliferative pathologies pointing toward the significance of IGH locus in oncogenic progression. Significantly, in the majority of B-cell neoplasms that carry an IGH;BCL3 rearrangement, it is a sole translocation involving an IGH locus. Case Presentation We report a patient who, in addition to trisomy 12, carried a rare double-hit translocation characterized by the IGH;BCL3 translocation and an additional clonal IGH;BCL2 translocation involving IGH and another proto-oncogene BCL2, t(14;18)(q32;q21), commonly found in follicular lymphoma. Further single nucleotide polymorphism (SNP) array-based analysis detected a duplication of the 58.8 kb region at 19q13.32 adjacent to the BCL3 translocation junction on chromosome 19q13. Interestingly, the duplicated region contained ERCC2 gene, which encodes a DNA excision repair protein involved in the cancer-prone syndrome, xeroderma pigmentosum. Conclusions Taken together our findings indicate the existence of double-translocation driven oncogenic events involving both IGH loci and proto-oncogenes BCL2 and BCL3. Importantly, the IGH;BCL3 translocation was characterized by the duplication of the genomic region adjacent to BCL3, containing a major DNA repair factor, ERCC2. Electronic supplementary material The online version of this article (doi:10.1186/s13039-015-0203-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roman Alpatov
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Billie Carstens
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Kimberly Harding
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Carolyn Jarrett
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Sudabeh Balakhani
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Jessica Lincoln
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Peter Brzeskiewicz
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Yu Guo
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Alex Ohene-Mobley
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Jamie LeRoux
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Veronica McDaniel
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Lynne Meltesen
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | - Diane Minka
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
| | | | - Cyrus Manavi
- Eastern Carolina Pathology Associates, 1705 Tarboro Street SW, Wilson, NC 27893 USA
| | - Karen Swisshelm
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, 3055 Roslyn Street, Suite 200, Denver, CO 80238 USA
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12
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Leich E, Hoster E, Wartenberg M, Unterhalt M, Siebert R, Koch K, Klapper W, Engelhard M, Puppe B, Horn H, Staiger AM, Stuhlmann-Laeisz C, Bernd HW, Feller AC, Hummel M, Lenze D, Stein H, Hartmann S, Hansmann ML, Möller P, Hiddemann W, Dreyling M, Ott G, Rosenwald A. Similar clinical features in follicular lymphomas with and without breaks in the BCL2 locus. Leukemia 2015; 30:854-60. [PMID: 26621338 DOI: 10.1038/leu.2015.330] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 01/18/2023]
Abstract
Approximately 15% of follicular lymphomas (FLs) lack breaks in the BCL2 locus. The aim of this study was to better define molecular and clinical features of BCL2-breakpoint/t(14;18)-negative FLs. We studied the presence of BCL2, BCL6 and MYC breaks by fluorescence in situ hybridization and the expression of BCL2, MUM1, CD10, P53 and Ki67 in large clinical trial cohorts of 540 advanced-stage FL cases and 116 early-stage disease FL patients treated with chemotherapy regimens and radiation, respectively. A total of 86% and 53% of advanced- and early-stage FLs were BCL2-breakpoint-positive, respectively. BCL2 was expressed in almost all FLs with BCL2 break and also in 86% and 69% of BCL2-breakpoint-negative advanced- and early-stage FLs, respectively. CD10 expression was significantly reduced in BCL2-breakpoint-negative FLs of all stages and MUM1 and Ki67 expression were significantly increased in BCL2-break-negative early-stage FLs. Patient characteristics did not differ between FLs with and without BCL2 breaks and neither did survival times in advanced-stage FLs. These results suggest that the molecular profile differs to some extent between FLs with and without BCL2 breaks and support the notion that FLs with and without BCL2 breaks belong to the same lymphoma entity.
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Affiliation(s)
- E Leich
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - E Hoster
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany
| | - M Wartenberg
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - M Unterhalt
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - R Siebert
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - K Koch
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Engelhard
- Department for Radiotherapy, University Hospital Essen, Essen, Germany
| | - B Puppe
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
| | - H Horn
- Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart and University of Tübingen, Tübingen, Germany
| | - A M Staiger
- Margarete Fischer-Bosch Institute of Clinical Pharmacology, Robert-Bosch-Krankenhaus, Stuttgart and University of Tübingen, Tübingen, Germany
| | - C Stuhlmann-Laeisz
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - H W Bernd
- Institute of Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A C Feller
- Institute of Pathology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - M Hummel
- Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany
| | - D Lenze
- Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Germany
| | - H Stein
- Pathodiagnostik Berlin, Berlin, Germany
| | - S Hartmann
- Institute of Pathology, University Hospital Frankfurt am, Frankfurt, Germany
| | - M L Hansmann
- Institute of Pathology, University Hospital Frankfurt am, Frankfurt, Germany
| | - P Möller
- Institute of Pathology, University Hospital Ulm, Ulm, Germany
| | - W Hiddemann
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - M Dreyling
- Department of Internal Medicine III, University Hospital Munich, Munich, Germany
| | - G Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - A Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken (CCC MF), Würzburg, Germany
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13
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Kirkegaard MM, Coupland SE, Prause JU, Heegaard S. Malignant lymphoma of the conjunctiva. Surv Ophthalmol 2015; 60:444-58. [PMID: 26003619 DOI: 10.1016/j.survophthal.2015.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/06/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
Conjunctival lymphomas constitute 25% of all ocular adnexal lymphomas. The majority are B-cell non-Hodgkin lymphomas (NHLs) (98%), whereas conjunctival T-cell NHLs are rare (2%). The most frequent subtype of conjunctival B-cell lymphoma is extranodal marginal zone lymphoma (EMZL; 81%), followed by follicular lymphoma (8%), diffuse large B-cell lymphoma (3%), and mantle cell lymphoma (3%). Extranodal marginal zone lymphoma occurs slightly more often in women and, along with follicular lymphoma, presents late in the seventh decade of life, whereas diffuse large B-cell lymphoma and especially mantle cell lymphoma have a predilection for the male gender and typically present in the eighth decade. Extranodal marginal zone lymphoma and follicular lymphoma present most frequently in the forniceal and bulbar conjunctiva. Conjunctival diffuse large B-cell lymphoma, mantle cell lymphoma and T-cell NHLs are characterized by a short duration of symptoms before the first ophthalmologic consultation. External beam radiotherapy is the treatment of choice for extranodal marginal zone lymphoma and follicular lymphoma, whereas diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell NHLs are mainly treated with chemotherapy. Conjunctival T-cell NHLs are associated with a particularly poor prognosis, with 50% of patients having progression or recurrence during a 1-year follow-up period.
