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Rodrigues C, Laranjeira P, Pinho A, Silva I, Silva S, Coucelo M, Oliveira AC, Simões AT, Damásio I, Silva HM, Urbano M, Sarmento-Ribeiro AB, Geraldes C, Domingues MR, Almeida J, Criado I, Orfao A, Paiva A. CD20+ T cells in monoclonal B cell lymphocytosis and chronic lymphocytic leukemia: frequency, phenotype and association with disease progression. Front Oncol 2024; 14:1380648. [PMID: 38606091 PMCID: PMC11007165 DOI: 10.3389/fonc.2024.1380648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction In monoclonal B cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL), the expansion of malignant B cells disrupts the normal homeostasis and interactions between B cells and T cells, leading to immune dysregulation. CD20+ T cells are a subpopulation of T cells that appear to be involved in autoimmune diseases and cancer. Methods Here, we quantified and phenotypically characterized CD20+ T cells from MBL subjects and CLL patients using flow cytometry and correlated our findings with the B-cell receptor mutational status and other features of the disease. Results and discussion CD20+ T cells were more represented within the CD8+ T cell compartment and they showed a predominant memory Tc1 phenotype. CD20+ T cells were less represented in MBL and CLL patients vs healthy controls, particularly among those with unmutated IGVH gene. The expansion of malignant B cells was accompanied by phenotypic and functional changes in CD20+ T cells, including an increase in follicular helper CD4+ CD20+ T cells and CD20+ Tc1 cells, in addition to the expansion of the TCR Vβ 5.1 in CD4+ CD20+ T cells in CLL.
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Affiliation(s)
- Cristiana Rodrigues
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Paula Laranjeira
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Group of Environmental Genetics of Oncobiology (CIMAGO), Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
| | - Aryane Pinho
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Center for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, Faculty of Sciences and Technology, University of Coimbra, Coimbra, Portugal
| | - Isabel Silva
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sandra Silva
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Margarida Coucelo
- Unidade Funcional de Hematologia Molecular, Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Catarina Oliveira
- Unidade Funcional de Hematologia Molecular, Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Teresa Simões
- Unidade Funcional de Hematologia Molecular, Serviço de Hematologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês Damásio
- Hematology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | | | - Mafalda Urbano
- Hematology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Bela Sarmento-Ribeiro
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Group of Environmental Genetics of Oncobiology (CIMAGO), Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Hematology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University Clinics of Hematology and Oncology and Laboratory of Oncobiology and Hematology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Catarina Geraldes
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Group of Environmental Genetics of Oncobiology (CIMAGO), Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Hematology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University Clinics of Hematology and Oncology and Laboratory of Oncobiology and Hematology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M. Rosário Domingues
- Mass Spectrometry Centre, Associated Laboratory for Green Chemistry (LAQV-REQUIMTE), Department of Chemistry, University of Aveiro, Aveiro, Portugal
- CESAM—Centre for Environmental and Marine Studies, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Julia Almeida
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Criado
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Orfao
- Translational and Clinical Research Program, Cancer Research Center (IBMCC, CSIC-University of Salamanca), Salamanca, Spain
- Department of Medicine, University of Salamanca (Universidad de Salamanca), Salamanca, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Biomedical Research Networking Centre Consortium of Oncology (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Artur Paiva
- Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Group of Environmental Genetics of Oncobiology (CIMAGO), Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
- Ciências Biomédicas Laboratoriais, Instituto Politécnico de Coimbra, Escola Superior de Tecnologia da Saúde de Coimbra (ESTESC)-Coimbra Health School, Coimbra, Portugal
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2
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Quinten E, Sepúlveda-Yáñez JH, Koning MT, Eken JA, Pfeifer D, Nteleah V, De Groen RAL, Saravia DA, Knijnenburg J, Stuivenberg-Bleijswijk HE, Pantic M, Agathangelidis A, Keppler-Hafkemeyer A, Van Bergen CAM, Uribe-Paredes R, Stamatopoulos K, Vermaat JSP, Zirlik K, Navarrete MA, Jumaa H, Veelken H. Autonomous B-cell receptor signaling and genetic aberrations in chronic lymphocytic leukemia-phenotype monoclonal B lymphocytosis in siblings of patients with chronic lymphocytic leukemia. Haematologica 2024; 109:824-834. [PMID: 37439337 PMCID: PMC10905078 DOI: 10.3324/haematol.2022.282542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
Clonal expansion of CD5-expressing B cells, commonly designated as monoclonal B lymphocytosis (MBL), is a precursor condition for chronic lymphocytic leukemia (CLL). The mechanisms driving subclinical MBL B-cell expansion and progression to CLL, occurring in approximately 1% of affected individuals, are unknown. An autonomously signaling B-cell receptor (BCR) is essential for the pathogenesis of CLL. The objectives of this study were functional characterization of the BCR of MBL in siblings of CLL patients and a comparison of genetic variants in MBL-CLL sibling pairs. Screening of peripheral blood by flow cytometry detected 0.2-480 clonal CLL-phenotype cells per microliter (median: 37/μL) in 34 of 191 (17.8%) siblings of CLL patients. Clonal BCR isolated from highly purified CLL-phenotype cells induced robust calcium mobilization in BCR-deficient murine pre-B cells in the absence of external antigen and without experimental crosslinking. This autonomous BCR signal was less intense than the signal originating from the CLL BCR of their CLL siblings. According to genotyping by single nucleotide polymorphism array, whole exome, and targeted panel sequencing, CLL risk alleles were found with high and similar prevalence in CLL patients and MBL siblings, respectively. Likewise, the prevalence of recurrent CLL-associated genetic variants was similar between CLL and matched MBL samples. However, copy number variations and small variants were frequently subclonal in MBL cells, suggesting their acquisition during subclinical clonal expansion. These findings support a stepwise model of CLL pathogenesis, in which autonomous BCR signaling leads to a non-malignant (oligo)clonal expansion of CD5+ B cells, followed by malignant progression to CLL after acquisition of pathogenic genetic variants.
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Affiliation(s)
- Edwin Quinten
- Department of Hematology, Leiden University Medical Center, Leiden
| | - Julieta H Sepúlveda-Yáñez
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands; School of Medicine, Universidad de Magallanes, Punta Arenas, Chile
| | - Marvyn T Koning
- Department of Hematology, Leiden University Medical Center, Leiden
| | - Janneke A Eken
- Department of Hematology, Leiden University Medical Center, Leiden
| | - Dietmar Pfeifer
- Department of Medicine I, University Medical Center Freiburg, Freiburg
| | - Valeri Nteleah
- Department of Hematology, Leiden University Medical Center, Leiden
| | | | | | - Jeroen Knijnenburg
- Department of Clinical Genetics, Leiden University Medical Center, Leiden
| | | | - Milena Pantic
- Department of Medicine I, University Medical Center Freiburg, Freiburg
| | - Andreas Agathangelidis
- Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece; Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | | | | | - Roberto Uribe-Paredes
- Department of Computer Engineering, Universidad de Magallanes, Punta Arenas, Chile; Centre for Biotechnology and Bioengineering, Santiago, Chile
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm
| | | | - Katja Zirlik
- Department of Medicine I, University Medical Center Freiburg, Freiburg, Germany; Tumor-und Brustzentrum Ostschweiz, Chur
| | | | | | - Hendrik Veelken
- Department of Hematology, Leiden University Medical Center, Leiden.
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Bravo-Perez C, Gurnari C. A tower of babel of acronyms? The shadowlands of MGUS/MBL/CHIP/TCUS. Semin Hematol 2024; 61:43-50. [PMID: 38350765 DOI: 10.1053/j.seminhematol.2024.01.004] [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: 10/25/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024]
Abstract
With the advent of outperforming and massive laboratory tools, such as multiparameter flow cytometry and next-generation sequencing, hematopoietic cell clones with putative abnormalities for a variety of blood malignancies have been appreciated in otherwise healthy individuals. These conditions do not fulfill the criteria of their presumed cancer counterparts, and thus have been recognized as their precursor states. This is the case of monoclonal gammopathy of unknown significance (MGUS), the first blood premalignancy state described, preceding multiple myeloma (MM) or Waldenström macroglobulinemia (WM). However, in the last 2 decades, an increasing list of clonopathies has been recognized, including monoclonal B cell lymphocytosis (MBL), which antecedes chronic lymphocytic leukemia (CLL), clonal hematopoiesis of indeterminate potential (CHIP) for myeloid neoplasms (MN), and T-cell clones of uncertain significance (TCUS) for T-cell large chronic lymphocytic leukemia (LGLL). While for some of these entities diagnostic boundaries are precisely set, for others these are yet to be fully defined. Moreover, despite mostly considered of "uncertain significance," they have not only appeared to predispose to malignancy, but also to be capable of provoking set of immunological and cardiovascular complications that may require specialized management. The clinical implications of the aberrant clones, together with the extensive knowledge generated on the pathogenetic events driving their evolution, raises the question whether earlier interventions may alter the natural history of the disease. Herein, we review this Tower of Babel of acronyms pinpointing diagnostic definitions, differential diagnosis, and the role of genomic profiling of these precursor states, as well as potential interventional strategies.
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Affiliation(s)
- Carlos Bravo-Perez
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, University of Murcia, IMIB-Pascual Parrilla, CIBERER - Instituto de Salud Carlos III, Murcia, Spain
| | - Carmelo Gurnari
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH; Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy.
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4
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Semenzato G, Ghobrial IM, Ghia P. Monoclonal B-cell lymphocytosis, monoclonal gammopathy of undetermined significance, and T-cell clones of uncertain significance: are these premalignant conditions sharing a common identity? Lancet Haematol 2023; 10:e549-e556. [PMID: 37407144 DOI: 10.1016/s2352-3026(23)00086-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 07/07/2023]
Abstract
Monoclonal B-cell lymphocytosis, monoclonal gammopathy of undetermined significance, and T-cell clones of uncertain significance are three premalignant conditions characterised by the presence of small clonal cell expansions in individuals without symptoms or signs that distinguish the related overt malignancies (chronic lymphocytic leukaemia, multiple myeloma, and T-cell large granular lymphocytic leukaemia). As most individuals with these precursor states never progress to malignancies, considerable interest has arisen in comprehending the steps involved in the progression to malignancy, providing more accurate models to investigate potential mechanisms of early blood cancer identification, prevention, and, possibly, intervention. Single-cell technologies and recent progress in high-throughput sequencing and multiomics approaches have contributed to a better definition of the pathophysiological mechanisms of these premalignant conditions, moving our knowledge in the field forward. In this Viewpoint, we analyse the seemingly shared biological trajectories in these precursor haematological malignancies in search of common pathogenetic events. In particular, we address the issue of interactions between expanding clones and their immune ecosystem, offering new clues that might prompt innovative ideas and inspire further investigations to understand the cellular and molecular dynamics entailing progression into overt malignant disease. The relationships between the non-leukaemic microenvironmental cells and the leukaemic counterpart, and the primary drivers of their initial clonal expansion, represent shared biologies that suggest a common identity among the premalignant conditions considered in this Viewpoint.
