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Kurz KS, Ott M, Kalmbach S, Steinlein S, Kalla C, Horn H, Ott G, Staiger AM. Large B-Cell Lymphomas in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Concepts. Cancers (Basel) 2023; 15:cancers15082285. [PMID: 37190213 DOI: 10.3390/cancers15082285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The family/class of the large B-cell lymphomas (LBCL) in the 5th edition of the World Health Organization (WHO) classification of haematolymphoid tumors (WHO-HAEM5) features only a few major changes as compared to the 4th edition. In most entities, there are only subtle changes, many of them only representing some minor modifications in diagnostic terms. Major changes have been made in the diffuse large B-cell lymphomas (DLBCL)/high-grade B-cell lymphomas (HGBL) associated with MYC and BCL2 and/or BCL6 rearrangements. This category now consists of MYC and BCL2 rearranged cases exclusively, while the MYC/BCL6 double hit lymphomas now constitute genetic subtypes of DLBCL, not otherwise specified (NOS) or of HGBL, NOS. Other major changes are the conceptual merger of lymphomas arising in immune-privileged sites and the description of LBCL arising in the setting of immune dysregulation/deficiency. In addition, novel findings concerning underlying biological mechanisms in the pathogenesis of the different entities are provided.
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Affiliation(s)
- Katrin S Kurz
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Michaela Ott
- Department of Pathology, Marienhospital, 70199 Stuttgart, Germany
| | - Sabrina Kalmbach
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Sophia Steinlein
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Claudia Kalla
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
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2
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Cook MR, Dunleavy K. Targeting The Tumor Microenvironment in Lymphomas: Emerging Biological Insights and Therapeutic Strategies. Curr Oncol Rep 2022; 24:1121-1131. [DOI: 10.1007/s11912-022-01250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/03/2022]
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3
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Cost-Effectiveness of Molecularly Guided Treatment in Diffuse Large B-Cell Lymphoma (DLBCL) in Patients under 60. Cancers (Basel) 2022; 14:cancers14040908. [PMID: 35205656 PMCID: PMC8870002 DOI: 10.3390/cancers14040908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Classifying diffuse large B-cell lymphoma (DLBCL) into cell-of-origin (COO) subtypes could allow for personalized cancer control. Evidence suggests that subtype-guided treatment may be beneficial in the activated B-cell (ABC) subtype of DLBCL, among patients under the age of 60. Methods: We estimated the cost-effectiveness of age- and subtype-specific treatment guided by gene expression profiling (GEP). A probabilistic Markov model examined costs and quality-adjusted life-years gained (QALY) accrued to patients under GEP-classified COO treatment over a 10-year time horizon. The model was calibrated to evaluate the adoption of ibrutinib as a first line treatment among patients under 60 years with ABC subtype DLBCL. The primary data source for efficacy was derived from published estimates of the PHOENIX trial. These inputs were supplemented with patient-level, real-world data from BC Cancer, which provides comprehensive cancer services to the population of British Columbia. Results: We found the cost-effectiveness of GEP-guided treatment vs. standard care was $77,806 per QALY (24.3% probability of cost-effectiveness at a willingness-to-pay (WTP) of $50,000/QALY; 53.7% probability at a WTP of $100,000/QALY) for first-line treatment. Cost-effectiveness was dependent on assumptions around decision-makers’ WTP and the cost of the assay. Conclusions: We encourage further clinical trials to reduce uncertainty around the implementation of GEP-classified COO personalized treatment in this patient population.
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Wang J, Huang J, Zeng Q. Network meta-analysis of targeted therapies for diffuse large B cell lymphoma. BMC Cancer 2020; 20:1218. [PMID: 33308179 PMCID: PMC7733263 DOI: 10.1186/s12885-020-07715-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/17/2020] [Indexed: 02/05/2023] Open
Abstract
Background The purpose of this network meta-analysis of randomized controlled trials (RCTs) was to compare rank targeted therapies for patients with diffuse large B-cell lymphoma (DLBCL). Methods The PubMed, EmBase, and Cochrane library electronic databases were systematically searched throughout December 2019. Direct and indirect evidence from relevant RCTs was identified for network meta-analysis. The pooled results for grade 3 or greater adverse events between targeted therapies and chemotherapy were calculated using a random-effects model. Results A total of 18 RCTs enrolling 8207 DLBCL patients were selected for the final meta-analysis. The results of the network analysis indicated that the addition of dacetuzumab (74.8%) to rituximab-based regimens or lenalidomide (77.1%) was associated with better therapeutic effects on overall survival, whereas dacetuzumab (80.4%) or bortezomib (70.8%) added to rituximab was most likely to improve events-free survival. Moreover, lenalidomide (93.8%) and I-tositumomab (77.2%) were associated with higher overall response rates. Finally, patients receiving targeted therapies were associated with an increased risk of diarrhea (RR: 2.63; 95%CI: 1.18–5.86; P = 0.019), and thrombocytopenia (RR: 1.41; 95%CI: 1.05–1.90; P = 0.023). Conclusions This study provides the best treatment strategy for DLBCL patients in terms of overall survival, events-free survival, and overall response rate. The findings of this study require validation with further large-scale RCTs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-020-07715-2.
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Affiliation(s)
- Jie Wang
- Department of Hematology, West China Hospital of Sichuan University, No. 37 Guoxuexiang Street, Chengdu, 610041, Sichuan, China.
| | - Jun Huang
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Qing Zeng
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
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5
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Liu Y, Barta SK. Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment. Am J Hematol 2019; 94:604-616. [PMID: 30859597 DOI: 10.1002/ajh.25460] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/13/2022]
Abstract
DISEASE OVERVIEW Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma originating from the germinal center, and it represents a heterogeneous group of diseases with variable outcomes that are differentially characterized by clinical features, cell of origin (COO), molecular features, and most recently, frequently recurring mutations. DIAGNOSIS DLBCL is ideally diagnosed from an excisional biopsy of a suspicious lymph node, which shows sheets of large cells that disrupt the underlying structural integrity of the follicle center and stain positive for pan-B-cell antigens, such as CD20 and CD79a. COO is determined by immunohistochemical stains, while molecular features such as double-hit or triple-hit disease are determined by fluorescent in situ hybridization analysis. Commercial tests for frequently recurring mutations are currently not routinely used to inform treatment. RISK STRATIFICATION Clinical prognostic systems for DLBCL, including the rituximab International Prognostic Index, age-adjusted IPI, and NCCN-IPI, use clinical factors for the risk stratification of patients, although this does not affect the treatment approach. Furthermore, DLBCL patients with non-germinal center B-cell (GCB)-like DLBCL (activated B-cell like and unclassifiable) have a poorer response to up-front chemoimmunotherapy (CI) compared to patients with GCB-like DLBCL. Those with c-MYC-altered disease alone and in combination with translocations in BCL2 and/or BCL6 (particularly when the MYC translocation partner is immunoglobulin) respond poorly to up-front CI and salvage autologous stem cell transplant at relapse. RISK-ADAPTED THERAPY This review will focus on differential treatment of DLBCL up-front and at the time of relapse by COO and molecular features.
