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Yimpak P, Bumroongkit K, Tantiworawit A, Rattanathammethee T, Aungsuchawan S, Daroontum T. Immunohistochemistry-based investigation of MYC, BCL2, and Ki-67 protein expression and their clinical impact in diffuse large B-cell lymphoma in upper Northern Thailand. PLoS One 2024; 19:e0307253. [PMID: 39038016 PMCID: PMC11262692 DOI: 10.1371/journal.pone.0307253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL) that accounts for approximately 25-40% of all NHL cases. The objective of this study was to investigate the protein expression, clinical impact, and prognostic role of MYC, BCL2, and Ki-67 in Thai DLBCL patients. A retrospective analysis was conducted on 100 DLBCL patients diagnosed between January 2018 and December 2019. Immunohistochemistry was used to assess the expression of MYC, BCL2, and Ki-67. The study revealed a significant association between extranodal involvement and positive cases of MYC and BCL2. MYC expressions were associated with Ki-67 expression, while BCL2 positivity was associated with the non-germinal center B-cell (non-GCB) subtype. However, there were no significant differences in the three-year overall survival (OS) and three-year progression-free survival (PFS) rates when using cut-off points of ≥ 40% for MYC, ≥ 50% for BCL2, and ≥ 70% for Ki-67. Notably, DLBCL cases with co-expression of MYC and BCL2 exhibited significantly inferior three-year OS compared to other cases (0% vs. 53%; p = 0.020). Multivariate analysis identified age ≥ 60 years and Eastern Cooperative Oncology Group (ECOG) performance status as independent prognostic factors. In conclusion, MYC, BCL2, and Ki-67 expression can serve as prognostic biomarkers; however, their prognostic value may vary based on the specific cut-off values used. Therefore, determining the appropriate threshold for each biomarker based on individual laboratory analyses and clinical outcomes is crucial.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/genetics
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Proto-Oncogene Proteins c-bcl-2/genetics
- Ki-67 Antigen/metabolism
- Male
- Female
- Proto-Oncogene Proteins c-myc/metabolism
- Proto-Oncogene Proteins c-myc/genetics
- Middle Aged
- Thailand/epidemiology
- Aged
- Adult
- Immunohistochemistry
- Retrospective Studies
- Prognosis
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Young Adult
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Affiliation(s)
- Phuttirak Yimpak
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokkan Bumroongkit
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Adisak Tantiworawit
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanawat Rattanathammethee
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirinda Aungsuchawan
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teerada Daroontum
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Negara I, Tomuleasa C, Buruiana S, Efremov DG. Molecular Subtypes and the Role of TP53 in Diffuse Large B-Cell Lymphoma and Richter Syndrome. Cancers (Basel) 2024; 16:2170. [PMID: 38927876 PMCID: PMC11201917 DOI: 10.3390/cancers16122170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy and a heterogeneous entity comprised of several biologically distinct subtypes. Recently, novel genetic classifications of DLBCL have been resolved based on common mutational patterns indicative of distinct pathways of transformation. However, the complicated and costly nature of the novel classifiers has precluded their inclusion into routine practice. In view of this, the status of the TP53 gene, which is mutated or deleted in 20-30% of the cases, has emerged as an important prognostic factor for DLBCL patients, setting itself apart from other predictors. TP53 genetic lesions are particularly enriched in a genetic subtype of DLBCL that shares genomic features with Richter Syndrome, highlighting the possibility of a subset of DLBCL arising from the transformation of an occult chronic lymphocytic leukemia-like malignancy, such as monoclonal B-cell lymphocytosis. Patients with TP53-mutated DLBCL, including those with Richter Syndrome, have a particularly poor prognosis and display inferior responses to standard chemoimmunotherapy regimens. The data presented in this manuscript argue for the need for improved and more practical risk-stratification models for patients with DLBCL and show the potential for the use of TP53 mutational status for prognostication and, in prospect, treatment stratification in DLBCL.
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Affiliation(s)
- Ivan Negara
- Molecular Hematology Unit, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
- Department of Internal Medicine, Hematology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, 2004 Chisinau, Moldova;
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Sanda Buruiana
- Department of Internal Medicine, Hematology, “Nicolae Testemitanu” State University of Medicine and Pharmacy, 2004 Chisinau, Moldova;
| | - Dimitar G. Efremov
- Molecular Hematology Unit, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
- Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia
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3
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Magazzino F, Aristei C, Passarelli A, Pierini A, De Giorgi U, Martinello R, Domenici L, Pignata S, Mangili G, Cormio G. Lymphomas of the Vulva: A Review of the MITO Rare Cancer Group. Cancers (Basel) 2024; 16:2102. [PMID: 38893221 PMCID: PMC11171216 DOI: 10.3390/cancers16112102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Since they are very rare tumors, lymphomas of the vulva are often not properly recognized. Patients with vulvar lymphoma are generally elderly and the classical manifestation of the disease is a vulvar mass. No significant age differences have been found between primary and secondary lymphoma. To make a correct diagnosis, it is therefore necessary to use not only histological examination but also the genetic and molecular profile in order to establish optimal therapeutic management. Literature analysis confirm the good prognosis of this disease.
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Affiliation(s)
- Francescapaola Magazzino
- Complex Operating Unit Obstetrics and Gynaecology, Ospedale Civile di San Donà di Piave-Venezia, AULSS4 Veneto Orientale, 30027 San Donà di Piave, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia General Hospital Sant’Andrea delle Fratte, University of Perugia, 06156 Perugia, Italy;
| | - Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80144 Napoli, Italy; (A.P.); (S.P.)
| | - Antonio Pierini
- Division of Hematolgy and Clinical Immunolgy, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy;
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, 44121 Ferrara, Italy;
| | - Lavinia Domenici
- 2nd Division of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy;
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80144 Napoli, Italy; (A.P.); (S.P.)
| | - Giorgia Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Gennaro Cormio
- Gynecologic Oncoly Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy
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4
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Woo YR, Kwon CS, Lee JE, Jeon BE, Kim TJ, Choo J, Seo YS, Kim SW. Ajania pacifica (Nakai) K. Bremer and Humphries Extract Limits MYC Expression to Induce Apoptosis in Diffuse Large B Cell Lymphoma. Curr Issues Mol Biol 2024; 46:4580-4594. [PMID: 38785546 PMCID: PMC11119827 DOI: 10.3390/cimb46050278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
The proto-oncogene MYC is frequently dysregulated in patients with diffuse large B-cell lymphoma (DLBCL) and plays a critical role in disease progression. To improve the clinical outcomes of patients with DLBCL, the development of strategies to target MYC is crucial. The use of medicinal plants for developing anticancer drugs has garnered considerable attention owing to their diverse mechanisms of action. In this study, 100 plant extracts of flora from the Republic of Korea were screened to search for novel agents with anti-DLBCL effects. Among them, Ajania pacifica (Nakai) K. Bremer and Humphries extract (APKH) efficiently suppressed the survival of DLBCL cells, while showing minimal toxicity toward normal murine bone marrow cells. APKH suppressed the expression of anti-apoptotic BCL2 family members, causing an imbalance between the pro-apoptotic and anti-apoptotic BCL2 members. This disrupted mitochondrial membrane potential, cytochrome c release, and pro-caspase-3 activation and eventually led to DLBCL cell death. Importantly, MYC expression was markedly downregulated by APKH and ectopic expression of MYC in DLBCL cells abolished the pro-apoptotic effects of APKH. These results demonstrate that APKH exerts anti-DLBCL effects by inhibiting MYC expression. Moreover, when combined with doxorubicin, an essential component of the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone), APKH synergistically enhanced the therapeutic effect of doxorubicin. This indicates that APKH may overcome drug resistance, which is common in patients with refractory/relapsed DLBCL. To identify compounds with anti-DLBCL activities in APKH, the chemical profile analysis of APKH was performed using UPLC-QTOF/MSe analysis and assessed for its anticancer activity. Based on the UPLC-QTOF/MSe chemical profiling, it is conceivable that APKH may serve as a novel agent targeting MYC and sensitizing drug-resistant DLBCL cells to CHOP chemotherapy. Further studies to elucidate how the compounds in APKH exert tumor-suppressive role in DLBCL are warranted.
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Affiliation(s)
- Ye-Rin Woo
- Department of Integrated Biological Science, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea; (Y.-R.W.); (C.-S.K.); (J.-E.L.); (B.-E.J.); (T.-J.K.)
| | - Chan-Seong Kwon
- Department of Integrated Biological Science, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea; (Y.-R.W.); (C.-S.K.); (J.-E.L.); (B.-E.J.); (T.-J.K.)
| | - Ji-Eun Lee
- Department of Integrated Biological Science, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea; (Y.-R.W.); (C.-S.K.); (J.-E.L.); (B.-E.J.); (T.-J.K.)
| | - Byeol-Eun Jeon
- Department of Integrated Biological Science, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea; (Y.-R.W.); (C.-S.K.); (J.-E.L.); (B.-E.J.); (T.-J.K.)
| | - Tae-Jin Kim
- Department of Integrated Biological Science, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea; (Y.-R.W.); (C.-S.K.); (J.-E.L.); (B.-E.J.); (T.-J.K.)
| | - Joy Choo
- Department of Biological Sciences, College of Arts and Sciences, Texas Tech University, Lubbock, TX 79409, USA;
| | - Young-Seob Seo
- Korea Research Institute of Standard and Science, Daejeon 34113, Republic of Korea;
| | - Sang-Woo Kim
- Department of Integrated Biological Science, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea; (Y.-R.W.); (C.-S.K.); (J.-E.L.); (B.-E.J.); (T.-J.K.)
- Department of Biological Sciences, College of Natural Sciences, Pusan National University, Busan 46241, Republic of Korea
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Blomme S, De Paepe P, Devos H, Emmerechts J, Snauwaert S, Cauwelier B. Alternative genetic alterations of MYC, BCL2, and/or BCL6 in high-grade B-cell lymphoma (HGBL) and diffuse large B-cell lymphoma (DLBCL): Can we identify different prognostic subgroups? Genes Chromosomes Cancer 2024; 63:e23211. [PMID: 37897298 DOI: 10.1002/gcc.23211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023] Open
Abstract
High-grade B-cell lymphoma (HGBL)/diffuse large B-cell lymphoma (DLBCL) with rearrangements (R) in MYC and BCL2 and/or BCL6 are correlated with poor prognosis. Little is known about the impact of other genetic alterations (gain (G) or amplification (A)) of these genes. The aim of the study was to investigate whether we can identify new prognostic subgroups. Fluorescence in situ hybridization (FISH) results from 169 HGBL/DLBCL were retrospectively categorized into: (1) concurrent MYC-R and BCL2-R and/or BCL6-R-samples with MYC-R and BCL2-R (+/- BCL6-R); n = 21, and HGBL/DLBCL with MYC-R and BCL6-R; n = 11; (2) concurrent R and G/A in MYC and BCL2 and/or BCL6 called "alternative HGBL/DLBCL"-samples with (n = 16) or without (n = 6) BCL2 involvement; (3) BCL2 and/or BCL6 alterations without MYC involvement (n = 35); (4) concurrent G/A in MYC and BCL2 and/or BCL6 without R (n = 25); and (5) "No alterations" (n = 55). Patients with HGBL/DLBCL-MYC/BCL2 and "alternative" HGBL/DLBCL (with BCL2 involvement) had significantly worse survival rates compared to the "no alterations" group. G/A of these genes in the absence of rearrangements did not show any prognostic significance. HGBL/DLBCL with MYC-R and BCL6-R without BCL2 involvement showed a better survival rate compared to HGBL/DLBCL-MYC/BCL2. According to immunohistochemistry, "double/triple" expression (DEL/TEL) did not show a significantly worse outcome compared to absent DEL/TEL. This study highlights the continued value of FISH assessment of MYC, BCL2, and BCL6 in the initial evaluation of HGBL/DLBCL with different survival rates between several genetic subgroups.