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Affiliation(s)
- Gianpietro Semenzato
- Haematology Section, Department of Medicine, University of Padova, Padua, Italy; Veneto Institute of Molecular Medicine, Padua, Italy.
| | | | - Paolo Ghia
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
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5
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Gargiulo E, Ribeiro EFO, Niemann CU. SOHO State of the Art Updates and Next Questions | Infections in Chronic Lymphocytic Leukemia Patients: Risks and Management. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:322-332. [PMID: 36868914 DOI: 10.1016/j.clml.2023.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Although chronic lymphocytic leukemia (CLL) is a malignancy characterized by accumulation of tumor cells in the blood, bone marrow, lymph nodes and secondary lymphoid tissues, the hallmark of the disease and the major cause of death for patients with CLL is actually immune dysfunction and associated infections. Despite improvement in treatment based on combination chemoimmunotherapy and targeted treatment with BTK and BCL-2 inhibitors leading to longer overall survival for patients with CLL, the mortality due to infections have not improved over the last 4 decades. Thus, infections are now the main cause of death for patients with CLL, posing threats to the patient whether during the premalignant state of monoclonal B lymphocytosis (MBL), during the watch & wait phase for treatment naïve patients, or upon treatment in terms of chemoimmunotherapy or targeted treatment. To test whether the natural history of immune dysfunction and infections in CLL can be changed, we have developed the machine learning based algorithm CLL-TIM.org to identify these patients. The CLL-TIM algorithm is currently being used for selection of patients for the clinical trial PreVent-ACaLL (NCT03868722), testing whether short-term treatment with the BTK inhibitor acalabrutinib and the BCL-2 inhibitor venetoclax can improve immune function and decrease the risk of infections for this high-risk patient population. We here review the background for and management of infectious risks in CLL.
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Affiliation(s)
- Ernesto Gargiulo
- Tumor-Stroma Interactions, Department of Oncology, Luxembourg Institute of Health, Luxembourg City, Luxembourg; Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; PERSIMUNE, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Center of Oncology and Hematology, Hospital Santa Lúcia Sul, Brasilia, Brazil; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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6
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Tang C, Shen Y, Soosapilla A, Mulligan SP. Monoclonal B-cell Lymphocytosis - a review of diagnostic criteria, biology, natural history, and clinical management. Leuk Lymphoma 2022; 63:2795-2806. [PMID: 35767361 DOI: 10.1080/10428194.2022.2092857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since first described almost two decades ago, there has been significant evolution in our definition and understanding of the biology and implications of monoclonal B-cell lymphocytosis (MBL). This review provides an overview of the definition, classification, biology, and natural history of MBL, mainly focused on the dominant CLL-like phenotype form of MBL. The increasingly recognized implications of MBL with respect to immune dysfunction are discussed, particularly in view of the COVID-19 pandemic, along with management recommendations for MBL in the clinic.
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Affiliation(s)
- Catherine Tang
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Gosford Hospital, Gosford, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Yandong Shen
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia
| | - Stephen P Mulligan
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
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7
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Galigalidou C, Zaragoza-Infante L, Iatrou A, Chatzidimitriou A, Stamatopoulos K, Agathangelidis A. Understanding Monoclonal B Cell Lymphocytosis: An Interplay of Genetic and Microenvironmental Factors. Front Oncol 2021; 11:769612. [PMID: 34858849 PMCID: PMC8631769 DOI: 10.3389/fonc.2021.769612] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
The term monoclonal B-cell lymphocytosis (MBL) describes the presence of a clonal B cell population with a count of less than 5 × 109/L and no symptoms or signs of disease. Based on the B cell count, MBL is further classified into 2 distinct subtypes: 'low-count' and 'high-count' MBL. High-count MBL shares a series of biological and clinical features with chronic lymphocytic leukemia (CLL), at least of the indolent type, and evolves to CLL requiring treatment at a rate of 1-2% per year, whereas 'low-count' MBL seems to be distinct, likely representing an immunological rather than a pre-malignant condition. That notwithstanding, both subtypes of MBL can carry 'CLL-specific' genomic aberrations such as cytogenetic abnormalities and gene mutations, yet to a much lesser extent compared to CLL. These findings suggest that such aberrations are mostly relevant for disease progression rather than disease onset, indirectly pointing to microenvironmental drive as a key contributor to the emergence of MBL. Understanding microenvironmental interactions is therefore anticipated to elucidate MBL ontogeny and, most importantly, the relationship between MBL and CLL.
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Affiliation(s)
- Chrysi Galigalidou
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), Thessaloniki, Greece.,Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Laura Zaragoza-Infante
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), Thessaloniki, Greece.,Hematology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
| | - Anastasia Iatrou
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), Thessaloniki, Greece
| | - Anastasia Chatzidimitriou
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), Thessaloniki, Greece.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), Thessaloniki, Greece.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Agathangelidis
- Institute of Applied Biosciences (INAB), Centre for Research and Technology Hellas (CERTH), Thessaloniki, Greece.,Department of Biology, School of Science, National and Kapodistrian University of Athens, Athens, Greece
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Smith T, Cunningham-Rundles C. Lymphoid malignancy in common variable immunodeficiency in a single-center cohort. Eur J Haematol 2021; 107:503-516. [PMID: 34255892 PMCID: PMC8497444 DOI: 10.1111/ejh.13687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
One of the complications of common variable immunodeficiency (CVID) is the development of lymphoid malignancy. In this retrospective, single-center study of 647 CVID subjects followed over 4 decades, we present immunologic and clinical phenotypes, pathology, treatment, and outcomes of 45 patients (15 males and 30 females, 7%) who developed 49 lymphoid malignancies. The mean age at CVID diagnosis was 42.6 years) and at lymphoma diagnosis was 48.8 years. Of the 41 with known follow up, 29 (70%) have died, 27 of these due to this diagnosis. Twelve are alive, in remission or have achieved cure; four others were alive at last encounter. Some patients had a history of only recurrent infections (36.3%); others had autoimmunity (33%), enteropathy (20%), and/or granulomatous disease (11%). Six had previously been treated for another cancer. This report also includes 6 additional living CVID patients who had been diagnosed with NHL; 4 were given treatment for this. However, on pathology review, the initial diagnosis was reversed, as the findings were more consistent with a benign lymphoproliferative process. This study outlines the high incidence of lymphoma in this single CVID cohort, and some of the diagnostic challenges presented due to immune dysregulation characteristic of this immune defect.
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Affiliation(s)
- Tukisa Smith
- Division of Clinical Immunology, Departments of Medicine and Pediatrics, PRISM Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Allergy and Immunology, Department of Medicine, UC San Diego Health, San Diego, CA, USA
| | - Charlotte Cunningham-Rundles
- Division of Clinical Immunology, Departments of Medicine and Pediatrics, PRISM Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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9
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Vlachonikola E, Sofou E, Chatzidimitriou A, Stamatopoulos K, Agathangelidis A. The Significance of B-cell Receptor Stereotypy in Chronic Lymphocytic Leukemia: Biological and Clinical Implications. Hematol Oncol Clin North Am 2021; 35:687-702. [PMID: 34174980 DOI: 10.1016/j.hoc.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The finding that (quasi)identical, stereotyped B-cell receptor (BcR) immunoglobulins IGs) are expressed in a significant fraction of chronic lymphocytic leukemia (CLL) highlighted the importance of antigen selection in disease pathogenesis. Subsets of patients sharing the same stereotyped BcR IG display consistent biological features and, at least for certain subsets, clinical presentation and outcome, including the response to particular treatment. On these grounds, BcR IG stereotypy emerges as a useful tool for dissecting the pronounced heterogeneity of CLL toward refining risk stratification and therapeutic management aligned with the principles of precision medicine.
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Affiliation(s)
- Elisavet Vlachonikola
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou - Thermis, 57001 Thermi, Thessaloniki, Greece; Department of Genetics and Molecular Biology, Faculty of Biology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Electra Sofou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou - Thermis, 57001 Thermi, Thessaloniki, Greece; Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Anastasia Chatzidimitriou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou - Thermis, 57001 Thermi, Thessaloniki, Greece; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala 75236, Sweden
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou - Thermis, 57001 Thermi, Thessaloniki, Greece; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala 75236, Sweden.
| | - Andreas Agathangelidis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th km Charilaou - Thermis, 57001 Thermi, Thessaloniki, Greece
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10
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Agathangelidis A, Galigalidou C, Scarfò L, Moysiadis T, Rovida A, Gounari M, Psomopoulos F, Ranghetti P, Galanis A, Davi F, Stamatopoulos K, Chatzidimitriou A, Ghia P. Infrequent "chronic lymphocytic leukemia-specific" immunoglobulin stereotypes in aged individuals with or without low-count monoclonal B-cell lymphocytosis. Haematologica 2021; 106:1178-1181. [PMID: 32586905 PMCID: PMC8018099 DOI: 10.3324/haematol.2020.247908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Andreas Agathangelidis
- Division of Experimental Oncology, Università Vita-Salute, Ospedale San Raffaele, Milan, Italy
| | - Chrysi Galigalidou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Lydia Scarfò
- Division of Experimental Oncology, Università Vita-Salute, Ospedale San Raffaele, Milan, Italy
| | - Theodoros Moysiadis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Alessandra Rovida
- Division of Experimental Oncology, Università Vita-Salute, Ospedale San Raffaele, Milan, Italy
| | - Maria Gounari
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Fotis Psomopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Pamela Ranghetti
- Division of Experimental Oncology, Università Vita-Salute, Ospedale San Raffaele, Milan, Italy
| | - Alex Galanis
- Dept. of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | - Frederic Davi
- Biological Hematology, Hopital Pitié-Salpetriere, Sorbonne Université, Paris, France
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | | | - Paolo Ghia
- Division of Experimental Oncology, Università Vita-Salute, Ospedale San Raffaele, Milan, Italy
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11
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New developments in non-Hodgkin lymphoid malignancies. Pathology 2021; 53:349-366. [PMID: 33685720 DOI: 10.1016/j.pathol.2021.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/23/2022]
Abstract
The revised fourth edition of the World Health Organization (WHO) Classification of Tumours of Haematopoietic and Lymphoid Tissues (2017) reflects significant advances in understanding the biology, genetic basis and behaviour of haematopoietic neoplasms. This review focuses on some of the major changes in B-cell and T-cell non-Hodgkin lymphomas in the 2017 WHO and includes more recent updates. The 2017 WHO saw a shift towards conservatism in the classification of precursor lesions of small B-cell lymphomas such as monoclonal B-cell lymphocytosis, in situ follicular and in situ mantle cell neoplasms. With more widespread use of next generation sequencing (NGS), special entities within follicular lymphoma and mantle cell lymphoma were recognised with recurrent genetic aberrations and unique clinicopathological features. The diagnostic workup of lymphoplasmacytic lymphoma and hairy cell leukaemia has been refined with the discovery of MYD88 L265P and BRAF V600E mutations, respectively, in these entities. Recommendations in the immunohistochemical evaluation of diffuse large B-cell lymphoma include determining cell of origin and expression of MYC and BCL2, so called 'double-expressor' phenotype. EBV-positive large B-cell lymphoma of the elderly has been renamed to recognise its occurrence amongst a wider age group. EBV-positive mucocutaneous ulcer is a newly recognised entity with indolent clinical behaviour that occurs in the setting of immunosuppression. Two lymphomas with recurrent genetic aberrations are newly included provisional entities: Burkitt-like lymphoma with 11q aberration and large B-cell lymphoma with IRF4 rearrangement. Aggressive B-cell lymphomas with MYC, BCL2 and/or BCL6 rearrangements, so called 'double-hit/triple-hit' lymphomas are now a distinct entity. Much progress has been made in understanding intestinal T-cell lymphomas. Enteropathy-associated T-cell lymphoma, type II, is now known to not be associated with coeliac disease and is hence renamed monomorphic epitheliotropic T-cell lymphoma. An indolent clonal T-cell lymphoproliferative disorder of the GI tract is a newly included provisional entity. Angioimmunoblastic T-cell lymphoma and nodal T-cell lymphomas with T-follicular helper phenotype are included in a single broad category, emphasising their shared genetic and phenotypic features. Anaplastic large cell lymphoma, ALK- is upgraded to a definitive entity with subsets carrying recurrent rearrangements in DUSP22 or TP63. Breast implant-associated anaplastic large cell lymphoma is a new provisional entity with indolent behaviour. Finally, cutaneous T-cell proliferations include a new provisional entity, primary cutaneous acral CD8-positive T-cell lymphoma, and reclassification of primary small/medium CD4-positive T-cell lymphoma as lymphoproliferative disorder.