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Affiliation(s)
- Marina M Kirkegaard
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Jan U Prause
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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14
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Ogden A, Rida PCG, Reid MD, Kucuk O, Aneja R. Die-hard survivors: heterogeneity in apoptotic thresholds may underlie chemoresistance. Expert Rev Anticancer Ther 2015; 15:277-81. [PMID: 25695344 DOI: 10.1586/14737140.2015.1016425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The unmatched efficacy of microtubule-targeting agents (MTAs) as chemotherapeutics was once assumed to originate from their impact on mitotic processes; however, this misconception is being eroded by amassing data that MTAs instead target interphase functions in patients' tumors. What remains murky is how MTAs target malignant cells over non-malignant ones if proliferation rates do not distinguish them. In many instances, malignant cells are actually more 'primed' for apoptosis than non-malignant ones. Nevertheless, even if most cells within the tumor are more apoptosis-susceptible than those in healthy tissues, there likely exist small subpopulations of apoptosis-resistant clones that engender incomplete responses to MTAs and relapse. Therefore, intratumor heterogeneity in terms of proximity to the apoptotic threshold must be better understood to facilitate the design of chemotherapeutic regimens, which may benefit from including drugs like BH3 mimetics that help in lowering the apoptotic threshold of tumor cells within these chemoresistant subpopulations.
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Affiliation(s)
- Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA
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15
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Ho C, Rodig SJ. Immunohistochemical markers in lymphoid malignancies: Protein correlates of molecular alterations. Semin Diagn Pathol 2015; 32:381-91. [PMID: 25769206 DOI: 10.1053/j.semdp.2015.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Histomorphology, immunohistochemistry (IHC), and genetics are essential tools for the evaluation and classification of lymphoid malignancies. Advances in diagnostic techniques include the development of immunohistochemical assays that can serve as surrogates for genetic tests. We review the performance of a select subset of assays that detect the aberrant expression of onco-proteins secondary to chromosomal translocations (MYC; BCL2), somatic mutations (BRAF V600E; NOTCH1), and gene copy number gains (CD274 (encoding PD-L1); PDCD1LG2 (encoding PD-L2)) in fixed tissue biopsy sections. We discuss the limitations of IHC, but also its primary advantage over genetics; specifically, its ability to assess the final, common phenotypic consequences of a multitude of genetic and non-genetic events that influence protein expression. The information provided by IHC and genetic testing are thus intimately related; surgical pathologists will increasingly need to interpret and integrate the results of both to provide a comprehensive assessment of tumor biology and guide therapy.
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Affiliation(s)
- Caleb Ho
- Department of Pathology, Brigham and Women 's Hospital, Boston, Massachusetts
| | - Scott J Rodig
- Department of Pathology, Brigham and Women 's Hospital, Boston, Massachusetts.
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16
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Inter- and intratumoral heterogeneity of BCL2 correlates with IgH expression and prognosis in follicular lymphoma. Blood Cancer J 2014; 4:e249. [PMID: 25303368 PMCID: PMC4220646 DOI: 10.1038/bcj.2014.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/20/2014] [Indexed: 11/15/2022] Open
Abstract
Most follicular lymphomas (FLs) are genetically defined by the t(14;18)(q32;q21) translocation that juxtaposes the BCL2 gene to the immunoglobulin heavy chain (IgH) 3' regulatory regions (IgH-3'RRs). Despite this recurrent translocation, FL cases are heterogeneous in terms of intratumoral clonal diversity for acquired mutations and variations in the tumor microenvironment. Here we describe an additional mechanism that contributes to inter- and intratumoral heterogeneity in FLs. By applying a novel single-molecule RNA fluorescence-based in situ hybridization (FISH) technique to detect mRNA molecules of BCL2 and IgH in single cells, we found marked heterogeneity in the number of BCL2 mRNA transcripts within individual lymphoma cells. Moreover, BCL2 mRNA molecules correlated with IgH mRNA molecules in individual cells both in t(14;18) lymphoma cell lines and in patient samples. Consistently, a strong correlation between BCL2 and IgH protein levels was found in a series of 205 primary FL cases by flow cytometry and immunohistochemistry. Inter- and intratumoral heterogeneity of BCL2 expression determined resistance to drugs commonly used in FL treatment and affected overall survival of FL patients. These data demonstrate that BCL2 and IgH expressions are heterogeneous and coregulated in t(14;18)-translocated cells, and determine the response to therapy in FL patients.