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Affiliation(s)
- Siska Blomme
- Department of Laboratory Medicine, AZ Sint-Jan Hospitals Brugge-Oostende, Brugge, Belgium
| | - Pascale De Paepe
- Department of Pathology, AZ Sint-Jan Hospitals Brugge-Oostende, Brugge, Belgium
| | - Helena Devos
- Department of Laboratory Medicine, AZ Sint-Jan Hospitals Brugge-Oostende, Brugge, Belgium
| | - Jan Emmerechts
- Department of Laboratory Medicine, AZ Sint-Jan Hospitals Brugge-Oostende, Brugge, Belgium
| | - Sylvia Snauwaert
- Department of Clinical Hematology, AZ Sint-Jan Hospitals Brugge-Oostende, Brugge, Belgium
| | - Barbara Cauwelier
- Department of Laboratory Medicine, AZ Sint-Jan Hospitals Brugge-Oostende, Brugge, Belgium
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Frigault MM, Mithal A, Wong H, Stelte-Ludwig B, Mandava V, Huang X, Birkett J, Johnson AJ, Izumi R, Hamdy A. Enitociclib, a Selective CDK9 Inhibitor, Induces Complete Regression of MYC+ Lymphoma by Downregulation of RNA Polymerase II Mediated Transcription. CANCER RESEARCH COMMUNICATIONS 2023; 3:2268-2279. [PMID: 37882668 PMCID: PMC10634346 DOI: 10.1158/2767-9764.crc-23-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
Double-hit diffuse large B-cell lymphoma (DH-DLBCL) is an aggressive, and often refractory, type of B-cell non-Hodgkin lymphoma (NHL) characterized by rearrangements in MYC and BCL2. Cyclin-dependent kinase 9 (CDK9) regulates transcriptional elongation and activation of transcription factors, including MYC, making it a potential targeted approach for the treatment of MYC+ lymphomas. Enitociclib is a well-tolerated and clinically active CDK9 inhibitor leading to complete metabolic remissions in 2 of 7 patients with DH-DLBCL treated with once weekly 30 mg intravenous administration. Herein, we investigate the pharmacodynamic effect of CDK9 inhibition in preclinical models and in blood samples from patients [DH-DLBCL (n = 10) and MYC+ NHL (n = 5)] treated with 30 mg i.v. once weekly enitociclib. Enitociclib shows significant regulation of RNA polymerase II Ser2 phosphorylation in a MYC-amplified SU-DHL-4 cell line and depletion of MYC and antiapoptosis protein MCL1 in SU-DHL-4 and MYC-overexpressing SU-DHL-10 cell lines in vitro. Tumor growth inhibition reaching 0.5% of control treated SU-DHL-10 xenografts is achieved in vivo and MYC and MCL1 depletion as well as evidence of apoptosis activation after enitociclib treatment is demonstrated. An unbiased analysis of the genes affected by CDK9 inhibition in both cell lines demonstrates that RNA polymerase II and transcription pathways are primarily affected and novel enitociclib targets such as PHF23 and TP53RK are discovered. These findings are recapitulated in blood samples from enitociclib-treated patients; while MYC downregulation is most robust with enitociclib treatment, other CDK9-regulated targets may be MYC independent delivering a transcriptional downregulation via RNA polymerase II. SIGNIFICANCE MYC+ lymphomas are refractory to standard of care and novel treatments that downregulate MYC are needed. The utility of enitociclib, a selective CDK9 inhibitor in this patient population, is demonstrated in preclinical models and patients. Enitociclib inhibits RNA polymerase II function conferring a transcriptional shift and depletion of MYC and MCL1. Enitociclib intermittent dosing downregulates transcription factors including MYC, providing a therapeutic window for durable responses in patients with MYC+ lymphoma.
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Affiliation(s)
| | | | | | | | | | - Xin Huang
- Vincerx Pharma, Inc., Palo Alto, California
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7
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Perry C, Greenberg O, Haberman S, Herskovitz N, Gazy I, Avinoam A, Paz-Yaacov N, Hershkovitz D, Avivi I. Image-Based Deep Learning Detection of High-Grade B-Cell Lymphomas Directly from Hematoxylin and Eosin Images. Cancers (Basel) 2023; 15:5205. [PMID: 37958379 PMCID: PMC10650414 DOI: 10.3390/cancers15215205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
Deep learning applications are emerging as promising new tools that can support the diagnosis and classification of different cancer types. While such solutions hold great potential for hematological malignancies, there have been limited studies describing the use of such applications in this field. The rapid diagnosis of double/triple-hit lymphomas (DHLs/THLs) involving MYC, BCL2 and/or BCL6 rearrangements is obligatory for optimal patient care. Here, we present a novel deep learning tool for diagnosing DHLs/THLs directly from scanned images of biopsy slides. A total of 57 biopsies, including 32 in a training set (including five DH lymphoma cases) and 25 in a validation set (including 10 DH/TH cases), were included. The DHL-classifier demonstrated a sensitivity of 100%, a specificity of 87% and an AUC of 0.95, with only two false positive cases, compared to FISH. The DHL-classifier showed a 92% predictive value as a screening tool for performing conventional FISH analysis, over-performing currently used criteria. The work presented here provides the proof of concept for the potential use of an AI tool for the identification of DH/TH events. However, more extensive follow-up studies are required to assess the robustness of this tool and achieve high performances in a diverse population.
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Affiliation(s)
- Chava Perry
- Hematology Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Orli Greenberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pathology Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6492601, Israel
| | - Shira Haberman
- Hematology Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Neta Herskovitz
- Hematology Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Inbal Gazy
- Imagene AI Ltd., Tel Aviv 6721409, Israel (N.P.-Y.)
| | | | | | - Dov Hershkovitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pathology Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6492601, Israel
| | - Irit Avivi
- Hematology Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Martínez-Martín S, Beaulieu ME, Soucek L. Targeting MYC-driven lymphoma: lessons learned and future directions. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2023; 6:205-222. [PMID: 37457123 PMCID: PMC10344726 DOI: 10.20517/cdr.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/24/2023] [Accepted: 03/22/2023] [Indexed: 07/18/2023]
Abstract
MYC plays a central role in tumorigenesis by orchestrating cell proliferation, growth and survival, among other transformation mechanisms. In particular, MYC has often been associated with lymphomagenesis. In fact, MYC overexpressing lymphomas such as high-grade B-cell lymphoma (HGBL) and double expressor diffuse large B-cell lymphomas (DLBCL), are considered addicted to MYC. In such a context, MYC targeting therapies are of special interest, as MYC withdrawal is expected to result in tumor regression. However, whether high MYC levels are always predictive of increased sensitivity to these approaches is not clear yet. Even though no MYC inhibitor has received regulatory approval to date, substantial efforts have been made to investigate avenues to render MYC a druggable target. Here, we summarize the different classes of molecules currently under development, which mostly target MYC indirectly in aggressive B-cell lymphomas, paying special attention to subtypes with MYC/BCL2 or BCL6 translocations or overexpression.
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Affiliation(s)
| | - Marie-Eve Beaulieu
- Peptomyc S.L., Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
| | - Laura Soucek
- Peptomyc S.L., Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Preclinical & Translational Research Program, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona 08035, Spain
- Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Ananthamurthy A. An immunohistochemical study of double-expressor lymphomas and its correlation with cell of origin. J Cancer Res Ther 2023; 19:S0. [PMID: 37147953 DOI: 10.4103/jcrt.jcrt_587_21] [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: 05/07/2023]
Abstract
Background Diffuse large B cell Lymphomas (DLBCL) that co express C MYC and BCL 2 are known as 'double expressor lymphomas' and are believed to have a worse prognosis than other diffuse large B cell lymphomas. This was a study to assess the frequency of double expressor lymphomas in our cohort of DLBCL. Aims and Objectives The aims of this study were to assess the frequency of double expression of C MYC and BCL 2 in cases of DLBCL and to correlate the same with clinicopathological parameters including cell of origin, namely germinal centre type versus non germinal centre type. Materials and Methods This was a retrospective observational study Immunostaining for MYC antibody and BCL2 were performed using the standard polymer/DAB technique. 40% for MYC and 50% for BCL2 were taken as cut off values.Chi square analysis was used to compare the variables, and a p value of less than 0.05 was taken as statistically significant. Results Of 40 cases studied, 11 (27.5%) were double expressors. There was no significant correlation of double expression with gender, site (nodal versus extra nodal), cell of origin namely germinal centre/non germinal centre types and Ki67 index when compared to the other group which did not show double expression. Conclusions Immunohistochemistry is a useful technique to detect double expressor lymphomas which are known to have an aggressive course. Cell of origin did not show significant correlation with double expression in our study.
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10
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Li S, Qiu L, Xu J, Lin P, Ok CY, Tang G, McDonnell TJ, James You M, Khanlari M, Miranda RN, Medeiros LJ. High-grade B-cell lymphoma (HGBL)-NOS is clinicopathologically and genetically more similar to DLBCL/HGBL-DH than DLBCL. Leukemia 2023; 37:422-432. [PMID: 36513804 DOI: 10.1038/s41375-022-01778-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
High-grade B-cell lymphoma, not otherwise specified (HGBL-NOS) is rare and data focused on these neoplasms is lacking. We studied the clinicopathologic and genetic features of 136 HGBL-NOS patients and compared them to patients with DLBCL/HGBL-DH (n = 224, defined by 5th Edition WHO) and DLBCL (n = 217). HGBL-NOS patients had clinical features similar to DLBCL/HGBL-DH patients. MYC rearrangement (MYC-R) was present in 43% of HGBL-NOS. With induction regimen similar to DLBCL/HGBL-DH patients, HGBL-NOS patients had a median overall survival (OS) of 28.9 months, similar to DLBCL/HGBL-DH (p = 0.48) but inferior to DLBCL patients (p = 0.03). R-EPOCH induction was associated with improved OS compared with R-CHOP. MYC-R, history of lymphoma, and high IPI were independent adverse prognostic factors in HGBL-NOS patients. Whole transcriptome profiling performed on a subset of HGBL-NOS cases showed a profile more similar to DLBCL/HGBL-DH than to DLBCL; 53% of HGBL-NOS had a DH-like signature (DH-like-Sig) and were enriched for MYC-R. DH-like-Sig+ HGBL-NOS patients had a poorer OS than DH-like-Sig-negative patients (p = 0.04). In conclusion, HGBL-NOS has clinicopathologic features and a gene expression profile more similar to DLBCL/HGBL-DH than to DLBCL. Cases of HGBL-NOS frequently carry MYC-R and have a DH-like-Sig+. R-EPOCH induction in HGBL-NOS appears associated with improved OS compared with standard R-CHOP.