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12
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Puiggros A, Blanco G, Muntasell A, Rodríguez-Rivera M, Nonell L, Altadill M, Puigdecanet E, Arnal M, Calvo X, Gimeno E, Abella E, Abrisqueta P, Bosch F, Yélamos J, Ferrer A, López-Botet M, Espinet B. Reduced expansion of CD94/NKG2C + NK cells in chronic lymphocytic leukemia and CLL-like monoclonal B-cell lymphocytosis is not related to increased human cytomegalovirus seronegativity or NKG2C deletions. Int J Lab Hematol 2021; 43:1032-1040. [PMID: 33615729 DOI: 10.1111/ijlh.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/29/2021] [Accepted: 02/06/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Dysregulated NK cell-mediated immune responses contribute to tumor evasion in chronic lymphocytic leukemia (CLL), although the NK cell compartment in CLL-like monoclonal B-cell lymphocytosis (MBL) is poorly understood. In healthy individuals, human cytomegalovirus (HCMV) induces the expansion of NK cells expressing high levels of CD94/NKG2C NK cell receptor (NKR) specific for HLA-E. METHODS We analyzed the expression of NKG2A, NKG2C, ILT2, KIR, CD161, and CD57 in 24 MBL and 37 CLL. NKG2C was genotyped in these patients and in 81 additional MBL/CLL, while NKG2C gene expression was assessed in 26 cases. In 8 CLL patients with increased lymphocytosis (≥20 × 109 /L), tumor HLA-E and HLA-G expression was evaluated. RESULTS NKR distribution did not significantly differ between MBL and CLL patients, although they exhibited reduced NKG2C+ NK cells compared with a non-CLL group (4.6% vs 12.2%, P = .012). HCMV+ patients showed increased percentages of NKG2C+ NK cells compared with HCMV- (7.3% vs 2.9%, P = .176). Frequencies of NKG2C deletions in MBL/CLL were similar to those of the general population. Low/undetectable NKG2C expression was found among NKG2C+/- (45%) and NKG2C+/+ (12%) patients. CLL cases with increased lymphocytosis displayed especially reduced NKG2C expression (1.8% vs 8.1%, P = .029) and tumor cells with high HLA-E (>98%) and variable HLA-G expression (12.4%, range: 0.5-56.4). CLL patients with low NKG2C expression (<7%) showed shorter time to first treatment (P = .037). CONCLUSION Reduced percentages of CD94/NKG2C+ NK cells were observed in CLL and MBL patients independently of HCMV serostatus and NKG2C zygosity, particularly in CLL patients with increased lymphocytosis, which could potentially be related to the exposure to tumor cells.
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Affiliation(s)
- Anna Puiggros
- Molecular Cytogenetics Laboratory, Hematological Cytology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain.,Translational Research on Hematological Neoplasms Group, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Gonzalo Blanco
- Molecular Cytogenetics Laboratory, Hematological Cytology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain.,Translational Research on Hematological Neoplasms Group, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Aura Muntasell
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - María Rodríguez-Rivera
- Molecular Cytogenetics Laboratory, Hematological Cytology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain.,Translational Research on Hematological Neoplasms Group, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | | | | | - Eulàlia Puigdecanet
- MARGenomics, IMIM, Barcelona, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain
| | | | - Xavier Calvo
- Molecular Cytogenetics Laboratory, Hematological Cytology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain.,Translational Research on Hematological Neoplasms Group, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Eva Gimeno
- Hematology Department, Hospital del Mar-IMIM, Barcelona, Spain.,Applied Clinical Research in Hematological Malignances, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Eugènia Abella
- Hematology Department, Hospital del Mar-IMIM, Barcelona, Spain.,Applied Clinical Research in Hematological Malignances, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Pau Abrisqueta
- Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francesc Bosch
- Hematology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José Yélamos
- Immunology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Ana Ferrer
- Molecular Cytogenetics Laboratory, Hematological Cytology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain.,Translational Research on Hematological Neoplasms Group, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Miguel López-Botet
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,University Pompeu Fabra (UPF), Barcelona, Spain
| | - Blanca Espinet
- Molecular Cytogenetics Laboratory, Hematological Cytology Laboratory, Pathology Department, Hospital del Mar, Barcelona, Spain.,Translational Research on Hematological Neoplasms Group, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
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13
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Blanco G, Puiggros A, Sherry B, Nonell L, Calvo X, Puigdecanet E, Chiu PY, Kieso Y, Ferrer G, Palacios F, Arnal M, Rodríguez-Rivera M, Gimeno E, Abella E, Rai KR, Abrisqueta P, Bosch F, Calon A, Ferrer A, Chiorazzi N, Espinet B. Chronic lymphocytic leukemia-like monoclonal B-cell lymphocytosis exhibits an increased inflammatory signature that is reduced in early-stage chronic lymphocytic leukemia. Exp Hematol 2021; 95:68-80. [PMID: 33421548 DOI: 10.1016/j.exphem.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022]
Abstract
Several studies in chronic lymphocytic leukemia (CLL) patients have reported impaired immune cell functions, which contribute to tumor evasion and disease progression. However, studies on CLL-like monoclonal B-cell lymphocytosis (MBL) are scarce. In the study described here, we characterized the immune environment in 62 individuals with clinical MBL, 56 patients with early-stage CLL, and 31 healthy controls. Gene expression arrays and quantitative reverse transcription polymerase chain reaction were performed on RNA from CD4+ peripheral blood cells; serum cytokines were measured with immunoassays; and HLA-DR expression on circulating monocytes, as well as the percentages of Th1, cytotoxic, exhausted, and effector CD4+ T cells, were evaluated by flow cytometry. In addition, cell cultures of clonal B cells and CD14-enriched or -depleted cell fractions were performed. Strikingly, MBL and early-stage CLL differed in pro-inflammatory signatures. An increased inflammatory drive orchestrated mainly by monocytes was identified in MBL, which exhibited enhanced phagocytosis, pattern recognition receptors, interleukin-8 (IL8), HMGB1, and acute response signaling pathways and increased pro-inflammatory cytokines (in particular IL8, interferon γ [IFNγ], and tumor necrosis factor α). This inflammatory signature was diminished in early-stage CLL (reduced IL8 and IFNγ levels, IL8 signaling pathway, and monocytic HLA-DR expression compared with MBL), especially in those patients with mutations in IGHV genes. Additionally, CD4+ T cells of MBL and early-stage CLL exhibited a similar upregulation of Th1 and cytotoxic genes and expanded CXCR3+ and perforin+ CD4+ T cells, as well as PD1+ CD4+ T cells, compared with controls. Cell culture assays disclosed tumor-supporting effects of monocytes similarly observed in MBL and early-stage CLL. These novel findings reveal differences in the inflammatory environment between MBL and CLL, highlighting an active role for antigen stimulation in the very early stages of the disease, potentially related to malignant B-cell transformation.
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Affiliation(s)
- Gonzalo Blanco
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Anna Puiggros
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Barbara Sherry
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY; Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
| | | | - Xavier Calvo
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | - Pui Yan Chiu
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Yasmine Kieso
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Gerardo Ferrer
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Florencia Palacios
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | | | - María Rodríguez-Rivera
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eva Gimeno
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Eugènia Abella
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Kanti R Rai
- Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Pau Abrisqueta
- Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francesc Bosch
- Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alexandre Calon
- Laboratori de Recerca Translacional en Microambient Tumoral, Cancer Research Program, IMIM, Barcelona, Spain
| | - Ana Ferrer
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Nicholas Chiorazzi
- Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Blanca Espinet
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
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14
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Casabonne D, Benavente Y, Seifert J, Costas L, Armesto M, Arestin M, Besson C, Hosnijeh FS, Duell EJ, Weiderpass E, Masala G, Kaaks R, Canzian F, Chirlaque MD, Perduca V, Mancini FR, Pala V, Trichopoulou A, Karakatsani A, La Vecchia C, Sánchez MJ, Tumino R, Gunter MJ, Amiano P, Panico S, Sacerdote C, Schmidt JA, Boeing H, Schulze MB, Barricarte A, Riboli E, Olsen A, Tjønneland A, Vermeulen R, Nieters A, Lawrie CH, de Sanjosé S. Serum levels of hsa-miR-16-5p, hsa-miR-29a-3p, hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-223-3p and subsequent risk of chronic lymphocytic leukemia in the EPIC study. Int J Cancer 2020; 147:1315-1324. [PMID: 32012253 DOI: 10.1002/ijc.32894] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is an incurable disease accounting for almost one-third of leukemias in the Western world. Aberrant expression of microRNAs (miRNAs) is a well-established characteristic of CLL, and the robust nature of miRNAs makes them eminently suitable liquid biopsy biomarkers. Using a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC), the predictive values of five promising human miRNAs (hsa-miR-16-5p, hsa-miR-29a-3p, hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-223-3p), identified in a pilot study, were examined in serum of 224 CLL cases (diagnosed 3 months to 18 years after enrollment) and 224 matched controls using Taqman based assays. Conditional logistic regressions were applied to adjust for potential confounders. The median time from blood collection to CLL diagnosis was 10 years (p25-p75: 7-13 years). Overall, the upregulation of hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-29a-3p was associated with subsequent risk of CLL [OR1∆Ct-unit increase (95%CI) = 1.42 (1.18-1.72), 1.64 (1.31-2.04) and 1.75 (1.31-2.34) for hsa-miR-150-5p, hsa-miR-155-5p and hsa-miR-29a-3p, respectively] and the strongest associations were observed within 10 years of diagnosis. However, the predictive performance of these miRNAs was modest (area under the curve <0.62). hsa-miR-16-5p and hsa-miR-223-3p levels were unrelated to CLL risk. The findings of this first prospective study suggest that hsa-miR-29a, hsa-miR-150-5p and hsa-miR-155-5p were upregulated in early stages of CLL but were modest predictive biomarkers of CLL risk.
