1
|
Lang C, Megyesfalvi Z, Lantos A, Oberndorfer F, Hoda MA, Solta A, Ferencz B, Fillinger J, Solyom-Tisza A, Querner AS, Egger F, Boettiger K, Klikovits T, Timelthaler G, Renyi-Vamos F, Aigner C, Hoetzenecker K, Laszlo V, Schelch K, Dome B. C-Myc protein expression indicates unfavorable clinical outcome in surgically resected small cell lung cancer. World J Surg Oncol 2024; 22:57. [PMID: 38369463 PMCID: PMC10875875 DOI: 10.1186/s12957-024-03315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/14/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND By being highly involved in the tumor evolution and disease progression of small cell lung cancer (SCLC), Myc family members (C-Myc, L-Myc, and N-Myc) might represent promising targetable molecules. Our aim was to investigate the expression pattern and prognostic relevance of these oncogenic proteins in an international cohort of surgically resected SCLC tumors. METHODS Clinicopathological data and surgically resected tissue specimens from 104 SCLC patients were collected from two collaborating European institutes. Tissue sections were stained by immunohistochemistry (IHC) for all three Myc family members and the recently introduced SCLC molecular subtype-markers (ASCL1, NEUROD1, POU2F3, and YAP1). RESULTS IHC analysis showed C-Myc, L-Myc, and N-Myc positivity in 48%, 63%, and 9% of the specimens, respectively. N-Myc positivity significantly correlated with the POU2F3-defined molecular subtype (r = 0.6913, p = 0.0056). SCLC patients with C-Myc positive tumors exhibited significantly worse overall survival (OS) (20 vs. 44 months compared to those with C-Myc negative tumors, p = 0.0176). Ultimately, in a multivariate risk model adjusted for clinicopathological and treatment confounders, positive C-Myc expression was confirmed as an independent prognosticator of impaired OS (HR 1.811, CI 95% 1.054-3.113, p = 0.032). CONCLUSIONS Our study provides insights into the clinical aspects of Myc family members in surgically resected SCLC tumors. Notably, besides showing that positivity of Myc family members varies across the patients, we also reveal that C-Myc protein expression independently correlates with worse survival outcomes. Further studies are warranted to investigate the role of Myc family members as potential prognostic and predictive markers in this hard-to-treat disease.
Collapse
Affiliation(s)
- Christian Lang
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Zsolt Megyesfalvi
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria.
- National Korányi Institute of Pulmonology, Budapest, Hungary.
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, 1122, Hungary.
| | - Andras Lantos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Mir Alireza Hoda
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Anna Solta
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Bence Ferencz
- National Korányi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, 1122, Hungary
| | - Janos Fillinger
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Alessandro Saeed Querner
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Felix Egger
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Kristiina Boettiger
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Thomas Klikovits
- Department of Thoracic Surgery, Clinic Floridsdorf, Vienna, Austria
| | - Gerald Timelthaler
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Ferenc Renyi-Vamos
- National Korányi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, 1122, Hungary
- National Institute of Oncology and National Tumor Biology Laboratory, Budapest, Hungary
| | - Clemens Aigner
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
| | - Viktoria Laszlo
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
- National Korányi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, 1122, Hungary
| | - Karin Schelch
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria
- Center for Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Balazs Dome
- Department of Thoracic Surgery; Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria.
- National Korányi Institute of Pulmonology, Budapest, Hungary.
- Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, 1122, Hungary.
- Department of Translational Medicine, Lund University, Lund, Sweden.
| |
Collapse
|
2
|
Baptista MJ, Tapia G, Muñoz‐Marmol A, Muncunill J, Garcia O, Montoto S, Gribben JG, Calaminici M, Martinez A, Veloza L, Martínez‐Trillos A, Aldamiz T, Menarguez J, Terol M, Ferrandez A, Alcoceba M, Briones J, González‐Barca E, Climent F, Muntañola A, Moraleda J, Provencio M, Abrisqueta P, Abella E, Colomo L, García‐Ballesteros C, Garcia‐Caro M, Sancho J, Ribera J, Mate J, Navarro J. Genetic and phenotypic characterisation of HIV-associated aggressive B-cell non-Hodgkin lymphomas, which do not occur specifically in this population: diagnostic and prognostic implications. Histopathology 2022; 81:826-840. [PMID: 36109172 PMCID: PMC9828544 DOI: 10.1111/his.14798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Abstract
The frequency of aggressive subtypes of B-cell non-Hodgkin lymphoma (B-NHL), such as high-grade B-cell lymphomas (HGBL) with MYC and BCL2 and/or BCL6 rearrangement (HGBL-DH/TH) or Burkitt-like lymphoma (BL) with 11q aberration, is not well known in the HIV setting. We aimed to characterise HIV-associated aggressive B-NHL according to the 2017 WHO criteria, and to identify genotypic and phenotypic features with prognostic impact. Seventy-five HIV-associated aggressive B-NHL were studied by immunohistochemistry (CD10, BCL2, BCL6, MUM1, MYC, and CD30), EBV-encoded RNAs (EBERs), and fluorescence in situ hybridisation (FISH) to evaluate the status of the MYC, BCL2, and BCL6 genes and chromosome 11q. The 2017 WHO classification criteria and the Hans algorithm, for the cell-of-origin classification of diffuse large B-cell lymphomas (DLBCL), were applied. In DLBCL cases, the frequencies of MYC and BCL6 rearrangements (14.9 and 27.7%, respectively) were similar to those described in HIV-negative patients, but BCL2 rearrangements were infrequent (4.3%). MYC expression was identified in 23.4% of DLBCL cases, and coexpression of MYC and BCL2 in 13.0%, which was associated with a worse prognosis. As for BL cases, the expression of MUM1 (30.4%) conferred a worse prognosis. Finally, the prevalence of HGBL-DH/TH and BL-like with 11q aberration are reported in the HIV setting. The phenotypic and genotypic characteristics of HIV-associated aggressive B-NHL are similar to those of the general population, except for the low frequency of BCL2 rearrangements in DLBCL. MYC and BCL2 coexpression in DLBCL, and MUM-1 expression in BL, have a negative prognostic impact on HIV-infected individuals.
Collapse
Affiliation(s)
- Maria Joao Baptista
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Ana‐María Muñoz‐Marmol
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Josep Muncunill
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Olga Garcia
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Silvia Montoto
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - John G Gribben
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - Maria Calaminici
- Centre for Haemato‐OncologyBarts Cancer Institute, Queen Mary University of LondonLondonUK
| | - Antonio Martinez
- Department of Pathology, Hospital Clinic, IDIBAPSUniversity of BarcelonaBarcelonaSpain
| | - Luis Veloza
- Department of Pathology, Hospital Clinic, IDIBAPSUniversity of BarcelonaBarcelonaSpain
| | | | - Teresa Aldamiz
- Department of Infectious DiseasesHospital Gregorio MarañónMadridSpain
| | | | - María‐José Terol
- Department of Hematology and OncologyHospital Clínic Universitari de ValènciaValenciaSpain
| | - Antonio Ferrandez
- Department of PathologyHospital Clínic Universitari de ValènciaValenciaSpain
| | - Miguel Alcoceba
- Department of HematologyHospital Universitario de Salamanca (HUS/IBSAL), CIBERONC and Centro de Investigación del Cáncer‐IBMCC (USAL‐CSIC)SalamancaSpain
| | - Javier Briones
- Department of Hematology, Hospital de la Santa Creu i Sant PauJosep Carreras Leukaemia Research Institute (IJC)BarcelonaSpain
| | - Eva González‐Barca
- Department of HematologyICO‐Hospital Duran i ReynalsL'Hospitalet de LlobregatSpain
| | - Fina Climent
- Department of PathologyHospital Universitari de Bellvitge‐IDIBELL, L'Hospitalet de LlobregatBadalonaSpain
| | - Ana Muntañola
- Department of Clinical HematologyHospital Universitari Mutua de TerrassaTerrassaSpain
| | - José‐María Moraleda
- Department of HematologyHospital Clinico Universitario Virgen de la ArrixacaMurciaSpain
| | - Mariano Provencio
- Department of Medical OncologyHospital Universitario Puerta De HierroMajadahondaSpain
| | - Pau Abrisqueta
- Department of HematologyHospital Vall d'HebrónBarcelonaSpain
| | | | - Lluis Colomo
- Department of PathologyHospital del MarBarcelonaSpain
| | | | | | - Juan‐Manuel Sancho
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - Josep‐Maria Ribera
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| | - José‐Luis Mate
- Department of Pathology, Hospital Germans Trias i Pujol, IGTPUniversitat Autònoma de BarcelonaBadalonaSpain
| | - José‐Tomas Navarro
- Department of Hematology, ICO‐Germans Trias i Pujol Hospital, Josep Carreras Leukaemia Research Institute (IJC)Universitat Autònoma de BarcelonaBadalonaSpain
| |
Collapse
|
3
|
Mishra P, Padhi S, Ayyanar P, Samal S, Das Majumdar S, Panigrahi A, Sable M. Clinicopathological and Immunohistochemical Profile of Mantle Cell Lymphoma: An Institutional Experience. Cureus 2021; 13:e16534. [PMID: 34430143 PMCID: PMC8378319 DOI: 10.7759/cureus.16534] [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] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Mantle cell lymphoma (MCL) is a biologically aggressive B-cell non-Hodgkin lymphoma (NHL) with distinctive morphologic, immunophenotypic, and molecular characteristics. Differentiation from other chronic lymphoproliferative disorders is essential for prognostication. Aim This paper aims to study the clinicopathological features of MCL with emphasis on immunohistochemical features and disease correlation. Method To do so, clinicopathological characteristics from 21 cases of MCL (14 males, seven females, M:F=2:1) diagnosed in the last five years i.e. 2015 to 2020, were retrospectively reviewed and correlated with immunohistochemistry (IHC) data. Particularly those pertaining to cyclin D1, SRY-box transcription factor 11 (SOX11), cluster of differentiation (CD) 5, CD23, MIB E3 ubiquitin protein ligase 1 (MIB1), tumor protein 53 (TP53), c-myelocytomatosis oncogene product (c-MYC), multiple myeloma oncogene 1 (MUM1), mouse double minute 2 homolog (MDM2), and Epstein-Barr virus latent membrane protein 1 (EBV-LMP1) expression with its aberrations. Observations This study shows that MCL constituted 4.2% (21/500) of all NHLs with a mean age of 57.5 years (median 60 years, range 30 to 80 years). The disease was nodal in 19, and extranodal in the remaining two cases. 14 of 21 (67%) had generalized lymphadenopathy and 71% had bone marrow (BM) involvement. The nodal involvement was diffuse in 9/17 (53%), 8/21 (38%) had a blastoid morphology, and an in-situ MCL pattern was not seen in any of the cases selected for the study. Cyclin D1 immunoexpression correlated well with SOX11; CD5-negative in five cases; and CD23-positive in three cases. TP53 and c-MYC expression were noted in 17/19 (89.4%) and 8/17 (47%), respectively. MUM1 registered positive in six cases. None of the cases showed immunopositivity for MDM2 and EBV-LMP1. Conclusion In essence, this study indicates that morphological and immunophenotypic subclassification of mantle cell lymphoma with a wider panel of IHC markers is essential for understanding disease biology and better prognostication.