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Affiliation(s)
- Shaoying Li
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States.
| | - Lianqun Qiu
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Jie Xu
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Pei Lin
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Chi Young Ok
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Guilin Tang
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Timothy J McDonnell
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - M James You
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Mahsa Khanlari
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - Roberto N Miranda
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
| | - L Jeffrey Medeiros
- Department of Hematopathology, UT MD Anderson Cancer Center, Houston, TX, United States
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11
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Thomas C, Thapa S, McLaughlin C, Halloran M, Porcu P. Point and counterpoint: Polatuzumab vedotin in the front-line therapy for diffuse large B- cell lymphoma. Front Oncol 2023; 12:1098375. [PMID: 36686842 PMCID: PMC9851376 DOI: 10.3389/fonc.2022.1098375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Colin Thomas
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, PA, United States,*Correspondence: Colin Thomas,
| | - Sameep Thapa
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Connor McLaughlin
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Molly Halloran
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Pierluigi Porcu
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, PA, United States
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12
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Laurent C, Cook JR, Yoshino T, Quintanilla-Martinez L, Jaffe ES. Follicular lymphoma and marginal zone lymphoma: how many diseases? Virchows Arch 2023; 482:149-162. [PMID: 36394631 PMCID: PMC9852150 DOI: 10.1007/s00428-022-03432-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/04/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022]
Abstract
Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are indolent mature B-cell neoplasms with variable clinical presentation and distinct histopathologic features. Recent advances in the biology and molecular characteristics of these lymphomas have further expanded our understanding of the heterogeneous nature of these lymphomas, with increasing recognition of specific disease entities within the broader categories of FL and MZL. Here, we discuss the conclusions of the 2022 International Consensus Classification of Mature Lymphoid Neoplasms (2022 ICC) dealing with FL, and review differences with the proposed WHO 5th Edition classification. We review issues related to grading and alternative forms of FL especially those lacking the genetic hallmark of FL, the t(14;18) chromosomal alteration. Among them, t(14;18)-negative CD23+ follicle center lymphoma has been proposed by the 2022 ICC as a provisional entity. Other follicle center-derived lymphomas such as pediatric-type follicular lymphoma, testicular follicular lymphoma, primary cutaneous follicle center lymphoma, and large B-cell lymphoma with IRF4 rearrangement are considered distinct entities separate from conventional FL. Importantly, large B-cell lymphoma with IRF4 rearrangement introduced as a provisional entity in the WHO 2017 is upgraded to a definite entity in the 2022 ICC. We also discuss diagnostic strategies for recognition of MZLs including splenic MZL, extranodal MZL (MALT lymphoma), and primary nodal MZL. The importance of molecular studies in the distinction among marginal zone lymphoma subtypes is emphasized, as well as their value in the differential diagnosis with other B-cell lymphomas.
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Affiliation(s)
- Camille Laurent
- Department of Pathology, Toulouse University Hospital Center, Cancer Institute University of Toulouse-Oncopole, Toulouse, France
| | - James R. Cook
- Department of Laboratory Medicine, Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH USA
| | - Tadashi Yoshino
- Department of Pathology, Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls Univesity of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tuebingen, Germany
| | - Elaine S. Jaffe
- National Cancer Institute, National Institutes of Health, Bethesda, MD USA
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13
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Wang Y, Jia S, Cao X, Ge S, Yu K, Chen Y. Application of next-generation sequencing in diffuse large B-cell lymphoma. Pharmacogenomics 2023; 24:59-68. [PMID: 36661028 DOI: 10.2217/pgs-2022-0140] [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: 01/21/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of invasive non-Hodgkin lymphoma. There is great heterogeneity in its molecular biological characteristics, clinical manifestations and prognosis. The use of rituximab has greatly improved the cure rate of DLBCL, but there are still 30% of patients with poor prognosis. In the era of precision medicine, the significance of molecular biology and genetic factors on the diagnosis, treatment and prognosis of patients has been found. Among these, next-generation sequencing technology plays an important role. This paper reviews the research progress of next-generation sequencing technology in the classification, diagnosis, prognosis and molecular targeted therapy of DLBCL.
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Affiliation(s)
- Yudi Wang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Suzhen Jia
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiubo Cao
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shengchen Ge
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yi Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
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14
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Shen J, Liu J. Bruton's tyrosine kinase inhibitors in the treatment of primary central nervous system lymphoma: A mini-review. Front Oncol 2022; 12:1034668. [PMID: 36465385 PMCID: PMC9713408 DOI: 10.3389/fonc.2022.1034668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/31/2022] [Indexed: 09/19/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a highly aggressive brain tumor with poor prognosis if no treatment. The activation of the NF-κB (nuclear factor kappa-B) is the oncogenic hallmark of PCNSL, and it was driven by B cell receptor (BCR) and Toll-like receptor (TLR) signaling pathways. The emergence of Bruton's tyrosine kinase inhibitors (BTKis) has brought the dawn of life to patients with PCNSL. This review summarizes the management of PCNSL with BTKis and potential molecular mechanisms of BTKi in the treatment of PCNSL. And the review will focus on the clinical applications of BTKi in the treatment of PCNSL including the efficacy and adverse events, the clinical trials currently being carried out, the underlying mechanisms of resistance to BTKi and possible solutions to drug resistance.
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Affiliation(s)
- Jing Shen
- Department of Hematology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Jinghua Liu
- Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Hematology, Northern Theater General Hospital, Shenyang, China
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15
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Yenamandra AK, Smith RB, Senaratne TN, Kang SHL, Fink JM, Corboy G, Hodge CA, Lu X, Mathew S, Crocker S, Fang M. Evidence-based review of genomic aberrations in diffuse large B cell lymphoma, not otherwise specified (DLBCL, NOS): Report from the cancer genomics consortium lymphoma working group. Cancer Genet 2022; 268-269:1-21. [PMID: 35970109 DOI: 10.1016/j.cancergen.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/26/2022] [Accepted: 07/31/2022] [Indexed: 01/25/2023]
Abstract
Diffuse large B cell lymphoma, not otherwise specified (DLBCL, NOS) is the most common type of non-Hodgkin lymphoma (NHL). The 2016 World Health Organization (WHO) classification defined DLBCL, NOS and its subtypes based on clinical findings, morphology, immunophenotype, and genetics. However, even within the WHO subtypes, it is clear that additional clinical and genetic heterogeneity exists. Significant efforts have been focused on utilizing advanced genomic technologies to further subclassify DLBCL, NOS into clinically relevant subtypes. These efforts have led to the implementation of novel algorithms to support optimal risk-oriented therapy and improvement in the overall survival of DLBCL patients. We gathered an international group of experts to review the current literature on DLBCL, NOS, with respect to genomic aberrations and the role they may play in the diagnosis, prognosis and therapeutic decisions. We comprehensively surveyed clinical laboratory directors/professionals about their genetic testing practices for DLBCL, NOS. The survey results indicated that a variety of diagnostic approaches were being utilized and that there was an overwhelming interest in further standardization of routine genetic testing along with the incorporation of new genetic testing modalities to help guide a precision medicine approach. Additionally, we present a comprehensive literature summary on the most clinically relevant genomic aberrations in DLBCL, NOS. Based upon the survey results and literature review, we propose a standardized, tiered testing approach which will help laboratories optimize genomic testing in order to provide the maximum information to guide patient care.
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Affiliation(s)
- Ashwini K Yenamandra
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37215, United States.
| | | | - T Niroshi Senaratne
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, United States
| | - Sung-Hae L Kang
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, United States
| | - James M Fink
- Department of Pathology and Laboratory Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Gregory Corboy
- Haematology, Pathology Queensland, Herston, Queensland, Australia; Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; School of Clinical Sciences, Monash University, Clayton, Vic, Australia; Department of Clinical Pathology, The University of Melbourne, Parkville, Vic, Australia
| | - Casey A Hodge
- Department of Pathology and Immunology, Barnes Jewish Hospital, St. Louis, MO, United States
| | - Xinyan Lu
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susan Mathew
- Department of Pathology, Weill Cornell Medicine, New York, NY, United States
| | - Susan Crocker
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Min Fang
- Fred Hutchinson Cancer Center and University of Washington, Seattle, WA, United States
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16
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Loeffler-Wirth H, Kreuz M, Schmidt M, Ott G, Siebert R, Binder H. Classifying Germinal Center Derived Lymphomas-Navigate a Complex Transcriptional Landscape. Cancers (Basel) 2022; 14:3434. [PMID: 35884496 PMCID: PMC9321060 DOI: 10.3390/cancers14143434] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Classification of lymphoid neoplasms is based mainly on histologic, immunologic, and (rarer) genetic features. It has been supplemented by gene expression profiling (GEP) in the last decade. Despite the considerable success, particularly in associating lymphoma subtypes with specific transcriptional programs and classifier signatures of up- or downregulated genes, competing molecular classifiers were often proposed in the literature by different groups for the same classification tasks to distinguish, e.g., BL versus DLBCL or different DLBCL subtypes. Moreover, rarer sub-entities such as MYC and BCL2 "double hit lymphomas" (DHL), IRF4-rearranged large cell lymphoma (IRF4-LCL), and Burkitt-like lymphomas with 11q aberration pattern (mnBLL-11q) attracted interest while their relatedness regarding the major classes is still unclear in many respects. We explored the transcriptional landscape of 873 lymphomas referring to a wide spectrum of subtypes by applying self-organizing maps (SOM) machine learning. The landscape reveals a continuum of transcriptional states activated in the different subtypes without clear-cut borderlines between them and preventing their unambiguous classification. These states show striking parallels with single cell gene expression of the active germinal center (GC), which is characterized by the cyclic progression of B-cells. The expression patterns along the GC trajectory are discriminative for distinguishing different lymphoma subtypes. We show that the rare subtypes take intermediate positions between BL, DLBCL, and FL as considered by the 5th edition of the WHO classification of haemato-lymphoid tumors in 2022. Classifier gene signatures extracted from these states as modules of coregulated genes are competitive with literature classifiers. They provide functional-defined classifiers with the option of consenting redundant classifiers from the literature. We discuss alternative classification schemes of different granularity and functional impact as possible avenues toward personalization and improved diagnostics of GC-derived lymphomas.
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Affiliation(s)
- Henry Loeffler-Wirth
- Interdisciplinary Centre for Bioinformatics, University Leipzig (IZBI), 04107 Leipzig, Germany; (H.L.-W.); (M.S.)
| | - Markus Kreuz
- Fraunhofer Institute for Cell Therapy and Immunology (IZI), 04103 Leipzig, Germany;
| | - Maria Schmidt
- Interdisciplinary Centre for Bioinformatics, University Leipzig (IZBI), 04107 Leipzig, Germany; (H.L.-W.); (M.S.)
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, 70376 Stuttgart, Germany;
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, 89073 Ulm, Germany;
| | - Hans Binder
- Interdisciplinary Centre for Bioinformatics, University Leipzig (IZBI), 04107 Leipzig, Germany; (H.L.-W.); (M.S.)
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17
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Qi Z, Duan L, Yuan G, Liu J, Li J, Li G, Yu Y, Xu Y, Ma S, Pan Y, Zhang Y. Clinical Impact of the Histopathological Index and Neuroimaging Features Status in Primary Central Nervous System Diffuse Large B-Cell Lymphoma: A Single-Center Retrospective Analysis of 51 Cases. Front Oncol 2022; 12:769895. [PMID: 35875161 PMCID: PMC9304881 DOI: 10.3389/fonc.2022.769895] [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: 09/02/2021] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is an uncommon non-Hodgkin lymphoma subtype, and its clinical and pathological characteristics remain unclear. PCNS-DLBCL patient data were retrospectively evaluated to determine clinical and pathological characteristics and prognostic factors. Furthermore, prognoses were calculated by Kaplan–Meier and Cox regression models based on clinical observations. In total, 51 immunocompetent patients were enrolled. The median age was 55 (range, 16–82) years, and the male-to-female ratio was 3:2. Headache (n = 19; 37%) and the frontal lobe (n = 16; 31%) were the most common presenting symptom and location, respectively. The median follow-up was 33 (range, 3–86) months, and the median overall survival (OS) and progression-free survival (PFS) were 18 months [95% confidence interval (CI), 21.2–34.2] and 15 months (95% CI, 16.9–28.7), respectively. Ki-67, cluster of differentiation-3, and deep brain involvement were independent prognostic markers. Moreover, multifocal lesions and deep brain involvement were unfavorable independent prognostic markers for PFS. This study indicates that targeted drug development for adverse prognostic factors is possible and provides guidance for clinical treatment decision-making.