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MESH Headings
- Biomarkers, Tumor/blood
- Case-Control Studies
- Europe/epidemiology
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Male
- MicroRNAs/blood
- Middle Aged
- Odds Ratio
- Predictive Value of Tests
- Prospective Studies
- Up-Regulation
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Affiliation(s)
- Delphine Casabonne
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Yolanda Benavente
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Julia Seifert
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
| | - Laura Costas
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - María Armesto
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
| | - María Arestin
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
| | - Caroline Besson
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
| | - Fatemeh S Hosnijeh
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric J Duell
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - María-Dolores Chirlaque
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Vittorio Perduca
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
- Laboratoire de Mathématiques Appliquées MAP5 (UMR CNRS 8145), Université Paris Descartes, Paris, France
| | - Francesca R Mancini
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Dept. of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Maria-Jose Sánchez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Universidad de Granada, Granada, Spain
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP), Ragusa, Italy
| | - Marc J Gunter
- Section of Nutrition and Metabolism, IARC, International Agency for Research on Cancer, Lyon, France
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città Della Salute e Della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - Aurelio Barricarte
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Elio Riboli
- School of Public Health, Imperial College London, London, United Kingdom
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, The Copenhagen University, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - Alexandra Nieters
- Institute for Immunodeficiency (IFI) Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Charles H Lawrie
- Molecular Oncology Group, Biodonostia Research Institute, San Sebastián, Spain
- Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Silvia de Sanjosé
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
- Reproductive Health, PATH, Seattle, WA
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15
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Smirnov AV, Afanasyev BV, Poddubnaya IV, Dobronravov VA, Khrabrova MS, Zakharova EV, Nikitin EA, Lysenko Kozlovskaya LV, Bobkova IN, Rameev VV, Batyushin MM, Moiseev IS, Darskaya EI, Pirogova OV, Mendeleeva LP, Biryukova LS. [Monoclonal gammopathy of renal significance: consensus of hematologists and nephrologists of Russia on the establishment of nosology, diagnostic approach and rationale for clone specific treatment]. TERAPEVT ARKH 2020; 92:10-22. [PMID: 33346441 DOI: 10.26442/00403660.2020.07.000659] [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: 08/25/2020] [Indexed: 11/22/2022]
Abstract
Monoclonal gammopathy of renal significance (MGRS) is a new nosology in modern nephrology and oncohematology. MGRS is defined as kidney injury due to nephrotoxic monoclonal immunoglobulin produced by the B-cell line clone which does not reach the hematological criteria for specific treatment initiation. Monoclonal proteins pathological effects on kidney parenchyma result in irreversible decline of kidney function till the end stage renal disease that in line with the position of International Consensus of hematologists and nephrologists determinates critical necessity for clone specific treatment in patients with MGRS despite the absence of hematological indications for treatment initiation. Main challenge of MGRS in Russian Federation is an inaccessibility of an in-time diagnostic and appropriate treatment for the great majority of patients due to the following reasons: 1) limited knowledge about the MGRS among hematologists and nephrologists; 2) lack of necessary diagnostic resources in most health-care facilities; 3) lack of approved clinical recommendations and medical economic standards for treatment of this pathological entity. Consensus document comprises the opinion of experts leading nephrologists and hematologists of Russian Federation on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment. Consensus document is based on conclusions and agreements reached during the conference of leading nephrologists and hematologists of Russia which was held in the framework of symposia Plasma cell dyscrasias and lymphoproliferative diseases: modern approaches to therapy, 1516 of March 2019, Pavlov First Saint Petersburg State Medical University. The present Consensus is intended to define the principal practical steps to resolve the problem of MGRS in Russian Federation that are summarized as final clauses.
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Affiliation(s)
- A V Smirnov
- Pavlov First Saint Petersburg State Medical University
| | - B V Afanasyev
- Pavlov First Saint Petersburg State Medical University
| | - I V Poddubnaya
- Russian Medical Academy of Continuous Professional Education
| | | | - M S Khrabrova
- Pavlov First Saint Petersburg State Medical University
| | - E V Zakharova
- Russian Medical Academy of Continuous Professional Education.,Yevdokimov Moscow State University of Medicine and Dentistry.,Botkin City Clinical Hospital
| | - E A Nikitin
- Russian Medical Academy of Continuous Professional Education.,Botkin City Clinical Hospital
| | | | - I N Bobkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Rameev
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - I S Moiseev
- Pavlov First Saint Petersburg State Medical University
| | - E I Darskaya
- Pavlov First Saint Petersburg State Medical University
| | - O V Pirogova
- Pavlov First Saint Petersburg State Medical University
| | | | - L S Biryukova
- Russian Medical Academy of Continuous Professional Education.,National Research Center for Hematology
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16
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Abstract
OPINION STATEMENT Treatment landscape of chronic lymphocytic leukemia (CLL) has changed since 2014 after the introduction of inhibitors of B-cell receptor signaling pathway (ibrutinib, acalabrutinib, idelalisib and duvelisib) and the inhibitor of the anti-apoptotic protein BCL-2 (venetoclax). In 2019, novel agents were upgraded from being a "great treatment option" to the "preferred choice" for all lines of treatment after number of randomized clinical trials proved their superiority compared to conventional chemoimmunotherapy (CIT) regimens. A growing number of next-generation molecules are in clinical trials with a promise of improved efficacy and less toxicity. This includes agents with expected better safety profile (zanubrutinib, umbralisib, etc.) or more importantly with a potential to overcome the resistance mechanism to early generation agents (ARQ-531, LOXO-305, or vecabrutinib). Early intervention has once again become an active topic of research and, if proven to provide an overall survival benefit, will eliminate the "watch and wait" strategy for asymptomatic CLL patients. Until then, treatment should only be offered to patients who meet the standard treatment indication in standard practice. With our upgraded therapeutic toolbox, there are and will be many unanswered questions. CLL field will need to define the optimal treatment sequence and most effective combinations with a goal of having a time-limited and chemotherapy-free regimen that provides longest remissions and potentially cure. Cellular immunotherapy with chimeric antigen receptor T-cell (CAR-T) may become available for high-risk CLL along with allogeneic stem cell transplant (allo-SCT). Financial toxicity of novel agents especially when used in combination will need to be an important aspect of research in coming years to avoid unnecessary overtreatment of patients. As current prognostic models (CLL-IPI, etc.) were developed and validated in the CIT era, there is ongoing effort to develop new models using clinical and molecular characteristics to accurately define high-risk CLL in the era of novel agents. We all need to keep in mind that access to the novel agents is currently limited to certain developed countries and every effort should be made to make sure patients around the world also benefit from these outstanding drugs.
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17
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Colombo M, Bagnara D, Reverberi D, Matis S, Cardillo M, Massara R, Mastracci L, Ravetti JL, Agnelli L, Neri A, Mazzocco M, Squillario M, Mazzarello AN, Cutrona G, Agathangelidis A, Stamatopoulos K, Ferrarini M, Fais F. Tracing CLL-biased stereotyped immunoglobulin gene rearrangements in normal B cell subsets using a high-throughput immunogenetic approach. Mol Med 2020; 26:25. [PMID: 32156260 PMCID: PMC7063734 DOI: 10.1186/s10020-020-00151-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/21/2020] [Indexed: 01/10/2023] Open
Abstract
Background B cell receptor Immunoglobulin (BcR IG) repertoire of Chronic Lymphocytic Leukemia (CLL) is characterized by the expression of quasi-identical BcR IG. These are observed in approximately 30% of patients, defined as stereotyped receptors and subdivided into subsets based on specific VH CDR3 aa motifs and phylogenetically related IGHV genes. Although relevant to CLL ontogeny, the distribution of CLL-biased stereotyped immunoglobulin rearrangements (CBS-IG) in normal B cells has not been so far specifically addressed using modern sequencing technologies. Here, we have investigated the presence of CBS-IG in splenic B cell subpopulations (s-BCS) and in CD5+ and CD5− B cells from the spleen and peripheral blood (PB). Methods Fractionation of splenic B cells into 9 different B cell subsets and that of spleen and PB into CD5+ and CD5− cells were carried out by FACS sorting. cDNA sequences of BcR IG gene rearrangements were obtained by NGS. Identification of amino acidic motifs typical of CLL stereotyped subsets was carried out on IGHV1-carrying gene sequences and statistical evaluation has been subsequently performed to assess stereotypes distribution. Results CBS-IG represented the 0.26% average of IGHV1 genes expressing sequences, were detected in all of the BCS investigated. CBS-IG were more abundant in splenic and circulating CD5+ B (0.57%) cells compared to CD5− B cells (0.17%). In all instances, most CBS IG did not exhibit somatic hypermutation similar to CLL stereotyped receptors. However, compared to CLL, they exhibited a different CLL subset distribution and a broader utilization of the genes of the IGHV1 family. Conclusions CBS-IG receptors appear to represent a part of the “public” BcR repertoire in normal B cells. This repertoire is observed in all BCS excluding the hypothesis that CLL stereotyped BcR accumulate in a specific B cell subset, potentially capable of originating a leukemic clone. The different relative representation of CBS-IG in normal B cell subgroups suggests the requirement for additional selective processes before a full transformation into CLL is achieved.
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Affiliation(s)
- Monica Colombo
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Davide Bagnara
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Daniele Reverberi
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Serena Matis
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Cardillo
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rosanna Massara
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Mastracci
- U.O. Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | | | - Luca Agnelli
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Antonino Neri
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Michela Mazzocco
- U.O. Laboratorio di Istocompatibilità, E.O. Ospedali Galliera, Genoa, Italy
| | - Margherita Squillario
- Department of Informatic Bioengeneering, Robotic and System Engeneering, University of Genoa, Genoa, Italy
| | | | - Giovanna Cutrona
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andreas Agathangelidis
- Institute of Applied Biosciences, Center for Research and Technology Hellas CERTH, Thessaloniki, Greece
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Center for Research and Technology Hellas CERTH, Thessaloniki, Greece
| | - Manlio Ferrarini
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Franco Fais
- U.O. Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Experimental Medicine, University of Genoa, Genoa, Italy
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18
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Parikh SA, Meacham PJ, Zent CS, Evans AG. Multiple B cell malignancies in patients with chronic lymphocytic leukemia: epidemiology, pathology, and clinical implications. Leuk Lymphoma 2020; 61:1037-1051. [PMID: 31928278 DOI: 10.1080/10428194.2019.1709830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is associated with increased risk for certain cancers, but relatively little is known about the risk for these patients to develop additional B cell malignancies. Here, we review the available epidemiological data on multiple B cell malignancies in CLL, discuss diagnostic methods and proper pathologic evaluation to distinguish CLL from other B cell malignancies, and address clinical challenges and unmet needs in caring for CLL patients with unrelated B cell malignancies and disease transformation. Considerations include CLL patients with unrelated monoclonal B cell lymphocytosis, biclonal CLL, secondary B cell non-Hodgkin lymphomas, and Richter syndrome - both clonally related transformation and de novo large B cell lymphoma. We address the challenges that remain in order to better understand the underlying risk factors and biology that may put CLL patients at increased risk of developing multiple B cell neoplasia.
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Affiliation(s)
- Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Andrew G Evans
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
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19
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Abstract
Chronic lymphocytic leukaemia (CLL), the most frequent type of leukaemia in adults, is a lymphoproliferative disorder that is characterized by the expansion of monoclonal, mature CD5+CD23+ B cells in the peripheral blood, secondary lymphoid tissues and bone marrow. CLL is an incurable disease with a heterogeneous clinical course, for which the treatment decision still relies on conventional parameters (such as clinical stage and lymphocyte doubling time). During the past 5 years, relevant advances have been made in understanding CLL biology. Indeed, substantial progress has been made in the identification of the putative cell of origin of CLL, and comprehensive studies have dissected the genomic, epigenomic and transcriptomic landscape of CLL. Advances in clinical management include improvements in our understanding of the prognostic value of different genetic lesions, particularly those associated with chemoresistance and progression to highly aggressive forms of CLL, and the advent of new therapies targeting crucial biological pathways. In this Review, we discuss new insights into the genetic lesions involved in the pathogenesis of CLL and how these genetic insights influence clinical management and the development of new therapeutic strategies for this disease.