Collapse
Affiliation(s)
- Pritinanda Mishra
- Pathology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| | - Somanath Padhi
- Pathology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| | - Pavithra Ayyanar
- Pathology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| | - Swagatika Samal
- Pathology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| | - Saroj Das Majumdar
- Radiation Oncology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| | - Ashutosh Panigrahi
- Hematology and Medical Oncology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| | - Mukund Sable
- Pathology, All India Institute of Medical Science (AIIMS), Bhubaneswar, IND
| |
Collapse
|
4
|
Westin J, Maris MB, Jacobson CA, Patel P, Lakhani N, Harb W, Patel-Donnelly D, McCaul K, Escobar C, Klencke B, Al-Katib AM. Safety and Efficacy of a DNA Oligonucleotide Therapy in Patients with Relapsed or Refractory Diffuse Large B-Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:52-59. [PMID: 34454850 DOI: 10.1016/j.clml.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND PNT2258 is a liposomal formulation that encapsulates multiple copies of PNT100, a native, chemically unmodified, 24-base DNA oligonucleotide designed to target the regulatory region upstream of the B-cell lymphoma 2 (BCL2) gene. METHODS This phase II, multicenter, single-arm, open-label, 2-stage design study investigated the single-agent activity of PNT2258 in patients with relapsed/refractory DLBCL. Initially, patients had to have a performance status (PS) of ≤2 and prior exposure to CD20-targeted therapy, an alkylating agent, and a steroid with no upper limit. Criteria were modified to PS of 0 or 1 and at least 1 to ≤3 prior therapies (identified as the target population) after observing an initially high frequency of rapid disease progression in patients with extensive prior therapies or poor PS. RESULTS The study was stopped early following an interim analysis, despite surpassing the protocol predetermined futility boundary, because the ORR was below the expectations of response in an evolving DLBCL treatment landscape. The final analysis included all 45 enrolled patients and demonstrated an ORR of 11%. In the response evaluable subset (n = 26), defined as patients in the target population with exposure to ≥8 doses of PNT2258 within the first 35 days and evaluable baseline/post-baseline scans, the ORR was 19%. The most common adverse events were fatigue (44%), nausea (42%), diarrhea (40%), pyrexia (36%), anemia (32%), and vomiting (27%). CONCLUSIONS PNT2258 was well-tolerated in a chemotherapy refractory DLBCL population. Despite demonstration of single-agent activity, ORR was lower than acceptable for further new therapy development.
Collapse
Affiliation(s)
- Jason Westin
- University of Texas M.D. Anderson Cancer Center, Department of Lymphoma & Myeloma, Houston, TX
| | | | - Caron A Jacobson
- Dana Farber Cancer Institute, Department of Medicine, Boston, MA
| | - Prapti Patel
- University of Texas Southwestern Medical Center, Department of Hematology/Oncology Dallas, TX
| | - Nehal Lakhani
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI
| | - Wael Harb
- Horizon Oncology Research, Inc., Lafayette, IN
| | | | - Kelly McCaul
- Avera Cancer Institute, Hematology and Bone Marrow Transplant, Sioux Falls, SD
| | | | - Barbara Klencke
- Sierra Oncology, Inc. (formerly ProNAi Therapeutics, Inc.), San Mateo, CA.
| | | |
Collapse
|
5
|
Alvarez-Lesmes J, Chapman JR, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery EA, Lossos IS, Sussman D, Poveda J. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 2021; 145:1585-1596. [PMID: 33836528 DOI: 10.5858/arpa.2020-0661-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The gastrointestinal (GI) tract is the most common site of extranodal non-Hodgkin lymphoma, accounting for 20% to 40% of all extranodal lymphomas. The majority of these are systemic processes secondarily involving the GI tract. Primary GI lymphomas are less common, accounting for approximately 10% to 15% of all non-Hodgkin lymphoma. Most non-Hodgkin lymphoma involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. OBJECTIVE.— To review the lymphoproliferative neoplasms of B-cell and T-cell lineage involving the luminal GI tract according to the most prevalent subtypes at each anatomic site. DATA SOURCE.— Systematic search of the PubMed database for updated literature on GI lymphomas epidemiology, subtypes, clinical, endoscopic, and genetic findings. Histologic images are derived from our collection of clinical cases. CONCLUSIONS.— The GI tract is the most common site of extranodal lymphoproliferative neoplasms. Recognition of the most frequently encountered GI lymphomas is imperative for patient management and treatment.
Collapse
Affiliation(s)
- Jessica Alvarez-Lesmes
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Jennifer R Chapman
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Daniel Cassidy
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Yi Zhou
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Monica Garcia-Buitrago
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Elizabeth A Montgomery
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Izidore S Lossos
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida (Lossos).,Department of Molecular and Cellular Pharmacology (Lossos), University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Sussman
- Division of Digestive Health and Liver Diseases (Sussman), University of Miami Miller School of Medicine, Miami, Florida
| | - Julio Poveda
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| |
Collapse
|
6
|
Naseem M, Asif M, Khadim MT, Ud-Din H, Jamal S, Shoaib I. The Frequency of Double Expresser in Selected Cases of High Grade Diffuse Large B-Cell Lymphomas. Asian Pac J Cancer Prev 2020; 21:1103-1107. [PMID: 32334477 PMCID: PMC7445973 DOI: 10.31557/apjcp.2020.21.4.1103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Diffuse large B-cell lymphomas (DLBCL) are fast-growing non-Hodgkin lymphomas that affect B-lymphocytes. Double expressor DLBCL is the concomitant expression of Myc and Bcl-2 proteins during lymphomas which results in poor prognosis of patients. This study aimed to determine the frequency of double expresser in high grade diffuse large B-cell lymphomas. Materials and Methods : The study was conducted on 74 cases (54 males (68.4%) and 20 females (25.3%)) of DLBCL between August 2018 to January 2019. The mean age of the 74 patients was 51.7 years + 18.5. Expression of proteins c-Myc, Bcl-2 and Bcl-6 were evaluated by immunohistochemistry. The involvement of primary lymph node was reported in 38 cases (51.3%) whereas, extra nodal site was observed in 22 cases (29.7%). Among the primary sites, the cervical lymph node enlargement was the most frequent site of presentation. Results: The rearrangement pattern was studied among 74 patients, 35 (47%) were found to have either one of the rearrangements i.e. Myc, Bcl-2, or Bcl-6. On the other hand, 14 (18.9%) had shown double rearrangements i.e. Bcl-2 and c-Myc (11 cases) and Bcl-6 and c-Myc (3 cases). The Bcl-2 and Bcl-6 rearrangements were demonstrated by 12 cases whereas 2 cases (2.7%) indicated all three types of rearrangements i.e. c-Myc, Bcl-2, and Bcl-6. In 11 cases the Bcl-2 and c-Myc rearrangements were found to be Bcl-2 > 50% and c-Myc > 40% and demonstrating the overall frequency of double expressers as 14.8%. The prognosis of the mentioned cases was extremely poor, median survival of 10 months. Conclusion: The concurrent expression of Bcl-2 and c-Myc was found to be 14% (level of expression for Bcl-2 > 50% and c-Myc > 40%) which is potentially a significant health burden and an emerging threat.