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Affiliation(s)
- Zhou Qi
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Lei Duan
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Guoqiang Yuan
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianli Liu
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
- Department of Medical Imaging, Lanzhou University Second Hospital, Lanzhou, China
| | - Jian Li
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Guoqiang Li
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Yue Yu
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Yanlong Xu
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shangxian Ma
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Yawen Pan
- Department of Neurosurgery, Key Laboratory of Neurology, Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
- *Correspondence: Yinian Zhang, ; Yawen Pan,
| | - Yinian Zhang
- Neurosurgery center of Zhujiang Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Yinian Zhang, ; Yawen Pan,
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18
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Kong H, Zhu H, Zheng X, Jiang M, Chen L, Lan L, Ren J, Luo X, Zheng J, Zheng Z, Chen Z, Hu J, Yang T. Machine Learning Models for the Diagnosis and Prognosis Prediction of High-Grade B-Cell Lymphoma. Front Immunol 2022; 13:919012. [PMID: 35686130 PMCID: PMC9171399 DOI: 10.3389/fimmu.2022.919012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
High-grade B-cell lymphoma (HGBL) is a newly introduced category of rare and heterogeneous invasive B-cell lymphoma (BCL), which is diagnosed depending on fluorescence in situ hybridization (FISH), an expensive and laborious analysis. In order to identify HGBL with minimal workup and costs, a total of 187 newly diagnosed BCL patients were enrolled in a cohort study. As a result, the overall survival (OS) and progression-free survival (PFS) of the HGBL group were inferior to those of the non-HGBL group. HGBL (n = 35) was more likely to have a high-grade histomorphology appearance, extranodal involvement, bone marrow involvement, and whole-body maximum standardized uptake (SUVmax). The machine learning classification models indicated that histomorphology appearance, Ann Arbor stage, lactate dehydrogenase (LDH), and International Prognostic Index (IPI) risk group were independent risk factors for diagnosing HGBL. Patients in the high IPI risk group, who are CD10 positive, and who have extranodal involvement, high LDH, high white blood cell (WBC), bone marrow involvement, old age, advanced Ann Arbor stage, and high SUVmax had a higher risk of death within 1 year. In addition, these models prompt the clinical features with which the patients should be recommended to undergo a FISH test. Furthermore, this study supports that first-line treatment with R-CHOP has dismal efficacy in HGBL. A novel induction therapeutic regimen is still urgently needed to ameliorate the poor outcome of HGBL patients.
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Affiliation(s)
- Hui Kong
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Haojie Zhu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoyun Zheng
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Meichen Jiang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lushan Chen
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lingqiong Lan
- Department of Hematology, The Second Hospital of Longyan, Longyan, China
| | - Jinhua Ren
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaofeng Luo
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jing Zheng
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhihong Zheng
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhizhe Chen
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianda Hu
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ting Yang
- Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
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19
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Alsuwaidan A, Koduru P, Fuda F, Manuel Jaso J, Chen M, Rosado F, Luu HS, Sweed N, Garcia R, Doucet M, Desai NB, Kumar KA, Awan FT, Ramakrishnan Geethakumari P, Chen W. A Combined Biomarker of Bright CD38 and MYC ≥55% Is Highly Predictive of Double-/Triple-Hit High-Grade B-Cell Lymphoma. Am J Clin Pathol 2022; 158:338-344. [PMID: 35511691 DOI: 10.1093/ajcp/aqac047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/24/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Diagnosis of high-grade B-cell lymphoma with MYC and BCL2 or BCL6 rearrangements (double-/triple-hit lymphoma [DTHL]) appears to mandate fluorescence in situ hybridization (FISH) testing for all large B-cell lymphoma (LBCL). Given the low incidence of DTHL, we aimed to identify flow cytometry (FC) and immunohistochemistry (IHC) features of DTHL that could be used to develop an optimal screening strategy. This combined FC-IHC approach has not yet been studied. METHODS We compared features of 40 cases of DTHL and 39 cases of diffuse LBCL (DLBCL) without MYC rearrangement. RESULTS Bright CD38 expression (CD38bright) by FC, high MYC expression (≥55%), and double-expressor phenotype by IHC were significantly associated with DTHL. The biomarker combining FC and IHC, CD38bright and/or MYC ≥55%, was superior to FC and IHC markers alone in predicting DTHL. Restricting FISH testing to approximately 25% of LBCL based on CD38brightand/or MYC ≥55% would detect approximately 95% of DTHL-BCL2 and approximately 75% of DHL-BCL6. CONCLUSIONS Our study demonstrated that the novel biomarker of CD38bright and/or MYC ≥55% is highly predictive of DTHL. Awareness of the advantages and limitations of this screening strategy would facilitate development of a rational diagnostic workflow to provide high-quality patient care.
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Affiliation(s)
- Abdullah Alsuwaidan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Prasad Koduru
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Franklin Fuda
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jesse Manuel Jaso
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mingyi Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Flavia Rosado
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nathan Sweed
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rolando Garcia
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Meggie Doucet
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Neil B Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kiran A Kumar
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farrukh T Awan
- Internal Medicine/Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Praveen Ramakrishnan Geethakumari
- Internal Medicine/Division of Hematologic Malignancies and Stem Cell Transplantation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Gordon MJ, Westin JR. Fitting double-hit lymphoma into the aggressive lymphoma spectrum: a square peg in a round hole? Leuk Lymphoma 2022; 63:1034-1044. [PMID: 34842019 DOI: 10.1080/10428194.2021.2008383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements or both, commonly called double-hit lymphoma (DHL), is an aggressive B-cell lymphoma that is molecularly distinct from diffuse large B-cell lymphoma (DLBCL) and is associated with poor outcomes. Recent advances in the molecular classification of DLBCL have identified distinct subsets, including genetic signatures which correlate with DHL and survival. DHL with concomitant TP53 mutation appears to be associated with a very poor prognosis. Standard chemo-immunotherapy is not an effective treatment for these patients and personalized, innovative strategies are needed. In this review, we summarize recent advances in the subclassification of DLBCL, with a focus on DHL. We also incorporate early, promising clinical trial data using CAR T and targeted therapies. Rationally designed clinical trials for DLBCL are needed to advance the care of patients with DHL and other adverse risk DLBCL subgroups.
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Affiliation(s)
- Max J Gordon
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jason R Westin
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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21
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Zhuang Y, Che J, Wu M, Guo Y, Xu Y, Dong X, Yang H. Altered pathways and targeted therapy in double hit lymphoma. J Hematol Oncol 2022; 15:26. [PMID: 35303910 PMCID: PMC8932183 DOI: 10.1186/s13045-022-01249-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/07/2022] [Indexed: 12/20/2022] Open
Abstract
High-grade B-cell lymphoma with translocations involving MYC and BCL2 or BCL6, usually referred to as double hit lymphoma (DHL), is an aggressive hematological malignance with distinct genetic features and poor clinical prognosis. Current standard chemoimmunotherapy fails to confer satisfying outcomes and few targeted therapeutics are available for the treatment against DHL. Recently, the delineating of the genetic landscape in tumors has provided insight into both biology and targeted therapies. Therefore, it is essential to understand the altered signaling pathways of DHL to develop treatment strategies with better clinical benefits. Herein, we summarized the genetic alterations in the two DHL subtypes (DHL-BCL2 and DHL-BCL6). We further elucidate their implications on cellular processes, including anti-apoptosis, epigenetic regulations, B-cell receptor signaling, and immune escape. Ongoing and potential therapeutic strategies and targeted drugs steered by these alterations were reviewed accordingly. Based on these findings, we also discuss the therapeutic vulnerabilities that coincide with these genetic changes. We believe that the understanding of the DHL studies will provide insight into this disease and capacitate the finding of more effective treatment strategies.
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Affiliation(s)
- Yuxin Zhuang
- Department of Lymphoma, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
- Hangzhou Institute of Innovative Medicine, Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, People’s Republic of China
| | - Jinxin Che
- Hangzhou Institute of Innovative Medicine, Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, People’s Republic of China
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, People’s Republic of China
| | - Meijuan Wu
- Department of Pathology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
| | - Yu Guo
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, People’s Republic of China
| | - Yongjin Xu
- Department of Lymphoma, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
| | - Xiaowu Dong
- Hangzhou Institute of Innovative Medicine, Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, People’s Republic of China
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, People’s Republic of China
- Cancer Center, Zhejiang University, Hangzhou, People’s Republic of China
| | - Haiyan Yang
- Department of Lymphoma, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
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22
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Osataphan S, Augustynowicz A, Perrino C, Lam P. Triple-hit high-grade B-cell lymphoma presenting with ovarian torsion. BMJ Case Rep 2021; 14:14/5/e242423. [PMID: 34059546 DOI: 10.1136/bcr-2021-242423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We report a case of a previously healthy woman in her early 70s who presented with 2 weeks of episodic abdominal pain and significant weight loss. Imaging of her abdomen revealed acute right ovarian torsion associated with bilateral ovarian enlargement and an indeterminant pelvic mass. An urgent laparoscopic bilateral oophorectomy was performed with pathological results consistent with triple-hit high-grade B-cell lymphoma. She was successfully treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab, intrathecal methotrexate and venetoclax with complete remission after three cycles. Ovarian lymphoma is a rare entity and its genetic features have not been well described. We performed a literature review, describe the current knowledge regarding ovarian lymphoma and its therapeutic implication in the genomic age.
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Affiliation(s)
- Soravis Osataphan
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Aleksandra Augustynowicz
- Department of Radiology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Carmen Perrino
- Department of Pathology, Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Prudence Lam
- Department of Hematology and Oncology, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
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23
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Elgaafary S, Nagel I, López C, Bens S, Szczepanowski M, Wagener R, Klapper W, Siebert R. Double-hit lymphoma of the male breast: a case report. J Med Case Rep 2020; 14:245. [PMID: 33339535 PMCID: PMC7747391 DOI: 10.1186/s13256-020-02526-2] [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: 06/18/2020] [Accepted: 09/08/2020] [Indexed: 12/04/2022] Open
Abstract
Background Whereas lymphoma of the female breast is already rare, lymphoma of the male breast has only anecdotally been reported. Within a study of 32 lymphoma of the breast reported between 1973 and 2014 as Burkitt lymphoma, we observed a single male case, which we report here. Case presentation A 72-years-old Caucasian man presented with a mass in his left breast. Clinical history included prior basal cell carcinoma, leiomyosarcoma, and administration of spironolactone. The reference pathology diagnosis at presentation was Burkitt lymphoma according to the Kiel Classification. The present re-investigation using fluorescence in situ hybridization revealed an IGH-MYC translocation and a break in the BCL2 locus in the tumor cells. Thus, in light of the current WHO classification, the diagnosis was revised to high-grade B-cell lymphoma with MYC and BCL2 rearrangement, Burkitt morphology (so-called “double-hit” lymphoma). Genome-wide chromosomal imbalance mapping revealed a complex pattern of aberrations in line with this diagnosis. The aberrations, including copy-number gains in chromosomes 3q and 18 and focal homozygous loss in 9p21.3, resembled typical changes of lymphomas affecting “immune-privileged” sites. Conclusion The present case adds to the understanding of the pathogenesis of male breast lymphomas, about which hardly any molecular characterization has been published yet.