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20
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de Faria-Moss M, Yamamoto M, Arrais-Rodrigues C, Criado I, Gomes CP, de Lourdes Chauffaille M, Gonçalves MV, Kimura E, Koulieris E, Borges F, Dighiero G, Pesquero JB, Almeida J, Orfao A. High frequency of chronic lymphocytic leukemia-like low-count monoclonal B-cell lymphocytosis in Japanese descendants living in Brazil. Haematologica 2019; 105:e298-e301. [PMID: 31727770 DOI: 10.3324/haematol.2019.230813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mariane de Faria-Moss
- Division of Hematology, Universidade Federal de São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - Mihoko Yamamoto
- Division of Hematology, Universidade Federal de São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - Celso Arrais-Rodrigues
- Division of Hematology, Universidade Federal de São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - Ignacio Criado
- Cancer Research Center, Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and CIBERONC CB16/12/00400 (Centro de Investigación Biomédica en Red de CÁNCER), Salamanca, Spain
| | - Caio Perez Gomes
- Division of Hematology, Universidade Federal de São Paulo (EPM-UNIFESP), Sao Paulo, Brazil.,Department of Biophysics (EPM-UNIFESP), Sao Paulo, Brazil
| | | | | | - Eliza Kimura
- Division of Hematology, Universidade Federal de São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | - Efstathios Koulieris
- Cancer Research Center, Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and CIBERONC CB16/12/00400 (Centro de Investigación Biomédica en Red de CÁNCER), Salamanca, Spain
| | - Fabio Borges
- Division of Hematology, Universidade Federal de São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
| | | | | | - Julia Almeida
- Cancer Research Center, Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and CIBERONC CB16/12/00400 (Centro de Investigación Biomédica en Red de CÁNCER), Salamanca, Spain
| | - Alberto Orfao
- Cancer Research Center, Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL) and CIBERONC CB16/12/00400 (Centro de Investigación Biomédica en Red de CÁNCER), Salamanca, Spain
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21
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Ott G, Klapper W, Feller AC, Hansmann ML, Möller P, Stein H, Rosenwald A, Fend F. [Revised version of the 4th edition of the WHO classification of malignant lymphomas : What is new?]. DER PATHOLOGE 2019; 40:157-168. [PMID: 30019203 DOI: 10.1007/s00292-018-0456-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
After 8 years, the WHO has now published the updated version of the 4th edition of the classification of hematopoietic and lymphoid tumors. This update provides a conceptual rewrite of existing entities as well as some new provisional entities and categories, particularly among the aggressive B‑cell lymphomas. Important new diagnostic categories include the high-grade B‑cell lymphomas, the large B‑cell lymphoma with IRF4 rearrangement, and the Burkitt-like lymphoma with 11q aberrations. Of particular importance, new concepts concerning the taxonomy and classification of early lymphoid lesions or precursor lesions are included, such as the in situ follicular neoplasia or the in situ mantle cell neoplasia. In addition, the concept of indolent lymphoproliferations, such as breast-implant-associated anaplastic large cell lymphoma and the indolent T‑cell lymphoproliferative disorder of the gastrointestinal tract, has been strengthened. Finally, diagnostic criteria for existing lymphoma entities have been refined.
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Affiliation(s)
- G Ott
- Abteilung für Klinische Pathologie, Robert-Bosch-Krankenhaus, und Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Auerbachstraße 110/112, 70376, Stuttgart, Deutschland.
| | - W Klapper
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A C Feller
- Hämatopathologie Lübeck, Lübeck, Deutschland
| | - M L Hansmann
- Senckenberg Institut für Pathologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - P Möller
- Institut für Pathologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - H Stein
- Pathodiagnostik Berlin, Berlin, Deutschland
| | - A Rosenwald
- Pathologisches Institut und Comprehensive Cancer Center Mainfranken, Universität Würzburg, Würzburg, Deutschland
| | - F Fend
- Institut für Pathologie und Neuropathologie, Eberhard-Karls-Universität, Tübingen, Deutschland
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22
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Maitre E, Troussard X. Monoclonal B-cell lymphocytosis. Best Pract Res Clin Haematol 2019; 32:229-238. [PMID: 31585623 DOI: 10.1016/j.beha.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022]
Abstract
Flow cytometry diagnostic practices can detect very low levels of clonal B cells in the peripheral blood. In the absence of clinical symptoms, cytopenia or organomegaly, the small clones may correspond to monoclonal B-cell leukemia (MBL) diagnosis. Most MBLs harbor a chronic lymphocytic leukemia (CLL) phenotype (e.g., CD5+, CD23+) and are referred to as CLL-type MBL. The two other types are atypical CLL-type MBL and non-CLL-type MBL. In addition to the phenotypical classification, the clonal B count is a major issue because of the impact on the prognosis and the risk of progression in CLL. It allows for the discrimination of two distinct types: high-count (HC) MBL and low-count (LC)-MBL based on a cutoff value of 0.5 × 109/L clonal B cells. LC MBL appears to be very stable over time and is probably related to immunosenescence. Conversely, HC MBL could be a premalignant state before the occurrence of CLL.
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Affiliation(s)
- Elsa Maitre
- Laboratoire d'hématologie biologique, CHU de Caen Normandie, Caen, 14033, CEDEX 9, France.
| | - Xavier Troussard
- Laboratoire d'hématologie biologique, CHU de Caen Normandie, Caen, 14033, CEDEX 9, France.
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23
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von Tresckow J, Eichhorst B, Bahlo J, Hallek M. The Treatment of Chronic Lymphatic Leukemia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:41-46. [PMID: 30855005 PMCID: PMC6415618 DOI: 10.3238/arztebl.2019.0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 09/28/2017] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) mainly affects older persons and is the commonest form of leukemia, with an incidence of 6 cases per 100 000 per- sons per year. In Germany, approximately 1000 men and 850 women die of CLL each year. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed and on the authors' scientific and clinical experience. RESULTS The diagnosis of CLL requires the detection of at least 5000 B-lymphocytes per microliter in the peripheral blood. Courses of CLL may be indolent and require no treatment, but may also be aggressive and progress rapidly. Treatment should be initiated when there is marked evidence of bone-marrow suppression or disease- related symptoms such as B symptoms or fatigue. In the past ten years, a number of targeted drugs have been introduced that can achieve a very good, long-lasting response, particularly when used in combination. The combination of chemotherapy with anti-CD20 antibodies (chemoimmunotherapy) is the standard first-line treat- ment. In younger patients without any relevant accompanying illnesses, the combi- nation of fludarabine, cyclophosphamide, and rituximab prolongs survival. Patients with comorbidities should be treated with a combination of chlorambucil and obinutuzumab. In the last few years, ibrutinib, idelalsib, and venetoclax have been approved for clinical use. These substances inhibit cellular signal transduction pathways and are being increasingly used. CONCLUSION Recent progress in the development of novel treatment options gives hope that CLL may soon be a controllable disease. Even at present, chemoimmuno- therapy can achieve a progression-free survival of more than eight years in certain genetically defined subgroups of CLL patients.
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Affiliation(s)
- Julia von Tresckow
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine I – Oncology, Hematology, Clinical Infectiology, Clinical Immunology, Hemostaseology, Internal Intensive Care; University Hospital Cologne, Cologne, Germany
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24
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Angelillo P, Capasso A, Ghia P, Scarfò L. Monoclonal B-cell lymphocytosis: Does the elderly patient need a specialistic approach? Eur J Intern Med 2018; 58:2-6. [PMID: 30268574 DOI: 10.1016/j.ejim.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
Monoclonal B-cell lymphocytosis (MBL) is defined by the presence of a monoclonal B-cell population in the peripheral blood (PB) at a concentration of <5 × 109/l and no signs or symptoms of a lymphoproliferative disorder. In around 75% of cases, the immunophenotype of the clonal B-cell expansions is superimposable to that of chronic lymphocytic leukemia (CLL), thus defined "CLL-like". Other cases may coexpress CD19, CD5, bright CD20, and lack CD23 ("atypical CLL"), while others are CD5-negative ("non-CLL"). Beside the immunophenotypic profile, a key distinction is based on the B-cell count, stratifying the MBL category in low (<0.5 × 109/l) or high-count (≥0.5 × 109/l). Low-count (LC) MBL is recognized in general population studies and it is not associated with lymphocytosis. High-count (HC) MBL is identified during the clinical work-up for lymphocytosis and carries a risk of progression to CLL requiring therapy of 1-2% per year in most series, warranting clinical monitoring over time. At the time of MBL diagnosis, the key point is the careful evaluation and exclusion of differential diagnoses. After the initial workup, the follow-up at a referral center by a hematologist would be desirable as, in addition to the obvious risk of progression to clinically relevant CLL, the appropriate management of MBL individuals should take into account the risk of developing infections, other cancers and autoimmune disorders. For those cases who indeed bear a risk, though limited, of clinical consequences, such as the majority of HC-MBL cases, current evidences suggest that they may benefit from a tailored and specialized approach.
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Affiliation(s)
- Piera Angelillo
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Antonella Capasso
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Lydia Scarfò
- Strategic Research Program on CLL, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
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25
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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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26
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Jaffe ES. Diagnosis and classification of lymphoma: Impact of technical advances. Semin Hematol 2018; 56:30-36. [PMID: 30573042 DOI: 10.1053/j.seminhematol.2018.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/08/2018] [Indexed: 01/19/2023]
Abstract
Our current understanding of the normal lymphoid system informs the modern classification of lymphomas. B-cell, T-cell, and natural killer-cell neoplasms often recapitulate normal stages of lymphoid cell differentiation and function. Moreover, the clinical manifestations of lymphomas often reflect the normal function of lymphoid cells in vivo. The multiparameter approach to classification adopted by the Revised European and American Lymphoma and subsequent WHO classifications facilitates the interpretation of clinical and translational studies, and provides a framework for the discovery of molecular alterations that drive these tumors. An accurate and precise classification of disease entities facilitates the discovery of the molecular basis of lymphoid neoplasms in the basic science laboratory, and leads to new diagnostic tools that play a role in clinical diagnosis.
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Affiliation(s)
- Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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27
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Criado I, Rodríguez-Caballero A, Gutiérrez ML, Pedreira CE, Alcoceba M, Nieto W, Teodosio C, Bárcena P, Romero A, Fernández-Navarro P, González M, Almeida J, Orfao A. Low-count monoclonal B-cell lymphocytosis persists after seven years of follow up and is associated with a poorer outcome. Haematologica 2018; 103:1198-1208. [PMID: 29567775 PMCID: PMC6029554 DOI: 10.3324/haematol.2017.183954] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/15/2018] [Indexed: 11/25/2022] Open
Abstract
Low-count monoclonal B-cell lymphocytosis is defined by the presence of very low numbers of circulating clonal B cells, usually phenotypically similar to chronic lymphocytic leukemia cells, whose biological and clinical significance remains elusive. Herein, we re-evaluated 65/91 low-count monoclonal B-cell lymphocytosis cases (54 chronic lymphocytic leukemia-like and 11 non-chronic lymphocytic leukemia-like) followed-up for a median of seven years, using high-sensitivity flow cytometry and interphase fluorescence in situ hybridization. Overall, the clone size significantly increased in 69% of low-count monoclonal B-cell lymphocytosis cases, but only one subject progressed to high-count monoclonal B-cell lymphocytosis. In parallel, the frequency of cytogenetic alterations increased over time (32% vs. 61% of cases, respectively). The absolute number of the major T-cell and natural killer cell populations also increased, but only among chronic lymphocytic leukemia-like cases with increased clone size vs. age- and sex-matched controls. Although progression to chronic lymphocytic leukemia was not observed, the overall survival of low-count monoclonal B-cell lymphocytosis individuals was significantly reduced vs. non-monoclonal B-cell lymphocytosis controls (P=0.03) plus the general population from the same region (P≤0.001), particularly among females (P=0.01); infection and cancer were the main causes of death in low-count monoclonal B-cell lymphocytosis. In summary, despite the fact that mid-term progression from low-count monoclonal B-cell lymphocytosis to high-count monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia appears to be unlikely, these clones persist at increased numbers, usually carrying more genetic alterations, and might thus be a marker of an impaired immune system indirectly associated with a poorer outcome, particularly among females.