Collapse
Affiliation(s)
- Maria Naseem
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Muhammad Asif
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Muhammad Tahir Khadim
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Hafeez Ud-Din
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Shahid Jamal
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Iman Shoaib
- Department of Forensic Medical Sciences, Molecular Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| |
Collapse
|
7
|
Smith-Togobo C, Pedersen MØ, Jensen SG, Duduyemi B, Gyasi RK, Ofori MF, Paintsil V, Renner L, Nørgaard P, Hviid L. Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana. BMC Cancer 2019; 19:1270. [PMID: 31888714 PMCID: PMC6937736 DOI: 10.1186/s12885-019-6488-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs). METHODS The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N = 55) or non-eBL (N = 56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements. RESULTS We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. CONCLUSION We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.
Collapse
Affiliation(s)
- Cecilia Smith-Togobo
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Ø Pedersen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steffen G Jensen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Richard K Gyasi
- Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Peter Nørgaard
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
8
|
Liu Y, Bian T, Zhang Y, Zheng Y, Zhang J, Zhou X, Xie J. A combination of LMO2 negative and CD38 positive is useful for the diagnosis of Burkitt lymphoma. Diagn Pathol 2019; 14:100. [PMID: 31484540 PMCID: PMC6727582 DOI: 10.1186/s13000-019-0876-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the clinical utility of LIM Domain Only 2 (LMO2) negative and CD38 positive in diagnosis of Burkitt lymphoma (BL). Methods LMO2 and CD38 expression determined by immunohistochemistry in 75 BL, 12 High-grade B-cell lymphoma, NOS (HGBL,NOS) and 3 Burkitt-like lymphomas with the 11q aberration. Results The sensitivity and specificity of LMO2 negative for detecting BL were 98.67 and 100%, respectively; those of CD38 positive were 98.67 and 66.67%, respectively. The sensitivity and specificity of a combination of both for detecting BL were 97.33 and 100%, respectively. In our study, the combined LMO2 negative and CD38 positive results had a higher area under the curve than either LMO2 negative or CD38 positive alone. Conclusions A combination of LMO2 negative and CD38 positive is useful for the diagnosis of Burkitt lymphoma.
Collapse
Affiliation(s)
- Yifei Liu
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Tingting Bian
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Yanlin Zhang
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100000, People's Republic of China
| | - Yuanyuan Zheng
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100000, People's Republic of China
| | - Jianguo Zhang
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, 226001, People's Republic of China
| | - Xiaoge Zhou
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100000, People's Republic of China.
| | - Jianlan Xie
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100000, People's Republic of China.
| |
Collapse
|
9
|
Cabanillas F, Shah B. Advances in Diagnosis and Management of Diffuse Large B-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:783-796. [PMID: 29126866 DOI: 10.1016/j.clml.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 12/16/2022]
Abstract
The management of diffuse large B-cell lymphoma (DLBCL) has been gradually evolving since the discovery of its 2 major forms, the germinal center B-like (GCB) and activated B-cell (ABC) types. Although the reference standard for the identification of these cell types is considered gene expression profiling (GEP), currently the only method commercially available is immunohistochemistry (IHC). The application of various IHC-based algorithms and their correlation with GEP and clinical outcome are discussed. Because of the adverse prognostic implications of the non-GCB type and its potential effects on treatment selection, the recently revised World Health Organization classification has included these biologic cell types. The management of double hit lymphomas, which almost exclusively fall under the GCB category, is discussed, together with the double expresser phenotype, which is usually grouped under the non-GCB type. The role of lenalidomide and ibrutinib in the management of the non-GCB type is examined. We also discuss the front-line management of primary mediastinal large cell lymphoma using the EPOCH (etoposide, prednisolone, Oncovin [vincristine], cyclophosphamide, hydroxydaunorubicin [doxorubicin]) regimen and examine new salvage data on immune checkpoint inhibitors for this clinical subtype. The prognosis, clinical features, and management of de novo CD5+ DLBCL are discussed, and newer and promising developments in the management of primary central nervous system lymphomas are presented in detail. The most popular salvage regimens and the application of high-dose chemotherapy with stem cell transplantation are assessed in detail. Finally, data on new treatment tactics such as CART (chimeric antigen receptor T-cell) cells and promising new drugs, including blinatumomab and venetoclax, are presented.
Collapse
Affiliation(s)
- Fernando Cabanillas
- Auxilio Mutuo Cancer Center, San Juan, Puerto Rico; Hematology-Oncology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; Department of Lymphoma-Myeloma, MD Anderson Cancer Center, Houston, TX; Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Bijal Shah
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| |
Collapse
|
10
|
Kim YJ, Won CH, Chang SE, Choi JH, Lee MW, Lee WJ. MYC protein expression is associated with poor prognosis in cutaneous diffuse large B-cell lymphoma. Australas J Dermatol 2017; 59:e240-e242. [DOI: 10.1111/ajd.12705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Young Jae Kim
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Chong Hyun Won
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Sung Eun Chang
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jee Ho Choi
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Mi Woo Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Woo Jin Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| |
Collapse
|
11
|
Nwanze J, Siddiqui MT, Stevens KA, Saxe D, Cohen C. MYC Immunohistochemistry Predicts MYC Rearrangements by FISH. Front Oncol 2017; 7:209. [PMID: 28983465 PMCID: PMC5613089 DOI: 10.3389/fonc.2017.00209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022] Open
Abstract
MYC is the proto-oncogene classically associated with Burkitt lymphoma (BL) located at chromosomal locus 8q24. Rearrangements of MYC are seen in nearly 100% of BL but have been reported in 3–16% of diffuse large B-cell lymphomas (DLBCLs). Rearrangements of MYC are tested for by flourescence in situ hybridization (FISH). In this study, we compared immunohistochemistry (IHC) using a monoclonal antibody directed against the human Myc protein to the current method, FISH. 31 cases were identified that had been tested for MYC rearrangements by FISH over 27 months with heterogeneity in the diagnoses: 5 BL; 10 DLBCL; 3 B-cell lymphoma unclassifiable between DLBCL and BL; 5 B-cell lymphoma not otherwise specified; 1 EBV-related B-cell lymphoma; 1 composite CLL/SLL-large cell lymphoma; and 6 designated as high-grade or aggressive B-cell lymphoma. Analysis by FISH was performed as part of the clinical workup, where a MYC rearrangement is defined as a split fusion signal in at least 5.7% of cells. Myc-IHC was interpreted as a qualitative positive (overexpressed) or negative (not overexpressed) result. 12 cases (39%) were positive for MYC rearrangements by FISH. Overall, 13 cases (42%) showed Myc overexpression by IHC, 11 of which harbored a MYC rearrangement by FISH. There were two false positives and one false negative. Thus, Myc-IHC predicted a MYC rearrangement by FISH with 92% sensitivity and 89% specificity. We can thus conclude that Myc-IHC should be a potentially useful screening tool for identifying lymphomas that may harbor a MYC rearrangement.
Collapse
Affiliation(s)
- Julum Nwanze
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, United States.,Department of Pathology and Laboratory Medicine, Tulane University Hospital, New Orleans, LA, United States
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, United States
| | - Keith A Stevens
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, United States
| | - Debra Saxe
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, United States
| | - Cynthia Cohen
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, United States
| |
Collapse
|
12
|
Raess PW, Moore SR, Cascio MJ, Dunlap J, Fan G, Gatter K, Olson SB, Braziel RM. MYC immunohistochemical and cytogenetic analysis are required for identification of clinically relevant aggressive B cell lymphoma subtypes. Leuk Lymphoma 2017; 59:1391-1398. [DOI: 10.1080/10428194.2017.1370547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Philipp W. Raess
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Stephen R. Moore
- Knight Diagnostic Laboratories, Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Michael J. Cascio
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Jennifer Dunlap
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Guang Fan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Ken Gatter
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Susan B. Olson
- Knight Diagnostic Laboratories, Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Rita M. Braziel
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
13
|
Chisholm KM, Krishnan C, Heerema-McKenney A, Natkunam Y. Immunohistochemical Profile of MYC Protein in Pediatric Small Round Blue Cell Tumors. Pediatr Dev Pathol 2017; 20:213-223. [PMID: 28521631 DOI: 10.1177/1093526616689642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deregulation of MYC oncoprotein in cancers can result from multiple oncogenic mechanisms. Although MYC translocations define Burkitt lymphoma and MYC protein expression is a poor prognostic factor in undifferentiated neuroblastomas, the distribution of MYC protein (c-MYC) across other pediatric small round blue cell tumors (SRBCT) has not been well characterized. We undertook this study to assess MYC protein expression in a large cohort of pediatric lymphomas, sarcomas, and other SRBCT. Tissue microarrays containing 302 SRBCT were successfully evaluated by immunohistochemistry using anti-MYC clone Y69, with nuclear positivity scored as 0%, 1%-25%, 26%-50%, 51%-75%, or 76%-100%. MYC protein staining of >50% of lesional cells was identified in 60% of Burkitt lymphomas, 50% of B lymphoblastic lymphomas, 33% of T lymphoblastic lymphomas, 31% of rhabdomyosarcomas, 33% of Ewing sarcomas, and 25% of soft tissue sarcomas, not otherwise specified. Only 14% of neuroblastomas showed >50% staining, and of these, if known, MYCN was not amplified. No cases of Wilms tumor, synovial sarcoma, or desmoplastic small round cell tumor had >50% staining. Recurrences and metastases often had the same percentage of MYC staining (15/30). In conclusion, MYC protein exhibited variable expression across and within pediatric SRBCT subtypes. Overall, these findings provide a baseline for MYC expression in pediatric SRBCT and suggest that there may be multiple mechanisms of MYC upregulation in these different neoplasms.