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Affiliation(s)
- Shaymaa Elgaafary
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, D-89081, Ulm, Germany.,Institute of Human Genetics, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany.,Division of Human Genetics and Genome Research, Department of Human Cytogenetic, Cairo, 12622, Egypt
| | - Inga Nagel
- Institute of Human Genetics, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany.,Institute of Experimental and Clinical Pharmacology, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein Campus Kiel, D-24105, Kiel, Germany
| | - Cristina López
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, D-89081, Ulm, Germany.,Institute of Human Genetics, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, D-89081, Ulm, Germany.,Institute of Human Genetics, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany
| | - Monika Szczepanowski
- Department of Internal Medicine II (Hematology), Laboratory of Hematology, University Hospital, Schleswig-Holstein Campus Kiel, D-24105, Kiel, Germany.,Hematopathology Section and Lymph Node Registry, Institute of Pathology Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany
| | - Rabea Wagener
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, D-89081, Ulm, Germany.,Institute of Human Genetics, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany
| | - Wolfram Klapper
- Hematopathology Section and Lymph Node Registry, Institute of Pathology Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, D-89081, Ulm, Germany. .,Institute of Human Genetics, Christian-Albrechts University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, D-24105, Kiel, Germany.
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24
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Wang X, Johnson V, Johnson L, Cook JR. RNA-Based next generation sequencing complements but does not replace fluorescence in situ hybridization studies for the classification of aggressive B-Cell lymphomas. Cancer Genet 2020; 252-253:43-47. [PMID: 33360122 DOI: 10.1016/j.cancergen.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/22/2020] [Accepted: 12/04/2020] [Indexed: 01/18/2023]
Abstract
Aggressive B-cell lymphomas are currently classified based in part upon the presence or absence of translocations involving BCL2, BCL6, and MYC. Most clinical laboratories employ fluorescence in situ hybridization (FISH) analysis for the detection of these rearrangements. The potential role of RNA-based sequencing approaches in the evaluation of malignant lymphoma is currently unclear. In this study, we performed RNA sequencing (RNAseq) in 37 cases of aggressive B-cell lymphomas using a commercially available next generation sequencing assay and compared results to previously performed FISH studies. RNAseq detected 1/7 MYC (14%), 3/8 BCL2 (38%) and 4/8 BCL6 (50%) translocations identified by FISH. RNAseq also detected 1 MYC/IGH fusion in a case not initially tested by FISH due to low MYC protein expression and 2 BCL6 translocations that were not detected by FISH. RNAseq identified the partner gene in each detected rearrangement, including a novel EIF4G1-BCL6 rearrangement. In summary, RNAseq complements FISH for the detection of rearrangements of BCL2, BCL6 and MYC in the evaluation and classification of aggressive B-cell lymphomas by detecting rearrangements that may be cryptic by FISH methods and by identifying the rearrangement partner genes. Detection of these clinically important translocations may be optimized by combined use of FISH and RNAseq.
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Affiliation(s)
- Xiaoqiong Wang
- Department of Laboratory Medicine, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | | | - James R Cook
- Department of Laboratory Medicine, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States.
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25
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Seviar D, Yousuff M, Chia Z, Ramesar K, Newman J, Howlett DC. Image-guided core needle biopsy as the first-line diagnostic approach in lymphoproliferative disorders-A review of the current literature. Eur J Haematol 2020; 106:139-147. [PMID: 33080089 DOI: 10.1111/ejh.13532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022]
Abstract
The World Health Organization (WHO) and numerous expert guidelines for lymphoma diagnosis and subclassification advocate the use of histology from surgical nodal excision biopsy (SEB) over core needle biopsy (CNB) due to perceived higher diagnostic yield. CNB is associated with lower morbidity and is more cost-effective compared to SEB. Furthermore, current practice increasingly demonstrates material obtained from CNB can rapidly diagnose individuals with a clinical suspicion of lymphoma and allow initiation of treatment in the majority of patients. We performed a literature review to assess the suitability of CNB in lymphoma diagnosis given recent advances in radiological and histopathological techniques in obtaining and processing tissue. Additionally, expert international guidelines in lymphoma diagnosis were compared. We found that CNB demonstrated a diagnostic efficacy between 79% and 97% (median 91%) where the diagnostic outcome was conclusive with full lymphoma subclassification. Studies demonstrate that there is a high diagnostic reproducibility amongst haematopathologists (87%-93%) in lymphoma diagnoses with full subtyping from material obtained via CNB. Furthermore, CNB is a safe, rapid and reliable method of obtaining tissue from lymph nodes for histopathological analysis. These procedures are minimally invasive, well-tolerated and should be considered the first-line diagnostic approach in clinical practice in patients with suspected lymphoproliferative disorders.
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Affiliation(s)
- Dale Seviar
- Department of Haematology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Mehreen Yousuff
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Zoe Chia
- Department of General Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Keith Ramesar
- Department of Histopathology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Joel Newman
- Department of Haematology, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - David C Howlett
- Department of Radiology, East Sussex Healthcare NHS Trust, Eastbourne, UK
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26
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Somatic copy number gains in MYC, BCL2, and BCL6 identifies a subset of aggressive alternative-DH/TH DLBCL patients. Blood Cancer J 2020; 10:117. [PMID: 33168821 PMCID: PMC7652824 DOI: 10.1038/s41408-020-00382-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 12/27/2022] Open
Abstract
Double/triple hit lymphoma (DH/TH), known as high-grade B-cell lymphoma (HGBL), is an aggressive diffuse large B cell lymphoma (DLBCL), defined as having concurrent MYC, BCL2, and/or BCL6 gene rearrangements. While gene rearrangements represent significant genetic events in cancer, copy number alterations (CNAs) also play an important role, and their contributions to rearrangements have yet to be fully elucidated. Using FISH and high-resolution CNA data, we defined the landscape of concurrent gene rearrangements and copy gains in MYC, BCL2, and BCL6, in a cohort of 479 newly diagnosed DLBCL. We also show that concurrent translocations and copy number alterations, in combinations similar to DH/TH, identify a unique subset of DLBCL, alternative DH/TH, that have survival outcomes similar to DH/TH DLBCL patients.
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27
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Double Hit Lymphoma Diagnosis and Treatment in Europe-A Cross-Sectional Survey of Clinical Practice by the EHA Lymphoma Working Party (EHA LyG). Hemasphere 2020; 4:e481. [PMID: 33134867 PMCID: PMC7587423 DOI: 10.1097/hs9.0000000000000481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022] Open
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28
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Mehta A, Verma A, Gupta G, Tripathi R, Sharma A. Double Hit and Double Expresser Diffuse Large B Cell Lymphoma Subtypes: Discrete Subtypes and Major Predictors of Overall Survival. Indian J Hematol Blood Transfus 2020; 36:627-634. [PMID: 33100703 PMCID: PMC7572989 DOI: 10.1007/s12288-019-01248-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/28/2019] [Indexed: 01/18/2023] Open
Abstract
Double hit lymphomas (DHL) and double expresser lymphomas (DEL) are subsets of diffuse large B cell lymphomas (DLBCL) which are being increasingly recognised as cause of treatment failure. This emphasizes the need for their separation from other DLBCL cases in order to prognosticate and administer more aggressive treatment to this set of patients. The present study was conducted with the aim to identify the DHL/DEL patients and study their distinctive clinicopathological profile and overall survival. This retrospective analysis involved 172 cases of DLBCL sub-classified on the basis of cell of origin. Immunohistochemical (IHC) analysis for MYC, BCL2, BCL6, MUM1 and CD10 was performed. Rearrangement studies were performed using break apart Fluorescent in situ hybridization. Overall survival (OS) was also evaluated. Distinctive clinical and pathological features of DHL and DEL were identified. Rearrangement study by FISH revealed seven cases of DHL (MYC + BCL2 &/or BCL6 rearrangement). Also, 20 patients (11.6%) showed a concurrent expression of BCL2 and MYC oncoproteins (DEL) on IHC. Most (6/7) DHL patients were double expressors also. The DHL patients demonstrated a significant association with female gender, high serum LDH levels (> 750 U/L) and GCB phenotype. DEL patients contrarily predominated amongst males, had intermediate LDH levels (251-500 U/L) and non GCB phenotype. The OS of the patients was 63.8% at 4 years. The OS of the DLBCL, DEL and DHL patients was 71.9%, 46.9%, and 0%, respectively at 4 years (p value 0.010). In case of DEL subtype, factors such as age < 60 years (66.7%), male sex (60.8%), nodal localization (52.5%), early disease stage (84.6%), low IPI score (60%), absence of B symptoms (50%), LDH < 250 U/L (80%) and GCB phenotype (53.3%) were associated with better OS. Further, the OS of DHL cases was 0% at 4 years. Double hit and double expresser lymphomas have poor prognostic outcomes and should be separated from DLBCL. All DELs should be tested for DHLs and especially those with immunoblastic morphology. DHL and DEL subtypes delineate the subtypes with inferior OS and reinstate the need for aggressive interventions.
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Affiliation(s)
- Anurag Mehta
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi India
- Molecular Diagnostic Services, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, Delhi 110085 India
| | - Ajita Verma
- Department of Laboratory and Transfusion Services, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi India
| | - Garima Gupta
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi India
| | - Rupal Tripathi
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi India
| | - Anurag Sharma
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi India
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29
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Khaleefah MM, Narayanan S, Dallal HAA, Jones CM, Friedland RP, Palade AE, Remmel KS, Shah JJ. Isolated oculomotor nerve palsy as a manifestation of diffuse large B cell lymphoma: A case report. Oncol Lett 2020; 20:285. [PMID: 33014163 PMCID: PMC7520722 DOI: 10.3892/ol.2020.12147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022] Open
Abstract
An isolated third nerve palsy presenting as the primary manifestation of a lymphoma is rare, with only few cases having been described. The present study reports an unusual case of a healthy 67-year old male diagnosed with isolated right oculomotor nerve palsy (ONP), who was found to have an underlying B cell lymphoma. The patient's medical records were accessed upon consent. A thorough physical examination, including stroke and infections work-ups were performed. A chest computerized tomography (CT), brain magnetic resonance imaging and positron emission tomography (PET) scans and a mediastinal tissue biopsy, were performed as part of systematic diagnostic evaluations. The current report suggests that a PET fluorodeoxyglucose study or a CT scan of the chest, abdomen and pelvis (with contrast) may help in the early diagnosis of a cancer responsible for ONP, particularly if brain vessel imaging does not show a posterior cerebral artery aneurysm as a cause for the defect.
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Affiliation(s)
- Muntadher M Khaleefah
- Department of Neurology, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Siddharth Narayanan
- Department of Surgery, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Hiba A Al Dallal
- Department of Pathology and Laboratory Medicine, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Christopher M Jones
- Department of Surgery, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Robert P Friedland
- Department of Neurology, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Adriana E Palade
- Department of Neurology, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Kerri S Remmel
- Department of Neurology, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
| | - Jignesh J Shah
- Department of Neurology, University of Louisville Hospital, University of Louisville, Louisville, KY 40202, USA
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30
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50% versus 70%: is there a difference between these BCL2 cut-offs in immunohistochemistry for diffuse large B-cell lymphomas (DLBCL)? SURGICAL AND EXPERIMENTAL PATHOLOGY 2020. [DOI: 10.1186/s42047-020-00070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
The World Health Organization’s (WHO) update of 2017 defines the cut-off for BCL2 in immunohistochemistry (IHC) in 50% of stained cells in diffuse large B-cell lymphomas (DLBCL). The WHO’s 2017 classification, however, has no standardized value. This study analyzes associations between immunohistochemistry results for BCL2 in relation to the detection of translocations of MYC, BCL2, and BCL6 in DLBCL.