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Affiliation(s)
- Ignacio Criado
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - Arancha Rodríguez-Caballero
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - M Laura Gutiérrez
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - Carlos E Pedreira
- Systems and Computing Department (PESC), COPPE, Federal University of Rio de Janeiro (UFRJ), Brazil
| | - Miguel Alcoceba
- Hematology Service, University Hospital of Salamanca, IBMCC, IBSAL, CIBERONC and Department of Nursery and Physiotherapy, University of Salamanca, Spain
| | - Wendy Nieto
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - Cristina Teodosio
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - Paloma Bárcena
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - Alfonso Romero
- Centro de Atención Primaria de Salud Miguel Armijo, Salamanca, Sanidad de Castilla y León (SACYL), Spain
| | - Paulino Fernández-Navarro
- Centro de Atención Primaria de Salud de Ledesma, Salamanca, Sanidad de Castilla y León (SACYL), Spain
| | - Marcos González
- Hematology Service, University Hospital of Salamanca, IBMCC, IBSAL, CIBERONC and Department of Nursery and Physiotherapy, University of Salamanca, Spain
| | - Julia Almeida
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
| | - Alberto Orfao
- Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine and Cytometry Service (NUCLEUS), University of Salamanca, IBSAL and CIBERONC, Spain
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Rawstron AC, Ssemaganda A, de Tute R, Doughty C, Newton D, Vardi A, Evans PAS, Stamatopoulos K, Owen RG, Lightfoot T, Wakeham K, Karabarinde A, Asiki G, Newton R. Monoclonal B-cell lymphocytosis in a hospital-based UK population and a rural Ugandan population: a cross-sectional study. LANCET HAEMATOLOGY 2018; 4:e334-e340. [PMID: 28668191 PMCID: PMC5493519 DOI: 10.1016/s2352-3026(16)30192-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 10/04/2016] [Accepted: 11/18/2016] [Indexed: 12/24/2022]
Abstract
Background Reported incidence of B-cell malignancies shows substantial geographical variation, being more common in the Americas and Europe than in Africa. This variation might reflect differences in diagnostic capability, inherited susceptibility, and infectious exposures. Monoclonal B-cell lymphocytosis (MBL) is a precursor lesion that can be screened for in apparently healthy people, allowing comparison of prevalence across different populations independently of health-care provision. We aimed to compare the prevalence and phenotypic characteristics of MBL in age-and-sex-matched populations from rural Uganda and the UK. Methods In this cross-sectional study, we recruited volunteers aged at least 45 years who were seronegative for HIV-1 from the established Ugandan General Population Cohort and obtained their whole-blood samples. We also obtained blood samples from anonymised waste material of age-and-sex-matched individuals (aged >45 years, with a normal blood count and no history of cancer) in the UK. We used flow cytometry to determine the presence of MBL, defined according to standard diagnostic criteria, in the samples and compared differences in the proportion of cases with chronic lymphocytic leukaemia (CLL)-phenotype MBL and CD5-negative MBL, as well as differences in absolute monoclonal B-cell count between the two cohorts. Findings Between Jan 15 and Dec 18, 2012, we obtained samples from 302 Ugandan volunteers and 302 UK individuals who were matched by age and sex to the Ugandan population. Overall MBL prevalence was higher in the Ugandan participants (42 [14%] individuals) than in the UK cohort (25 [8%]; p=0·038). CLL-phenotype MBL was detected in three (1%) Ugandan participants and 21 (7%) UK participants (p=0·00021); all three Ugandan participants had absolute monoclonal B-cell count below one cell per μL, whereas the 21 UK participants had a median absolute number of circulating neoplastic cells of 4·6 (IQR 2–12) cells per μL. The prevalence of CD5-negative MBL was higher in the Ugandan cohort (41 [14%], of whom two [5%] also had CLL-phenotype MBL) than in the UK cohort (six [2%], of whom two [33%] also had CLL-phenotype MBL; p<0·0001), but the median absolute B-cell count was similar (227 [IQR 152–345] cells per μL in the Ugandan cohort vs 135 [105–177] cells per μL in the UK cohort; p=0·13). Interpretation MBL is common in both Uganda and the UK, but the substantial phenotypic differences might reflect fundamental differences in the pathogenesis of B-cell lymphoproliferative disorders. Funding UK Medical Research Council and UK Department for International Development.
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Affiliation(s)
- Andy C Rawstron
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Aloysius Ssemaganda
- International AIDS Vaccine Initiative, Uganda Virus Research Institute, Entebbe, Uganda
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Chi Doughty
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Darren Newton
- Section of Experimental Haematology, University of Leeds, Leeds, UK
| | - Anna Vardi
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece
| | - Paul A S Evans
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thessaloniki, Greece; Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Tracy Lightfoot
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Katie Wakeham
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Alex Karabarinde
- Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Gershim Asiki
- Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Robert Newton
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK; Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda.
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García Vela JA, García Marco JA. Minimal residual disease in chronic lymphocytic leukaemia. Med Clin (Barc) 2018; 150:144-149. [PMID: 28864095 DOI: 10.1016/j.medcli.2017.06.067] [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: 06/02/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Abstract
Minimal residual disease (MRD) assessment is an important endpoint in the treatment of chronic lymphocytic leukaemia (CLL). It is highly predictive of prolonged progression-free survival (PFS) and overall survival and could be considered a surrogate for PFS in the context of chemoimmunotherapy based treatment. Evaluation of MRD level by flow cytometry or molecular techniques in the era of the new BCR and Bcl-2 targeted inhibitors could identify the most cost-effective and durable treatment sequencing. A therapeutic approach guided by the level of MRD might also determine which patients would benefit from an early stop or consolidation therapy. In this review, we discuss the different MRD methods of analysis, which source of tumour samples must be analysed, the future role of the detection of circulating tumour DNA, and the potential role of MRD negativity in clinical practice in the modern era of CLL therapy.
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Affiliation(s)
- José Antonio García Vela
- Laboratorio de Citometría de Flujo, Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - José Antonio García Marco
- Laboratorio de Genética Molecular, Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Madrid, España
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30
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Blanco G, Vardi A, Puiggros A, Gómez-Llonín A, Muro M, Rodríguez-Rivera M, Stalika E, Abella E, Gimeno E, López-Sánchez M, Senín A, Calvo X, Abrisqueta P, Bosch F, Ferrer A, Stamatopoulos K, Espinet B. Restricted T cell receptor repertoire in CLL-like monoclonal B cell lymphocytosis and early stage CLL. Oncoimmunology 2018; 7:e1432328. [PMID: 29872562 DOI: 10.1080/2162402x.2018.1432328] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 01/16/2023] Open
Abstract
Analysis of the T cell receptor (TR) repertoire of chronic lymphocytic leukemia-like monoclonal B cell lymphocytosis (CLL-like MBL) and early stage CLL is relevant for understanding the dynamic interaction of expanded B cell clones with bystander T cells. Here we profiled the T cell receptor β chain (TRB) repertoire of the CD4+ and CD8+ T cell fractions from 16 CLL-like MBL and 13 untreated, Binet stage A/Rai stage 0 CLL patients using subcloning analysis followed by Sanger sequencing. The T cell subpopulations of both MBL and early stage CLL harbored restricted TRB gene repertoire, with CD4+ T cell clonal expansions whose frequency followed the numerical increase of clonal B cells. Longitudinal analysis in MBL cases revealed clonal persistence, alluding to persistent antigen stimulation. In addition, the identification of shared clonotypes among different MBL/early stage CLL cases pointed towards selection of the T cell clones by common antigenic elements. T cell clonotypes previously described in viral infections and immune disorders were also detected. Altogether, our findings evidence that antigen-mediated TR restriction occurs early in clonal evolution leading to CLL and may further increase together with B cell clonal expansion, possibly suggesting that the T cell selecting antigens are tumor-related.
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Affiliation(s)
- Gonzalo Blanco
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Vardi
- Institute of Applied Biosciences, CERTH, Thessaloniki, Greece
| | - Anna Puiggros
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | - Andrea Gómez-Llonín
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | - Manuel Muro
- Immunology Service, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - María Rodríguez-Rivera
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | | | - Eugenia Abella
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain
| | - Eva Gimeno
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain
| | - Manuela López-Sánchez
- Immunology Service, University Clinical Hospital Virgen de la Arrixaca-Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Alicia Senín
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain
| | - Xavier Calvo
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | - Pau Abrisqueta
- Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francesc Bosch
- Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Ferrer
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | | | - Blanca Espinet
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain.,Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Programme, IMIM-Hospital del Mar, Barcelona, Spain
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Jaffe ES, Barr PM, Smith SM. Understanding the New WHO Classification of Lymphoid Malignancies: Why It's Important and How It Will Affect Practice. AMERICAN SOCIETY OF CLINICAL ONCOLOGY EDUCATIONAL BOOK. AMERICAN SOCIETY OF CLINICAL ONCOLOGY. ANNUAL MEETING 2017. [PMID: 28561690 DOI: 10.14694/edbk_175437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Improved delineation of lymphoid malignancy biology has prompted refinement of the 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tumors with a new framework introduced in 2016. This knowledge has provided valuable insights regarding management. Early clonal proliferations have been set apart given their limited potential for malignant dissemination. Increasing knowledge of molecular drivers of aggressive lymphomas has allowed subclassification and opportunity for clinical investigations to personalize therapy. New insights into T-cell pathophysiology has allowed grouping based on shared molecular and cellular features. This article will summarize the key changes in terms of diagnosis and histopathologic definitions, the impact of these changes on clinical management, and the challenges of future research in this field.
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Affiliation(s)
- Elaine S Jaffe
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Paul M Barr
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Sonali M Smith
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
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32
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Hsi ED. 2016 WHO Classification update-What's new in lymphoid neoplasms. Int J Lab Hematol 2017; 39 Suppl 1:14-22. [DOI: 10.1111/ijlh.12650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- E. D. Hsi
- Department of Laboratory Medicine; Cleveland Clinic; Cleveland OH USA
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33
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Furtado FM, Scheucher PS, Santana BA, Zanette DL, Calado RDT, Rego EM, Matos DM, Falcão RP. Comparison of microRNA expression in high-count monoclonal B-cell lymphocytosis and Binet A chronic lymphocytic leukemia. Rev Bras Hematol Hemoter 2017; 39:237-243. [PMID: 28830603 PMCID: PMC5568587 DOI: 10.1016/j.bjhh.2017.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/24/2017] [Accepted: 03/24/2017] [Indexed: 11/05/2022] Open
Abstract
Background Evidence suggests that monoclonal B-cell lymphocytosis precedes all chronic lymphocytic leukemia cases, although the molecular mechanisms responsible for disease progression are not understood. Aberrant miRNA expression may contribute to the pathogenesis of chronic lymphocytic leukemia. The objective of this study was to compare miRNA expression profiles of patients with Binet A chronic lymphocytic leukemia with those of subjects with high-count monoclonal B-cell lymphocytosis and healthy volunteers (controls). Methods Twenty-one chronic lymphocytic leukemia patients, 12 subjects with monoclonal B-cell lymphocytosis and ten healthy volunteers were enrolled in this study. Flow cytometry CD19+CD5+-based cell sorting was performed for the chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis groups and CD19+ cells were sorted to analyze the control group. The expressions of miRNAs (miR-15a, miR-16-1, miR-29b, miR-34a, miR-181a, miR-181b and miR-155) were determined by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Results Significant differences between the expressions in the chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis groups were restricted to the expression of miR-155, which was higher in the former group. A comparison between healthy controls and monoclonal B-cell lymphocytosis/chronic lymphocytic leukemia patients revealed higher miR-155 and miR-34a levels and lower miR-15a, miR-16-1, miR-181a and miR-181b in the latter group. Conclusions Our results show a progressive increase of miR-155 expression from controls to monoclonal B-cell lymphocytosis to chronic lymphocytic leukemia. The role of miR-155 in the development of overt chronic lymphocytic leukemia in individuals with monoclonal B-cell lymphocytosis must be further analyzed.
