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Cortese MJ, Wei W, Cerdeña S, Watkins MP, Olson M, Jodon G, Kaiser J, Haverkos B, Hughes ME, Namoglu E, Grover NS, Snow A, Orellana-Noia V, Rainey M, Sohail M, Rudoni J, Portell C, Voorhees T, Landsburg DJ, Kamdar M, Kahl BS, Hill BT. A multi-center analysis of the impact of DA-EPOCH-R dose-adjustment on clinical outcomes of patients with double/triple-hit lymphoma. Leuk Lymphoma 2023; 64:107-118. [PMID: 36323309 DOI: 10.1080/10428194.2022.2140281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with double- and triple-hit lymphomas (DHL/THL) have inferior outcomes with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and higher-intensity regimens such as dose-adjusted (DA)-EPOCH-R are standard. Dose-intensification of DA-EPOCH-R is guided by hematologic toxicity, without conclusive benefit for DHL/THL patients. To determine if cumulative doses of DA-EPOCH-R or compliance with dose adjustment impacts survival, we retrospectively evaluated detailed clinical data from 109 adult (age ≥18 years) patients with DHL/THL treated with ≥4 cycles of induction DA-EPOCH-R from 2014 to 2019 at six centers. A comprehensive multivariate analysis was performed. Survival outcomes for the entire cohort were comparable to historical estimates for DHL/THL treated with this regimen (median follow-up 27.9 months). Overall survival (OS) and progression-free survival (PFS) were not significantly associated with cumulative chemotherapy dose, dose escalation, or compliance with dose adjustment. Heterogeneous dosing practices were observed. Prospective investigation is warranted to evaluate the practice of dose adjustment of R-EPOCH for patients with DHL/THL.
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Affiliation(s)
- Matthew J Cortese
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, OH, USA
| | - Wei Wei
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Lerner Research Institute, Cleveland, OH, USA
| | - Sebastian Cerdeña
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Marcus P Watkins
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Marissa Olson
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Gray Jodon
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Jeff Kaiser
- University of Colorado Cancer Center, Aurora, CO, USA
| | | | - Mitchell E Hughes
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Esin Namoglu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Natalie S Grover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Anson Snow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Victor Orellana-Noia
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA
| | - Magdalena Rainey
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammad Sohail
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Joslyn Rudoni
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Craig Portell
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, USA
| | - Timothy Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel J Landsburg
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Manali Kamdar
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Brad S Kahl
- Barnes-Jewish Hospital, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland, OH, USA
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2
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Samineni D, Huang W, Gibiansky L, Ding H, Zhang R, Li C, Sinha A, Rajwanshi R, Humphrey K, Bazeos A, Salem AH, Miles D. Population Pharmacokinetics and Exposure-Response Analyses for Venetoclax in Combination with R-CHOP in Relapsed/Refractory and Previously Untreated Patients with Diffuse Large B Cell Lymphoma. Adv Ther 2022; 39:598-618. [PMID: 34822104 PMCID: PMC8799559 DOI: 10.1007/s12325-021-01919-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022]
Abstract
Introduction Outcomes remain poor in patients with diffuse large B cell lymphoma (DLBCL) who overexpress BCL-2 protein. We present population pharmacokinetics (PopPK) and exposure–response (ER) analyses for venetoclax (a selective BCL-2 inhibitor) administered with rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in patients with relapsed/refractory (R/R) and previously untreated (1L) non-Hodgkin lymphoma (NHL) from the phase 1b/2 CAVALLI study, to confirm dose selection for future studies. Methods Analyses included 216 patients with R/R or 1L NHL treated for eight 21-day cycles with 400–800 mg venetoclax (cycle 1: days 4–10; cycles 2–8: days 1–10) in combination with R for eight cycles and CHOP for 6–8 cycles. A legacy PopPK model for venetoclax was used to describe the observed data and provide post hoc PK parameters. Venetoclax steady-state exposure (AUCss) was used to predict clinical efficacy, safety, or tolerability. To isolate the effect of venetoclax, ER analyses referenced data from the R-CHOP arm of a historical control study, GOYA, in 1L DLBCL. Results There was no significant association between venetoclax AUCss and progression-free survival or complete response either for all-comers or the BCL-2-immunohistochemistry-positive subpopulation. No statistically significant trends were observed with venetoclax AUCss and the key grade ≥ 3 adverse events and serious adverse events. Similar dose intensities were observed for venetoclax and R-CHOP components across venetoclax exposures, suggesting venetoclax did not impact delivery of the R-CHOP backbone. Conclusions The PopPK and ER analyses, in addition to the positive benefit–risk observed in the clinical data, support the selection of 800 mg venetoclax given with R-CHOP for future studies in BCL-2-immunohistochemistry-positive patients with 1L DLBCL. Trial Registration ClinicalTrials.gov Identifier NCT02055820. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01919-z.