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Affiliation(s)
- Yang Liu
- Fox Chase Cancer Center, Department of Hematology and Oncology Philadelphia Pennsylvania
| | - Stefan Klaus Barta
- Perelman Center for Advanced Medicine, University of Pennsylvania, Division Philadelphia Pennsylvania
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6
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Aljoundi AK, Agoni C, Olotu FA, Soliman MES. Turning to Computer-aided Drug Design in the Treatment of Diffuse Large B-cell Lymphoma: Has it been Helpful? Anticancer Agents Med Chem 2019; 19:1325-1339. [PMID: 30950356 DOI: 10.2174/1871520619666190405111526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Amidst the numerous effective therapeutic options available for the treatment of Diffuse Large B-cell Lymphoma (DLBCL), about 30-40% of patients treated with first-line chemoimmunotherapy still experience a relapse or refractory DLBCL. This has necessitated a continuous search for new therapeutic agents to augment the existing therapeutic arsenal. METHODS The dawn of Computer-Aided Drug Design (CADD) in the drug discovery process has accounted for persistency in the application of computational approaches either alone or in combinatorial strategies with experimental methods towards the identification of potential hit compounds with high therapeutic efficacy in abrogating DLBCL. RESULTS This review showcases the interventions of structure-based and ligand-based computational approaches which have led to the identification of numerous small molecule inhibitors against implicated targets in DLBCL therapy, even though many of these potential inhibitors are piled-up awaiting further experimental validation and exploration. CONCLUSION We conclude that a successful and a conscious amalgamation of CADD and experimental approaches could pave the way for the discovery of the next generation potential leads in DLBCL therapy with improved activities and minimal toxicities.
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Affiliation(s)
- Aimen K Aljoundi
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Clement Agoni
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Fisayo A Olotu
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
| | - Mahmoud E S Soliman
- Molecular Bio-computation and Drug Design Laboratory, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4001, South Africa
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Ge Z, Zhou X, Gu Y, Han Q, Li J, Chen B, Ge Q, Dovat E, Payne JL, Sun T, Song C, Dovat S. Ikaros regulation of the BCL6/BACH2 axis and its clinical relevance in acute lymphoblastic leukemia. Oncotarget 2018; 8:8022-8034. [PMID: 28030830 PMCID: PMC5352379 DOI: 10.18632/oncotarget.14038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/24/2016] [Indexed: 12/27/2022] Open
Abstract
B-Cell CLL/Lymphoma 6 (BCL6) is a proto-oncogene that is highly expressed in acute lymphoblastic leukemia (ALL). BTB and CNC Homology 1 Basic Leucine Zipper Transcription Factor 2 (BACH2) is a suppressor of transcription. The BACH2-BCL6 balance controls selection at the pre-B cell receptor checkpoint by regulating p53 expression. However, the underlying mechanism and the clinical relevance of the BCL6/BACH2 axis are unknown. Here, we found that Ikaros, a tumor suppressor encoded by IKZF1, directly binds to both the BCL6 and BACH2 promoters where it suppresses BCL6 and promotes BACH2 expression in B-cell ALL (B-ALL) cells. Casein kinase 2 (CK2) inhibitors increase Ikaros function thereby inhibiting BCL6 and promoting BACH2 expression in an Ikaros-dependent manner. We also found that the expression of BCL6 is higher while BACH2 expression is lower in patients with B-ALL than normal bone marrow control. High BCL6 and low BACH2 expression is associated with high leukemic cell proliferation, unfavorable clinical and laboratory features, and inferior outcomes. Moreover, IKZF1 deletion is associated with high BCL6 and low BACH2 expression in B-ALL patients. CK2 inhibitors increase Ikaros binding to the promoter of BCL6 and BACH2 and suppress BCL6 while promoting BACH2 expression in the primary B-ALL cells. Our data indicates that Ikaros regulates expression of the BCL6/BACH2 axis in B-ALL. High BCL6 and low BACH2 expression are associated with Ikaros dysregulation and have a potential effect on the development of B-ALL.
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Affiliation(s)
- Zheng Ge
- Department of Hematology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.,International Cooperative Leukemia Group and International Cooperative Laboratory of Hematology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China
| | - Xilian Zhou
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Yan Gu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Qi Han
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Baoan Chen
- Department of Hematology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.,International Cooperative Leukemia Group and International Cooperative Laboratory of Hematology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China
| | - Qinyu Ge
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Elanora Dovat
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA 17033, USA
| | - Jonathon L Payne
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA 17033, USA.,Loma Linda University School of Medicine, Department of Basic Sciences, Loma Linda, CA 92350, USA
| | - Tianyu Sun
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
| | - Chunhua Song
- International Cooperative Leukemia Group and International Cooperative Laboratory of Hematology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.,Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA 17033, USA
| | - Sinisa Dovat
- International Cooperative Leukemia Group and International Cooperative Laboratory of Hematology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.,Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA 17033, USA
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8
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Gaudio E, Tarantelli C, Ponzoni M, Odore E, Rezai K, Bernasconi E, Cascione L, Rinaldi A, Stathis A, Riveiro E, Cvitkovic E, Zucca E, Bertoni F. Bromodomain inhibitor OTX015 (MK-8628) combined with targeted agents shows strong in vivo antitumor activity in lymphoma. Oncotarget 2018; 7:58142-58147. [PMID: 27494885 PMCID: PMC5295419 DOI: 10.18632/oncotarget.10983] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/07/2016] [Indexed: 11/25/2022] Open
Abstract
The bromodomain inhibitor OTX015 (MK-8628) has shown anti-lymphoma activity as a single agent in both the preclinical and clinical settings, as well as in vitro synergism with several anticancer agents. Here, we report in vivo data for OTX015 in combination with the histone deacetylase inhibitor vorinostat, the Bruton's tyrosine kinase inhibitor ibrutinib, the anti-CD20 monoclonal antibody rituximab, and the mTOR inhibitor everolimus in a diffuse large B cell lymphoma model. The antitumor effect of OTX015-containing combinations in SU-DHL-2 xenografts in mice was much stronger than the activity of the corresponding single agents with almost complete tumor eradication for all four combinations. Pharmacokinetic analyses showed similar OTX015 levels in plasma and tumor samples of approximately 1.5 μM, which is equivalent to the concentration showing strong in vitro activity. For all four combinations, mean terminal levels of the bromodomain inhibitor differed from those in mice exposed to single agent OTX015, indicating a need for thorough pharmacokinetic investigations in phase I combination studies. In conclusion, our results provide a strong rationale to explore OTX015-containing combinations in the clinical lymphoma setting.