Method
Sixty-seven patients with DLBCL were evaluated using IHC, with CD20, CD10, BCL6, BCL2, MUM1, TDT and MYC, and fluorescence in situ hybridization (FISH) for translocations involving the BCL2, BCL6, and MYC. Two cut-offs for BCL2 in IHC were used (50 and 70%), with the calculation of sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPV), accuracy and concordance test, with a significance level of 5%.
Results
Using a 70% cut-off, there is a good relationship between S (88.9%, IC95% = 68.4–109.4) and E (67.2, 95% CI = 55.2–79.3), with a high NPV (97.5, 95% CI = 92.7–102.3) and statistically significant agreement (K = 0.30, p = 0.02). Using a 50% cut-off, S and NPV increase to 100%, with a specificity of 39.7% (95% CI = 27.1–52.2) and a statistically significant concordance (K = 0.15, p = 0.017).
Conclusion
Reduction in the percentage of immunostaining increases the detection of DLBCL with a “double-expressor” immunophenotype. The lower criterion amplifies the S and the NPV of IHC to detect translocations involving the BCL2 gene, with an impact on the diagnosis of DLBCL “double expressor”, an unfavorable prognostic group.
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Solimando AG, Annese T, Tamma R, Ingravallo G, Maiorano E, Vacca A, Specchia G, Ribatti D. New Insights into Diffuse Large B-Cell Lymphoma Pathobiology. Cancers (Basel) 2020; 12:cancers12071869. [PMID: 32664527 PMCID: PMC7408689 DOI: 10.3390/cancers12071869] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL), accounting for about 40% of all cases of NHL. Analysis of the tumor microenvironment is an important aspect of the assessment of the progression of DLBCL. In this review article, we analyzed the role of different cellular components of the tumor microenvironment, including mast cells, macrophages, and lymphocytes, in the tumor progression of DLBCL. We examined several approaches to confront the available pieces of evidence, whereby three key points emerged. DLBCL is a disease of malignant B cells spreading and accumulating both at nodal and at extranodal sites. In patients with both nodal and extranodal lesions, the subsequent induction of a cancer-friendly environment appears pivotal. The DLBCL cell interaction with mature stromal cells and vessels confers tumor protection and inhibition of immune response while delivering nutrients and oxygen supply. Single cells may also reside and survive in protected niches in the nodal and extranodal sites as a source for residual disease and relapse. This review aims to molecularly and functionally recapitulate the DLBCL–milieu crosstalk, to relate niche and pathological angiogenic constitution and interaction factors to DLBCL progression.
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Affiliation(s)
- Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine ‘G. Baccelli’, University of Bari Medical School, 70124 Bari, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS Istituto Tumori “Giovanni Paolo II” of Bari, 70124 Bari, Italy
- Correspondence: (A.G.S.); (D.R.); Tel.: +39-3395626475 (A.G.S.); +39-080.5478326 (D.R.)
| | - Tiziana Annese
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs, University of Bari Medical School, 70124 Bari, Italy; (T.A.); (R.T.)
| | - Roberto Tamma
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs, University of Bari Medical School, 70124 Bari, Italy; (T.A.); (R.T.)
| | - Giuseppe Ingravallo
- Department of Emergency and Transplantation, Pathology Section, University of Bari Medical School, 70100 Bari, Italy; (G.I.); (E.M.)
| | - Eugenio Maiorano
- Department of Emergency and Transplantation, Pathology Section, University of Bari Medical School, 70100 Bari, Italy; (G.I.); (E.M.)
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine ‘G. Baccelli’, University of Bari Medical School, 70124 Bari, Italy;
| | - Giorgina Specchia
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, 70100 Bari, Italy;
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences, and Sensory Organs, University of Bari Medical School, 70124 Bari, Italy; (T.A.); (R.T.)
- Correspondence: (A.G.S.); (D.R.); Tel.: +39-3395626475 (A.G.S.); +39-080.5478326 (D.R.)
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32
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Patients with double/triple copy number gains on C-MYC, BCL2, and/or BCL6 treated with standard chemotherapy have a similarly poor prognosis than those with high-grade B cell lymphoma with C-MYC and BCL2 and/or BCL6 rearrangements: a single-center experience on a consecutive cohort of large B cell lymphomas. Ann Hematol 2020; 99:2125-2132. [PMID: 32613279 PMCID: PMC7419349 DOI: 10.1007/s00277-020-04124-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022]
Abstract
High-grade B cell lymphomas with rearrangements on C-MYC and BCL2 and/or BCL6 (HGBL with MYC and BCL2 and/or Bcl6 rearrangement) are associated with worse clinical outcomes and thus were introduced as a separate new category in the recently updated WHO classification. From 2012 to 2016, we analyzed a consecutive cohort of large B cell lymphomas (LBCLs) for C-MYC, BCL2, and BCL6 rearrangements and correlated our results with clinical-pathological parameters. Ten of 78 (13%) cases had a C-MYC and BCL2 and/or BCL6 rearrangement, so-called double or triple hit (DH), while double/triple copy number gains (CNGs) were found in eight (10%) patients. Patients with a high-grade lymphoma with DH or CNG progressed significantly more often after first-line chemotherapy (p = 0.005). When treated with standard chemotherapy, patients with a DH or CNG had a significantly worse overall (OS) and recurrence free survival (RFS) compared with all other patients (p = 0.033 and p < 0.001, respectively). Thus, patients with a diffuse large B cell lymphoma, harboring a double/triple CNG, seem to have a similar poor prognosis than those with a DH. Though our data can only be regarded as preliminary, our results warrant further investigations to fully elucidate the role of CNGs as well as underlying molecular mechanisms resulting in aggressive behavior in LBCL.
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Identification of "Double Hit" Lymphomas Using Updated WHO Criteria: Insights From Routine MYC Immunohistochemistry in 272 Consecutive Cases of Aggressive B-Cell Lymphomas. Appl Immunohistochem Mol Morphol 2020; 27:410-415. [PMID: 29629947 DOI: 10.1097/pai.0000000000000657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aggressive lymphomas with MYC and BCL2 and/or BCL6 translocations ("double hit" lymphomas, DHL) represent a distinct diagnostic category in the updated World Health Organization (WHO) classification. The diagnostic yield of MYC immunohistochemistry (IHC) for the identification of DHL is currently uncertain. MYC IHC was performed in 272 consecutive cases of aggressive B-cell lymphoma, and results correlated with fluorescence in situ hybridization (FISH) for MYC translocations. Among 156 patients with IHC and FISH data, MYC IHC identified MYC translocations with 89% sensitivity, 38% specificity, 92% negative predictive value, and 29% positive predictive value. Three of 15 (20%) of DHL were MYC IHC negative. One case contained a MYC translocation detectable IGH/MYC fusion probes but not MYC break-apart probes. A subset of DHL lack MYC protein expression, and recognition of this subset of cases requires FISH testing. These results provide an appropriate diagnostic algorithm for implementation of 2016 WHO diagnostic criteria.
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Schieppati F, Balzarini P, Fisogni S, Re A, Pagani C, Bianchetti N, Micheli L, Passi A, Ferrari S, Maifredi A, Bottelli C, Leopaldo R, Pellegrini V, Facchetti F, Rossi G, Tucci A. An increase in MYC copy number has a progressive negative prognostic impact in patients with diffuse large B-cell and high-grade lymphoma, who may benefit from intensified treatment regimens. Haematologica 2020; 105:1369-1378. [PMID: 31399522 PMCID: PMC7193495 DOI: 10.3324/haematol.2019.223891] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022] Open
Abstract
MYC translocations, a hallmark of Burkitt lymphoma, occur in 5-15% of diffuse large B-cell lymphoma, and have a negative prognostic impact. Numerical aberrations of MYC have also been detected in these patients, but their incidence and prognostic role are still controversial. We analyzed the clinical impact of MYC increased copy number on 385 patients with diffuse large B-cell lymphoma screened at diagnosis for MYC, BCL2, and BCL6 rearrangements. We enumerated the number of MYC copies, defining as amplified those cases with an uncountable number of extra-copies. The prevalence of MYC translocation, increased copy number and amplification was 8.8%, 15%, and 1%, respectively. Patients with 3 or 4 gene copies, accounting for more than 60% of patients with MYC copy number changes, had a more favorable outcome compared to patients with >4 copies or translocation of MYC, and were not influenced by the type of treatment received as first-line. Stratification according to the number of MYC extra-copies showed a negative correlation between an increasing number of copies and survival. Patients with >7 copies or the amplification of MYC had the poorest prognosis. Patients with >4 copies of MYC showed a similar, trending towards worse prognosis compared to patients with MYC translocation. The survival of patients with >4 copies, translocation or amplification of MYC seemed to be superior if intensive treatments were used. Our study underlines the importance of fluorescence in situ hybridization testing at diagnosis of diffuse large B-cell lymphoma to detect the rather frequent and clinically significant numerical aberrations of MYC.
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Affiliation(s)
| | - Piera Balzarini
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Brescia, Italy
| | - Simona Fisogni
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Brescia, Italy
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia
| | - Chiara Pagani
- Department of Hematology, ASST Spedali Civili di Brescia
| | | | - Lorenzo Micheli
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Brescia, Italy
| | - Angela Passi
- Department of Hematology, ASST Spedali Civili di Brescia
| | | | | | | | | | - Vilma Pellegrini
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Brescia, Italy
| | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili di Brescia
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Naseem M, Asif M, Khadim MT, Ud-Din H, Jamal S, Shoaib I. The Frequency of Double Expresser in Selected Cases of High Grade Diffuse Large B-Cell Lymphomas. Asian Pac J Cancer Prev 2020; 21:1103-1107. [PMID: 32334477 PMCID: PMC7445973 DOI: 10.31557/apjcp.2020.21.4.1103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Diffuse large B-cell lymphomas (DLBCL) are fast-growing non-Hodgkin lymphomas that affect B-lymphocytes. Double expressor DLBCL is the concomitant expression of Myc and Bcl-2 proteins during lymphomas which results in poor prognosis of patients. This study aimed to determine the frequency of double expresser in high grade diffuse large B-cell lymphomas. Materials and Methods : The study was conducted on 74 cases (54 males (68.4%) and 20 females (25.3%)) of DLBCL between August 2018 to January 2019. The mean age of the 74 patients was 51.7 years + 18.5. Expression of proteins c-Myc, Bcl-2 and Bcl-6 were evaluated by immunohistochemistry. The involvement of primary lymph node was reported in 38 cases (51.3%) whereas, extra nodal site was observed in 22 cases (29.7%). Among the primary sites, the cervical lymph node enlargement was the most frequent site of presentation. Results: The rearrangement pattern was studied among 74 patients, 35 (47%) were found to have either one of the rearrangements i.e. Myc, Bcl-2, or Bcl-6. On the other hand, 14 (18.9%) had shown double rearrangements i.e. Bcl-2 and c-Myc (11 cases) and Bcl-6 and c-Myc (3 cases). The Bcl-2 and Bcl-6 rearrangements were demonstrated by 12 cases whereas 2 cases (2.7%) indicated all three types of rearrangements i.e. c-Myc, Bcl-2, and Bcl-6. In 11 cases the Bcl-2 and c-Myc rearrangements were found to be Bcl-2 > 50% and c-Myc > 40% and demonstrating the overall frequency of double expressers as 14.8%. The prognosis of the mentioned cases was extremely poor, median survival of 10 months. Conclusion: The concurrent expression of Bcl-2 and c-Myc was found to be 14% (level of expression for Bcl-2 > 50% and c-Myc > 40%) which is potentially a significant health burden and an emerging threat.