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Affiliation(s)
- Divya Samineni
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA.
| | - Weize Huang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | - Hao Ding
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | - Rong Zhang
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | - Chunze Li
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | | | | | | | - Ahmed Hamed Salem
- AbbVie Inc., North Chicago, IL, USA
- Ain Shams University, Cairo, Egypt
| | - Dale Miles
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
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3
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Li S, Fang J, Si T, Lu Y, Jiang L. Salvianolic acid A inhibits the growth of diffuse large B-cell lymphoma through MAPK pathways. Exp Hematol 2021; 94:60-68.e2. [PMID: 33278489 DOI: 10.1016/j.exphem.2020.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/13/2020] [Accepted: 11/28/2020] [Indexed: 12/19/2022]
Abstract
Treatment options are limited in patients with diffuse large B-cell lymphoma (DLBCL). Salvianolic acid A (SAA) is a water-soluble phenolic acid extracted from Salvia miltiorrhiza (Danshen) with anti-tumor properties. The anti-leukemic activity of SAA found in our recent research prompted us to investigate the therapeutic effect and mechanism of action of SAA in DLBCL. In the work described here, we found that SAA inhibited the viability of DLBCL cells by inducing cellular apoptosis, which was accompanied by upregulation of Bax and cleavage of PARP. Pre-incubation of SAA increased the phosphorylation of JNK, while it decreased the phosphorylation of p38 and ERK in DLBCL cells. Importantly, pharmacologic JNK inhibition partially mitigated the anti-survival effect of SAA, and inhibition of p38 and ERK synergized with SAA. Furthermore, SAA suppressed DLBCL tumor growth in a xenograft mouse model in vivo. Therefore, our data suggest the therapeutic utility of SAA in the management of DLBCL.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/chemistry
- Antineoplastic Agents, Phytogenic/pharmacology
- Antineoplastic Agents, Phytogenic/therapeutic use
- Caffeic Acids/chemistry
- Caffeic Acids/pharmacology
- Caffeic Acids/therapeutic use
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Humans
- Lactates/chemistry
- Lactates/pharmacology
- Lactates/therapeutic use
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- MAP Kinase Signaling System/drug effects
- Male
- Mice, Inbred BALB C
- Salvia miltiorrhiza/chemistry
- Mice
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Affiliation(s)
- Shuting Li
- Department of Pathology, Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, Ningbo, China
| | - Jingwen Fang
- Department of Pathology, Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, Ningbo, China
| | - Ting Si
- Department of Hematology, Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Ying Lu
- Department of Hematology, Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Lei Jiang
- Department of Pathology, Zhejiang Provincial Key Laboratory of Pathophysiology, Ningbo University School of Medicine, Ningbo, China.