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Affiliation(s)
- Eugenio Gaudio
- Lymphoma and Genomics Research Program, Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Chiara Tarantelli
- Lymphoma and Genomics Research Program, Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | | | - Elodie Odore
- Institut Curie, Hôpital René Huguenin, Saint-Cloud, France
| | - Keyvan Rezai
- Institut Curie, Hôpital René Huguenin, Saint-Cloud, France
| | - Elena Bernasconi
- Lymphoma and Genomics Research Program, Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Luciano Cascione
- Lymphoma and Genomics Research Program, Institute of Oncology Research (IOR), Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Andrea Rinaldi
- Lymphoma and Genomics Research Program, Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | | | | | - Emanuele Zucca
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Francesco Bertoni
- Lymphoma and Genomics Research Program, Institute of Oncology Research (IOR), Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
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Dunleavy K, Erdmann T, Lenz G. Targeting the B-cell receptor pathway in diffuse large B-cell lymphoma. Cancer Treat Rev 2018; 65:41-46. [PMID: 29549872 DOI: 10.1016/j.ctrv.2018.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 12/22/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous diagnostic category with different molecular subtypes defined by distinct gene expression patterns and divergent mechanisms of oncogenic activation. Several studies have suggested an inferior survival for patients of the activated B-cell-like (ABC) versus the germinal center B-cell-like (GCB) DLBCL subtype which has led to increasing interest in investigating pharmacological inhibition of signaling pathways which contribute to lymphomagenesis and that are specifically utilized by ABC DLBCL cells. One of these signaling cascades is the B-cell receptor (BCR) pathway and several approaches in clinical trials to target this cascade have demonstrated promising therapeutic activity. This review discusses our current understanding of the role of BCR signaling in different DLBCL subtypes, including primary central nervous system lymphoma (PCNSL), a subgroup of DLBCL that is particularly dependent on BCR signaling. One specific aim of this review is to highlight novel approaches to therapeutically target BCR signaling in DLBCL.
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Affiliation(s)
- Kieron Dunleavy
- George Washington University Cancer Center, Washington DC, USA.
| | - Tabea Erdmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany; Cluster of Excellence EXC 1003, Cells in Motion, Münster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany; Cluster of Excellence EXC 1003, Cells in Motion, Münster, Germany
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Conte C, Palmaro A, Grosclaude P, Daubisse-Marliac L, Despas F, Lapeyre-Mestre M. A novel approach for medical research on lymphomas: A study validation of claims-based algorithms to identify incident cases. Medicine (Baltimore) 2018; 97:e9418. [PMID: 29480830 PMCID: PMC5943849 DOI: 10.1097/md.0000000000009418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The use of claims database to study lymphomas in real-life conditions is a crucial issue in the future. In this way, it is essential to develop validated algorithms for the identification of lymphomas in these databases. The aim of this study was to assess the validity of diagnosis codes in the French health insurance database to identify incident cases of lymphomas according to results of a regional cancer registry, as the gold standard.Between 2010 and 2013, incident lymphomas were identified in hospital data through 2 algorithms of selection. The results of the identification process and characteristics of incident lymphomas cases were compared with data from the Tarn Cancer Registry. Each algorithm's performance was assessed by estimating sensitivity, predictive positive value, specificity (SPE), and negative predictive value.During the period, the registry recorded 476 incident cases of lymphomas, of which 52 were Hodgkin lymphomas and 424 non-Hodgkin lymphomas. For corresponding area and period, algorithm 1 provides a number of incident cases close to the Registry, whereas algorithm 2 overestimated the number of incident cases by approximately 30%. Both algorithms were highly specific (SPE = 99.9%) but moderately sensitive. The comparative analysis illustrates that similar distribution and characteristics are observed in both sources.Given these findings, the use of claims database can be consider as a pertinent and powerful tool to conduct medico-economic or pharmacoepidemiological studies in lymphomas.
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Affiliation(s)
- Cécile Conte
- LEASP-UMR 1027, Inserm-University of Toulouse
- Medical and Clinical Pharmacology Unit
| | - Aurore Palmaro
- LEASP-UMR 1027, Inserm-University of Toulouse
- Medical and Clinical Pharmacology Unit
- CIC 1436, Toulouse University Hospital
| | - Pascale Grosclaude
- LEASP-UMR 1027, Inserm-University of Toulouse
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France
| | - Laetitia Daubisse-Marliac
- LEASP-UMR 1027, Inserm-University of Toulouse
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France
| | - Fabien Despas
- LEASP-UMR 1027, Inserm-University of Toulouse
- Medical and Clinical Pharmacology Unit
- CIC 1436, Toulouse University Hospital
| | - Maryse Lapeyre-Mestre
- LEASP-UMR 1027, Inserm-University of Toulouse
- Medical and Clinical Pharmacology Unit
- CIC 1436, Toulouse University Hospital
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11
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Dunleavy K, Wilson WH. Diagnosis and Treatment of Diffuse Large B-Cell Lymphoma and Burkitt Lymphoma. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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Bauer WM, Aichelburg MC, Griss J, Skrabs C, Simonitsch-Klupp I, Schiefer AI, Kittler H, Jäger U, Zeyda M, Knobler R, Stingl G. Molecular classification of tumour cells in a patient with intravascular large B-cell lymphoma. Br J Dermatol 2017; 178:215-221. [PMID: 28733977 DOI: 10.1111/bjd.15841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal LBCL. It is characterized by the proliferation of tumour cells exclusively intraluminally in small blood vessels of different organs. The clinical manifestation depends on the type of organ affected; additionally, a haemophagocytic syndrome can be observed in some patients. OBJECTIVES The aim was to further understand the nosology of this lymphoma as, due to its rarity and in spite of detailed immunohistochemical investigations, its exact nosology is only incompletely understood. METHODS We used microarray-based analysis of gene expression of tumour cells isolated from a patient with primary manifestation of the lymphoma in the skin and compared it with various other diffuse LBCLs (DLBCLs) as well as a previously published DLBCL classifier. RESULTS In unsupervised analyses, the tumour cells clustered together with non-germinal centre B-cell (non-GCB) DLBCL samples but were clearly distinct from GCB-DLBCL. Analogous to non-GCB DLBCL, molecular cell-of-origin classification revealed similarity to bone-marrow derived plasma cells. CONCLUSIONS The IVLBCL of this patient showed molecular similarity to non-GCB DLBCL. Due to the prognostic and increasingly also therapeutic relevance of molecular subtyping in DLBCL, this method, in addition to immunohistochemistry, should also be considered for the diagnosis of IVLBCL in the future.