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Affiliation(s)
- Maria Naseem
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Muhammad Asif
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Muhammad Tahir Khadim
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Hafeez Ud-Din
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Shahid Jamal
- Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Iman Shoaib
- Department of Forensic Medical Sciences, Molecular Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
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Li J, Liu X, Yao Z, Zhang M. High-Grade B-Cell Lymphomas, Not Otherwise Specified: A Study of 41 Cases. Cancer Manag Res 2020; 12:1903-1912. [PMID: 32214848 PMCID: PMC7082796 DOI: 10.2147/cmar.s243753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/03/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To analyze the clinical and pathological characteristics, treatment, and prognosis of high-grade B-cell lymphomas, not otherwise specified (HGBL, NOS), and to increase awareness of this type of lymphoma. Patients and Methods We collected clinical and pathological data of 41 cases of newly diagnosed HGBL, NOS, and analyzed diagnosis, prognosis and treatment to examine progression-free survival (PFS) and overall survival (OS). Results Among the 41 cases studied, the median PFS was 6.0 months and the median OS was 18.0 months. Compared with patients treated with the R-CHOP regimen, patients treated with a high-intensity chemotherapy (DA-EPOCH-R, R-CODOX-M/IVAC, or R-Hyper-CVAD) had superior PFS and OS (PFS: χ2=4.173, P=0.041; OS: χ2=5.200, P=0.023). A subgroup analysis showed that the OS for the double-expressor lymphoma (DEL) was inferior to that for the non-DEL (χ2=4.563, P=0.033), and this trend was also seen for the single-hit lymphoma with MYC rearrangement (SHL) and the non-SHL (χ2=4.955, P=0.026). Patients with low International Prognostic Index (IPI) scores (≤2) had better survival rates than those with high scores (>2) (PFS: χ2=6.482, P=0.011; OS: χ2=10.156, P=0.001). Conclusion HGBL, NOS is associated with a high degree of malignancy, short survival period, and substantial extranodal involvement. High-intensity chemotherapy may improve patient prognosis. While IPI scores statistically correlated with the prognosis, SHL and DEL correlated with an inferior survival rate. New and improved treatments will be needed for HGBL, NOS.
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Affiliation(s)
- Jiayin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, People's Republic of China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450000, Republic of China
| | - Xiaoyin Liu
- Department of Hematology, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, People's Republic of China
| | - Zhihua Yao
- Department of Internal Medicine, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan 450008, People's Republic of China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, People's Republic of China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan 450000, Republic of China
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Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma). Am J Clin Oncol 2019; 42:304-316. [PMID: 29419530 DOI: 10.1097/coc.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.
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Chen Y, Chen H, Chen L, Zheng X, Yang X, Zheng Z, Zheng J, Yang T, Liu T, Yang Y, Hu J. Immunohistochemical overexpression of BCL-2 protein predicts an inferior survival in patients with primary central nervous system diffuse large B-cell lymphoma. Medicine (Baltimore) 2019; 98:e17827. [PMID: 31702637 PMCID: PMC6855480 DOI: 10.1097/md.0000000000017827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This study was designed to analyze the clinical characteristics and prognostic value of c-MYC and BCL-2 proteins expression in patients with primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL).82 patients newly diagnosed with PCNS-DLBCL, from January 2008 to November 2018, were enrolled in this study. Clinical characteristics, immunohistochemical features, laboratory examinations, and treatment outcome were analyzed among these patients.Among these 82 cases, 45 were males (54.9%) and 37 were females (45.1%). Age ranged from 16 to 78 years old, and 29 patients (35.4%) were elder than 60 years old, with median age at 57 years old. According to Hans classification, 25 were accounted for origin of germinal center B-cell (GCB) subtype (30.5%) and 49 were accounted for non-GCB subtype (59.8%), respectively. Eight patients were unclassified due to lack of detailed pathological results. The median survival of these 82 patients was 30 months, and 1-year, 3-year, and 5-year overall survival (OS) rate was 59.7%, 44.6%, and 34.1%, respectively. Patients treated with sequential HD-MTX based chemotherapies showed a superior prognosis than those without. In combination with rituximab, the outcome was further improved. The median OS was 55 months in HD-MTX + R group, 27 months in HD-MTX group, and 9 months in other groups, respectively. Univariate analysis identified age ≥60, ECOG score ≥ 2 points, and overexpression of BCL-2 protein (≥85%) were adverse prognostic factors for OS. Co-expression of c-MYC (≥40%) and BCL-2 (≥50%) proteins was associated with poor ECOG score, high Ki-67 expression, and trended towards an inferior outcome. Gender, lesion location, number of lesions, lactic dehydrogenase (LDH), cell of origin, BCL-6 protein expression, expression of c-MYC protein alone and Ki-67 ≥85% had no significant impact on OS.In patients with PCNS-DLBCL, age ≥60 years old, ECOG score ≥2 points, and overexpression of BCL-2 protein (≥85%) were associated with a poor survival. HD-MTX based chemotherapies in combination with rituximab could improve the prognosis.
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Harkins RA, Chang A, Patel SP, Lee MJ, Goldstein JS, Merdan S, Flowers CR, Koff JL. Remaining challenges in predicting patient outcomes for diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:959-973. [PMID: 31513757 PMCID: PMC6821591 DOI: 10.1080/17474086.2019.1660159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma and is an aggressive malignancy with heterogeneous outcomes. Diverse methods for DLBCL outcomes assessment ranging from clinical to genomic have been developed with variable predictive and prognostic success.Areas covered: The authors provide an overview of the various methods currently used to estimate prognosis in DLBCL patients. Models incorporating cell of origin, genomic features, sociodemographic factors, treatment effectiveness measures, and machine learning are described.Expert opinion: The clinical and genetic heterogeneity of DLBCL presents distinct challenges in predicting response to therapy and overall prognosis. Successful integration of predictive and prognostic tools in clinical trials and in a standard clinical workflow for DLBCL will likely require a combination of methods incorporating clinical, sociodemographic, and molecular factors with the aid of machine learning and high-dimensional data analysis.
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Affiliation(s)
- R. Andrew Harkins
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | - Andres Chang
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
| | | | - Michelle J. Lee
- Emory University School of Medicine, Atlanta, Georgia 30322-1007, USA
| | | | - Selin Merdan
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
- Georgia Institute of Technology, Atlanta, Georgia 30332-0002, USA
| | | | - Jean L. Koff
- Winship Cancer Institute of Emory University, Atlanta, Georgia 30322-1007, USA
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40
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Cunningham AM, Harrington AM. Ancillary Studies in the Diagnostic Evaluation of Large B-Cell Lymphoma. Arch Pathol Lab Med 2019; 143:1464-1471. [PMID: 31584842 DOI: 10.5858/arpa.2019-0331-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Large B-cell lymphoma classification has changed significantly over the decades, evolving from a purely morphologic categorization to one using sophisticated ancillary studies including molecular analysis, immunohistochemistry, and cytogenetics, in addition to morphology and clinical presentation. OBJECTIVE.— To discuss and interpret the key ancillary studies required for subclassification in 2019 and review the differential diagnosis of diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS). DATA SOURCES.— Recent literature on the subcategories of large B-cell lymphoma is reviewed, along with relevant updates from the 2016 World Health Organization Classification of Tumours of Hematopoietic and Lymphoid Tissues, with an emphasis on Epstein-Barr virus-positive lymphoproliferative disorders, high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, and large B-cell lymphoma with IRF4 rearrangement. CONCLUSIONS.— Cases with DLBCL, NOS histology can be further subclassified on the basis of cell of origin studies, Epstein-Barr virus-encoded small RNAs, MYC and BCL2 and/or BCL6 rearrangement studies, and other relevant cytogenetic and immunohistochemical studies. The diagnosis of DLBCL, NOS is therefore a diagnosis of exclusion.
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41
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High Incidence and Clinical Significance of MYC Rearrangements in Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type. Am J Surg Pathol 2019; 42:1488-1494. [PMID: 30113335 DOI: 10.1097/pas.0000000000001132] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) and primary cutaneous follicle center lymphoma (PCFCL) are cutaneous B-cell lymphomas (CBCL) with different clinical characteristics and behavior. PCDLBCL-LT is the most aggressive CBCL with a relatively poor prognosis. In nodal diffuse large B-cell lymphoma (DLBCL), rearrangements of the MYC gene, especially in combination with a second hit in BCL2 and/or BCL6, and double protein expression of MYC and BCL2 (DE) are adverse prognostic factors. As the clinical significance of these factors in CBCL is largely unknown, we studied the frequency and prognostic value of MYC rearrangements and DE in a cohort of 44 patients with PCDLBCL-LT and 17 patients with PCFCL. Compared with nodal DLBCL (9% to 14%), the PCDLBCL-LT patients had a high incidence of MYC rearrangements (32%), but only 2 patients (4%) had a second hit, both with BCL6. PCDLBCL-LT patients with a MYC rearrangement showed an inferior disease-specific survival (Log-rank, P=0.036) and disease-free survival (Log-rank, P=0.028), but no significant adverse effect on overall survival (Log-rank, P=0.157) at 5 years compared with patients without a MYC rearrangement. DE, present in 65% of the PCDLBCL-LT patients, was not associated with reduced survival. In the PCFCL group, MYC rearrangements and DE were not detected. In conclusion, this study identifies a high incidence of MYC rearrangements in PCDLBCL-LT compared to nodal DLBCL and further shows that a MYC rearrangement is an inferior prognostic marker in these patients. Therefore, our data suggest that it is useful to perform MYC-FISH in all newly diagnosed PCDLBCL-LT patients.
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Misyurina AE, Kravchenko SK, Kovrigina AM, Magomedova AU, Plastinina LV, Obukhova TN, Misyurin AV, Misyurin VA, Grebenuk LA, Babaeva FE, Baryakh EA, Vorobiev AI. [The role of translocations involving c-MYC/8q24, BCL2/18q21 and/or BCL6/3q27 genes in patients with follicular lymphoma. Retrospective analysis of single - centre data]. TERAPEVT ARKH 2019; 91:52-62. [PMID: 32598736 DOI: 10.26442/00403660.2019.07.000070] [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: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Aim of the issue was to compare clinical characteristics and treatment results of patients with follicular lymphoma (FL) with translocations involving loci of c-MYC/8q24, BCL2/18q21 and/or BCL6/3q27 genes and patients with high - grade B-cell lymphoma [High - grade B-cell lymphoma (HGBL), double - hit (DH)]. Materials and methods. Since 2004 to 2017 years in National Research Center for Hematology 12 patients with high - grade B-cell lymphoma double - hit (HGBL DH) and 6 FL patients with translocations involving c-MYC and BCL2 and/or BCL6 had been treated. We performed a comparative analysis of clinical characterisctics in both groups. As primary endpoints was assessed frequency of complete remission (CR) or progressive disease (PD); as secondary endpoints - overall (OS) and event - free survival (EFS). Results. 5 patients with HGBL DH had c-MYC/BCL6, 7 - c-MYC/BCL2 rearrangements; 2 patients with FL had c-MYC/BCL2, 3 - c-MYC/BCL6, 1 - c-MYC/BCL2/BCL6 rearrangements. FL was represented by grade 3A in 2, grade 3B - in 4 cases, 3 of them had large - cell transformation. In HGBL DH and FL patients had no significant differences in clinical characteristics. The majority of patients had a widespread tumour, increased LDH activity, high frequency of extranodal and bone marrow involvement. Ki-67 expression level was lower in patients with FL (p.