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17
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Lack of expression of TUBB3 characterizes both BCL2-positive and BCL2-negative follicular lymphoma. Mod Pathol 2014; 27:808-13. [PMID: 24232867 DOI: 10.1038/modpathol.2013.182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/09/2022]
Abstract
Follicular lymphoma is characterized by aberrant BCL2 expression, a feature that is exploited for diagnostic purposes. However, a certain percentage of follicular lymphomas might be BCL2-negative by immunohistochemistry, increasing the difficulties in differentiating them from follicular hyperplasia. The expression of TUBB3 has been recently reported as negative in a small series of follicular lymphomas. We have therefore tested a larger series, including 61 BCL2-positive and 25 BCL2-negative cases, and compared them with 61 reactive lymphoid tissues. First, a subjective score of TUBB3 staining was applied, showing that it was consistently positive in reactive germinal centers, while most follicular lymphomas were negative; in fact, only 10/61 (16%) BCL2-positive and 1/25 (4%) BCL2-negative cases showed a positive staining for TUBB3, while 58/61 (95%) of tissues with follicular hyperplasia were positive. The application of a standardized scoring system to a large number of follicles, based on virtual slides, demonstrated that reactive lymphoid tissues had a significantly higher number of TUBB3-positive follicles both compared with BCL2-positive cases and to BCL2-negative cases. Our data support the use of TUBB3 staining in differentiating follicular lymphoma, including BCL2-negative cases, from follicular hyperplasia.
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18
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Burkhard R, Bhagat G, Cogliatti SB, Rossi D, Gaidano G, Pasqualucci L, Novak U. BCL2mutation spectrum in B-cell non-Hodgkin lymphomas and patterns associated with evolution of follicular lymphoma. Hematol Oncol 2014; 33:23-30. [DOI: 10.1002/hon.2132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 11/22/2013] [Accepted: 12/20/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Regula Burkhard
- Experimental Oncology/Hematology, Department of Clinical Research; University of Bern; Bern Switzerland
- Graduate School for Cellular and Biomedical Sciences; University of Bern; Bern Switzerland
| | - Govind Bhagat
- Herbert Irving Comprehensive Cancer Center; Columbia University Medical Center and New York Presbyterian Hospital; New York NY USA
- Department of Pathology and Cell Biology; Columbia University Medical Center and New York Presbyterian Hospital; New York NY USA
| | | | - Davide Rossi
- Division of Hematology, Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; Novara Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine; Amedeo Avogadro University of Eastern Piedmont; Novara Italy
| | - Laura Pasqualucci
- Herbert Irving Comprehensive Cancer Center; Columbia University Medical Center and New York Presbyterian Hospital; New York NY USA
- Department of Pathology and Cell Biology; Columbia University Medical Center and New York Presbyterian Hospital; New York NY USA
- Institute for Cancer Genetics; Columbia University; New York NY USA
| | - Urban Novak
- Experimental Oncology/Hematology, Department of Clinical Research; University of Bern; Bern Switzerland
- Department of Medical Oncology, Inselspital; Bern University Hospital and University of Bern; Bern Switzerland
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19
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Gravelle P, Jean C, Familiades J, Decaup E, Blanc A, Bezombes-Cagnac C, Laurent C, Savina A, Fournié JJ, Laurent G. Cell growth in aggregates determines gene expression, proliferation, survival, chemoresistance, and sensitivity to immune effectors in follicular lymphoma. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 184:282-95. [PMID: 24231431 DOI: 10.1016/j.ajpath.2013.09.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 01/03/2023]
Abstract
Lymphomas grow as dense aggregates in patients, but whether this spatial organization affects lymphoma cell biology is unknown. We grew follicular lymphoma (FL) cells in vitro as multicellular aggregates of lymphoma cells to investigate this question. Gene expression analysis revealed that 612 genes were differentially expressed when cells grew in multicellular aggregates of lymphoma cells rather than in suspension. These genes correspond to several GO biological processes, such as hypoxia, activation of NF-κB pathway, and negative regulation of cell cycle, a gene signature also found in the transcriptomes from FL biopsies. Pimonidazole staining, HIF-1A accumulation, and VEGFA release confirmed that cells in multicellular aggregates of lymphoma cells actually respond to hypoxia. In adaptation to such conditions, they also displayed an activated NF-κB pathway and a quiescent status far more frequently than in suspension. When cultured in three dimensions, FL cells display resistance to doxorubicin and bendamustine, two drugs largely used in FL therapy, compared to FL cultured in suspension. Finally, multicellular aggregates of lymphoma cells were also found to be less sensitive to purified natural killer cells. To conclude, our study shows that in FL, spatial organization results in dramatic changes in FL biology, including gene expression, proliferation, drug resistance, and immune escape.
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Affiliation(s)
- Pauline Gravelle
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France.