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Affiliation(s)
- W M Bauer
- Department for Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - M C Aichelburg
- Department for Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - J Griss
- Department for Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
| | - C Skrabs
- Department of Internal Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | | | - A I Schiefer
- Department for Pathology, Medical University of Vienna, Vienna, Austria
| | - H Kittler
- Department for Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - U Jäger
- Department of Internal Medicine I, Division of Haematology and Haemostaseology, Medical University of Vienna, Vienna, Austria
| | - M Zeyda
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University, of Vienna, Vienna, Austria
| | - R Knobler
- Department for Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria
| | - G Stingl
- Department for Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
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Nabhan C, Mato AR. Emerging Strategies in Treating Double Hit Lymphomas. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:563-568. [DOI: 10.1016/j.clml.2017.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
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Leonard JP, Kolibaba KS, Reeves JA, Tulpule A, Flinn IW, Kolevska T, Robles R, Flowers CR, Collins R, DiBella NJ, Papish SW, Venugopal P, Horodner A, Tabatabai A, Hajdenberg J, Park J, Neuwirth R, Mulligan G, Suryanarayan K, Esseltine DL, de Vos S. Randomized Phase II Study of R-CHOP With or Without Bortezomib in Previously Untreated Patients With Non-Germinal Center B-Cell-Like Diffuse Large B-Cell Lymphoma. J Clin Oncol 2017; 35:3538-3546. [PMID: 28862883 DOI: 10.1200/jco.2017.73.2784] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To evaluate the impact of the addition of bortezomib to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) on outcomes in previously untreated patients with non-germinal center B-cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL). Patients and Methods After real-time determination of non-GCB DLBCL using the Hans immunohistochemistry algorithm, 206 patients were randomly assigned (1:1; stratified by International Prognostic Index [IPI] score) to six 21-day cycles of standard R-CHOP alone or R-CHOP plus bortezomib 1.3 mg/m2 intravenously on days 1 and 4 (VR-CHOP). The primary end point, progression-free survival (PFS), was evaluated in 183 patients with centrally confirmed non-GCB DLBCL who received one or more doses of study drug (91 R-CHOP, 92 VR-CHOP). Results After a median follow-up of 34 months, with 25% (R-CHOP) and 18% (VR-CHOP) of patients having had PFS events, the hazard ratio (HR) for PFS was 0.73 (90% CI, 0.43 to 1.24) with VR-CHOP ( P = .611). Two-year PFS rates were 77.6% with R-CHOP and 82.0% with VR-CHOP; they were 65.1% versus 72.4% in patients with high-intermediate/high IPI (HR, 0.67; 90% CI, 0.34 to 1.29), and 90.0% versus 88.9% (HR, 0.85; 90% CI, 0.35 to 2.10) in patients with low/low-intermediate IPI. Overall response rate with R-CHOP and VR-CHOP was 98% and 96%, respectively. The overall survival HR was 0.75 (90% CI, 0.38 to 1.45); 2-year survival rates were 88.4% and 93.0%, respectively. In the safety population (100 R-CHOP and 101 VR-CHOP patients), grade ≥ 3 adverse events included neutropenia (53% v 49%), thrombocytopenia (13% v 29%), anemia (7% v 15%), leukopenia (26% v 25%), and neuropathy (1% v 5%). Conclusion Outcomes for newly diagnosed, prospectively enrolled patients with non-GCB DLBCL were more favorable than expected with R-CHOP and were not significantly improved by adding bortezomib.
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Affiliation(s)
- John P Leonard
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Kathryn S Kolibaba
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - James A Reeves
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Anil Tulpule
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Ian W Flinn
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Tatjana Kolevska
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Robert Robles
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Christopher R Flowers
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Robert Collins
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Nicholas J DiBella
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Steven W Papish
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Parameswaran Venugopal
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Andrew Horodner
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Amir Tabatabai
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Julio Hajdenberg
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Jaehong Park
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Rachel Neuwirth
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - George Mulligan
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Kaveri Suryanarayan
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Dixie-Lee Esseltine
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
| | - Sven de Vos
- John P. Leonard, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY; Kathryn S. Kolibaba, Compass Oncology, Vancouver, WA; Kathryn S. Kolibaba and Nicholas J. DiBella, US Oncology Research, The Woodlands; Robert Collins, University of Texas Southwestern Medical Center, Dallas, TX; James A. Reeves, Florida Cancer Specialists, Fort Myers; Julio Hajdenberg, University of Florida Health Cancer Center at Orlando Health, Orlando, FL; Anil Tulpule, Keck Medicine of University of Southern California; Sven de Vos, University of California at Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles; Tatjana Kolevska, Kaiser Permanente Medical Center Northern California, Vallejo; Robert Robles, Bay Area Cancer Research Group (Diablo Valley Medical Group), Pleasant Hill; Andrew Horodner, Cancer Care Associates Medical Group, Redondo Beach, CA; Ian W. Flinn, Sarah Cannon Research Institute, Nashville, TN; Christopher R. Flowers, Winship Cancer Institute of Emory University, Atlanta, GA; Nicholas J. DiBella, Rocky Mountain Cancer Centers, Aurora, CO; Steven W. Papish, Summit Medical Group MD Anderson Cancer Center, Camden, NJ; Parameswaran Venugopal, Rush University Medical Center, Chicago, IL; Amir Tabatabai, York Cancer Center/Cancer Care Associates of York, York, PA; and Jaehong Park, Rachel Neuwirth, George Mulligan, Kaveri Suryanarayan, and Dixie-Lee Esseltine, Millennium Pharmaceuticals, Cambridge, MA
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15
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Fowler NH, Cheah CY, Gascoyne RD, Gribben J, Neelapu SS, Ghia P, Bollard C, Ansell S, Curran M, Wilson WH, O'Brien S, Grant C, Little R, Zenz T, Nastoupil LJ, Dunleavy K. Role of the tumor microenvironment in mature B-cell lymphoid malignancies. Haematologica 2017; 101:531-40. [PMID: 27132279 DOI: 10.3324/haematol.2015.139493] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/28/2016] [Indexed: 12/19/2022] Open
Abstract
The tumor microenvironment is the cellular and molecular environment in which the tumor exists and with which it continuously interacts. In B-cell lymphomas, this microenvironment is intriguing in that it plays critical roles in the regulation of tumor cell survival and proliferation, fostering immune escape as well as the development of treatment resistance. The purpose of this review is to summarize the proceedings of the Second Annual Summit on the Immune Microenvironment in Hematologic Malignancies that took place on September 11-12, 2014 in Dublin, Ireland. We provide a timely overview of the composition and biological relevance of the cellular and molecular microenvironment interface and discuss the role of interactions between the microenvironment and neoplastic cells in a variety of B-cell lymphomas. In addition, we focus on various novel therapeutic strategies that target the tumor microenvironment, including agents that modulate B-cell receptor pathways and immune-checkpoints, chimeric antigen receptor T cells and immunomodulatory agents.