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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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Alsuwaidan A, Pirruccello E, Jaso J, Koduru P, Garcia R, Krueger J, Doucet M, Chaudhry R, Fuda F, Chen W. Bright CD38 Expression by Flow Cytometric Analysis Is a Biomarker for Double/Triple Hit Lymphomas with a Moderate Sensitivity and High Specificity. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:368-374. [DOI: 10.1002/cyto.b.21770] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Abdullah Alsuwaidan
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Elaina Pirruccello
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Jesse Jaso
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Prasad Koduru
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Rolando Garcia
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | | | - Meggie Doucet
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Rahman Chaudhry
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Franklin Fuda
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
| | - Weina Chen
- Department of PathologyUniversity of Texas Southwestern Medical Center Dallas Texas
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45
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Zhang Y, Wang H, Ren C, Yu H, Fang W, Zhang N, Gao S, Hou Q. Correlation Between C-MYC, BCL-2, and BCL-6 Protein Expression and Gene Translocation as Biomarkers in Diagnosis and Prognosis of Diffuse Large B-cell Lymphoma. Front Pharmacol 2019; 9:1497. [PMID: 30666200 PMCID: PMC6330311 DOI: 10.3389/fphar.2018.01497] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/07/2018] [Indexed: 12/22/2022] Open
Abstract
This study investigates the protein expression of C-MYC, BCL-2, and BCL-6 in diffuse large B-cell lymphoma (DLBCL) and their relationship with genetic abnormalities. A retrospective study of 42 cases on paraffin-embedded tissue specimens diagnosed with DLBCL was performed using immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). The expression of C-MYC, BCL-2, BCL-6 protein, and gene abnormalities in these tissue samples was analyzed. The relationship in genetic abnormalities and Ki-67, Hans classification, gender, and age was also evaluated. It was found that the positive rate of C-MYC expression was 47.6% (20/42), the rate of C-MYC gene abnormality was 26.2% (11/42), in which gene translocation accounted for 23.8% (10/42) and gene amplification 2.4% (1/42); C-MYC protein expression was positively correlated with C-MYC gene translocation (χ2 = 11.813; P = 0.001); C-MYC gene translocation was mainly found in germinal center B cell type (χ2 = 4.029; P = 0.045). The positive rate of BCL-2 protein expression was 85.71% (36/42), the positive rate of translocation was 42.86% (18/42) and the amplification rate was 26.19% (11/42); the overexpression of BCL-2 protein was correlated with the BCL-2 translocation (χ2 = 3.407; P = 0.029). The positive rate of BCL-6 protein expression was 45.24% (19/42), the positive rate of BCL-6 translocation was 14.29% (6/42) and the positive rate of BCL-6 amplification was 7.14% (3/42); the overexpression of BCL-6 protein was significantly correlated with BCL-6 translocation (χ2 = 6.091; P = 0.014). The Ki-67 index was significantly higher in C-MYC translocation cases than in non-C-MYC translocation cases (χ2 = 4.492; P = 0.034). Taken together, our results suggest that the protein expression of C-MYC, BCL-2, and BCL-6 are positively correlated with their gene translocation. Overexpression of C-MYC, BCL-2, BCL-6 protein suggests the possibility of translocation. Therefore, immunohistochemical detection of C-MYC, BCL-2, and BCL-6 are useful in diagnosis and prognosis of DLBCL.
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Affiliation(s)
- YunXiang Zhang
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Hui Wang
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Cuiai Ren
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Hai Yu
- Department of Pathology, Werfang Traditional Chinese Hospital, Weifang, China
| | - Wenjia Fang
- Department of Clinical Medicine, Nanchang University Medical College, Nanchang, China
| | - Na Zhang
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Sumei Gao
- Department of Pathology, Weifang People's Hospital, Weifang, China
| | - Qian Hou
- Department of Pathology, Weifang People's Hospital, Weifang, China
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46
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De Paoli E, Bandiera L, Ravano E, Cesana C, Grillo G, Mancini V, De Canal G, Bonoldi E, Soriani S. A double-hit High-grade B-cell lymphoma with three-way translocation t(3;8;14)(q27;q24;q32) involving BCL6, MYC, and IGH. Clin Case Rep 2018; 6:2411-2415. [PMID: 30564339 PMCID: PMC6293148 DOI: 10.1002/ccr3.1871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/28/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
We describe an High-grade B-cell lymphoma case, in which a complex translocation t(3;8;14) with effects on the genes BCL6, MYC, and IGH, was detected. This case could be the first double-hit lymphoma with a single chromosome rearrangement causing the double effect with three genes involved.
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Affiliation(s)
- Elena De Paoli
- Department of Laboratory MedicineASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Laura Bandiera
- Department of Laboratory MedicineASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Emanuele Ravano
- Division of HematologyASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Clara Cesana
- Department of Laboratory MedicineASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Giovanni Grillo
- Division of HematologyASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Valentina Mancini
- Division of HematologyASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Gabriella De Canal
- Department of Laboratory MedicineASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Emanuela Bonoldi
- Department of Laboratory MedicineASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Silvia Soriani
- Department of Laboratory MedicineASST Grande Ospedale Metropolitano NiguardaMilanItaly
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47
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Juárez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment. Cancer Control 2018; 25:1073274818778256. [PMID: 29779412 PMCID: PMC6028178 DOI: 10.1177/1073274818778256] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary gastric lymphoma (PGL) is the most common extranodal non-Hodgkin lymphoma and represents a wide spectrum of disease, ranging from indolent low-grade marginal zone lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma to aggressive diffuse large B-cell lymphoma. The PGL is a relatively rare cancer and easily misdiagnosed due to its unspecific symptoms of the digestive tract. The medical literature and ongoing clinical trials were reviewed on the clinical presentation, diagnosis, prognosis, prevention, and treatment of PGL. Primary gastric lymphoma is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Magnetic resonance imaging and endoscopic ultrasonography have helped in staging of these cancers. The clinical course and prognosis of this disease are dependent on histopathological subtype and stage at the time of diagnosis. A global therapeutic approach to the cure of PGL has completely changed over the past 10 years, including innovative and conservative options to reduce treatment toxicity. Due to the rarity of PGL, many aspects of this neoplasm are still controversial. The incidence of this disease is increasing, making it necessary for clinicians to understand the clinical symptoms, workup, and treatment of these lymphomas.
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Affiliation(s)
| | - Lubomir Sokol
- 2 Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Julio C Chavez
- 2 Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Samir Dalia
- 3 Hematology/Oncology, Mercy Clinic Oncology and Hematology-Joplin, MO, USA
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48
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Riedell PA, Smith SM. Double hit and double expressors in lymphoma: Definition and treatment. Cancer 2018; 124:4622-4632. [PMID: 30252929 DOI: 10.1002/cncr.31646] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/30/2018] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
Emerging biologic subsets and new prognostic markers are significantly and adversely affecting curability after standard chemoimmunotherapy for aggressive B-cell lymphomas. The identification of concurrent MYC and B-cell CLL/lymphoma 2 (BCL2) deregulation, whether at a genomic or protein level, has opened a new era of investigation within the most common subtype of aggressive B-cell lymphomas. Double-hit lymphoma (DHL), defined as a dual rearrangement of MYC and BCL2 and/or B-cell CLL/lymphoma 6 (BCL6) genes, is an uncommon subset accounting for 5% to 7% of all diffuse large B-cell lymphomas (DLBCLs), and long-term survivors are rare. Double-expressor lymphoma (DEL), defined as overexpression of MYC and BCL2 proteins not related to underlying chromosomal rearrangements, is not a distinct entity in the current World Health Organization classification but accounts for 20% to 30% of DLBCL cases and also has poor outcomes. There are many practical considerations related to identifying, determining the prognosis of, and managing DHL and DEL.
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Affiliation(s)
- Peter A Riedell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
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49
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Lynch RC, Gratzinger D, Advani RH. Clinical Impact of the 2016 Update to the WHO Lymphoma Classification. Curr Treat Options Oncol 2018; 18:45. [PMID: 28670664 DOI: 10.1007/s11864-017-0483-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT The 2016 revision of the WHO classification of lymphoid neoplasms includes new entities along with a clearer definition of provisional and definitive subtypes based on better understanding of the molecular drivers of lymphomas. These changes impact current treatment paradigms and provide a framework for future clinical trials. Additionally, this update recognizes several premalignant or predominantly indolent entities and underscores the importance of avoiding unnecessarily aggressive treatment in the latter subsets.
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Affiliation(s)
- Ryan C Lynch
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ranjana H Advani
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford University Medical Center, 875 Blake Wilbur Drive, Suite CC-2338, Stanford, CA, 94305-5821, USA.
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50
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Magnoli F, Bernasconi B, Vivian L, Proserpio I, Pinotti G, Campiotti L, Mazzucchelli L, Sessa F, Tibiletti MG, Uccella S. Primary extranodal diffuse large B-cell lymphomas: Many sites, many entities? Clinico-pathological, immunohistochemical and cytogenetic study of 106 cases. Cancer Genet 2018; 228-229:28-40. [PMID: 30553470 DOI: 10.1016/j.cancergen.2018.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/13/2018] [Accepted: 08/02/2018] [Indexed: 02/08/2023]
Abstract
We analyzed the clinicopathological, immunohistochemical and cytogenetic features of 106 extranodal (EN) diffuse large B-cell lymphomas (DLBCLs) from stomach (34 cases), intestine (10), cervico-cephalic region (11), central nervous system (13), testes (21), skin (8), and miscellaneous sites (9). Hans' algorithm and the immunohistochemical double expressor score (DES) for MYC and BCL2 were applied to all cases. A subset of fifty-eight cases were analyzed with fluorescent in situ hybridization (FISH) with specific break apart probes for BCL6, MYC, BCL2, CCND1, BCL10 and MALT1 genes. Clinical records were available for all patients. The immunohistochemical study showed that, in our series of EN-DLBCLs, the Hans' subgroup and the DES differed significantly according to the site of origin. At FISH analysis, BCL6 and BCL2 were the most commonly rearranged genes in non-GC and in GC cases, respectively. Gastrointestinal lymphomas displayed the highest rate of gene rearrangements, often with MYC involvement. One testicular DLBCL showed BCL2/MYC double hit. At survival analysis, cerebral and testicular origin was associated with poor prognosis. In addition, Hans' subgroup and other immunohistochemical markers influenced patients' outcome. In conclusion, our data suggest that immunophenotypic, genetic and survival characteristics of EN-DLBCL are related to the specific primary site of the disease.
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Affiliation(s)
- Francesca Magnoli
- Department Of Medicine and Surgery, Unit of Pathology, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy; Department of Pathology, ASST Sette Laghi, Varese, Italy
| | - Barbara Bernasconi
- Department of Obstetrics and Gynecology, ASST Sette Laghi, Varese, Italy
| | - Lisa Vivian
- Department Of Medicine and Surgery, Unit of Pathology, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy
| | | | | | - Leonardo Campiotti
- Department of Medicine and Surgery, Unit of Internal Medicine, University of Insubria, Varese, Italy
| | | | - Fausto Sessa
- Department Of Medicine and Surgery, Unit of Pathology, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy
| | | | - Silvia Uccella
- Department Of Medicine and Surgery, Unit of Pathology, University of Insubria, Via O. Rossi, 9, 21100 Varese, Italy.
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