| | - Christine Jean
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France
| | - Julien Familiades
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France
| | - Emilie Decaup
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France; Roche Research Institute, Boulogne Billancourt, France
| | - Amandine Blanc
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France
| | - Christine Bezombes-Cagnac
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France
| | - Camille Laurent
- University of Toulouse III: Paul Sabatier, Toulouse, France; INSERM UMR1047, Center for Pathophysiology of Toulouse Purpan, Toulouse, France; Department of Anatomopathology, Hospital Purpan, Toulouse, France
| | | | - Jean-Jacques Fournié
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France
| | - Guy Laurent
- National Institute of Health and Medical Research (INSERM) UMR1037-Cancer, Research Center of Toulouse, Toulouse, France; University of Toulouse III: Paul Sabatier, Toulouse, France; National Center for Scientific Research ERL 5294, Toulouse, France; Carnot Lymphoma Institute (CALYM), Toulouse, France; Laboratoire d'Excellence Toulouse Cancer: TOUCAN, Toulouse, France; Department of Hematology, Hospital Purpan, Toulouse, France
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20
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Chan JKC, Ip YT, Cheuk W. The Utility of Immunohistochemistry for Providing Genetic Information on Tumors. Int J Surg Pathol 2013; 21:455-75. [PMID: 24065374 DOI: 10.1177/1066896913502529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With advances in immunohistochemical technology and growing knowledge of the molecular genetics of tumors, immunohistochemistry is playing an increasingly important role in providing genetic information for tumors. Specific chromosomal translocations can be demonstrated through detection of the protein product of one of the genes involved in gene fusion (such as BCL2, cyclin D, and ALK). Some mutations can be detected by (1) aberrant localization of the protein product (such as β-catenin and nucleophosmin), (2) abnormal accumulation of the protein product as a result of stabilization of the protein (such as p53), and (3) mutation-specific antibodies directed against the mutant protein (such as isocitrate dehydrogenase gene R132H mutation, epidermal growth factor receptor gene L858R and exon 19 deletion mutations, and BRAF gene V600E mutation). Gene deletion or loss of function can be demonstrated by the loss of immunostaining for the protein product (such as mismatch repair proteins in microsatellite-unstable tumors, E-cadherin in lobular carcinoma of the breast, and INI1 in rhabdoid tumors, atypical teratoid/rhabdoid tumors, and epithelioid sarcomas). Gene amplification can be demonstrated by overexpression of the protein product (such as HER2 in breast and gastric cancers, and MDM2 or CDK4 in well-differentiated/dedifferentiated liposarcomas). Viruses associated with tumors can be demonstrated directly (such as Epstein-Barr virus latent membrane protein-1 in Hodgkin lymphomas, human herpesvirus 8 in Kaposi sarcomas, and Merkel cell polyomavirus in Merkel cell carcinomas) or by a surrogate marker (such as p16 in human papillomavirus infection). In this review, examples are given to illustrate the principles and pitfalls of these applications.
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Affiliation(s)
| | | | - Wah Cheuk
- Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR China
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21
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Diagnostic challenges in a case of B cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Int J Hematol 2013; 98:478-82. [DOI: 10.1007/s12185-013-1414-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
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22
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Adam P, Baumann R, Schmidt J, Bettio S, Weisel K, Bonzheim I, Fend F, Quintanilla-Martínez L. The BCL2 E17 and SP66 antibodies discriminate 2 immunophenotypically and genetically distinct subgroups of conventionally BCL2-"negative" grade 1/2 follicular lymphomas. Hum Pathol 2013; 44:1817-26. [PMID: 23642737 DOI: 10.1016/j.humpath.2013.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
Follicular lymphoma (FL) is characterized by the translocation t(14;18)(q32;q21) resulting in constitutive overexpression of BCL2. However, in 10% to 15% of FL grade 1/2, immunohistochemical staining for BCL2 remains negative. To analyze the incidence of BCL2 negativity and the underlying molecular mechanisms in FL grade 1/2, BCL2 expression was investigated with 3 antibodies (clones 100D5, E17, SP66). The presence of a break in the BCL2 locus was determined by fluorescence in situ hybridization. The region of the BCL2 gene where the epitope of the standard BCL2 antibody resides was sequenced. Twenty-two (9.2%) of 240 identified cases of FL grade 1/2 were negative with the standard BCL2 antibody. Of these, 12 cases (55%) carried a break in the BCL2 gene locus, which, in all but one case, correlated with BCL2 expression using the alternative antibodies E17 and SP66 and with missense mutations of BCL2. Ten (45%) of the 22 cases had an intact BCL2 gene locus; 2 cases carried a BCL6/IGH translocation. All 10 cases were negative for the E17/SP66 antibodies and showed a wild-type sequence of BCL2. Six of these showed an aberrant phenotype, with CD10 negativity (30%) or CD23 expression (30%). In summary, the alternative E17/SP66 antibodies identify 2 immunohistochemically and genetically distinct subgroups of BCL2-"negative" FL grade 1/2.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Clone Cells
- DNA Mutational Analysis
- DNA, Neoplasm/analysis
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- In Situ Hybridization, Fluorescence
- Lymph Nodes/metabolism
- Lymph Nodes/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/metabolism
- Male
- Middle Aged
- Neoplasm Grading
- Point Mutation
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-2/immunology
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Translocation, Genetic
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Affiliation(s)
- Patrick Adam
- Institute of Pathology, Comprehensive Cancer Center, University of Tübingen, D-72076 Tübingen, Germany
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23
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Marafioti T, Copie-Bergman C, Calaminici M, Paterson JC, Shende VH, Liu H, Baia M, Ramsay AD, Agostinelli C, Brière J, Clear A, Du MQ, Piccaluga PP, Masir N, Nacheva EP, Sujobert P, Shanmugam K, Grogan TM, Brooks SP, Khwaja A, Ardeshna K, Townsend W, Pileri SA, Haioun C, Linch D, Gribben JG, Gaulard P, Isaacson PG. Another look at follicular lymphoma: immunophenotypic and molecular analyses identify distinct follicular lymphoma subgroups. Histopathology 2013; 62:860-75. [PMID: 23509938 DOI: 10.1111/his.12076] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 11/27/2012] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to analyse the immunophenotypic and molecular features of a large series of follicular lymphomas, focusing in particular on atypical cases that fail to express CD10 and/or bcl-2. Such cases present diagnostic pitfalls, especially with regard to the differential diagnosis from follicular hyperplasia and marginal zone B-cell lymphoma. Therefore, we also included an immunohistochemical evaluation of stathmin, which is strongly expressed by germinal centre B cells, as a putative new marker for follicular lymphomas, particularly those with an atypical phenotype. METHODS AND RESULTS Two hundred and five follicular lymphomas were investigated with immunohistochemistry and fluorescence in-situ hybridization (FISH). The use of three distinct anti-bcl-2 antibodies together with CD10 expression data and FISH analysis for bcl-2 and bcl-6 rearrangements allowed subclassification of follicular lymphoma into four distinct subgroups: (i) CD10-positive/bcl-2-positive, (ii) CD10-positive/bcl-2-negative, (iii) CD10-negative/bcl-2-positive, and (iv) CD10-negative/bcl-2-negative. All cases were bcl-6-positive. STMN1 (stathmin) was shown to be helpful in diagnosing bcl-2-negative and/or CD10-negative follicular lymphomas, and in their distinction from marginal zone B-cell lymphoma. CONCLUSIONS Combined immunohistological and molecular analyses reveal that follicular lymphomas showing an atypical immunophenotypic and molecular profile exist, and we demonstrate that STMN1 represents a novel useful diagnostic marker for these.