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4
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Bisso A, Sabò A, Amati B. MYC in Germinal Center-derived lymphomas: Mechanisms and therapeutic opportunities. Immunol Rev 2019; 288:178-197. [PMID: 30874346 DOI: 10.1111/imr.12734] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
The rearrangement of immunoglobulin loci during the germinal center reaction is associated with an increased risk of chromosomal translocations that activate oncogenes such as MYC, BCL2 or BCL6, thus contributing to the development of B-cell lymphomas. MYC and BCL2 activation are initiating events in Burkitt's (BL) and Follicular Lymphoma (FL), respectively, but can occur at later stages in other subtypes such as Diffuse Large-B Cell Lymphoma (DLBCL). MYC can also be activated during the progression of FL to the transformed stage. Thus, either DLBCL or FL can give rise to aggressive double-hit lymphomas (DHL) with concurrent activation of MYC and BCL2. Research over the last three decades has improved our understanding of the functions of these oncogenes and the basis for their cooperative action in lymphomagenesis. MYC, in particular, is a transcription factor that contributes to cell activation, growth and proliferation, while concomitantly sensitizing cells to apoptosis, the latter being blocked by BCL2. Here, we review our current knowledge about the role of MYC in germinal center B-cells and lymphomas, discuss MYC-induced dependencies that can sensitize cancer cells to select pharmacological inhibitors, and illustrate their therapeutic potential in aggressive lymphomas-and in particular in DHL, in combination with BCL2 inhibitors.
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Affiliation(s)
- Andrea Bisso
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Arianna Sabò
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bruno Amati
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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5
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Resistance to BTK inhibition by ibrutinib can be overcome by preventing FOXO3a nuclear export and PI3K/AKT activation in B-cell lymphoid malignancies. Cell Death Dis 2019; 10:924. [PMID: 31801949 PMCID: PMC6892912 DOI: 10.1038/s41419-019-2158-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023]
Abstract
Chronic activation of the Bruton’s tyrosine kinase (BTK)-mediated B-cell receptor (BCR) signaling is a hallmark of many B-cell lymphoid malignancies, including chronic lymphocytic leukemia (CLL) and diffuse large B-cell lymphoma (DLBCL). Ibrutinib, an FDA approved, orally administered BTK inhibitor, has demonstrated high response rates, however, complete responses are infrequent and acquired resistance to BTK inhibition can emerge. In this study, we generated ibrutinib-resistant (IB-R) cell lines by chronic exposure of CLL and activated B-cell (ABC)-DLBCL cells to ibrutinib in order to investigate the mechanism of acquired resistance to ibrutinib. IB-R cell lines demonstrated downregulation of FOXO3a and PTEN levels and activation of AKT, with their levels being low in the nuclei of resistant cells in comparison to the sensitive counterparts. Inhibition of PI3K and AKT using idelalisib and MK2206, respectively increased ibrutinib-induced apoptosis in IB-R cells by downregulation of pAKT473 and restoring FOXO3a levels, demonstrating the importance of these cell survival factors for ibrutinib-resistance. Notably, the exportin 1 inhibitor, selinexor synergized with ibrutinib in IB-R cells and restored nuclear abundance of FOXO3a and PTEN, suggesting that nuclear accumulation of FOXO3a and PTEN facilitates increase in ibrutinib-induced apoptosis in IB-R cells. These data demonstrate that reactivation of FOXO3a nuclear function enhances the efficacy of ibrutinib and overcomes acquired resistance to ibrutinib. Together, these findings reveal a novel mechanism that confers ibrutinib resistance via aberrant nuclear/cytoplasmic subcellular localization of FOXO3a and could be exploited by rational therapeutic combination regimens for effectively treating lymphoid malignancies.
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6
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Novo M, Castellino A, Nicolosi M, Santambrogio E, Vassallo F, Chiappella A, Vitolo U. High-grade B-cell lymphoma: how to diagnose and treat. Expert Rev Hematol 2019; 12:497-506. [DOI: 10.1080/17474086.2019.1624157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mattia Novo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Alessia Castellino
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Maura Nicolosi
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Elisa Santambrogio
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Francesco Vassallo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Annalisa Chiappella
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Umberto Vitolo
- Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
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7
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Li LR, Wang L, He YZ, Young KH. Current perspectives on the treatment of double hit lymphoma. Expert Rev Hematol 2019; 12:507-514. [PMID: 31117849 DOI: 10.1080/17474086.2019.1623020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Double hit lymphoma (DHL) represents a new diagnostic category with genetic, immunohistochemical and clinical characteristics intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Patients with DHL usually experience poor survival after frontline R-CHOP treatment and require alternative therapies. However, the ideal therapeutic options remain undefined. Areas covered: Traditional therapies for the treatment of DHL are discussed, including intensive induction, hematopoietic stem cell transplantation (HSCT), methotrexate CNS-directed prophylaxis, and radiation therapy. The authors further introduce small-molecule inhibitors targeting myc or bcl-2 signaling pathways, chimeric antigen receptor T-cell therapy, programmed death-1 monoclonal antibody and immunomodulatory drugs as novel approaches. Expert opinion: No standard treatment exists for DHL. At present, DA-EPOCH-R exhibits an upfront induction option. Central nervous system prophylaxis with methotrexate is recommended as part of the induction therapy. For those who do not obtain complete remission, HSCT or clinical trials should be considered. Targeted approaches, especially chimeric antigen receptor T-cell therapies and small-molecule inhibitors targeting myc or bcl-2, exhibit the potential of improving outcomes for patients with DHL. High-throughput sequencing is a promising technique both at diagnosis and relapse, in order to predict outcomes and potential novel therapies.