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Affiliation(s)
- Nathan H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chan Yoon Cheah
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Department of Haematology, Pathwest Laboratory Medicine WA and Sir Charles Gairdner Hospital, Perth, Western Australia University of Western Australia, Perth, Canada
| | - Randy D Gascoyne
- British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada
| | - John Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, London, UK
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Ghia
- Università Vita-Salute San Raffaele, Division of Experimental Oncology, IRCCS Istituto Scientifico San Raffaele, Milan, Italy Department of Onco-Hematology, Ospedale San Raffaele, Milan, Italy
| | | | | | - Michael Curran
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wyndham H Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Richard Little
- Cancer Therapeutic Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kieron Dunleavy
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, MD, USA
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16
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How gene polymorphisms can influence clinical response and toxicity following R-CHOP therapy in patients with diffuse large B cell lymphoma. Blood Rev 2017; 31:235-249. [DOI: 10.1016/j.blre.2017.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 12/07/2016] [Accepted: 02/03/2017] [Indexed: 12/20/2022]
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17
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Staiger AM, Ziepert M, Horn H, Scott DW, Barth TFE, Bernd HW, Feller AC, Klapper W, Szczepanowski M, Hummel M, Stein H, Lenze D, Hansmann ML, Hartmann S, Möller P, Cogliatti S, Lenz G, Trümper L, Löffler M, Schmitz N, Pfreundschuh M, Rosenwald A, Ott G. Clinical Impact of the Cell-of-Origin Classification and the MYC/ BCL2 Dual Expresser Status in Diffuse Large B-Cell Lymphoma Treated Within Prospective Clinical Trials of the German High-Grade Non-Hodgkin's Lymphoma Study Group. J Clin Oncol 2017; 35:2515-2526. [PMID: 28525305 DOI: 10.1200/jco.2016.70.3660] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To explore the prognostic impact and interdependence of the cell-of-origin (COO) classification, dual expression (DE) of MYC and BCL2 proteins, and MYC, BCL2, and BCL6 translocations in two prospectively randomized clinical trials of patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Overall, 452 formalin-fixed paraffin-embedded samples from two prospective, randomized DLBCL trials (RICOVER-60, prospective, randomized study for patients > 60 years, all IPI groups; and R-MegaCHOEP, prospective, randomized study for patients ≤ 60 years with age-adjusted IPI 2,3) of the German High-Grade Non-Hodgkin Lymphoma Study Group were analyzed with the Lymph2Cx assay for COO classification, with immunohistochemistry for MYC and BCL2, and with fluorescent in situ hybridization for MYC, BCL2, and BCL6 rearrangements. Results COO classification was successful in 414 of 452 samples. No significant differences with respect to COO (activated B-cell [ABC]-like DLBCL v germinal center B-cell [GCB]-like DLBCL) were observed in event-free survival, progression-free survival, and overall survival in patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in the RICOVER-60 trial. Also, no differences with respect to COO were observed in multivariable analyses adjusted for International Prognostic Index factors in event-free survival (hazard ratio [HR] of ABC-like disease v GCB-like disease, 1.0; 95% CI, 0.6 to 1.6; P = .93), progression-free survival (HR, 1.1; 95% CI, 0.6 to 1.8; P = .82), and overall survival (HR, 1.0; 95% CI, 0.6 to 1.8; P = .96). Similar results were observed in the R-MegaCHOEP trial. In patients treated with R-CHOP, DE status was associated with significantly inferior survival compared with nonDE within the GCB, but not within the ABC subgroup. DE status was associated with significantly inferior outcome compared with patients with ABC-like DLBCL without DE (5-year PFS rate, 39% [95% CI,19% to 59%] v 68% [95% CI, 52% to 85%]; P = .03) and compared with patients with GCB-like DLBCL without DE. When data from patients with nonDE were analyzed separately, the outcome of patients in the ABC subgroup was inferior to that of patients in the GCB subgroup (5-year PFS rate, 68% [95% CI, 52% to 85%] v 85% [95% CI, 74% to 96%]; P = .04). Conclusion COO profiling in two prospective randomized DLBCL trials failed to identify prognostic subgroups, whereas dual expression of MYC and BCL2 was predictive of poor survival. Evaluation of prognostic or predictive biomarkers in the management of DLBCL, such as the COO, within prospective clinical trials will be important in the future.
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Affiliation(s)
- Annette M Staiger
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Marita Ziepert
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heike Horn
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - David W Scott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Thomas F E Barth
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Heinz-Wolfram Bernd
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Alfred C Feller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Wolfram Klapper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Monika Szczepanowski
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Hummel
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Harald Stein
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Dido Lenze
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Martin-Leo Hansmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sylvia Hartmann
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Peter Möller
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sergio Cogliatti
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Georg Lenz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Lorenz Trümper
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Markus Löffler
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Norbert Schmitz
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Michael Pfreundschuh
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andreas Rosenwald
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
| | - German Ott
- Annette M. Staiger, Heike Horn, and German Ott, Institute of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart; Annette M. Staiger and Heike Horn, Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart; Annette M. Staiger and Heike Horn, University of Tuebingen, Tuebingen; Marita Ziepert and Markus Löffler, Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Leipzig; Thomas F.E. Barth and Peter Möller, Institute of Pathology, Universitätsklinikum Ulm, Ulm; Heinz-Wolfram Bernd and Alfred C. Feller, Haematopathologie Luebeck, Luebeck; Wolfram Klapper and Monika Szczepanowski, Institute of Pathology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Monika Szczepanowski, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel; Michael Hummel and Dido Lenze, Institute of Pathology, Campus Benjamin Franklin, Charité Universitätsmedizin; Harald Stein, Pathodiagnostik Berlin, Berlin; Martin-Leo Hansmann and Sylvia Hartmann, Dr. Senckenberg Institute of Pathology, Goethe University Hospital, Frankfurt; Georg Lenz, Translational Oncology, Albert-Schweitzer-Campus 1, University Hospital Münster, and Cluster of Excellence EXC 1003, Cells in Motion, Münster; Lorenz Trümper, Georg-August Universität, Göttingen; Norbert Schmitz, Asklepios Klinik St Georg, Hamburg; Michael Pfreundschuh, Saarland University Medical School, Homburg/Saar; Andreas Rosenwald, Institute of Pathology, Universität Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany; David W. Scott, Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; and Sergio Cogliatti, Institute of Pathology, Kantonal Hospital St Gallen, St Gallen, Switzerland
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Miura K, Konishi J, Miyake T, Makita M, Hojo A, Masaki Y, Uno M, Ozaki J, Yoshida C, Niiya D, Kitazume K, Maeda Y, Takizawa J, Sakai R, Yano T, Yamamoto K, Sunami K, Hiramatsu Y, Aoyama K, Tsujimura H, Murakami J, Hatta Y, Kanno M. A Host-Dependent Prognostic Model for Elderly Patients with Diffuse Large B-Cell Lymphoma. Oncologist 2017; 22:554-560. [PMID: 28408622 DOI: 10.1634/theoncologist.2016-0260] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/29/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Decision-making models for elderly patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) are in great demand. PATIENTS AND METHODS The Society of Lymphoma Treatment in Japan (SoLT-J), in collaboration with the West-Japan Hematology and Oncology Group (West-JHOG), collected and retrospectively analyzed the clinical records of ≥65-year-old patients with DLBCL treated with R-CHOP from 19 sites across Japan to build an algorithm that can stratify adherence to R-CHOP. RESULTS A total of 836 patients with a median age of 74 years (range, 65-96 years) were analyzed. In the SoLT-J cohort (n = 555), age >75 years, serum albumin level <3.7 g/dL, and Charlson Comorbidity Index score ≥3 were independent adverse risk factors and were defined as the Age, Comorbidities, and Albumin (ACA) index. Based on their ACA index score, patients were categorized into "excellent" (0 points), "good" (1 point), "moderate" (2 points), and "poor" (3 points) groups. This grouping effectively discriminated the 3-year overall survival rates, mean relative total doses (or relative dose intensity) of anthracycline and cyclophosphamide, unanticipated R-CHOP discontinuance rates, febrile neutropenia rates, and treatment-related death rates. Additionally, the ACA index showed comparable results for these clinical parameters when it was applied to the West-JHOG cohort (n = 281). CONCLUSION The ACA index has the ability to stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of elderly patients with DLBCL treated with R-CHOP. The Oncologist 2017;22:554-560 IMPLICATIONS FOR PRACTICE: Currently, little is known regarding how to identify elderly patients with diffuse large B-cell lymphoma who may tolerate a full dose of chemotherapy or to what extent cytotoxic drugs should be reduced in some specific conditions. The Society of Lymphoma Treatment in Japan developed a host-dependent prognostic model consisting of higher age (>75 years), hypoalbuminemia (<3.7 g/dL), and higher Charlson Comorbidity Index score (≥3) for such elderly patients. This model can stratify the prognosis, tolerability to cytotoxic drugs, and adherence to treatment of these patients and thus help clinicians in formulating personalized treatment strategies for this growing patient population.