Collapse
Affiliation(s)
- Karen M Chisholm
- 1 Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.,2 Now at Seattle Children's Hospital, Department of Laboratories, Seattle, Washington, USA
| | - Chandra Krishnan
- 3 Dell Children's Medical Center, Department of Pathology, Austin, Texas, USA
| | - Amy Heerema-McKenney
- 4 Pathology and Laboratory Medicine Institute, Cleveland Clinic Cleveland, Ohio, USA
| | - Yasodha Natkunam
- 1 Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
14
|
Nguyen L, Papenhausen P, Shao H. The Role of c-MYC in B-Cell Lymphomas: Diagnostic and Molecular Aspects. Genes (Basel) 2017; 8:genes8040116. [PMID: 28379189 PMCID: PMC5406863 DOI: 10.3390/genes8040116] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 12/25/2022] Open
Abstract
c-MYC is one of the most essential transcriptional factors, regulating a diverse array of cellular functions, including proliferation, growth, and apoptosis. Dysregulation of c-MYC is essential in the pathogenesis of a number of B-cell lymphomas, but is rarely reported in T-cell lymphomas. c-MYC dysregulation induces lymphomagenesis by loss of the tight control of c-MYC expression, leading to overexpression of intact c-MYC protein, in contrast to the somatic mutations or fusion proteins seen in many other oncogenes. Dysregulation of c-MYC in B-cell lymphomas occurs either as a primary event in Burkitt lymphoma, or secondarily in aggressive lymphomas such as diffuse large B-cell lymphoma, plasmablastic lymphoma, mantle cell lymphoma, or double-hit lymphoma. Secondary c-MYC changes include gene translocation and gene amplification, occurring against a background of complex karyotype, and most often confer aggressive clinical behavior, as evidenced in the double-hit lymphomas. In low-grade B-cell lymphomas, acquisition of c-MYC rearrangement usually results in transformation into highly aggressive lymphomas, with some exceptions. In this review, we discuss the role that c-MYC plays in the pathogenesis of B-cell lymphomas, the molecular alterations that lead to c-MYC dysregulation, and their effect on prognosis and diagnosis in specific types of B-cell lymphoma.
Collapse
Affiliation(s)
- Lynh Nguyen
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
| | - Peter Papenhausen
- Cytogenetics Laboratory, Laboratory Corporation of America, Research Triangle Park, NC 27709, USA.
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
| |
Collapse
|
15
|
Crebbp loss cooperates with Bcl2 overexpression to promote lymphoma in mice. Blood 2017; 129:2645-2656. [PMID: 28288979 DOI: 10.1182/blood-2016-08-733469] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 03/05/2017] [Indexed: 12/16/2022] Open
Abstract
CREBBP is targeted by inactivating mutations in follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). Here, we provide evidence from transgenic mouse models that Crebbp deletion results in deficits in B-cell development and can cooperate with Bcl2 overexpression to promote B-cell lymphoma. Through transcriptional and epigenetic profiling of these B cells, we found that Crebbp inactivation was associated with broad transcriptional alterations, but no changes in the patterns of histone acetylation at the proximal regulatory regions of these genes. However, B cells with Crebbp inactivation showed high expression of Myc and patterns of altered histone acetylation that were localized to intragenic regions, enriched for Myc DNA binding motifs, and showed Myc binding. Through the analysis of CREBBP mutations from a large cohort of primary human FL and DLBCL, we show a significant difference in the spectrum of CREBBP mutations in these 2 diseases, with higher frequencies of nonsense/frameshift mutations in DLBCL compared with FL. Together, our data therefore provide important links between Crebbp inactivation and Bcl2 dependence and show a role for Crebbp inactivation in the induction of Myc expression. We suggest this may parallel the role of CREBBP frameshift/nonsense mutations in DLBCL that result in loss of the protein, but may contrast the role of missense mutations in the lysine acetyltransferase domain that are more frequently observed in FL and yield an inactive protein.
Collapse
|
16
|
Definition of MYC genetic heteroclonality in diffuse large B-cell lymphoma with 8q24 rearrangement and its impact on protein expression. Mod Pathol 2016; 29:844-53. [PMID: 27125356 DOI: 10.1038/modpathol.2016.71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/01/2016] [Accepted: 03/06/2016] [Indexed: 12/24/2022]
Abstract
MYC rearrangement can be detected in a subgroup of diffuse large B-cell lymphoma characterized by unfavorable prognosis. In contrast to Burkitt lymphoma, the correlation between MYC rearrangement and MYC protein expression in diffuse large B-cell lymphoma is less clear, as approximately one-third of rearranged cases show negative or low expression by immunohistochemistry. To better understand whether specific characteristics of the MYC rearrangement may influence its protein expression, we investigated 43 de novo diffuse large B-cell lymphoma positive for 8q24 rearrangement by FISH, using 14 Burkitt lymphoma for comparison. Different cell populations (clones), breakpoints (classical vs non-classical FISH patterns), partner genes (IGH vs non-IGH) and immunostaining were detected and analyzed using computerized image systems. In a subgroup of diffuse large B-cell lymphoma, we observed different clones within the same tumor distinguishing the founder clone with MYC rearrangement alone from other subclones, carrying MYC rearrangement coupled with loss/extra copies of derivatives/normal alleles. This picture, which we defined MYC genetic heteroclonality, was found in 42% of cases and correlated to negative MYC expression (P=0.026). Non-classical FISH breakpoints were detected in 16% of diffuse large B-cell lymphoma without affecting expression (P=0.040). Non-IGH gene was the preferential partner of rearrangement in those diffuse large B-cell lymphoma showing MYC heteroclonality (P=0.016) and/or non-classical FISH breakpoints (P=0.058). MYC heteroclonality was not observed in Burkitt lymphoma and all cases had positive MYC expression. Non-classical FISH MYC breakpoint and non-IGH partner were found in 29 and 20% of Burkitt lymphoma, respectively. In conclusion, MYC genetic heteroclonality is a frequent event in diffuse large B-cell lymphoma and may have a relevant role in modulating MYC expression.
Collapse
|
17
|
Mughal MK, Akhter A, Street L, Pournazari P, Shabani-Rad MT, Mansoor A. Acute myeloid leukaemia: expression of MYC protein and its association with cytogenetic risk profile and overall survival. Hematol Oncol 2016; 35:350-356. [PMID: 26856970 DOI: 10.1002/hon.2279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/23/2015] [Accepted: 12/14/2015] [Indexed: 01/17/2023]
Abstract
Acute myeloid leukaemia (AML) is a clinically aggressive disease with marked genetic heterogeneity. Cytogenetic abnormalities provide the basis for risk stratification into clinically favourable, intermediate, and unfavourable groups. There are additional genetic mutations, which further influence the prognosis of patients with AML. Most of these result in molecular aberrations whose downstream target is MYC. It is therefore logical to study the relationship between MYC protein expression and cytogenetic risk groups. We studied MYC expression by immunohistochemistry in a large cohort (n = 199) of AML patients and correlated these results with cytogenetic risk profile and overall survival (OS). We illustrated differential expression of MYC protein across various cytogenetic risk groups (p = 0.03). Highest expression of MYC was noted in AML patients with favourable cytogenetic risk group. In univariate analysis, MYC expression showed significant negative influence of OS in favourable and intermediate cytogenetic risk group (p = 0.001). Interestingly, MYC expression had a protective effect in the unfavourable cytogenetic risk group. In multivariate analysis, while age and cytogenetic risk group were significant factors influencing survival, MYC expression by immunohistochemistry methods also showed some marginal impact (p = 0.069). In conclusion, we have identified differential expression of MYC protein in relation to cytogenetic risk groups in AML patients and documented its possible impact on OS in favourable and intermediate cytogenetic risk groups. These preliminary observations mandate additional studies to further investigate the routine clinical use of MYC protein expression in AML risk stratification. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Muhammad Kashif Mughal
- Department of Pathology & Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Ariz Akhter
- Department of Pathology & Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Lesley Street
- Department of Medicine, Division of Hematology and Hematological Malignancies, University of Calgary, Calgary, Alberta, Canada
| | - Payam Pournazari
- Department of Pathology & Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Meer-Taher Shabani-Rad
- Department of Pathology & Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Adnan Mansoor
- Department of Pathology & Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Clinical features, tumor biology, and prognosis associated with MYC rearrangement and Myc overexpression in diffuse large B-cell lymphoma patients treated with rituximab-CHOP. Mod Pathol 2015; 28:1555-73. [PMID: 26541272 DOI: 10.1038/modpathol.2015.118] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/16/2015] [Accepted: 08/29/2015] [Indexed: 12/19/2022]
Abstract
MYC dysregulation, including MYC gene rearrangement and Myc protein overexpression, is of increasing clinical importance in diffuse large B-cell lymphoma (DLBCL). However, the roles of MYC and the relative importance of rearrangement vs overexpression remain to be refined. Gaining knowledge about the tumor biology associated with MYC dysregulation is important to understand the roles of MYC and MYC-associated biology in lymphomagenesis. In this study, we determined MYC rearrangement status (n=344) and Myc expression (n=535) in a well-characterized DLBCL cohort, individually assessed the clinical and pathobiological features of patients with MYC rearrangement and Myc protein overexpression, and analyzed the prognosis and gene expression profiling signatures associated with these MYC abnormalities in germinal center B-cell-like and activated B-cell-like DLBCL. Our results showed that the prognostic importance of MYC rearrangement vs Myc overexpression is significantly different in germinal center B-cell-like vs activated B-cell-like DLBCL. In germinal center B-cell-like DLBCL, MYC-rearranged germinal center B-cell-like DLBCL patients with Myc overexpression significantly contributed to the clinical, biological, and prognostic characteristics of the overall Myc-overexpressing germinal center B-cell-like DLBCL group. In contrast, in activated B-cell-like DLBCL, the occurrence, clinical and biological features, and prognosis of Myc overexpression were independent of MYC rearrangement. High Myc levels and Myc-independent mechanisms, either tumor cell intrinsic or related to tumor microenvironment, conferred significantly worse survival to MYC-rearranged germinal center B-cell-like DLBCL patients, even among Myc(high)Bcl-2(high) DLBCL patients. This study provides new insight into the tumor biology and prognostic effects associated with MYC dysregulation and suggest that detection of both MYC translocations and evaluation of Myc and Bcl-2 expression is necessary to predict the prognosis of DLBCL patients.