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Affiliation(s)
- Lin-Rong Li
- a Second Clinical Medical College , Southern Medical University , Guangzhou , China
| | - Liang Wang
- b Department of Hematology , Zhujiang Hospital of Southern Medical University , Guangzhou , China
| | - Ying-Zhi He
- b Department of Hematology , Zhujiang Hospital of Southern Medical University , Guangzhou , China
| | - Ken H Young
- c Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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8
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Dheur MS, Poirel HA, Ameye G, Tilman G, Saussoy P, Defour JP, Camboni A, Van Den Neste E, Coulie PG, van Baren N. Characterization of two new high-grade B-cell lymphoma cell lines with MYC and BCL2 rearrangements that are suitable for in vitro drug sensitivity studies. Leuk Lymphoma 2018; 60:1043-1052. [PMID: 30277098 DOI: 10.1080/10428194.2018.1508663] [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] [Indexed: 01/01/2023]
Abstract
High-grade B-cell lymphomas with MYC and BCL2 or BCL6 rearrangements are highly aggressive B-cell lymphomas called double-hit lymphomas (HGBL-DH). They are particularly refractory to standard treatments and carry a poor prognosis. Fragments of resected tumoral lymph nodes from two HGBL-DH patients were put in culture. Continuously proliferating cells were characterized and compared with the original tumors. In both cases, the proliferating cells and the tumor displayed MYC and BCL2 rearrangements. Both cell lines (called LB5848-LYMP and LB5871-LYMP) presented a high proliferation rate and were maintained in culture for more than one year. Upon injection in immunodeficient mice, LB5848-LYMP gave rise to lymphoid tumors. In vitro treatment of these cell lines with a BCL2-inhibitory drug (ABT-199) selectively stopped their proliferation. These new cell lines represent valuable tools for studying HGBL-DH and for the in vitro testing of candidate therapies targeting HGBL-DH. LB5848-LYMP is also suitable for similar experiments in vivo.
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Affiliation(s)
- Marie-Sophie Dheur
- a Cellular Genetics Unit , de Duve Institute, Université Catholique de Louvain , Brussels , Belgium
| | - Hélène A Poirel
- b Centre de Génétique Humaine , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Geneviève Ameye
- b Centre de Génétique Humaine , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Gaëlle Tilman
- b Centre de Génétique Humaine , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Pascale Saussoy
- c Department of Clinical Biology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Jean-Philippe Defour
- c Department of Clinical Biology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Alessandra Camboni
- d Department of Pathology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Tour Franklin , Brussels , Belgium.,e Department of Hematology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Eric Van Den Neste
- e Department of Hematology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Pierre G Coulie
- a Cellular Genetics Unit , de Duve Institute, Université Catholique de Louvain , Brussels , Belgium
| | - Nicolas van Baren
- a Cellular Genetics Unit , de Duve Institute, Université Catholique de Louvain , Brussels , Belgium
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9
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Wight JC, Chong G, Grigg AP, Hawkes EA. Prognostication of diffuse large B-cell lymphoma in the molecular era: moving beyond the IPI. Blood Rev 2018; 32:400-415. [PMID: 29605154 DOI: 10.1016/j.blre.2018.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/21/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with variable outcomes. Despite the majority of patients being cured with combination chemoimmunotherapy, up to 30% eventually succumb to the disease. Until recently, baseline prognostic assessment has centred on the International Prognostic Index (IPI), although this index is yet to impact strongly on treatment choice. Molecular features such as cell of origin, MYC and BCL-2 genetic alterations and protein overexpression were identified over a decade ago, yet their prognostic value is still not fully elucidated. Adding complexity are the plethora of new clinical, biological and molecular prognostic markers described in the recent literature, most of which lack independent validation, likely act as surrogate markers for those already in common use and have yet to substantially impact on therapeutic decision making. This review comprehensively assesses the value of individual prognostic markers in the clinical setting and their potential to predict response to novel agents, and ways to optimise their use in future research.