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Affiliation(s)
- Teresa Marafioti
- Department of Histopathology, University College Hospital, London, UK.
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24
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Abstract
The small B-cell neoplasms represent some of the most frequently encountered lymphoproliferative disorders in routine surgical pathology practice. This report reviews the current diagnostic criteria for classifying small B-cell neoplasms and distinguishing them from newly recognized precursor conditions that do not appear to represent overt lymphomas. Newly available immunohistochemical stains and molecular studies that may assist in the diagnosis and classification of these neoplasms are also discussed.
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Affiliation(s)
- James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
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25
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Copie-Bergman C. [Pitfalls and update in Haematopathology. Case 1. Follicular lymphoma grade 1-2 according to the WHO classification 2008, "pseudo BCL2 negative" with low and heterogeneous expression of the CD10]. Ann Pathol 2012; 32:331-5. [PMID: 23141940 DOI: 10.1016/j.annpat.2012.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 07/02/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Christiane Copie-Bergman
- Département de pathologie, groupe Henri Mondor-Albert Chenevier, université Paris-Est Créteil (UPEC), AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
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26
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Variation in BCL2 protein expression in follicular lymphomas without t(14;18) chromosomal translocations. Pathology 2012; 44:228-33. [PMID: 22406486 DOI: 10.1097/pat.0b013e3283513fb2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The hallmark of follicular lymphoma is the t(14;18)(q32;q21) chromosomal translocations that lead to deregulation of BCL2 expression in tumour cells. However, not all cases of follicular lymphoma express BCL2, nor is the t(14;18) translocation always present. Follicular lymphomas lacking the BCL2 rearrangement are less well studied with regards to their immunohistochemical and molecular features. This study aims to investigate the BCL2 protein expression pattern in t(14;18) negative follicular lymphomas. METHODS BCL2 protein expression pattern was analysed in 26 cases of t(14;18) negative follicular lymphoma [determined by fluorescence in situ hybridisation (FISH)], using antibodies against two-different epitopes, i.e., the widely-used antibody BCL2/124 and an alternative antibody E17. RESULTS Two of the t(14;18) negative cases showed evidence of BCL2 amplification and trisomy 18. A total of 13 cases (50%) lacked BCL2 expression. In 10 cases (38%) the expression was heterogeneous and in only three cases (12%) the BCL2 expression was strongly positive. These cases could thus be subdivided into three subgroups: Group I, normal BCL2 genes (i.e., no evidence of translocation or amplification), and BCL2 protein negative; Group II, normal BCL2 genes but BCL2 protein positive; and Group III, presence of other genetic alterations, i.e., BCL2 amplification and trisomy 18, and BCL2 protein positive. CONCLUSIONS This study suggests that it may be possible on the basis of staining to predict that the t(14;18) translocation is absent if a case is either negative for BCL2 protein with different antibodies or has heterogeneous BCL2 expression, possibly acquired through a physiological process of differentiation.
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Abstract
Abstract
A plethora of genetic abnormalities has been described in B-cell lymphomas, some of which arise when physiologic mechanisms involved in the generation of immunologic diversity go awry. Several different lymphoma types, such as follicular lymphoma (FL), mantle cell lymphoma (MCL), and Burkitt lymphoma (BL), are associated with hallmark translocations that occur as a consequence of these errors (t(14;18)(q32;q21), t(11;14)(q13;q32), and t(8;14)(q24;q32), respectively); however, none of these associations is absolute and none is completely diagnostically specific or sensitive. The advantages and limitations of a variety of different testing strategies in the 2 most common lymphomas, FL and diffuse large B-cell lymphoma (DLBCL), are reviewed herein, including an evaluation of the role of PCR-based approaches, FISH, and more nascent genomic technologies. The use of immunophenotypic strategies that may potentially provide, albeit imperfectly, more user-friendly surrogates for underlying genetic aberrations and cell-of-origin designations derived from gene-expression profiling analyses are also discussed. Finally, a newly designated category of lymphoma with features intermediate between DLBCL and BL is appraised, highlighting the central role of genetic analysis in this diagnostic gray zone.
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Li JN, Zhang WY, Tang Y, Li GD, Dong DD. In situ follicular lymphoma with progressive transformation of the germinal centers confirmed by laser capture microdissection, IGH gene rearrangement analysis, and fluorescence in situ hybridization for t(14;18). Hum Pathol 2011; 43:138-43. [PMID: 21733560 DOI: 10.1016/j.humpath.2011.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 02/05/2023]
Abstract
The authors report an unusual case of in situ follicular lymphoma associated with progressive transformation of the germinal centers. The patient was a 74-year-old Chinese woman with sequential lymphadenopathy in the right and left cervical regions over a period of 2 months. The first biopsy revealed in situ follicular lymphoma with progressive transformation of germinal centers, and the biopsy of the second lymph node led to a diagnosis of in situ follicular lymphoma. The immunophenotype, polymerase chain reaction amplification of the immunoglobulin heavy chain gene, and fluorescence in situ hybridization for t(14;18) were analyzed in each biopsy specimen, which showed both specimens to have t(14;18)(q32;q21) and revealed progression from polyclonality to monoclonality. These findings suggest a case of multicentric in situ follicular lymphoma and provide new insights into the pathogenesis of this disease.