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34
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Furtado FM, Scheucher PS, Santana BA, Scatena NF, Calado RT, Rego EM, Matos DM, Falcão RP. Telomere length analysis in monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia Binet A. ACTA ACUST UNITED AC 2017; 50:e6019. [PMID: 28423121 PMCID: PMC5441285 DOI: 10.1590/1414-431x20176019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/22/2017] [Indexed: 11/22/2022]
Abstract
Monoclonal B-cell lymphocytosis (MBL) is an asymptomatic clinical entity characterized by the proliferation of monoclonal B cells not meeting the diagnosis criteria for chronic lymphocytic leukemia (CLL). MBL may precede the development of CLL, but the molecular mechanisms responsible for disease progression and evolution are not completely known. Telomeres are usually short in CLL and their attrition may contribute to disease evolution. Here, we determined the telomere lengths of CD5+CD19+ cells in MBL, CLL, and healthy volunteers. Twenty-one CLL patients, 11 subjects with high-count MBL, and 6 with low-count MBL were enrolled. Two hundred and sixty-one healthy volunteers aged 0 to 88 years were studied as controls. After diagnosis confirmation, a flow cytometry CD19+CD5+-based cell sorting was performed for the study groups. Telomere length was determined by qPCR. Telomere length was similar in the 3 study groups but shorter in these groups compared to normal age-matched subjects that had been enrolled in a previous study from our group. These findings suggest that telomere shortening is an early event in CLL leukemogenesis.
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Affiliation(s)
- F M Furtado
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P S Scheucher
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - B A Santana
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - N F Scatena
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R T Calado
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E M Rego
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D M Matos
- Hospital Universitário Walter Cantidio, Faculdade de Medicina de Fortaleza, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - R P Falcão
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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García-Álvarez M, Alcoceba M, López-Parra M, Puig N, Antón A, Balanzategui A, Prieto-Conde I, Jiménez C, Sarasquete ME, Chillón MC, Gutiérrez ML, Corral R, Alonso JM, Queizán JA, Vidán J, Pardal E, Peñarrubia MJ, Bastida JM, García-Sanz R, Marín L, González M. HLA specificities are associated with prognosis in IGHV-mutated CLL-like high-count monoclonal B cell lymphocytosis. PLoS One 2017; 12:e0172978. [PMID: 28249016 PMCID: PMC5332061 DOI: 10.1371/journal.pone.0172978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/12/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction Molecular alterations leading progression of asymptomatic CLL-like high-count monoclonal B lymphocytosis (hiMBL) to chronic lymphocytic leukemia (CLL) remain poorly understood. Recently, genome-wide association studies have found 6p21.3, where the human leukocyte antigen (HLA) system is coded, to be a susceptibility risk region for CLL. Previous studies have produced discrepant results regarding the association between HLA and CLL development and outcome, but no studies have been performed on hiMBL. Aims We evaluated the role of HLA class I (-A, -B and -C) and class II (-DRB1 and -DQB1) in hiMBL/CLL susceptibility, hiMBL progression to CLL, and treatment requirement in a large series of 263 patients diagnosed in our center with hiMBL (n = 156) or Binet A CLL (n = 107). Results No consistent association between HLA specificities and hiMBL or CLL susceptibility was found. With a median follow-up of 7.7 years, 48/156 hiMBLs (33%) evolved to asymptomatic CLLs, while 16 hiMBLs (10%) and 44 CLLs (41%) required treatment. No HLA specificities were found to be significantly associated with hiMBL progression or treatment in the whole cohort. However, within antigen-experienced immunoglobulin heavy-chain (IGHV)-mutated hiMBLs, which represents the highest proportion of hiMBL cases (81%), the presence of HLA-DQB1*03 showed a trend to a higher risk of progression to CLL (60% vs. 26%, P = 0.062). Moreover, HLA-DQB1*02 specificity was associated with a lesser requirement for 15-year treatment (10% vs. 36%, P = 0.012). Conclusion In conclusion, our results suggest a role for HLA in IGHV-mutated hiMBL prognosis, and are consistent with the growing evidence of the influence of 6p21 on predisposition to CLL. Larger non-biased series are required to enable definitive conclusions to be drawn.
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Affiliation(s)
- María García-Álvarez
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Miguel Alcoceba
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
- CIBERONC, Madrid, Spain
| | - Miriam López-Parra
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Noemí Puig
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Alicia Antón
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Ana Balanzategui
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Isabel Prieto-Conde
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Cristina Jiménez
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - María E. Sarasquete
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - M. Carmen Chillón
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
- CIBERONC, Madrid, Spain
| | - María Laura Gutiérrez
- Cytometry Service-NUCLEUS, Department of Medicine, Cancer Research Center (IBMCC-CSIC/USAL) and IBSAL (University of Salamanca), Salamanca, Spain
| | - Rocío Corral
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - José María Alonso
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
| | - José Antonio Queizán
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
| | - Julia Vidán
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
| | - Emilia Pardal
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
| | - María Jesús Peñarrubia
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
| | - José M. Bastida
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
| | - Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
- * E-mail:
| | - Luis Marín
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
- CIBERONC, Madrid, Spain
| | - Marcos González
- Department of Hematology, University Hospital of Salamanca (HUS-IBSAL), Salamanca, Spain
- Cooperative Working Group on Lymphomas and Lymphoproliferative Disorders of the Castilla y León Society of Hematology and Hemotherapy (SCLHH), Castilla y León, Spain
- CIBERONC, Madrid, Spain
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Xochelli A, Oscier D, Stamatopoulos K. Clonal B-cell lymphocytosis of marginal zone origin. Best Pract Res Clin Haematol 2017; 30:77-83. [DOI: 10.1016/j.beha.2016.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 12/25/2022]
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Sorigue M, Maluquer C, Junca J. Phenotypic Characterization of Trisomy 12 Monoclonal B-Cell Lymphocytosis. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:374-378. [DOI: 10.1002/cyto.b.21517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 12/13/2016] [Accepted: 02/06/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Marc Sorigue
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol; Universitat Autònoma de Barcelona, Josep Carreras Leukemia Research Institute; Badalona Spain
| | - Clara Maluquer
- Department of Hematology, Hospital Germans Trias i Pujol; Universitat Autònoma de Barcelona; Badalona Spain
| | - Jordi Junca
- Hematology Laboratory, ICO-Hospital Germans Trias i Pujol; Universitat Autònoma de Barcelona, Josep Carreras Leukemia Research Institute; Badalona Spain
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Jaffe ES, Barr PM, Smith SM. Understanding the New WHO Classification of Lymphoid Malignancies: Why It's Important and How It Will Affect Practice. Am Soc Clin Oncol Educ Book 2017; 37:535-546. [PMID: 28561690 PMCID: PMC6324533 DOI: 10.1200/edbk_175437] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Improved delineation of lymphoid malignancy biology has prompted refinement of the 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tumors with a new framework introduced in 2016. This knowledge has provided valuable insights regarding management. Early clonal proliferations have been set apart given their limited potential for malignant dissemination. Increasing knowledge of molecular drivers of aggressive lymphomas has allowed subclassification and opportunity for clinical investigations to personalize therapy. New insights into T-cell pathophysiology has allowed grouping based on shared molecular and cellular features. This article will summarize the key changes in terms of diagnosis and histopathologic definitions, the impact of these changes on clinical management, and the challenges of future research in this field.
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Affiliation(s)
- Elaine S Jaffe
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Paul M Barr
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Sonali M Smith
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
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Kalpadakis C, Pangalis GA, Vassilakopoulos TP, Roumelioti M, Sachanas S, Korkolopoulou P, Koulieris E, Moschogiannis M, Yiakoumis X, Tsirkinidis P, Pontikoglou C, Rondoyianni D, Papadaki HA, Panayiotidis P, Angelopoulou MK. Detection of L265P MYD-88
mutation in a series of clonal B-cell lymphocytosis of marginal zone origin (CBL-MZ). Hematol Oncol 2016; 35:542-547. [DOI: 10.1002/hon.2361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Maria Roumelioti
- 1st Department of Propedeutics; Laikon General Hospital; University of Athens; Athens Greece
| | - Sotirios Sachanas
- Department of Haematology; Athens Medical Center Psychikon Branch; Athens Greece
| | | | - Efstathios Koulieris
- Department of Haematology; Athens Medical Center Psychikon Branch; Athens Greece
| | - Maria Moschogiannis
- Department of Haematology; Athens Medical Center Psychikon Branch; Athens Greece
| | - Xanthi Yiakoumis
- Department of Haematology; Athens Medical Center Psychikon Branch; Athens Greece
| | - Pantelis Tsirkinidis
- Department of Haematology; Athens Medical Center Psychikon Branch; Athens Greece
| | | | - Dimitra Rondoyianni
- Department of Anatomic Pathology; Evangelismos Hospital of Athens; Athens Greece
| | - Helen A. Papadaki
- Department of Haematology; University of Crete; Heraklion Crete Greece
| | | | - Maria K. Angelopoulou
- Department of Haematology; Laikon General Hospital; University of Athens; Athens Greece
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40
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Present and future of personalized medicine in CLL. Best Pract Res Clin Haematol 2016; 29:100-110. [PMID: 27742064 DOI: 10.1016/j.beha.2016.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 07/19/2016] [Accepted: 08/04/2016] [Indexed: 12/27/2022]
Abstract
Medicine has been 'personalized' (i.e. centred in persons) since its foundation. Recently, however, the term 'personalized medicine' (or, better, 'precision medicine') has been introduced to define 'a form of medicine that uses information about a person's genes, proteins, and environment to prevent, diagnose, and treat disease'. This concept has gained momentum thanks to next-generation-sequencing (NGS) techniques that allow identification of molecular characteristics unique to the patient and to the tumour. It is hoped that NGS will not only contribute to a better understanding of chronic lymphocytic leukaemia (CLL), but will identify disease subsets that could benefit from specific treatment interventions. Recent advances in diagnosis (e.g. high-resolution immunophenotyping, markers of genetic abnormalities), prognosis (e.g. biomarkers), response predictors [e.g. del(17p)/TP53 mutations even at subclonal level], treatment (e.g. BCR signalling inhibitors, BCL2 antagonists, CAR-T cells) and methods to evaluate minimal residual disease constitute good examples of tools facilitating 'personalized' management of patients with CLL.
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41
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The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127:2375-90. [PMID: 26980727 DOI: 10.1182/blood-2016-01-643569] [Citation(s) in RCA: 5019] [Impact Index Per Article: 627.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/09/2016] [Indexed: 02/06/2023] Open
Abstract
A revision of the nearly 8-year-old World Health Organization classification of the lymphoid neoplasms and the accompanying monograph is being published. It reflects a consensus among hematopathologists, geneticists, and clinicians regarding both updates to current entities as well as the addition of a limited number of new provisional entities. The revision clarifies the diagnosis and management of lesions at the very early stages of lymphomagenesis, refines the diagnostic criteria for some entities, details the expanding genetic/molecular landscape of numerous lymphoid neoplasms and their clinical correlates, and refers to investigations leading to more targeted therapeutic strategies. The major changes are reviewed with an emphasis on the most important advances in our understanding that impact our diagnostic approach, clinical expectations, and therapeutic strategies for the lymphoid neoplasms.