Collapse
|
19
|
Chen BJ, Chang ST, Weng SF, Huang WT, Chu PY, Hsieh PP, Jung YC, Kuo CC, Chuang YT, Chuang SS. EBV-associated Burkitt lymphoma in Taiwan is not age-related. Leuk Lymphoma 2015; 57:644-53. [DOI: 10.3109/10428194.2015.1076928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,
| | - Sheng-Tsung Chang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan,
- Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan,
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan,
| | - Wan-Ting Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan,
- College of Medicine, Kaohsiung and Chang Gung University, Kaohsiung, Taiwan,
| | - Pei-Yi Chu
- Department of Pathology, St. Martin De Porres Hospital, Chiayi, Taiwan,
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan,
| | - Pin-Pen Hsieh
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
- National Defense Medical Center, Taipei, Taiwan,
| | - Yun-Chih Jung
- Department of Pathology, Sin-Lau Christian Hospital, Tainan, Taiwan,
| | - Chun-Chi Kuo
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan,
| | - Yu-Ting Chuang
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan, and
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan,
- Department of Pathology, College of Medicine, Taipei Medical University and National Taiwan University, Taipei, Taiwan
| |
Collapse
|
20
|
Wang J, Zhou M, Xu JY, Chen B, Ouyang J. Combination of BCL-2 and MYC protein expression improves high-risk stratification in diffuse large B-cell lymphoma. Onco Targets Ther 2015; 8:2645-50. [PMID: 26425100 PMCID: PMC4583112 DOI: 10.2147/ott.s86093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate whether the addition of two biological markers (MYC and BCL-2 protein overexpression) improves the stratification of high-risk patients with diffuse large B-cell lymphoma (DLBCL). Method Seven risk factors were identified at diagnosis, and a maximum of 7 points were assigned to each patient. The patients were classified according to four risk groups: low (0–1), low-intermediate (2–3), high-intermediate (4), and high (5–7). Only high-risk patients with DLBCL were included in this analysis. We retrospectively examined 20 cases from 2008 to 2013 at the Nanjing Drum Tower Hospital. Results The median expression of MYC protein was 60%, and 17 of 20 (65%) evaluable cases overexpressed MYC. The median expression of BCL-2 protein was also 60%. Eighteen of 20 (90%) evaluable cases showed BCL-2 overexpression. Additionally, 12 out of 20 cases (60%) demonstrated coexpression of MYC and BCL-2 proteins. The percentages of overall survival and progression-free survival at the median follow-up time (36 months) were 33.3%±16.1% and 16.9%±13.5%, respectively. By comparison, nine, four, and 20 patients were classified as high risk based on the International Prognostic Index (IPI), National Comprehensive Cancer Network(NCCN)-IPI, and revised IPI criteria, respectively. According to the IPI and NCCN-IPI stratification, the risk groups demonstrated closely overlapping survival curves. In addition, four out of 20 cases were identified as low-intermediate risk according to the NCCN-IPI criteria. Conclusion The addition of MYC and BCL-2 protein expression to the IPI could identify a subset of DLBCL patients with high-risk clinicopathological characteristics and poor clinical outcome.
Collapse
Affiliation(s)
- Jing Wang
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Min Zhou
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Jing-Yan Xu
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Bing Chen
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Jian Ouyang
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| |
Collapse
|
21
|
MYC Cytogenetic Status Correlates With Expression and Has Prognostic Significance in Patients With MYC/BCL2 Protein Double-positive Diffuse Large B-cell Lymphoma. Am J Surg Pathol 2015; 39:1250-8. [DOI: 10.1097/pas.0000000000000433] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
22
|
Testoni M, Zucca E, Young KH, Bertoni F. Genetic lesions in diffuse large B-cell lymphomas. Ann Oncol 2015; 26:1069-1080. [PMID: 25605746 PMCID: PMC4542576 DOI: 10.1093/annonc/mdv019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/05/2014] [Accepted: 12/15/2014] [Indexed: 01/04/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma in adults, accounting for 35%-40% of all cases. The combination of the anti-CD20 monoclonal antibody rituximab with anthracycline-based combination chemotherapy (R-CHOP, rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) lead to complete remission in most and can cure more than half of patients with DLBCL. The diversity in clinical presentation, as well as the pathologic and biologic heterogeneity, suggests that DLBCL comprises several disease entities that might ultimately benefit from different therapeutic approaches. In this review, we summarize the current literature focusing on the genetic lesions identified in DLBCL.
Collapse
Affiliation(s)
- M Testoni
- Lymphoma and Genomics Research Program, IOR Institute of Oncology Research, Bellinzona
| | - E Zucca
- Lymphoma Unit, IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - K H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Bertoni
- Lymphoma and Genomics Research Program, IOR Institute of Oncology Research, Bellinzona; Lymphoma Unit, IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| |
Collapse
|
23
|
Tapia G, Baptista MJ, Muñoz-Marmol AM, Gaafar A, Puente-Pomposo M, Garcia O, Marginet-Flinch R, Sanz C, Navarro JT, Sancho JM, Ribera JM, Ariza A, Mate JL. MYC protein expression is associated with poor prognosis in primary diffuse large B-cell lymphoma of the central nervous system. APMIS 2015; 123:596-603. [PMID: 26010683 DOI: 10.1111/apm.12390] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
MYC and BCL2 gene translocations and protein expression have recently demonstrated to be of prognostic significance in systemic diffuse large B-cell lymphoma (DLBCL). However, their role in primary central nervous system DLBCL (CNS-DLBCL) prognosis has been scarcely analyzed. We studied the immunophenotype, the status of the MYC, BCL2, and BCL6 genes and the clinical features of a series of 42 CNS-DLBCL and evaluated their prognostic significance. We found high MYC protein expression in 43% of cases, and this was associated with lower overall survival (OS). Cases with concurrent expression of MYC and BCL2 showed a lower OS, although the difference did not reach statistical significance. Translocations involving the MYC or BCL2 genes were not detected. The BCL6 gene was frequently translocated, but was unrelated to survival. We conclude that MYC protein expression detected by immunohistochemistry identifies a CNS-DLBCL subset with worse prognosis and may contribute to a more accurate risk stratification of CNS-DLBCL patients.
Collapse
Affiliation(s)
- Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Maria-Joao Baptista
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ana-Maria Muñoz-Marmol
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Ayman Gaafar
- Department of Pathology, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Olga Garcia
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ruth Marginet-Flinch
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Carolina Sanz
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Jose-Tomas Navarro
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Josep-Maria Ribera
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Aurelio Ariza
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Jose-Luis Mate
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| |
Collapse
|
24
|
Li KD, Miles R, Tripp SR, Glenn MJ, Perkins SL, Salama M. Clinicopathologic evaluation of MYC expression in primary mediastinal (thymic) large B-cell lymphoma. Am J Clin Pathol 2015; 143:598-604. [PMID: 25780014 DOI: 10.1309/ajcpkug0uqo0hmdj] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Based on previous molecular studies, a small fraction of primary mediastinal (thymic) large B-cell lymphoma (PMBL) demonstrates MYC alterations. However, no studies have evaluated MYC protein expression by immunohistochemistry (IHC) with follow-up fluorescence in situ hybridization (FISH) analysis. We aim to evaluate the clinicopathologic importance of MYC IHC expression in PMBL. METHODS Three pathologists independently evaluated MYC IHC expression in 32 cases of PMBL for percent tumor positivity and nuclear intensity. FISH analysis for MYC rearrangement was performed on cases with high MYC IHC expression. Clinical data including treatment, follow-up, and outcome were also reviewed in a subset of cases. RESULTS Variable MYC protein expression by IHC was detected in 30 (94%) of 32 cases of PMBL. One-third of the positive cases (10/30) showed high MYC IHC expression of at least 30% nuclear positivity. FISH analyses for MYC rearrangement on these 10 cases were negative. Review of clinical data on a subset of cases with high and low MYC IHC expression showed no differences in clinical outcome. CONCLUSIONS MYC protein expression by IHC is present in most PMBLs. Increased MYC protein expression can be seen in one-third of the cases; however, it does not correlate with genetic abnormalities by FISH. There is also no significant impact of MYC protein expression on clinical outcomes.