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MESH Headings
- Aged
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/pathology
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Clone Cells
- Disease Progression
- Female
- Gene Rearrangement
- Germinal Center/pathology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunophenotyping
- In Situ Hybridization, Fluorescence/methods
- Laser Capture Microdissection
- Lymphoma/genetics
- Lymphoma/pathology
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Translocation, Genetic
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Affiliation(s)
- Jin-nan Li
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
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Piccaluga PP, Pileri SA, Agostinelli C, Klapper W, Lennert K. Follicular lymphoma: stillSix characters in search of an author? Leuk Lymphoma 2011; 52:1655-67. [PMID: 21657965 DOI: 10.3109/10428194.2011.575493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Follicular lymphoma (FL) is regarded as a distinct entity in the literature as well as in the 2008 edition of the WHO classification of tumours of haematopoietic and lymphoid tissues. Nevertheless, there are still several issues that are matters of controversy such as the grading system or the exact biological location of grade 3B FL. This makes FL somewhat like the Six characters in search of an author of Pirandello's comedy. Here, we revise the morphology and pathobiology of FL by highlighting both the areas remaining critical and future perspectives. This review was inspired by the reappraisal of Professor Lennert's personal archive that represents a unique legacy for the entire scientific community.
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Chisholm C, Cockerell CJ. Functions and uses of immunohistochemical stains in cutaneous infiltrates of hematopoietic origin: a review for the practicing dermatologist. J Cutan Med Surg 2011; 15:65-83. [PMID: 21477554 DOI: 10.2310/7750.2011.10024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Immunohistochemical stains, particularly those for cutaneous lymphomas, have similar-sounding names, which may lead to confusion among dermatologists who are not well versed in the terminology of the tools used for pathologic diagnosis. Also aiding in this is the fact that some familiar stains are constantly investigated for novel utility in different tumors, and a plethora of new stains regularly emerge in the peer-reviewed literature. OBJECTIVE To review the major stains encountered in dermatopathologic reports for cutaneous lymphomas. A select number of other stains are reviewed that are either new and under investigation in several cutaneous processes or have a new use described in recent reports. METHODS The peer-reviewed literature was searched and analyzed for the accepted purposes of using these markers. RESULTS All pertinent findings for these immunostains are reported with the purpose of educating the dermatology community. CONCLUSION This review serves as a reference to clarify potentially confusing immunohistochemical stains.
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Affiliation(s)
- Cary Chisholm
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Masir N, Jones M, Marafioti T, Mason DY. Heterogeneous expression of B cell-associated markers in follicular lymphoma. Histopathology 2011; 58:633-6. [PMID: 21371078 DOI: 10.1111/j.1365-2559.2011.03782.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The link between evasion of apoptosis and the development of cellular hyperplasia and ultimately cancer is implicitly clear if one considers how many cells are produced each day and, hence, how many cells must die to make room for the new ones (reviewed in Raff, 1996). Furthermore, cells are frequently experiencing noxious stimuli that can cause lesions in their DNA and faults in DNA replication can occur during cellular proliferation. Such DNA damage needs to be repaired efficiently or cells with irreparable damage must be killed to prevent subsequent division of aberrant cells that may fuel tumorigenesis (reviewed in Weinberg, 2007). The detection of genetic lesions in human cancers that activate prosurvival genes or disable proapoptotic genes have provided the first evidence that defects in programmed cell death can cause cancer (Tagawa et al., 2005; Tsujimoto et al., 1984; Vaux, Cory, and Adams, 1988) and this concept was proven by studies with genetically modified mice (Egle et al., 2004b; Strasser et al., 1990a). It is therefore now widely accepted that evasion of apoptosis is a requirement for both neoplastic transformation and sustained growth of cancer cells (reviewed in Cory and Adams, 2002; Hanahan and Weinberg, 2000; Weinberg, 2007). Importantly, apoptosis is also a major contributor to anticancer therapy-induced killing of tumor cells (reviewed in Cory and Adams, 2002; Cragg et al., 2009). Consequently, a detailed understanding of apoptotic cell death will help to better comprehend the complexities of tumorigenesis and should assist with the development of improved targeted therapies for cancer based on the direct activation of the apoptotic machinery (reviewed in Lessene, Czabotar, and Colman, 2008).