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Affiliation(s)
- Joel C Wight
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia.
| | - Geoffrey Chong
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia.
| | - Andrew P Grigg
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia; University of Melbourne, Melbourne, Australia.
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia; University of Melbourne, Melbourne, Australia; Eastern Health, Box Hill, Australia.
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10
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Ravà M, D’Andrea A, Nicoli P, Gritti I, Donati G, Doni M, Giorgio M, Olivero D, Amati B. Therapeutic synergy between tigecycline and venetoclax in a preclinical model of MYC/BCL2 double-hit B cell lymphoma. Sci Transl Med 2018; 10:10/426/eaan8723. [DOI: 10.1126/scitranslmed.aan8723] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/08/2017] [Accepted: 12/28/2017] [Indexed: 01/10/2023]
Abstract
High-grade B cell lymphomas with concurrent activation of the MYC and BCL2 oncogenes, also known as double-hit lymphomas (DHL), show dismal prognosis with current therapies. MYC activation sensitizes cells to inhibition of mitochondrial translation by the antibiotic tigecycline, and treatment with this compound provides a therapeutic window in a mouse model of MYC-driven lymphoma. We now addressed the utility of this antibiotic for treatment of DHL. BCL2 activation in mouse Eμ-myc lymphomas antagonized tigecycline-induced cell death, which was specifically restored by combined treatment with the BCL2 inhibitor venetoclax. In line with these findings, tigecycline and two related antibiotics, tetracycline and doxycycline, synergized with venetoclax in killing human MYC/BCL2 DHL cells. Treatment of mice engrafted with either DHL cell lines or a patient-derived xenograft revealed strong antitumoral effects of the tigecycline/venetoclax combination, including long-term tumor eradication with one of the cell lines. This drug combination also had the potential to cooperate with rituximab, a component of current front-line regimens. Venetoclax and tigecycline are currently in the clinic with distinct indications: Our preclinical results warrant the repurposing of these drugs for combinatorial treatment of DHL.
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11
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Esteve-Arenys A, Valero JG, Chamorro-Jorganes A, Gonzalez D, Rodriguez V, Dlouhy I, Salaverria I, Campo E, Colomer D, Martinez A, Rymkiewicz G, Pérez-Galán P, Lopez-Guillermo A, Roué G. The BET bromodomain inhibitor CPI203 overcomes resistance to ABT-199 (venetoclax) by downregulation of BFL-1/A1 in in vitro and in vivo models of MYC+/BCL2+ double hit lymphoma. Oncogene 2018; 37:1830-1844. [PMID: 29353886 DOI: 10.1038/s41388-017-0111-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/16/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022]
Abstract
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, mostly known as double-hit lymphoma (DHL), is a rare entity characterized by morphologic and molecular features between Burkitt lymphoma and the clinically manageable diffuse large B-cell lymphoma (DLBCL). DHL patients usually undergo a rapidly progressing clinical course associated with resistance to standard chemo-immunotherapy. As a consequence, the prognosis of this entity is particularly poor with a median overall survival inferior to 1 year. ABT-199 (venetoclax) is a potent and selective small-molecule antagonist of BCL-2 recently approved for the treatment of a specific subtype of lymphoid neoplasm. In this study, we demonstrate that single-agent ABT-199 efficiently displaces BAX from BCL-2 complexes but fails to maintain a significant antitumor activity over time in most MYC+/BCL2+DHL cell lines and primary cultures, as well as in a xenograft mouse model of the disease. We further identify the accumulation of the BCL2-like protein BFL-1 to be a major mechanism involved in acquired resistance to ABT-199. Noteworthy, this phenomenon can be counteracted by the BET bromodomain inhibitor CPI203, since gene expression profiling identifies BCL2A1, the BFL-1 coding gene, as one of the top apoptosis-related gene modulated by this compound. Upon CPI203 treatment, simultaneous downregulation of MYC and BFL-1 further overcomes resistance to ABT-199 both in vitro and in vivo, engaging synergistic caspase-mediated apoptosis in DHL cultures and tumor xenografts. Together, these findings highlight the relevance of BFL-1 in DH lymphoma-associated drug resistance and support the combined use of a BCL-2 antagonist and a BET inhibitor as a promising therapeutic strategy for patients with aggressive DHL.