Collapse
Affiliation(s)
- K. David Li
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Rodney Miles
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Sheryl R. Tripp
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | | | - Sherrie L. Perkins
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | - Mohamed Salama
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| |
Collapse
|
25
|
When and how to test for C-MYC in aggressive B cell lymphomas. J Hematop 2015. [DOI: 10.1007/s12308-014-0220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
26
|
|
27
|
Hwang DH, Sun H, Rodig SJ, Hornick JL, Sholl LM. Myc protein expression correlates with MYC amplification in small-cell lung carcinoma. Histopathology 2015; 67:81-9. [PMID: 25407018 DOI: 10.1111/his.12622] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/15/2014] [Indexed: 01/31/2023]
Abstract
AIMS Myc family members are important contributors to oncogenesis in a variety of tumours. Identification of therapeutic targets is needed in small-cell lung carcinoma (SCLC), an aggressive disease with limited treatment options. Sequencing studies have identified MYC amplification in 2-7% of SCLCs. This study aims to determine the rate of MYC gene amplification and its correlation with Myc protein overexpression in SCLC. METHODS AND RESULTS One hundred and three cases of formalin-fixed, paraffin-embedded SCLC were examined. Myc protein expression was scored according to the extent of immunohistochemical staining. MYC copy number (CN) was evaluated with dual-colour chromogenic in-situ hybridization (CISH) for the MYC locus and a chromosome 8 (Chr8) centromeric control. Amplification was defined as a MYC/Chr8 ratio of ≥2. Thirty-eight per cent of SCLCs had some degree of Myc protein expression, and 9% of cases were MYC-amplified. MYC CN was significantly correlated with the extent of Myc protein expression (Spearman's ρ = 0.57, P < 0.01). There was no significant association between Myc expression or CN and clinicopathological features. CONCLUSIONS MYC amplification by CISH was identified in 9% of SCLCs, and correlated with protein expression. As novel Myc-targeted therapies are developed, CISH and IHC should be considered as biomarkers of Myc pathway dysregulation in SCLC.
Collapse
Affiliation(s)
- David H Hwang
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Heather Sun
- Dana Farber/Harvard Cancer Center Pathology Core, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Dana Farber/Harvard Cancer Center Pathology Core, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
28
|
O'Malley DP, Auerbach A, Weiss LM. Practical Applications in Immunohistochemistry: Evaluation of Diffuse Large B-Cell Lymphoma and Related Large B-Cell Lymphomas. Arch Pathol Lab Med 2015; 139:1094-107. [DOI: 10.5858/arpa.2014-0451-cp] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Diffuse large B-cell lymphoma is the most commonly diagnosed subtype of lymphoma worldwide. The current World Health Organization (WHO) classification includes several subtypes, based on a combination of clinical, immunohistochemical, and genetic differences. Immunohistochemical staining is essential in evaluating diffuse large B-cell lymphoma and many related large B-cell lymphomas and aggressive B-cell lymphomas.
Objective
To address different immunohistochemical features used for identification, subclassification, prognosis and in some cases, therapy, of diffuse large B-cell lymphoma and related lymphomas.
Data Sources
The information outlined in this review article is based on our experiences with routine cases, on the current WHO classification of hematopoietic and lymphoid tumors, and on a review of English-language articles published throughout 2014.
Conclusions
Features and diagnostic criteria of diffuse large B-cell lymphoma, aggressive variants of B-cell lymphomas, including Burkitt lymphoma and “double-hit” lymphomas, are discussed. Identification of cell of origin (germinal center type versus activated B-cell type) is discussed at length. Finally, practical approaches for diagnosis are discussed.
Collapse
Affiliation(s)
| | | | - Lawrence M. Weiss
- From Clarient Diagnostic Services, Aliso Viejo, California (Drs O'Malley and Weiss); and Joint Pathology Center, Silver Spring, Maryland (Dr Auerbach)
| |
Collapse
|
29
|
Cheah CY, Oki Y, Westin JR, Turturro F. A clinician's guide to double hit lymphomas. Br J Haematol 2014; 168:784-95. [DOI: 10.1111/bjh.13276] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/24/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Chan Yoon Cheah
- Department of Lymphoma/Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Jason R. Westin
- Department of Lymphoma/Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Francesco Turturro
- Department of Lymphoma/Myeloma; University of Texas MD Anderson Cancer Center; Houston TX USA
| |
Collapse
|
30
|
Zhang X(M, Aguilera N. New Immunohistochemistry for B-Cell Lymphoma and Hodgkin Lymphoma. Arch Pathol Lab Med 2014; 138:1666-72. [DOI: 10.5858/arpa.2014-0058-ra] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
B-cell non-Hodgkin lymphoma is a heterogeneous group of lymphoproliferative malignancies with different clinical behaviors and treatments. It is important to differentiate individual B-cell lymphoma to apply the best treatment and management. Morphology and immunohistochemistry are the primary tools used for diagnosing lymphoma. There is a characteristic pattern of expression with immunohistochemical antibodies in most well-defined B-cell lymphomas. Some cases of B-cell lymphoma, however, show unusual morphologic and immunophenotypic features. The new and sometimes more specific antibodies have been developed recently, which may further define those lymphomas. Only with use of the antibodies over time does their true nature and specificity become evident.
Objectives
To present new antibodies for B-cell lymphoma that enhance the probability for diagnosis or can act as alternate markers in unusual cases, in which a B-cell lymphoma does not present with characteristic immunohistochemical staining, and to present prognostic markers that allow for better management of patients with specific B-cell lymphomas.
Data Sources
Data were obtained from literature review and figures from slides in personal practice.
Conclusions
The immunohistochemical antibodies presented in this article increase our ability to understand, diagnosis, and manage patients with B-cell lymphoma.
Collapse
Affiliation(s)
- Xiaohong (Mary) Zhang
- From the Department of Laboratory Medicine, Geisinger Medical Laboratories, Wilkes-Barre, Pennsylvania (Dr Zhang)
| | - Nadine Aguilera
- and the Department of Pathology, University of Virginia Health System, Charlottesville (Dr Aguilera)
| |
Collapse
|
31
|
Petrich AM, Nabhan C, Smith SM. MYC-associated and double-hit lymphomas: A review of pathobiology, prognosis, and therapeutic approaches. Cancer 2014; 120:3884-95. [DOI: 10.1002/cncr.28899] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/13/2014] [Accepted: 05/27/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Adam M. Petrich
- Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Chadi Nabhan
- The University of Chicago Pritzker School of Medicine; Chicago Illinois
| | - Sonali M. Smith
- The University of Chicago Pritzker School of Medicine; Chicago Illinois
| |
Collapse
|
32
|
Rearrangements of MYC gene facilitate risk stratification in diffuse large B-cell lymphoma patients treated with rituximab-CHOP. Mod Pathol 2014; 27:958-71. [PMID: 24336156 DOI: 10.1038/modpathol.2013.214] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/01/2013] [Accepted: 10/06/2013] [Indexed: 02/03/2023]
Abstract
In order to address the debatable prognostic role of MYC rearrangements in diffuse large B-cell lymphoma patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone, we evaluated MYC rearrangements by fluorescence in situ hybridization in 563 cases using break-apart probes and IGH/MYC dual-fusion probes. Concurrent BCL2 and BCL6 aberrations were also assessed. Data were correlated with clinicopathological variables and prognostic parameters. MYC rearrangements were observed in 39/432 evaluable cases (9%), including 4 rearrangements detectable only with the dual-fusion probes, 15 detectable only with the break-apart probes and 20 detectable with both dual-fusion probes and break-apart probes. MYC rearrangements correlated with germinal center B-cell origin (P=0.02), MYC protein expression (P=0.032), and larger tumor mass size (P=0.0003). Patients with MYC rearrangements were more likely to be treatment resistant (P<0.0001). All types of MYC rearrangements were associated with poorer disease-specific survival, that is, 20/39 dead, median disease-specific survival 42 months, compared with 98/393 dead among the non-rearranged cases, median disease-specific survival not reached (P=0.0002). Cases with MYC rearrangements that overexpressed MYC protein were at risk with respect to disease-specific survival independent of the International Prognostic Index (P=0.046 and P<0.001, respectively). Presence of concurrent BCL2 aberrations but not of BCL6 aberrations was prognostically additive. Radiotherapy seemed to diminish the prognostic effects of MYC rearrangements in diffuse large B-cell lymphoma patients since only 2/10 irradiated patients with MYC rearrangements died of/with disease, compared with 16/28 non-irradiated patients with MYC rearrangements. We conclude that MYC rearrangements add prognostic information for individual risk estimation and such cases might represent a distinct, biologically determined disease subgroup.