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Affiliation(s)
- Katsuhiro Miura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Konishi
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takaaki Miyake
- Department of Oncology/Hematology, Shimane University Hospital, Shimane, Japan
| | - Masanori Makita
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Atsuko Hojo
- Division of Hematology and Oncology, Kasukabe Medical Center, Saitama, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Masatoshi Uno
- Division of Internal Medicine, Kaneda Hospital, Okayama, Japan
| | - Jun Ozaki
- Department of Hematology, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Chikamasa Yoshida
- Department of Hematology, National Hospital Organization Minami-Okayama Medical Center, Okayama, Japan
| | - Daigo Niiya
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | - Koichi Kitazume
- Department of Hematology, Showa General Hospital, Tokyo, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomofumi Yano
- Department of Hematology, Okayama Rosai Hospital, Okayama, Japan
| | | | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yasushi Hiramatsu
- Department of Hematology and Oncology, Japanese Red Cross Society Himeji Hospital, Hyogo, Japan
| | - Kazutoshi Aoyama
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Hideki Tsujimura
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masatoshi Kanno
- Oncology Center, Nara Medical University Hospital, Nara, Japan
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19
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Gifford G, Gabrielli S, Gill A, Greenwood M, Wong K, Best G, Nevell D, McIlroy K, Kliman D, Ilmay-Gillespie L, Tiley C, Miranda S, Armytage T, Stevenson W. Lymphoma cell-of-origin assignment by gene expression profiling is clinically meaningful across broad laboratory contexts. Br J Haematol 2017; 181:272-275. [DOI: 10.1111/bjh.14556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Grace Gifford
- Northern Blood Research Centre; Kolling Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
- Department of Haematology and Transfusion Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Sara Gabrielli
- Northern Blood Research Centre; Kolling Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - Anthony Gill
- Department of Anatomical Pathology; Royal North Shore Hospital; Sydney New South Wales Australia
- Cancer Diagnosis and Pathology Group; Kolling Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - Matthew Greenwood
- Northern Blood Research Centre; Kolling Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
- Department of Haematology and Transfusion Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Kelly Wong
- Department of Haematology and Transfusion Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Giles Best
- Northern Blood Research Centre; Kolling Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - David Nevell
- Department of Anatomical Pathology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Kirsty McIlroy
- Department of Anatomical Pathology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - David Kliman
- Department of Haematology and Transfusion Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Louise Ilmay-Gillespie
- Department of Haematology and Transfusion Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Campbell Tiley
- Department of Haematology; Gosford Hospital; Gosford New South Wales Australia
| | - Sunaina Miranda
- Department of Haematology; Gosford Hospital; Gosford New South Wales Australia
| | - Tasman Armytage
- Department of Haematology; Gosford Hospital; Gosford New South Wales Australia
| | - William Stevenson
- Northern Blood Research Centre; Kolling Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
- Department of Haematology and Transfusion Medicine; Royal North Shore Hospital; Sydney New South Wales Australia
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20
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Schmidt-Hansen M, Berendse S, Marafioti T, McNamara C. Does cell-of-origin or MYC, BCL2 or BCL6 translocation status provide prognostic information beyond the International Prognostic Index score in patients with diffuse large B-cell lymphoma treated with rituximab and chemotherapy? A systematic review. Leuk Lymphoma 2017; 58:2403-2418. [DOI: 10.1080/10428194.2017.1287364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mia Schmidt-Hansen
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Sabine Berendse
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Teresa Marafioti
- Department of Histopathology, University College London Hospital, London, UK
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21
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Horn H, Staiger AM, Ott G. New targeted therapies for malignant lymphoma based on molecular heterogeneity. Expert Rev Hematol 2016; 10:39-51. [DOI: 10.1080/17474086.2017.1268046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Heike Horn
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Stuttgart, Germany
| | - Annette M. Staiger
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Stuttgart, Germany
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany
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22
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An oxidative stress-based mechanism of doxorubicin cytotoxicity suggests new therapeutic strategies in ABC-DLBCL. Blood 2016; 128:2797-2807. [PMID: 27737889 DOI: 10.1182/blood-2016-03-705814] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 10/03/2016] [Indexed: 12/16/2022] Open
Abstract
Diffuse large B-cell lymphomas (DLBCLs) contain 2 major molecular subtypes; namely, the germinal center B-cell-like (GCB) and the activated B-cell-like (ABC) DLBCLs. It is well documented that ABC-DLBCL cases have a significantly poorer survival response than GCB-DLBCLs in both the CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) and the rituximab (R)-CHOP eras. However, the underlying cause of this subtype disparity is poorly understood. Nevertheless, these clinical observations raise the possibility for an ABC-DLBCL-specific resistance mechanism that is directed toward 1 of the CHOP components and is inadequately addressed by rituximab. Here, we report that the main cytotoxic ingredient in CHOP, doxorubicin (Dox), has subtype-specific mechanisms of cytotoxicity in DLBCLs resulting from differences in the subcellular distribution pattern. Specifically, in cell line models of ABC-DLBCL, Dox is often enriched in the cytoplasm away from the nuclear DNA. As a result, Dox-induced cytotoxicity in ABC-DLBCLs is often dependent on oxidative stress, rather than DNA damage response. These findings are corroborated by gene signature analysis, which demonstrates that basal oxidative stress status predicts treatment outcome among patients with ABC-DLBCL, but not patients with GCB-DLBCL. In terms of redox-related resistance mechanism, our results suggest that STAT3 confers Dox resistance in ABC-DLBCLs by reinforcing an antioxidant program featuring upregulation of the SOD2 gene. Furthermore, a small-molecule STAT3 inhibitor synergizes with CHOP to trigger oxidative stress and kill ABC-DLBCL cells in preclinical models. These results provide a mechanistic basis for development of novel therapies that target either STAT3 or redox homeostasis to improve treatment outcomes for ABC-DLBCLs.