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Affiliation(s)
- A Esteve-Arenys
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - J G Valero
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - A Chamorro-Jorganes
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - D Gonzalez
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - V Rodriguez
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - I Dlouhy
- Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - I Salaverria
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - E Campo
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - D Colomer
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Hematopathology Unit, Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - A Martinez
- Hematopathology Unit, Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - G Rymkiewicz
- Department of Pathology, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - P Pérez-Galán
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain
| | - A Lopez-Guillermo
- Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain.,Department of Hematology, Hospital Clinic, Barcelona, Spain
| | - G Roué
- Aggressive B-cell Lymphoma Study Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain. .,Division of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), CIBERONC, Barcelona, Spain. .,Laboratory of Experimental Hematology, Department of Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
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12
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Chen L, Zhang JS, Liu DG, Cui D, Meng ZL. An algorithmic approach to diagnose haematolymphoid neoplasms in effusion by combining morphology, immunohistochemistry and molecular cytogenetics. Cytopathology 2017; 29:10-21. [PMID: 28913874 DOI: 10.1111/cyt.12449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- L. Chen
- Department of Pathology; Beijing Hospital; National Centre of Gerontology; No. 1 Da Hua Road Dong Dan Beijing China
| | - J. S. Zhang
- Department of Pathology; Beijing Hospital; National Centre of Gerontology; No. 1 Da Hua Road Dong Dan Beijing China
| | - D. G. Liu
- Department of Pathology; Beijing Hospital; National Centre of Gerontology; No. 1 Da Hua Road Dong Dan Beijing China
| | - D. Cui
- Department of Pathology; Beijing Hospital; National Centre of Gerontology; No. 1 Da Hua Road Dong Dan Beijing China
| | - Z. L. Meng
- Department of Pathology; Peking Union Medical College Hospital; Chinese Academy of Medical Science; Dongcheng District Beijing China
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13
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Okolo ON, Johnson AC, Yun S, Arnold SJ, Anwer F. Rare transformation to double hit lymphoma in Waldenstrom's macroglobulinemia. Immunotherapy 2017; 9:709-714. [PMID: 28771100 DOI: 10.2217/imt-2017-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Waldenström macroglobulinemia (WM) is a lymphoproliferative lymphoma that is characterized by monoclonal immunoglobulin M (IgM) protein and bone marrow infiltration. Its incidence is rare and rarer still is its ability to transform to a B-cell lymphoma, particularly the aggressive diffuse large B-cell lymphoma, which bodes a poor prognosis. When transformation includes mutations of MYC, BCL-2 and/or BCL-6, it is known as a 'double hit' or 'triple hit' lymphoma respectively. This paper presents a rare case of WM with mutations positive for MYC and BCL2, making it a case of double hit B-cell lymphoplasmacytic lymphoma with plasmatic differentiation without morphological transformation to aggressive histology like DLBCL. The paper also broadens to include discussions on current topics in the classification, diagnosis, possible causes of transformation, and treatment of WM, including transformation to double hit lymphoma. The significance of this case lies in that the presence of double hit lymphoma-like genetic mutations in WM have not been previously described in the literature and potentially such changes are harbinger of extra-nodal presentation, aggressive growth, and possibly poor prognosis, if data from other double-hit lymphoma are extrapolated.