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Affiliation(s)
- Gemma Kelly
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Andreas Strasser
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Melbourne, Australia
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Kelly JL, Novak AJ, Fredericksen ZS, Liebow M, Ansell SM, Dogan A, Wang AH, Witzig TE, Call TG, Kay NE, Habermann TM, Slager SL, Cerhan JR. Germline variation in apoptosis pathway genes and risk of non-Hodgkin's lymphoma. Cancer Epidemiol Biomarkers Prev 2010; 19:2847-58. [PMID: 20855536 DOI: 10.1158/1055-9965.epi-10-0581] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The t(14;18)(q32;q21) translocation is the most commonly observed chromosomal translocation in non-Hodgkin's lymphoma (NHL), resulting in constitutive Bcl-2 expression and apoptosis inhibition. In addition, germline variation in both BCL2L11 (BIM) and CASP9, known regulators of apoptosis, has recently been linked to NHL risk. We conducted a comprehensive evaluation of 36 apoptosis pathway genes with risk of NHL. METHODS We genotyped 226 single-nucleotide polymorphisms (SNP) from 36 candidate genes in a clinic-based study of 441 newly diagnosed NHL cases and 475 frequency-matched controls. We used principal components analysis to assess gene-level associations, and logistic regression to assess SNP-level associations. MACH was used for imputation of SNPs in BCL2L11 and CASP9. RESULTS In gene-level analyses, BCL2L11 (P = 0.0019), BCLAF1 (P = 0.0097), BAG5 (P = 0.026), and CASP9 (P = 0.0022) were associated with NHL risk after accounting for multiple testing (tail strength, 0.38; 95% confidence interval, 0.05-0.70). Two of the five BCL2L11 tagSNPs (rs6746608 and rs12613243), both genotyped BCLAF1 tagSNPs (rs797558 and rs703193), the single genotyped BAG5 tagSNP (rs7693), and three of the seven genotyped CASP9 tagSNPs (rs6685648, rs2020902, and rs2042370) were significant at P < 0.05. We successfully imputed BCL2L11 and CASP9 SNPs previously linked to NHL, and replicated all four BCL2L11 and two of three CASP9 SNPs. CONCLUSION We replicated the association of BCL2L11 and CASP9 with NHL risk at the gene and SNP level, and identified novel associations with BCLAF1 and BAG5. IMPACT Closer evaluation of germline variation of genes in the apoptosis pathway with risk of NHL and its subtypes is warranted.
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Affiliation(s)
- Jennifer L Kelly
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
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Barrans S, Crouch S, Smith A, Turner K, Owen R, Patmore R, Roman E, Jack A. Rearrangement of MYC Is Associated With Poor Prognosis in Patients With Diffuse Large B-Cell Lymphoma Treated in the Era of Rituximab. J Clin Oncol 2010; 28:3360-5. [DOI: 10.1200/jco.2009.26.3947] [Citation(s) in RCA: 448] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Rearrangement of MYC occurs in a proportion of diffuse large B-cell lymphomas (DLBCL), where they may be associated with an adverse clinical outcome. The aim of this study was to determine the frequency of MYC translocations in DLBCL and their prognostic impact in the era of cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (CHOP-R) therapy. Patients and Methods Three hundred three patients with previously untreated DLBCL, with no evidence of underlying follicular lymphoma, were investigated using immunohistochemistry and interphase fluorescent in situ hybridization for MYC, BCL6, and t(14;18)/BCL2 rearrangements. All patients (median age, 71.1 years; range, 23 to 96 years) were treated when CHOP-R was standard therapy for DLBCL and observed for a maximum of 4 years. Overall survival (OS) at 3 years was 49% (95% CI, 42% to 56%). Results MYC rearrangements were demonstrated in 35 (14%) of 245 biopsies with data available. Of these, 26 (74%) also had a t(14;18), 10 (26%) were BCL6 and MYC rearranged, and seven had all three abnormalities. Only age, International Prognostic Index, and MYC rearrangement retained prognostic significance in the final model. OS was significantly worse for patients with rearrangement of MYC (survival probability at 2 years = 0.35 in v 0.61 in the nonrearranged group). Conclusion The presence of a MYC rearrangement is a strongly adverse prognostic factor in CHOP-R–treated patients and can be used in combination with patients' age and IPI to accurately predict clinical outcome. In DLBCL, rearrangement of MYC is rarely found as the sole genetic abnormality and the poor prognosis of these patients is likely to reflect a synergistic effect alongside deregulation of BCL6 or BCL2.
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Affiliation(s)
- Sharon Barrans
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Simon Crouch
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Alex Smith
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Kathryn Turner
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Roger Owen
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Russell Patmore
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Eve Roman
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
| | - Andrew Jack
- From the Haematology Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds; Epidemiology & Genetics Unit, University of York; Queen's Center for Oncology and Haematology, Castle Hill Hospital, Cottingham; and Hull York Medical School, United Kingdom
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Masir N, Campbell LJ, Jones M, Mason DY. Pseudonegative BCL2 protein expression in a t(14;18) translocation positive lymphoma cell line: a need for an alternative BCL2 antibody. Pathology 2010; 42:212-6. [PMID: 20350212 DOI: 10.3109/00313021003631296] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The t(14;18)(q32;q21) chromosomal translocation induces BCL2 protein expression in most follicular lymphomas. However, a small number of cases lack BCL2 expression despite carrying the t(14;18)(q32;q21) translocation. This study aims to explore the mechanism accounting for the lack of BCL2 protein expression when the t(14;18) translocation is present. METHODS BCL2 expression in the t(14;18) positive cell lines FL18, Karpas-422, SU-DHL-4 and SU-DHL-6, was analysed by Western blotting and by immunohistochemistry using two different antibodies. FISH analysis was performed to confirm the cytogenetic changes in the cell lines and real time quantitative PCR was used to evaluate the BCL2 mRNA level. Sequence analysis of translocated BCL2 was performed on FL18, Karpas-422, SU-DHL-4 and SU-DHL-6 cell lines. RESULTS In FL18, Karpas-422, and SU-DHL-4, the BCL2 mRNA level correlated with the BCL2 protein expression. In contrast, BCL2 protein was not detected in SU-DHL-6 line using standard anti-BCL2 antibody (BCL2/124), despite the presence of the t(14;18) translocation and high level of mRNA. cDNA sequencing of translocated BCL2 showed three mutations in the SU-DHL-6 cell line, one of which resulted in an amino acid substitution (I48F) in the region recognised by the standard BCL2 antibody, whereas the other two were silent mutations at aa71 and aa72. Interestingly, when BCL2 expression was tested with an alternative antibody, E17, the protein was detected in SU-DHL-6, suggesting that the 'negativity' of SU-DHL-6 line for BCL2 using the standard antibody is spurious. Amino acid changes were found in Karpas-422 (G47D, P59L) and SU-DHL-4 (P59T, S117R) but these did not affect BCL2 detection. CONCLUSIONS This study suggests that some somatic mutations of the translocated BCL2 gene may prevent epitope recognition by BCL2 antibodies, and hence cause false negative expression using the standard antibody. It is recommended that in practice all BCL2 negative cases should routinely be stained with an alternative antibody to prevent false negativity.