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23
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Dhakal S, Bates JE, Casulo C, Friedberg JW, Becker MW, Liesveld JL, Constine LS. Patterns and Timing of Failure for Diffuse Large B-Cell Lymphoma After Initial Therapy in a Cohort Who Underwent Autologous Bone Marrow Transplantation for Relapse. Int J Radiat Oncol Biol Phys 2016; 96:372-378. [DOI: 10.1016/j.ijrobp.2016.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/07/2016] [Accepted: 05/19/2016] [Indexed: 01/29/2023]
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Ewing's Sarcoma as a Second Malignancy in Long-Term Survivors of Childhood Hematologic Malignancies. Sarcoma 2016; 2016:5043640. [PMID: 27524931 PMCID: PMC4976151 DOI: 10.1155/2016/5043640] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/19/2016] [Indexed: 12/20/2022] Open
Abstract
Modern multimodal treatment has significantly increased survival for patients affected by hematologic malignancies, especially in childhood. Following remission, however, the risk of developing a further malignancy is an important issue. The long-term estimated risk of developing a sarcoma as a secondary malignancy is increased severalfold in comparison to the general population. Ewing's sarcoma family encompasses a group of highly aggressive, undifferentiated, intra- and extraosseous, mesenchymal tumors, caused by several types of translocations usually involving the EWSR1 gene. Translocation associated sarcomas, such as Ewing sarcoma, are only rarely encountered as therapy associated secondary tumors. We describe the clinical course and management of three patients from a single institution with Ewing's sarcoma that followed successfully treated lymphoblastic T-cell leukemia or non-Hodgkin lymphoma. The literature on secondary Ewing's sarcoma is summarized and possible pathogenic mechanisms are critically discussed.
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25
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Burotto M, Berkovits A, Dunleavy K. Double hit lymphoma: from biology to therapeutic implications. Expert Rev Hematol 2016; 9:669-78. [PMID: 27166590 DOI: 10.1080/17474086.2016.1182858] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is a molecularly heterogeneous disease defined by different cellular origins and mechanisms of oncogenic activation. Approximately 10% of DLBCL cases harbor a MYC rearrangement and this has been associated with a more aggressive clinical course following standard therapy. AREAS COVERED So-called 'double-hit lymphomas' (DHL) or 'triple hit lymphomas' (THL) occur when MYC is concurrently rearranged with BCL2 and/or BCL6. These tumors are characterized by high proliferation rate and a very poor outcome following standard R-CHOP (rituximab, cyclophosphamide, doxorubicin vincristine and prednisone) therapy, in most (though not all) studies that have looked at this. Though there is a paucity of published experience with other chemotherapy regimens, there is emerging evidence that more intensive approaches may improve outcome. Recently, there has been a lot of focus in the literature on 'double-expresser lymphomas' (DEL) with high MYC, BCL2 and/or BCL6 expression but typically without rearrangements of these genes. These DEL cases, have a poor outcome with R-CHOP and there is little consensus on how they should be approached. Expert commentary: This review will focus on the biology and treatment of DHL and DEL, discuss the outcome of these diseases with current standard as well as promising new approaches and conclude with a section on novel agents that are in development for these diseases.
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Affiliation(s)
- Mauricio Burotto
- a Hemato-Oncology Service, Clinica Alemana de Santiago , School of Medicine Universidad del Desarrollo , Santiago , Chile
| | - Alejandro Berkovits
- a Hemato-Oncology Service, Clinica Alemana de Santiago , School of Medicine Universidad del Desarrollo , Santiago , Chile
| | - Kieron Dunleavy
- b Lymphoid Malignancies Branch, Center for Cancer Research , National Cancer Institute , Bethesda , MD , USA
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26
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Ko TM, Wong CS, Wu JY, Chen YT. Pharmacogenomics for personalized pain medicine. ACTA ACUST UNITED AC 2016; 54:24-30. [PMID: 26976339 DOI: 10.1016/j.aat.2016.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 11/26/2022]
Abstract
Pharmacogenomics aims to unravel the way that human genetic variation affects drug efficacy and toxicity. Genome-wide association studies and candidate gene findings suggest that genetic approaches may help choose the most appropriate drug and dosage while preventing adverse drug reactions (ADRs). Pain is an unpleasant feeling that usually results from tissue damage. The management of different types of pain (acute, chronic, inflammatory, neuropathic, or cancer) is challenging. Currently, drug intervention is the first-line therapy for resolving pain. However, differences in drug efficacy between individuals are common with pain medications. Moreover, some patients experience ADRs after being treated with specific pain drugs. This review discusses the use of drugs for pain management in the context of the recent pharmacogenomic studies on ADRs and drug efficacy.
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Affiliation(s)
- Tai-Ming Ko
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Shung Wong
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yuan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
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27
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Gifford GK, Gill AJ, Stevenson WS. Molecular subtyping of diffuse large B-cell lymphoma: update on biology, diagnosis and emerging platforms for practising pathologists. Pathology 2016; 48:5-16. [DOI: 10.1016/j.pathol.2015.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 01/04/2023]
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28
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Devarakonda S, Morgensztern D, Govindan R. Genomic alterations in lung adenocarcinoma. Lancet Oncol 2015; 16:e342-51. [PMID: 26149886 DOI: 10.1016/s1470-2045(15)00077-7] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 12/11/2022]
Abstract
Treatment for non-small-cell lung cancer is evolving from the use of cytotoxic chemotherapy to personalised treatment based on molecular alterations. This past decade has witnessed substantial progress in the treatment of patients with EGFR mutations and ALK rearrangements, and it is now possible to study complex genomic alterations in cancer using next-generation sequencing. Sequencing data from large-scale consortia, such as The Cancer Genome Atlas, as well as several independent groups, have helped identify novel drivers and potentially targetable alterations in lung adenocarcinomas. These data clearly suggest that lung adenocarcinoma is associated with distinct genomic alterations compared with other lung cancer subtypes, and highlight the widespread molecular heterogeneity that underlies the disease. In this Review, we discuss some of the key findings from genomic studies of lung adenocarcinoma.
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Affiliation(s)
- Siddhartha Devarakonda
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Daniel Morgensztern
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA; Alvin J Siteman Cancer Center, St Louis, MO, USA
| | - Ramaswamy Govindan
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA; Alvin J Siteman Cancer Center, St Louis, MO, USA.