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Affiliation(s)
- Onyemaechi N Okolo
- Department of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 8572, USA
| | - Ariel C Johnson
- University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85721, USA
| | - Seongseok Yun
- Hematology & Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Stacy J Arnold
- Division of Pathology, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85721, USA
| | - Faiz Anwer
- Department of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 8572, USA.,Division of Hematology, Oncology, Blood & Marrow Transplantation, Department of Medicine, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85721, USA
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14
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Bischin AM, Dorer R, Aboulafia DM. Transformation of Follicular Lymphoma to a High-Grade B-Cell Lymphoma With MYC and BCL2 Translocations and Overlapping Features of Burkitt Lymphoma and Acute Lymphoblastic Leukemia: A Case Report and Literature Review. Clin Med Insights Blood Disord 2017; 10:1179545X17692544. [PMID: 28579851 PMCID: PMC5428247 DOI: 10.1177/1179545x17692544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/16/2017] [Indexed: 12/16/2022]
Abstract
Most commonly, histologic transformation (HT) from follicular lymphoma (FL) manifests as a diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS). Less frequently, HT may result in a high-grade B-cell lymphoma (HGBL) with MYC and B-cell lymphoma protein 2 (BCL2) and/or BCL6 gene rearrangements, also known as “double-hit” or “triple-hit” lymphomas. In the 2016 revision of the World Health Organization (WHO) classification of lymphoid neoplasms, the category B-cell lymphoma, unclassifiable was eliminated due to its vague criteria and limiting diagnostic benefit. Instead, the WHO introduced the HGBL category, characterized by MYC and BCL2 and/or BCL6 rearrangements. Cases that present as an intermediate phenotype of DLBCL and Burkitt lymphoma (BL) will fall within this HGBL category. Very rarely, HT results in both the intermediate DLBCL and BL phenotypes and exhibits lymphoblastic features, in which case the WHO recommends that this morphologic appearance should be noted. In comparison with de novo patients with DLBCL, NOS, those with MYC and BCL2 and/or BCL6 gene rearrangements have a worse prognosis. A 63-year-old woman presented with left neck adenopathy. Laboratory assessments, including complete blood count, complete metabolic panel, serum lactate dehydrogenase, and β2-microglobulin, were all normal. A whole-body computerized tomographic (CT) scan revealed diffuse adenopathy above and below the diaphragm. An excisional node biopsy showed grade 3A nodular FL. The Ki67 labeling index was 40% to 50%. A bone marrow biopsy showed a small focus of paratrabecular CD20+ lymphoid aggregates. She received 6 cycles of bendamustine (90 mg/m2 on days +1 and +2) and rituximab (375 mg/m2 on day +2), with each cycle delivered every 4 weeks. A follow-up CT scan at completion of therapy showed a partial response with resolution of axillary adenopathy and a dramatic shrinkage of the large retroperitoneal nodes. After 18 months, she had crampy abdominal pain in the absence of B symptoms. Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-d-glucose integrated with CT (18F-FDG PET/CT) scan showed widespread adenopathy, diffuse splenic involvement, and substantial marrow involvement. Biopsy of a 2.4-cm right axillary node (SUVmax of 16.1) showed involvement by grade 3A FL with a predominant nodular pattern of growth. A bone marrow biopsy once again showed only a small focus of FL. She received idelalisib (150 mg twice daily) and rituximab (375 mg/m2, monthly) beginning May 2015. After 4 cycles, a repeat CT scan showed a complete radiographic response. Idelalisib was subsequently held while she received corticosteroids for immune-mediated colitis. A month later, she restarted idelalisib with a 50% dose reduction. After 2 weeks, she returned to clinic complaining of bilateral hip and low lumbar discomfort but no B symptoms. A restaging 18F-FDG PET/CT in January 2016 showed dramatic marrow uptake. A bone marrow aspirate showed sheets of tumor cells representing a spectrum from intermediate-sized cells with lymphoblastic features to very large atypical cells with multiple nucleoli. Two distinct histologies were present; one remained consistent with the patient’s known FL with a predominant nodular pattern and the other consistent with HT (the large atypical cells expressed PAX5, CD10, BCL2, and c-MYC and were negative for CD20, MPO, CD34, CD30, and BCL6). Focal areas showed faint, heterogeneous expression of terminal deoxynucleotidyl transferase best seen on the clot section. Ki67 proliferation index was high (4+/4). Fluorescence in situ hybridization analysis showed 2 populations with MYC amplification and/or rearrangement and no evidence of BCL6 rearrangement; a karyotype analysis showed a complex abnormal female karyotype with t(14;18) and multiple structural and numerical abnormalities. She started dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin with concomitant prophylactic intrathecal methotrexate and cytarabine. She had but a short-lived response before dying in hospice from progressive lymphoma. Whether idelalisib could provide a microenvironment for selection of more aggressive clones needs to be addressed. Our patient’s clinical course is confounded by the incorporation of idelalisib while being further complicated by the complexity of HT and the mechanisms in which first-line chemotherapy regimens affect double-hit lymphoma.
