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Zhuang Y, Che J, Wu M, Guo Y, Xu Y, Dong X, Yang H. Altered pathways and targeted therapy in double hit lymphoma. J Hematol Oncol 2022; 15:26. [PMID: 35303910 PMCID: PMC8932183 DOI: 10.1186/s13045-022-01249-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/07/2022] [Indexed: 12/20/2022] Open
Abstract
High-grade B-cell lymphoma with translocations involving MYC and BCL2 or BCL6, usually referred to as double hit lymphoma (DHL), is an aggressive hematological malignance with distinct genetic features and poor clinical prognosis. Current standard chemoimmunotherapy fails to confer satisfying outcomes and few targeted therapeutics are available for the treatment against DHL. Recently, the delineating of the genetic landscape in tumors has provided insight into both biology and targeted therapies. Therefore, it is essential to understand the altered signaling pathways of DHL to develop treatment strategies with better clinical benefits. Herein, we summarized the genetic alterations in the two DHL subtypes (DHL-BCL2 and DHL-BCL6). We further elucidate their implications on cellular processes, including anti-apoptosis, epigenetic regulations, B-cell receptor signaling, and immune escape. Ongoing and potential therapeutic strategies and targeted drugs steered by these alterations were reviewed accordingly. Based on these findings, we also discuss the therapeutic vulnerabilities that coincide with these genetic changes. We believe that the understanding of the DHL studies will provide insight into this disease and capacitate the finding of more effective treatment strategies.
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Affiliation(s)
- Yuxin Zhuang
- Department of Lymphoma, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
- Hangzhou Institute of Innovative Medicine, Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, People’s Republic of China
| | - Jinxin Che
- Hangzhou Institute of Innovative Medicine, Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, People’s Republic of China
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, People’s Republic of China
| | - Meijuan Wu
- Department of Pathology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
| | - Yu Guo
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, People’s Republic of China
| | - Yongjin Xu
- Department of Lymphoma, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
| | - Xiaowu Dong
- Hangzhou Institute of Innovative Medicine, Institute of Drug Discovery and Design, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, People’s Republic of China
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, People’s Republic of China
- Cancer Center, Zhejiang University, Hangzhou, People’s Republic of China
| | - Haiyan Yang
- Department of Lymphoma, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People’s Republic of China
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Laude M, Lebras L, Sesques P, Ghesquieres H, Favre S, Bouabdallah K, Croizier C, Guieze R, Drieu La Rochelle L, Gyan E, Chin R, Aurran‐Schleinitz T, Marouf A, Deau‐Fischer B, Coppo P, Malot S, Roussel X, Chauchet A, Schwarz M, Bescond C, Lamy de la Chapelle T, Bussot L, Carras S, Burlet B, Rossi C, Daniel A, Morschhauser F, Subtil F, Michallet A. First-line treatment of double-hit and triple-hit lymphomas: Survival and tolerance data from a retrospective multicenter French study. Am J Hematol 2021; 96:302-311. [PMID: 33306213 DOI: 10.1002/ajh.26068] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/12/2022]
Abstract
Historically, double or triple hit lymphoma (DHL and THL) have poor outcomes with conventional chemotherapy, but there is currently no guideline. We report the French experience in managing DHL and THL in first line using collective data on both survival and tolerance. All consecutive patients with newly diagnosis of large B-cell lymphoma with MYC, BCL2, and/or BCL6 rearrangements, as determined by FISH between January 2013 and April 2019 were included. Based on the eligibility criteria, 160 patients were selected among the 184 patients identified. With a median follow-up of 32 months, 2- and 4-year progression free survival (PFS) rates were 40% and 28% with R-CHOP compared with 57% and 52% with intensive chemotherapy (P = .063). There was no difference in overall survival (OS). For advanced stages, PFS was significantly longer with intensive chemotherapy than with R-CHOP (P = .029). There was no impact of autologous stem cell transplantation among patient in remission. For patients with central nervous system (CNS) involvement, the 2-year PFS and OS rate was 21% and 39%, vs 57% and 75% without CNS disease (P = .007 and P < .001). By multivariate analysis, elevated IPI score and CNS disease were strongly and independently associated with a poorer survival, whereas treatment was not significantly associated with OS. This is the largest series reporting the treatment of DHL and THL in Europe. The PFS was significantly longer with an intensive regimen for advanced stage, but no difference in OS, supporting the need for a prospective randomized trial.