Collapse
|
33
|
Clinical significance of MYC expression and/or "high-grade" morphology in non-Burkitt, diffuse aggressive B-cell lymphomas: a SWOG S9704 correlative study. Am J Surg Pathol 2014; 38:494-501. [PMID: 24625415 DOI: 10.1097/pas.0000000000000147] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The clinicopathologic findings in Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL) may show significant overlap, and MYC abnormalities, found in all BLs, also occur in a subset of DLBCL. The 2008 World Health Organization classification introduced the category of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL" (BCLU) in recognition of this overlap, but the clinical significance of BCLU (ie, "high-grade") morphology and the relationship between BCLU morphology and MYC abnormalities remains unclear. In this study, we identified 260 cases of non-Burkitt, diffuse aggressive B-cell lymphomas from SWOG S9704, a phase 3 randomized study of standard immunochemotherapy versus autologous stem cell transplantation. Of these, 31 cases (12%) showed BCLU morphology, and 229 (88%) showed typical DLBCL morphology. Of 198, 27 (14%) were positive for MYC by immunohistochemistry. BCLU morphology was associated with an increased incidence of MYC expression but otherwise was not associated with distinct clinicopathologic features or significantly decreased survival. MYC-positive cases were morphologically and phenotypically heterogenous and were associated with poor progression-free and overall survival in multivariate analysis. These findings confirm that BCLU does not represent a distinct clinicopathologic entity and demonstrate that BCLU morphology alone does not significantly impact survival compared with typical DLBCL. In contrast, MYC protein expression is a poor prognostic factor that may be associated with either BCLU or DLBCL morphology, and MYC immunohistochemistry is suggested for routine prognostic evaluation (Clinicaltrials.gov identifier: NCT00004031).
Collapse
|
34
|
Zhou M, Wang J, Ouyang J, Xu JY, Chen B, Zhang QG, Zhou RF, Yang YG, Shao XY, Xu Y, Chen YM, Fan XS, Wu HY. MYC protein expression is associated with poor prognosis in diffuse large B cell lymphoma patients treated with RCHOP chemotherapy. Tumour Biol 2014; 35:6757-62. [PMID: 24719189 DOI: 10.1007/s13277-014-1907-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022] Open
Abstract
This study aims to investigate the prognostic significance of the MYC protein expression in diffuse large B cell lymphoma (DLBCL) patients treated with RCHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). A total of 60 patients with DLBCL from 2008 to 2013 were included. Formalin-fixed, paraffin-embedded DLBCL samples were analyzed for MYC protein expression and divided into high or low MYC group. The MYC protein expression and the international prognostic variables were evaluated. The high MYC protein expression predicted a shorter 3-year estimated overall survival (OS) and progression-free survival (PFS) versus the low MYC protein expression (57 % vs. 96 %, P < 0.001 and 50 % vs. 96 %, P = 0.001, respectively). Multivariate analysis confirmed the prognostic significance of the MYC protein expression for both OS (HR, 11.862; 95 % CI, 1.462-96.218; P = 0.021) and PFS (HR, 6.073; 95 % CI, 1.082-34.085; P = 0.040). MYC protein expression with International Prognostic Index (IPI) score distinguished patients into three risk groups with different 3-year OS rates (χ (2) 23.079; P < 0.001) and distinct 3-year PFS rates (χ (2) 15.862; P < 0.001). This study suggests that the MYC protein expression is an important inferior prognostic factor for survival in patients with DLBCL treated with RCHOP. The combinative model with IPI score and MYC protein expression could stratify DLBCL patients into prognostically relevant subgroups more effectively than either the IPI or the MYC alone.
Collapse
Affiliation(s)
- Min Zhou
- Department of Hematology, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210008, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Detection of MYC rearrangement in high grade B cell lymphomas: correlation of MYC immunohistochemistry and FISH analysis. Pathology 2014; 46:211-5. [DOI: 10.1097/pat.0000000000000076] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Xie Y, Bulbul MA, Ji L, Inouye CM, Groshen SG, Tulpule A, O’Malley DP, Wang E, Siddiqi IN. p53 expression is a strong marker of inferior survival in de novo diffuse large B-cell lymphoma and may have enhanced negative effect with MYC coexpression: a single institutional clinicopathologic study. Am J Clin Pathol 2014; 141:593-604. [PMID: 24619762 DOI: 10.1309/ajcpphmz6vhf0wqv] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine interactions among clinical factors and pathologic biomarkers in predicting the outcome of patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab-based immunochemotherapy. METHODS In 85 patients treated at a single institution, clinicopathologic variables were analyzed, including the International Prognostic Index (IPI); germinal/nongerminal center phenotype; MYC, p53, BCL2, Ki-67, and Epstein-Barr virus (EBV) expression; and MYC translocation status. RESULTS In univariate analysis, overall survival (OS) was worse for patients with high IPI scores, nongerminal center phenotype, high MYC and p53 expression by immunohistochemistry, and EBV positivity. In multivariable analysis, p53 expression was the strongest prognostic factor (P < .05) independent of IPI and cell of origin. A significant positive association between p53 and MYC expression was found. Moreover, coexpression of p53/MYC had an enhanced negative effect on OS independent of BCL2 expression. CONCLUSIONS Immunohistochemical assessment of p53, particularly in combination with MYC, could be useful in identifying a high-risk subgroup of DLBCL.
Collapse
Affiliation(s)
- Yi Xie
- Department of Pathology, University of Southern California, Los Angeles, CA
| | | | - Lingyun Ji
- Department of Preventive Medicine and Biostatistics, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Casey M. Inouye
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Susan G. Groshen
- Department of Preventive Medicine and Biostatistics, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Anil Tulpule
- Department of Medicine, Division of Hematology, University of Southern California, Los Angeles, CA
| | | | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Imran N. Siddiqi
- Department of Pathology, University of Southern California, Los Angeles, CA
| |
Collapse
|
37
|
ALK-positive large B-cell lymphomas express a terminal B-cell differentiation program and activated STAT3 but lack MYC rearrangements. Mod Pathol 2013; 26:1329-37. [PMID: 23599149 PMCID: PMC6368829 DOI: 10.1038/modpathol.2013.73] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 02/08/2023]
Abstract
ALK-positive large B-cell lymphoma is an aggressive lymphoid neoplasm characterized by a monomorphic proliferation of immunoblast-like cells expressing a plasmablastic phenotype and carrying ALK rearrangements. MYC rearrangements are frequent in plasmablastic lymphomas, advanced plasma cell myelomas and a subgroup of diffuse large B-cell lymphomas, but their presence in ALK-positive large B-cell lymphomas is unknown. MYC expression is downregulated by BLIMP1, a master modulator of plasma cell differentiation. BLIMP1 and MYC are upregulated by STAT3, a signal transducer activated by ALK. To determine the role of BLIMP1, MYC and STAT3 in the pathogenesis of ALK-positive large B-cell lymphomas, we investigated MYC rearrangement and the expression of MYC, phosphorylated STAT3, BLIMP1, PAX5 and XBP1 in 12 ALK-positive large B-cell lymphomas. All cases expressed ALK with a granular cytoplasmic pattern. Nine cases had a split signal consistent with an ALK rearrangement. Three additional cases showed a deletion of the 5' or 3' end of the ALK probe consistent with cryptic translocation. PAX5 was virtually negative in all cases tested, whereas BLIMP1 was expressed in all tumors and XBP1 in 11 of 12. Phosphorylated STAT3 was observed in all cases with a strong and diffuse nuclear pattern. MYC rearrangements were not identified in any tumor, but MYC gains and amplification were detected in six cases and one case, respectively. MYC protein was expressed in all tumors independently of MYC gene alterations. These results indicate that ALK-positive large B-cell lymphomas express a complete plasmablastic differentiation program but, contrary to plasmablastic lymphomas, do not have MYC rearrangements. STAT3 is constantly activated and may be an alternative mechanism to promote MYC expression in these tumors. The relevance of the ALK/STAT3 pathway in the pathogenesis of ALK-positive large B-cell lymphomas may offer an attractive target for new therapies.
Collapse
|
38
|
Oberley MJ, Rajguru SA, Zhang C, Kim K, Shaw GR, Grindle KM, Kahl BS, Kanugh C, Laffin J, Yang DT. Immunohistochemical evaluation of MYC expression in mantle cell lymphoma. Histopathology 2013; 63:499-508. [PMID: 23926923 DOI: 10.1111/his.12207] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
AIM To assess the validity and potential clinical utility of evaluating MYC expression by immunohistochemistry (IHC) in mantle cell lymphoma (MCL). METHODS AND RESULTS MYC IHC was scored on a tissue microarray containing 62 MCLs and 29 controls by two pathologists. Inter-observer correlation was high (intra-class correlation of 0.98). MYC IHC scores correlated with MYC expression (Spearman's rank correlation 0.69, P < 0.0001) and weakly with Ki67 proliferation index (Spearman's rank correlation 0.30, P = 0.03). Six blastic MCLs did not have higher mean MYC IHC scores or MYC mRNA expression than non-blastic MCLs. None of 57 cases assessed, including all of the blastic cases, showed MYC rearrangement by fluorescence in-situ hybridization. Multivariate analysis with backward selection from potential predictors including age, lactate dehydrogenase, leukocyte count, MIPI score, ECOG performance status, blastic morphology and Ki67 index showed that MYC IHC score is an independent predictor of progression-free survival (hazard ratio 2.34, 95% CI 1.42-3.88, P = 0.0009) and overall survival (hazard ratio 1.90, 95% CI 1.05-3.43, P = 0.034). CONCLUSIONS We show that a new monoclonal anti-MYC antibody can enable accurate and reproducible visual assessment of MYC expression that is independently predictive of clinical outcomes in MCL.