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Affiliation(s)
- Alina M Bischin
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Russell Dorer
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Department of Hematology and Oncology, Virginia Mason Medical Center, Seattle, WA, USA.,Division of Hematology, School of Medicine, University of Washington, Seattle, WA, USA
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15
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A new method for real-time evaluation of pepsin digestion of paraffin-embedded tissue sections, prior to fluorescence in situ hybridisation. Virchows Arch 2017; 470:567-573. [DOI: 10.1007/s00428-017-2097-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 01/28/2017] [Accepted: 02/16/2017] [Indexed: 01/02/2023]
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16
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Dozzo M, Carobolante F, Donisi PM, Scattolin A, Maino E, Sancetta R, Viero P, Bassan R. Burkitt lymphoma in adolescents and young adults: management challenges. Adolesc Health Med Ther 2017; 8:11-29. [PMID: 28096698 PMCID: PMC5207020 DOI: 10.2147/ahmt.s94170] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
About one-half of all Burkitt lymphoma (BL) patients are younger than 40 years, and one-third belong to the adolescent and young adult (AYA) subset, defined by an age between 15 and 25-40 years, based on selection criteria used in different reports. BL is an aggressive B-cell neoplasm displaying highly characteristic clinico-diagnostic features, the biologic hallmark of which is a translocation involving immunoglobulin and c-MYC genes. It presents as sporadic, endemic, or epidemic disease. Endemicity is pathogenetically linked to an imbalance of the immune system which occurs in African children infected by malaria parasites and Epstein-Barr virus, while the epidemic form strictly follows the pattern of infection by HIV. BL shows propensity to extranodal involvement of abdominal organs, bone marrow, and central nervous system, and can cause severe metabolic and renal impairment. Nevertheless, BL is highly responsive to specifically designed short-intensive, rotational multiagent chemotherapy programs, empowered by the anti-CD20 monoclonal antibody rituximab. When carefully applied with appropriate supportive measures, these modern programs achieve a cure rate of approximately 90% in the average AYA patient, irrespective of clinical stage, which is the best result achievable in any aggressive lymphoid malignancy to date. The challenges ahead concern the following: optimization of management in underdeveloped countries, with reduction of diagnostic and referral-for-care intervals, and the applicability of currently curative regimens; the development of lower intensity but equally effective treatments for frail or immunocompromised patients at risk of death by complications; the identification of very high-risk patients through positron-emission tomography and minimal residual disease assays; and the assessment in these and the few refractory/relapsed ones of new monoclonals (ofatumumab, blinatumomab, inotuzumab ozogamicin) and new molecules targeting c-MYC and key proliferative steps of B-cell malignancies.
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Affiliation(s)
- Massimo Dozzo
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Pietro Maria Donisi
- Simple Departmental Operative Unit of Anatomic Pathology, Ospedale Ss. Giovanni e Paolo, Venice, Italy
| | | | - Elena Maino
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | | | - Piera Viero
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
| | - Renato Bassan
- Complex Operative Unit of Hematology, Ospedale dell’Angelo
- Correspondence: Renato Bassan, Complex Operative Unit of Hematology, Ospedale dell’Angelo, Via Paccagnella 11, 30174 Mestre-Venice, Italy, Tel +39 41 965 7362, Fax +39 41 965 7361, Email
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17
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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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