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Affiliation(s)
- Noraidah Masir
- *Pathology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Masir N, Jones M, Lee AM, Goff LK, Clear AJ, Lister A, Marafioti T, Mason DY. The expression of Bcl-2 by proliferating cells varies in different categories of B-cell lymphoma. Histopathology 2010; 56:617-26. [DOI: 10.1111/j.1365-2559.2010.03524.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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B-cell lymphomas with concurrent IGH-BCL2 and MYC rearrangements are aggressive neoplasms with clinical and pathologic features distinct from Burkitt lymphoma and diffuse large B-cell lymphoma. Am J Surg Pathol 2010; 34:327-40. [PMID: 20118770 DOI: 10.1097/pas.0b013e3181cd3aeb] [Citation(s) in RCA: 292] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
B-cell lymphomas with concurrent IGH-BCL2 and MYC rearrangements, also known as "double-hit" lymphomas (DHL), are rare neoplasms characterized by highly aggressive clinical behavior, complex karyotypes, and a spectrum of pathologic features overlapping with Burkitt lymphoma (BL), diffuse large B-cell lymphoma (DLBCL) and B-lymphoblastic lymphoma/leukemia (B-LBL). The clinical and pathologic spectrum of this rare entity, including comparison to other high-grade B-cell neoplasms, has not been well defined. We conducted a retrospective analysis of clinical and pathologic features of 20 cases of DHL seen at our institution during a 5-year period. In addition, we carried out case-control comparisons of DHL with BL and International Prognostic Index (IPI)-matched DLBCL. The 11 men and 9 women had a median age of 63.5 years (range 32 to 91). Six patients had a history of grade 1 to 2 follicular lymphoma; review of the prior biopsy specimens in 2 of 5 cases revealed blastoid morphology. Eighteen patients had Ann Arbor stage 3 or 4 disease and all had elevated serum lactate dehydrogenase (LDH) levels at presentation. Extranodal disease was present in 17/20 (85%), bone marrow involvement in 10/17 (59%) and central nervous system (CNS) disease in 5/11 (45%). Nineteen patients were treated with combination chemotherapy, of whom 18 received rituximab and 14 received CNS-directed therapy. Fourteen patients (70%) died within 8 months of diagnosis. Median overall survival in the DHL group (4.5 mo) was inferior to both BL (P=0.002) and IPI-matched DLBCL (P=0.04) control patients. Twelve DHL cases (60%) were classified as B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL, 7 cases (35%) as DLBCL, not otherwise specified, and 1 case as B-LBL. Distinguishing features from BL included expression of Bcl2 (P<0.0001), Mum1/IRF4 (P=0.006), Ki-67 <95% (P<0.0001), and absence of EBV-EBER (P=0.006). DHL commonly contained the t(8;22) rather than the t(8;14) seen in most BL controls (P=0.001), and exhibited a higher number of chromosomal aberrations (P=0.0009). DHL is a high-grade B-cell neoplasm with a poor prognosis, resistance to multiagent chemotherapy, and clinical and pathologic features distinct from other high-grade B-cell neoplasms. Familiarity with the morphologic and immunophenotypic spectrum of DHL is important in directing testing to detect concurrent IGH-BCL2 and MYC rearrangements when a karyotype is unavailable. The aggressive clinical behavior and combination of genetic abnormalities seen in these cases may warrant categorization as a separate entity in future classifications and call for novel therapeutic approaches.
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Lymphomas with concurrent BCL2 and MYC translocations: the critical factors associated with survival. Blood 2009; 114:2273-9. [PMID: 19597184 DOI: 10.1182/blood-2009-03-212191] [Citation(s) in RCA: 440] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BCL2 and MYC are oncogenes commonly deregulated in lymphomas. Concurrent BCL2 and MYC translocations (BCL2(+)/MYC(+)) were identified in 54 samples by karyotype and/or fluorescence in situ hybridization with the aim of correlating clinical and cytogenetic characteristics to overall survival. BCL2(+)/MYC(+) lymphomas were diagnosed as B-cell lymphoma unclassifiable (BCLU; n = 36) with features intermediate between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL); DLBCL (n = 17), or follicular lymphoma (n = 1). Despite the presence of a t(14;18), 5 cases were BCL2 protein-negative. Nonimmunoglobulin gene/MYC (non-IG/MYC) translocations occurred in 24 of 54 cases (44%) and were highly associated with DLBCL morphology (P < .001). Over a median follow-up of 5.3 years, 6 patients remained in remission and 32 died within 6 months of the MYC(+) rearrangement, irrespective of whether MYC(+) occurred at diagnosis (31 of 54) or transformation (23 of 54; P = .53). A non-IG/MYC translocation partner, absent BCL2 protein expression and treatment with rituximab-based chemotherapy, were associated with a more favorable outcome, but a low International Prognostic Index score and DLBCL morphology were independent predictors of overall survival. A comprehensive cytogenetic analysis of BCL2 and MYC status on all aggressive lymphomas may identify a group of high-risk patients who may benefit from chemotherapeutic regimens that include rituximab and/or BCL2-targeted therapy.
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