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29
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Tilly H, Gomes da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A, Walewski J, André M, Johnson PW, Pfreundschuh M, Ladetto M. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v116-25. [PMID: 26314773 DOI: 10.1093/annonc/mdv304] [Citation(s) in RCA: 518] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- H Tilly
- Centre Henri-Becquerel, Université de Rouen, Rouen, France
| | | | - U Vitolo
- A.O. Città della Salute e della Scienza di Torino, Turin, Italy
| | - A Jack
- St James's University Hospital, Leeds, UK
| | - M Meignan
- Henri Mondor University Hospital, Créteil, France
| | | | - J Walewski
- Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - M André
- CHU Dinant-Godinne, UCL Namur, Yvoir, Belgium
| | - P W Johnson
- Cancer Research UK, University of Southampton, Southampton, UK
| | - M Pfreundschuh
- Innere Medizin I, Universität des Saarlandes, Hamburg, Germany
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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30
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Zucca E, Bertoni F, Vannata B, Cavalli F. Emerging role of infectious etiologies in the pathogenesis of marginal zone B-cell lymphomas. Clin Cancer Res 2015; 20:5207-16. [PMID: 25320370 DOI: 10.1158/1078-0432.ccr-14-0496] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Extranodal marginal zone B-cell lymphomas of the mucosa-associated lymphoid tissue (MALT) arise from lymphoid populations that are induced by chronic inflammation in extranodal sites. The most frequently affected organ is the stomach, where MALT lymphoma is incontrovertibly associated with a chronic gastritis induced by a microbial pathogen, Helicobacter pylori. Gastric MALT lymphoma therefore represents a paradigm for evaluating inflammation-associated lymphomagenesis, which may lead to a deeper understanding of a possible etiologic association between other microorganisms and nongastric marginal zone lymphomas. Besides infectious etiology, chronic inflammation caused by autoimmune diseases, such as Sjögren syndrome or Hashimoto thyroiditis, can also carry a significant risk factor for the development of marginal zone lymphoma. In addition to the continuous antigenic drive, additional oncogenic events play a relevant role in lymphoma growth and progression to the point at which the lymphoproliferative process may eventually become independent of antigenic stimulation. Recent studies on MALT lymphomas have in fact demonstrated genetic alterations affecting the NF-κB) pathway, a major signaling pathway involved in many cancers. This review aims to present marginal zone lymphoma as an example of the close pathogenetic link between chronic inflammation and tumor development, with particular attention to the role of infectious agents and the integration of these observations into everyday clinical practice. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Emanuele Zucca
- Lymphoma Unit, Division of Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Francesco Bertoni
- Lymphoma Unit, Division of Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. Lymphoma and Genomics Research Program, IOR Institute of Oncology Research, Bellinzona, Switzerland
| | - Barbara Vannata
- Lymphoma Unit, Division of Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Franco Cavalli
- Lymphoma Unit, Division of Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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31
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O'Connor OA, Tobinai K. Putting the clinical and biological heterogeneity of non-hodgkin lymphoma into context. Clin Cancer Res 2015; 20:5173-81. [PMID: 25320367 DOI: 10.1158/1078-0432.ccr-14-0574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The lymphomas represent one of the most heterogeneous groups of malignancies in all of cancer medicine. Whether one attempts to understand these diseases in the context of their complicated ontogeny, unique biologic features, or clinical presentation, this heterogeneity has been a mixed blessing. On the one hand, it has created an ever-changing way to classify these diseases, as classification schemes have been compelled to reflect the rapidly emerging information that seems to split the disease into smaller and smaller subtypes. On the other hand, the biologic and clinical dissection of these diseases has allowed for the identification of unique biologic features-features that have led to novel targets and generated a plethora of new drugs. Virtually every subtype of non-Hodgkin lymphoma has benefited from these efforts to understand the biology of the different subtypes. This paradigm has led to new clinical trials that tailor novel drug regimens to specific biologic disease subtypes. As a prelude to this CCR Focus section, we attempt to put this evolving heterogeneity into context, bridging historical and modern-day views of classification of these diseases. Then, some of the world's leading lymphoma researchers share their perspectives on how to formulate new concepts of care in this era of biologic discovery. Over a relatively short time, the advances in lymphoma research have been nothing short of stunning. There now seems to be little doubt that these recent breakthroughs will redound favorably on the majority of patients diagnosed with a lymphoproliferative malignancy. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Owen A O'Connor
- Medicine and Experimental Therapeutics, Center for Lymphoid Malignancies, Columbia University Medical Center, College of Physicians and Surgeons, The New York Presbyterian Hospital, New York, New York.
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
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32
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Bachy E, Salles G. Are we nearing an era of chemotherapy-free management of indolent lymphoma? Clin Cancer Res 2015; 20:5226-39. [PMID: 25320372 DOI: 10.1158/1078-0432.ccr-14-0437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Indolent B-cell lymphomas are heterogeneous, comprising three grades of follicular lymphoma, small lymphocytic lymphoma, Waldenstöm macroglobulinemia, marginal zone lymphoma, and most recently, possibly low proliferative mantle cell lymphoma. These lymphomas are characterized by a high responsiveness to chemotherapy or immunochemotherapy; however, in most cases, conventional therapy might not offer a cure. Furthermore, the patient's age at diagnosis, at time to first or subsequent relapses, as well as potential comorbidities often preclude the use of chemotherapy. Recent progress has been made in our understanding of dysregulated pathways and immunologic antitumor responses in indolent lymphoma. Major therapeutic advances have been achieved in the development of nonchemotherapeutic agents, making "chemo-free" treatment a near-future reality. In this article, we highlight these promising approaches, such as the combination of anti-CD20 antibodies with immunomodulatory drugs, with mAbs directed against other surface antigens such as CD22, with immunomodulatory antibodies such as PD-1, or with inhibitors of key steps in the B-cell receptor pathway signaling. However, the cost of such therapies and potential, albeit manageable, toxicity should be considered. Phase III trials will confirm the benefit of these new treatment strategies that do not require a chemotherapeutic drug and help us identify their exact place in the therapeutic armamentarium for indolent lymphoma. Here we focus on follicular lymphoma, which is the most frequent subtype of indolent lymphoma and for which an increasing body of evidence has emerged that supports the dawn of a new era of chemotherapy-free treatment. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Emmanuel Bachy
- Hospices Civils de Lyon, Service d'Hématologie, Pierre Bénite Cedex, France. Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite Cedex, France
| | - Gilles Salles
- Hospices Civils de Lyon, Service d'Hématologie, Pierre Bénite Cedex, France. Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux, Université de Lyon, Pierre Bénite Cedex, France.
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33
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Dreyling M, Ferrero S, Vogt N, Klapper W. New paradigms in mantle cell lymphoma: is it time to risk-stratify treatment based on the proliferative signature? Clin Cancer Res 2015; 20:5194-206. [PMID: 25320369 DOI: 10.1158/1078-0432.ccr-14-0836] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The elucidation of crucial biologic pathways of cell survival and proliferation has led to the development of highly effective drugs, some of which have markedly improved mantle cell lymphoma (MCL) therapeutic opportunities in the past 10 years. Moreover, an undeniable clinical heterogeneity in treatment response and disease behavior has become apparent in this neoplasm. Thus, the need for biologic markers stratifying patients with MCL in risk classes deserving different treatment approaches has recently been fervently expressed. Among several newly discovered biomarkers, the dismal predictive value of a high proliferative signature has been broadly recognized in large studies of patients with MCL. Different techniques have been used to assess tumor cell proliferation, including mitotic index, immunostaining with Ki-67 antibody, and gene expression profiling. Ki-67 proliferative index, in particular, has been extensively investigated, and its negative impact on relapse incidence and overall survival has been validated in large prospective clinical trials. However, one important pitfall limiting its widespread use in clinical practice is the reported interobserver variability, due to the previous lack of a standardized approach for quantification among different laboratories. In the present review, we describe some of the major techniques to assess cell proliferation in MCL, focusing in particular on the Ki-67 index and its need for a standardized approach to be used in multicenter clinical trials. The value of MCL biologic prognostic scores (as MIPI-b) is discussed, along with our proposal on how to integrate these scores in the planning of future trials investigating a tailored therapeutic approach for patients with MCL. See all articles in this CCR Focus section, "Paradigm Shifts in Lymphoma."
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Affiliation(s)
- Martin Dreyling
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, München, Germany.
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Italy
| | - Niklas Vogt
- Department of Pathology, Hematopathology Section and Lymph Node Registry Kiel. University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry Kiel. University Hospital Schleswig-Holstein, Campus Kiel, Germany
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