Collapse
Affiliation(s)
- Matthew J Oberley
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Muñoz-Mármol AM, Sanz C, Tapia G, Marginet R, Ariza A, Mate JL. MYCstatus determination in aggressive B-cell lymphoma: the impact of FISH probe selection. Histopathology 2013; 63:418-24. [DOI: 10.1111/his.12178] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ana M Muñoz-Mármol
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Badalona; Barcelona; Spain
| | | | | | - Ruth Marginet
- Department of Pathology; Hospital Universitari Germans Trias i Pujol; Badalona; Barcelona; Spain
| | | | | |
Collapse
|
40
|
Valera A, López-Guillermo A, Cardesa-Salzmann T, Climent F, González-Barca E, Mercadal S, Espinosa I, Novelli S, Briones J, Mate JL, Salamero O, Sancho JM, Arenillas L, Serrano S, Erill N, Martínez D, Castillo P, Rovira J, Martínez A, Campo E, Colomo L. MYC protein expression and genetic alterations have prognostic impact in patients with diffuse large B-cell lymphoma treated with immunochemotherapy. Haematologica 2013; 98:1554-62. [PMID: 23716551 DOI: 10.3324/haematol.2013.086173] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
MYC alterations influence the survival of patients with diffuse large B-cell lymphoma. Most studies have focused on MYC translocations but there is little information regarding the impact of numerical alterations and protein expression. We analyzed the genetic alterations and protein expression of MYC, BCL2, BCL6, and MALT1 in 219 cases of diffuse large B-cell lymphoma. MYC rearrangement occurred as the sole abnormality (MYC single-hit) in 3% of cases, MYC and concurrent BCL2 and/or BCL6 rearrangements (MYC double/triple-hit) in 4%, MYC amplifications in 2% and MYC gains in 19%. MYC single-hit, MYC double/triple-hit and MYC amplifications, but not MYC gains or other gene rearrangements, were associated with unfavorable progression-free survival and overall survival. MYC protein expression, evaluated using computerized image analysis, captured the unfavorable prognosis of MYC translocations/amplifications and identified an additional subset of patients without gene alterations but with similar poor prognosis. Patients with tumors expressing both MYC/BCL2 had the worst prognosis, whereas those with double-negative tumors had the best outcome. High MYC expression was associated with shorter overall survival irrespectively of the International Prognostic Index and BCL2 expression. In conclusion, MYC protein expression identifies a subset of diffuse large B-cell lymphoma with very poor prognosis independently of gene alterations and other prognostic parameters.
Collapse
|
41
|
Perry AM, Crockett D, Dave BJ, Althof P, Winkler L, Smith LM, Aoun P, Chan WC, Fu K, Greiner TC, Bierman P, Gregory Bociek R, Vose JM, Armitage JO, Weisenburger DD. B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and burkitt lymphoma: study of 39 cases. Br J Haematol 2013; 162:40-9. [DOI: 10.1111/bjh.12343] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - David Crockett
- Department of Internal Medicine; University of Nebraska Medical Center; Omaha; NE; USA
| | - Bhavana J. Dave
- Human Genetics Laboratory; Munroe-Meyer Institute; University of Nebraska Medical Center; Omaha; NE; USA
| | - Pamela Althof
- Human Genetics Laboratory; Munroe-Meyer Institute; University of Nebraska Medical Center; Omaha; NE; USA
| | - Lisa Winkler
- Human Genetics Laboratory; Munroe-Meyer Institute; University of Nebraska Medical Center; Omaha; NE; USA
| | - Lynette M. Smith
- Department of Biostatistics; University of Nebraska Medical Center; Omaha; NE; USA
| | - Patricia Aoun
- Department of Pathology; City of Hope National Medical Center; Duarte; CA; USA
| | - Wing C. Chan
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha; NE; USA
| | - Kai Fu
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha; NE; USA
| | - Timothy C. Greiner
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha; NE; USA
| | - Phillip Bierman
- Department of Internal Medicine; University of Nebraska Medical Center; Omaha; NE; USA
| | - Robert Gregory Bociek
- Department of Internal Medicine; University of Nebraska Medical Center; Omaha; NE; USA
| | - Julie M. Vose
- Department of Internal Medicine; University of Nebraska Medical Center; Omaha; NE; USA
| | - James O. Armitage
- Department of Internal Medicine; University of Nebraska Medical Center; Omaha; NE; USA
| | | |
Collapse
|
42
|
High levels of bcl-2 protein expression do not correlate with genetic abnormalities but predict worse prognosis in patients with lymphoblastic lymphoma. Tumour Biol 2013; 34:1441-50. [PMID: 23494176 DOI: 10.1007/s13277-013-0647-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022] Open
Abstract
We aimed to investigate bcl-2, bcl-6, and c-myc rearrangements in patients with lymphoblastic lymphoma (LBL), especially focus on the correlation of protein expression with genetic abnormalities. Moreover, their prognostic significance was further analyzed in LBL. Protein expression and genetic abnormalities of bcl-2, bcl-6, and c-myc were investigated in microarrayed tumors from 33 cases of T cell LBL and eight cases of B cell lineage. Immunohistochemical (IHC) staining was performed to evaluate protein expression, including bcl-2, bcl-6, c-myc, TdT, CD1α, CD34, Ki-67, PAX-5, CD2, CD3, CD4, CD8, and CD20. Genetic abnormalities of bcl-2, bcl-6, and c-myc were detected by dual color fluorescence in situ hybridization (FISH). Bcl-2 protein was positive in 51.2 % (21/41) of the patients, bcl-6 protein in 7.3 % (three out of 41), and c-myc protein in 78.0 % (32/41). Bcl-2 breakpoint was found in two cases by FISH analysis. There was no evidence of bcl-6 or c-myc rearrangement in patients with LBL. However, both gene gain and loss events occurred in bcl-2, bcl-6, and c-myc. A univariate analysis showed that stage III or IV, elevated lactate dehydrogenase (LDH), and positivity for bcl-2 protein were associated with shorter survival (p<0.05). Enhanced protein expression and detectable genetic abnormalities of bcl-2, bcl-6, and c-myc were observed in patients with LBL. No statistical correlation was found between IHC results and cytogenetic findings. Stage III or IV, elevated LDH, and positivity for bcl-2 protein were identified as adverse prognostic factors. The patients with more adverse factors would have increasingly worse prognosis.
Collapse
|
43
|
Green TM, Young KH, Visco C, Xu-Monette ZY, Orazi A, Go RS, Nielsen O, Gadeberg OV, Mourits-Andersen T, Frederiksen M, Pedersen LM, Møller MB. Immunohistochemical double-hit score is a strong predictor of outcome in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone. J Clin Oncol 2012; 30:3460-7. [PMID: 22665537 DOI: 10.1200/jco.2011.41.4342] [Citation(s) in RCA: 501] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Approximately 5% of diffuse large B-cell lymphomas (DLBCLs) are double-hit lymphomas (DHLs) with translocations of both MYC and BCL2. DHLs are characterized by poor outcome. We tested whether DLBCLs with high expression of MYC protein and BCL2 protein share the clinical features and poor prognosis of DHLs. PATIENTS AND METHODS Paraffin-embedded lymphoma samples from 193 patients with de novo DLBCL who were uniformly treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) were studied using immunohistochemistry for MYC, BCL2, CD10, BCL6, and MUM1/interferon regulatory factor 4, and fluorescent in situ hybridization (FISH) for MYC and BCL2. RESULTS FISH analysis identified DHL in 6% of patients, who showed the expected poor overall survival (OS; P = .002). On the basis of immunohistochemical MYC and BCL2 expression, a double-hit score (DHS) was assigned to all patients with DLBCL. The DHS-2 group, defined by high expression of both MYC and BCL2 protein, comprised 29% of the patients. DHS 2 was significantly associated with lower complete response rate (P = .004), shorter OS (P < .001), and shorter progression-free survival (PFS; P < .001). The highly significant correlation with OS and PFS was maintained in multivariate models that controlled for the International Prognostic Index and the cell-of-origin subtype (OS, P < .001; PFS, P < .001). DHS was validated in an independent cohort of 116 patients who were treated with R-CHOP. CONCLUSION The immunohistochemical DHS defined a large subset of DLBCLs with double-hit biology and was strongly associated with poor outcome in patients treated with R-CHOP.
Collapse
Affiliation(s)
- Tina Marie Green
- Department of Pathology, Odense University Hospital, J.B. Winsløws Vej 15, DK-5000 Odense C, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|