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Affiliation(s)
| | - Laure Lebras
- Department of Hematology and Medical Oncology Centre Léon Bérard Lyon France
| | - Pierre Sesques
- Department of Hematology Hospices Civils de Lyon Lyon France
| | | | - Simon Favre
- Department of Hematology and Cell Therapy University Hospital of Bordeaux Bordeaux France
| | - Krimo Bouabdallah
- Department of Hematology and Cell Therapy University Hospital of Bordeaux Bordeaux France
| | - Carolyne Croizier
- Department of Hematology and Cell Therapy Estaing University Hospital Clermont‐Ferrand France
| | - Romain Guieze
- Department of Hematology and Cell Therapy Estaing University Hospital Clermont‐Ferrand France
| | | | - Emmanuel Gyan
- Department of Hematology and Cell Therapy University Hospital of Tours Tours France
| | - Roza Chin
- Department of Hemato‐Oncology Institut Paoli Calmette Marseille France
| | | | - Amira Marouf
- Department of Hematology Cochin Hospital Paris France
| | | | - Paul Coppo
- Department of Hematology and French Reference Center for Thrombotic Microangiopathies Saint‐Antoine Hospital Paris France
| | - Sandrine Malot
- Department of Hematology and French Reference Center for Thrombotic Microangiopathies Saint‐Antoine Hospital Paris France
| | | | - Adrien Chauchet
- Department of Hematology University Hospital of Besançon Besançon France
| | | | - Charles Bescond
- Department of Hematology University Hospital of Angers Angers France
| | | | | | - Sylvain Carras
- Department of Hematology University Hospital of Grenobles Alpes Grenoble France
| | | | - Cédric Rossi
- Department of Clinical Hematology University Hospital of Dijon Dijon France
| | | | | | - Fabien Subtil
- Department of Biostatistics Hospices Civils de Lyon Lyon France
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Chen PT, Jorsan K, Avezbakiyev B, Akhtar C, Wang JC. Aggressive Diffuse Intermediate Size B-Cell Lymphoma With P53 Mutation Presented as Primary Bone Marrow Lymphoma. J Investig Med High Impact Case Rep 2020; 8:2324709620982765. [PMID: 33349058 PMCID: PMC7758647 DOI: 10.1177/2324709620982765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Primary bone marrow lymphoma (PBML) is a disease entity in which lymphoma primarily originates in the bone marrow without signs of involvement of lymph nodes, spleen, liver, or any other organs, and excludes leukemia/lymphoma. PBML has been a rare presentation of malignant lymphoma, and most of the cases have a poor prognosis and require rapid diagnoses and treatments. Among all PBMLs, diffuse large B-cell lymphoma (DLBCL) is the most common pathological subtype. Over 25 years and from 7 institutions, the International Extranodal Lymphoma Study Group retrospectively collected PBML cases and, in 2012, published these 21 cases, including 19 cases of B-cell lymphoma and 2 cases of peripheral T-cell lymphoma. Among the B-cell types, DLBCL accounted for 79% and follicular lymphoma (FL) for 21%. DLBCLs were characterized by the existence of large cells. In this article, we present a rare case of high-grade aggressive type with P53 mutation, intermediate-sized B-cell lymphoma, excluded FL by the absence of FL lymphoma markers, presented as PBML. Our patient had rapid progression and succumbed to the disease shortly after diagnosis. Upon literature review, 62 B-cell lymphoma cases were identified that presented as PBML (51 high-grade and 11 low-grade)—mostly case reports. Among these, only one case was reported as intermediate-sized DLBCL-like lymphoma but not with aggressive features. Our case represents the first case of aggressive intermediate-sized lymphoma, not a FL, with P53 mutation, highly elevated lactate dehydrogenase, and Ki-67 presented as PBML. Such a profile would need to be quickly recognized and aggressive treatment applied, such as CART (chimeric antigen receptor T-cells) therapy or DA-EPOCH-R (dose-adjusted EPOCH [etoposide-prednisone-oncovin-cyclophosphamide-hydroxydaunorubicin] and rituximab) with or without venetoclax.
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Affiliation(s)
- Pei Ting Chen
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Karan Jorsan
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | | | - Cheema Akhtar
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
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Alzahrani M, Al-Mansour MM, Apostolidis J, Barefah A, Dada R, Alhejazi A, Alayed Y, Motabi I, Radwi M, Al-Hashmi H. Saudi Lymphoma Group's Clinical Practice Guidelines for Diagnosis, Management and Follow-up of Patients with Various Types of Lymphoma during the Coronavirus Disease 2019 Pandemic. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:227-238. [PMID: 32952517 PMCID: PMC7485653 DOI: 10.4103/sjmms.sjmms_457_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
The Saudi Lymphoma Group had previously published recommendations on the management of the major subtypes of lymphoma. However, the effect the currently ongoing coronavirus disease 2019 (COVID-19) pandemic has on the management of patients with lymphoma has been paramount. Therefore, the Saudi Lymphoma Group has decided to provide clinical practice guidelines for the diagnosis, management and follow-up of patients with various types of lymphoma during the COVID-19 pandemic.
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Affiliation(s)
- Musa Alzahrani
- Department of Medicine and Oncology Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mubarak M. Al-Mansour
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Dammam, Saudi Arabia
| | - John Apostolidis
- Department of Adult Hematology and Stem Cell Transplantation, Oncology Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ahmed Barefah
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reyad Dada
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
- Department of Medicine, College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- Department of Oncology, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yasir Alayed
- Radiation Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibraheem Motabi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mansoor Radwi
- Department of Hematology, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Hani Al-Hashmi
- Department of Adult Hematology and Stem Cell Transplantation, Oncology Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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