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42
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Rodríguez Preciado SY, Barros-Núñez P. El estado mutacional de las inmunoglobulinas en pacientes con leucemia linfocítica crónica: significado y pronóstico. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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43
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Abstract
Recent investigations have provided an increasingly complete picture of the genetic landscape of chronic lymphocytic leukaemia (CLL). These analyses revealed that the CLL genome displays a high degree of heterogeneity between patients and within the same patient. In addition, they highlighted molecular mechanisms and functionally relevant biological programmes that may be important for the pathogenesis and therapeutic targeting of this disease. This Review focuses on recent insights into the understanding of CLL biology, with emphasis on the role of genetic lesions in the initiation and clinical progression of CLL. We also consider the translation of these findings into the development of risk-adapted and targeted therapeutic approaches.
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Affiliation(s)
- Giulia Fabbri
- Institute for Cancer Genetics, Columbia University, New York, New York 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York 10032, USA
| | - Riccardo Dalla-Favera
- Institute for Cancer Genetics, Columbia University, New York, New York 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York 10032, USA
- Department of Pathology and Cell Biology and New York, New York 10032, USA
- Departments of Genetics and Development and Microbiology and Immunology, Columbia University, New York, New York 10032, USA
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44
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Abstract
Monoclonal B-cell lymphocytosis (MBL) is defined as a laboratory abnormality where small (<5 x 10(9)/L) clonal B-cell populations are detected in the peripheral blood of otherwise healthy subjects. According to the immunophenotype, MBL is labeled as chronic lymphocytic leukemia (CLL)-like (75% of cases), atypical CLL, and CD5-negative. Concentration of clonal B cells differentiates low- (LC) and high-count (HC)-MBL (< or ≥ 0.5 x 10(9)/L, respectively). Thanks to technical improvements, we are able to identify CLL-like clonal B-cell populations at increased frequency with age, but we are still far from understanding its relationship with clinically overt CLL. LC-MBL, requiring high-throughput screening technique to be identified in population studies, seems to be a bird of a different feather and several hints suggest that LC-MBL is related to aging and/or chronic antigenic stimulation. Immunogenetic, cytogenetic and genetic data support the notion that HC-MBL, usually identified in the clinical setting, is a premalignant condition and, based on biological parameters, it is frequently difficult to differentiate it from early stage CLL. The rapid improvement and widespread availability of cutting-edge technology, in particular next-generation sequencing (NGS), raises hope that we are getting closer to unveiling the fundamental nature of MBL and CLL and how they are related to each other.
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Affiliation(s)
- Lydia Scarfò
- Department of Onco-Haematology and Division of Experimental Oncology, IRCCS San Raffaele Hospital and Università Vita-Salute San Raffaele, Milan, Italy.
| | - Paolo Ghia
- Department of Onco-Haematology and Division of Experimental Oncology, IRCCS San Raffaele Hospital and Università Vita-Salute San Raffaele, Milan, Italy
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45
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Klinger M, Zheng J, Elenitoba-Johnson KSJ, Perkins SL, Faham M, Bahler DW. Next-generation IgVH sequencing CLL-like monoclonal B-cell lymphocytosis reveals frequent oligoclonality and ongoing hypermutation. Leukemia 2015; 30:1055-61. [PMID: 26686246 DOI: 10.1038/leu.2015.351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/27/2015] [Accepted: 12/11/2015] [Indexed: 12/23/2022]
Abstract
Chronic lymphocytic leukemia (CLL) develops from CLL-like monoclonal B-cell lymphocytosis (MBL) which represents a low-level asymptomatic expansion of cells that phenotypically resemble CLL. Although antigen selection plays a key role during CLL development, it is not known whether this occurs in early MBL or only during progression to CLL. Recent studies suggested that MBL sometimes displays oligoclonality, but these used techniques with limited sensitivity and specificity and were not conclusive. In this study, we combine cell sorting and next-generation sequencing of rearranged immunoglobulin heavy chain variable (IgVH) genes to thoroughly assess the VH repertoire and oligoclonality of purified MBL cells. Clonal functional rearrangements or clonotypes were identified in 29 of 30 sequenced cases, with 7 or 24% having two clonotypes with unrelated CDR3 sequences. In four of the seven cases with unrelated clonotypes, VH segments from the same family were used. In addition, 6 of 29 cases showed clear evidence of ongoing VH gene hypermutation with three of these being among the seven with unrelated clonotypes. This study conclusively shows that MBL cases often contain multiple B-cell clones, the first to report ongoing VH gene mutation in MBL, and that antigen selection appears to occur in early MBL.
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Affiliation(s)
- M Klinger
- Sequenta, Inc., South San Francisco, CA, USA
| | - J Zheng
- Sequenta, Inc., South San Francisco, CA, USA
| | - K S J Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S L Perkins
- Department of Pathology, ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
| | - M Faham
- Sequenta, Inc., South San Francisco, CA, USA
| | - D W Bahler
- Department of Pathology, ARUP Laboratories, University of Utah, Salt Lake City, UT, USA
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46
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A complementary role of multiparameter flow cytometry and high-throughput sequencing for minimal residual disease detection in chronic lymphocytic leukemia: an European Research Initiative on CLL study. Leukemia 2015; 30:929-36. [PMID: 26639181 PMCID: PMC4832072 DOI: 10.1038/leu.2015.313] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/14/2015] [Accepted: 09/14/2015] [Indexed: 12/21/2022]
Abstract
In chronic lymphocytic leukemia (CLL) the level of minimal residual disease (MRD) after therapy is an independent predictor of outcome. Given the increasing number of new agents being explored for CLL therapy, using MRD as a surrogate could greatly reduce the time necessary to assess their efficacy. In this European Research Initiative on CLL (ERIC) project we have identified and validated a flow-cytometric approach to reliably quantitate CLL cells to the level of 0.0010% (10−5). The assay comprises a core panel of six markers (i.e. CD19, CD20, CD5, CD43, CD79b and CD81) with a component specification independent of instrument and reagents, which can be locally re-validated using normal peripheral blood. This method is directly comparable to previous ERIC-designed assays and also provides a backbone for investigation of new markers. A parallel analysis of high-throughput sequencing using the ClonoSEQ assay showed good concordance with flow cytometry results at the 0.010% (10−4) level, the MRD threshold defined in the 2008 International Workshop on CLL guidelines, but it also provides good linearity to a detection limit of 1 in a million (10−6). The combination of both technologies would permit a highly sensitive approach to MRD detection while providing a reproducible and broadly accessible method to quantify residual disease and optimize treatment in CLL.
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Abstract
Abstract
The increasing use of immunophenotypic and molecular analysis in the routine evaluation of patients with lymphocytosis, lymphadenopathy, or other hematologic disorders has led to the identification of unexpected small clonal lymphoid populations. These clones, sometimes with disease-specific markers, such as the t(14;18), are especially challenging for the clinician because of their unknown biologic potential and uncertain clinical behavior. Study of these early lymphoid lesions is providing important clues to the process of lymphomagenesis, and may provide the rationale for preemptive therapy in the future. More and more, the hematologist/oncologist is consulted regarding otherwise healthy individuals with lymphadenopathy and/or lymphocytosis, and pathology reports that confound the referring internist or surgeon. The report does not name a malignant lymphoproliferative disorder, but is not completely “normal”. Does the patient have a benign or malignant condition? How should they be evaluated? Is treatment indicated? These patients prove challenging for the consulting hematologist as well as the referring physician. In this review, we will focus on some of these scenarios and attempt to provide guidance for their management.
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48
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Biasoli I, Spector N. Monoclonal B-cell lymphocytosis. Rev Bras Hematol Hemoter 2015; 37:285-6. [PMID: 26408358 PMCID: PMC4685083 DOI: 10.1016/j.bjhh.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/28/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Irene Biasoli
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
| | - Nelson Spector
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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49
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Strati P, Shanafelt TD. Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification. Blood 2015; 126:454-62. [PMID: 26065657 PMCID: PMC4624440 DOI: 10.1182/blood-2015-02-585059] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/23/2015] [Indexed: 01/09/2023] Open
Abstract
Monoclonal B lymphocytosis (MBL) is defined as the presence of a clonal B-cell population in the peripheral blood with fewer than 5 × 10(9)/L B-cells and no other signs of a lymphoproliferative disorder. The majority of cases of MBL have the immunophenotype of chronic lymphocytic leukemia (CLL). MBL can be categorized as either low count or high count based on whether the B-cell count is above or below 0.5 × 10(9)/L. Low-count MBL can be detected in ∼5% of adults over the age of 40 years when assessed using standard-sensitivity flow cytometry assays. A number of biological and genetic characteristics distinguish low-count from high-count MBL. Whereas low-count MBL rarely progresses to CLL, high-count MBL progresses to CLL requiring therapy at a rate of 1% to 2% per year. High-count MBL is distinguished from Rai 0 CLL based on whether the B-cell count is above or below 5 × 10(9)/L. Although individuals with both high-count MBL and CLL Rai stage 0 are at increased risk of infections and second cancers, the risk of progression requiring treatment and the potential to shorten life expectancy are greater for CLL. This review highlights challenging questions regarding the classification, risk stratification, management, and supportive care of patients with MBL and CLL.
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Affiliation(s)
- Paolo Strati
- Mayo Clinic College of Medicine, Division of Hematology, Rochester, MN
| | - Tait D Shanafelt
- Mayo Clinic College of Medicine, Division of Hematology, Rochester, MN
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50
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Matos DM, Furtado FM, Falcão RP. Monoclonal B-cell lymphocytosis in individuals from sporadic (non-familial) chronic lymphocytic leukemia families persists over time, but does not progress to chronic B-cell lymphoproliferative diseases. Rev Bras Hematol Hemoter 2015; 37:292-5. [PMID: 26408361 PMCID: PMC4685047 DOI: 10.1016/j.bjhh.2015.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/24/2015] [Accepted: 05/08/2015] [Indexed: 11/06/2022] Open
Abstract
Background Monoclonal B-cell lymphocytosis is classified as ‘high-count or clinical’ monoclonal B-cell lymphocytosis and ‘low-count or population’ monoclonal B-cell lymphocytosis. Previously, 167 first-degree relatives pertaining to sporadic (non-familial) chronic lymphocytic leukemia families were studied and the presence of seven monoclonal B-cell lymphocytosis individuals was reported. Objective The aim of this report is to describe the outcomes of five of the original monoclonal B-cell lymphocytosis individuals. Methods Flow cytometry analysis was performed on mononuclear cells previously isolated from peripheral blood samples. A strategy of sequential gating designed to identify the population of CD19+/CD5+ B-lymphocytes was used and, subsequently, the monoclonal B-cell lymphocytosis cells were characterized by the CD20weak/CD79bweak/negative phenotype. Results The monoclonal B-cell lymphocytosis clone showed consistent stability over time with little variations in size. After a median follow-up of 7.6 years, none of the five monoclonal B-cell lymphocytosis individuals progressed to chronic lymphocytic leukemia or other B-cell lymphoproliferative disease. Conclusions The data of this study suggest that chronic lymphocytic leukemia-like monoclonal B-cell lymphocytosis detected in the context of sporadic chronic lymphocytic leukemia families is not prone to clinical evolution and could be just a sign of immune senescence.
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