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Shi ZF, Li KKW, Liu APY, Chung NYF, Wong SC, Chen H, Woo PYM, Chan DTM, Mao Y, Ng HK. The Molecular Landscape of Primary CNS Lymphomas (PCNSLs) in Children and Young Adults. Cancers (Basel) 2024; 16:1740. [PMID: 38730692 PMCID: PMC11083424 DOI: 10.3390/cancers16091740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Pediatric brain tumors are often noted to be different from their adult counterparts in terms of molecular features. Primary CNS lymphomas (PCNSLs) are mostly found in elderly adults and are uncommon in children and teenagers. There has only been scanty information about the molecular features of PCNSLs at a young age. We examined PCNSLs in 34 young patients aged between 7 and 39 years for gene rearrangements of BCl2, BCL6, CCND1, IRF4, IGH, IGL, IGK, and MYC, homozygous deletions (HD) of CDKN2A, and HLA by FISH. Sequencing was performed using WES, panel target sequencing, or Sanger sequencing due to the small amount of available tissues. The median OS was 97.5 months and longer than that for older patients with PCNSLs. Overall, only 14 instances of gene rearrangement were found (5%), and patients with any gene rearrangement were significantly older (p = 0.029). CDKN2A HD was associated with a shorter OS (p < 0.001). Only 10/31 (32%) showed MYD88 mutations, which were not prognostically significant, and only three of them were L265P mutations. CARD11 mutations were found in 8/24 (33%) cases only. Immunophenotypically, the cases were predominantly GCB, in contrast to older adults (61%). In summary, we showed that molecular findings identified in the PCNSLs of the older patients were only sparingly present in pediatric and young adult patients.
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Affiliation(s)
- Zhi-Feng Shi
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China
| | - Kay Ka-Wai Li
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; (K.K.-W.L.); (N.Y.-F.C.); (S.-C.W.)
| | - Anthony Pak-Yin Liu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong, China
| | - Nellie Yuk-Fei Chung
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; (K.K.-W.L.); (N.Y.-F.C.); (S.-C.W.)
| | - Sze-Ching Wong
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; (K.K.-W.L.); (N.Y.-F.C.); (S.-C.W.)
| | - Hong Chen
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Peter Yat-Ming Woo
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong, China; (P.Y.-M.W.); (D.T.-M.C.)
| | - Danny Tat-Ming Chan
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong, China; (P.Y.-M.W.); (D.T.-M.C.)
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China
| | - Ho-Keung Ng
- Hong Kong and Shanghai Brain Consortium (HSBC), Hong Kong, China
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China; (K.K.-W.L.); (N.Y.-F.C.); (S.-C.W.)
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Iorgulescu JB, Medeiros LJ, Patel KP. Predictive and prognostic molecular biomarkers in lymphomas. Pathology 2024; 56:239-258. [PMID: 38216400 DOI: 10.1016/j.pathol.2023.12.001] [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: 12/03/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
Recent advances in molecular diagnostics have markedly expanded our understanding of the genetic underpinnings of lymphomas and catalysed a transformation in not just how we classify lymphomas, but also how we treat, target, and monitor affected patients. Reflecting these advances, the World Health Organization Classification, International Consensus Classification, and National Comprehensive Cancer Network guidelines were recently updated to better integrate these molecular insights into clinical practice. We summarise here the molecular biomarkers of lymphomas with an emphasis on biomarkers that have well-supported prognostic and predictive utility, as well as emerging biomarkers that show promise for clinical practice. These biomarkers include: (1) diagnostic entity-defining genetic abnormalities [e.g., B-cell acute lymphoblastic leukaemia (B-ALL) with KMT2A rearrangement]; (2) molecular alterations that guide patients' prognoses (e.g., TP53 loss frequently conferring worse prognosis); (3) mutations that serve as the targets of, and often a source of acquired resistance to, small molecular inhibitors (e.g., ABL1 tyrosine kinase inhibitors for B-ALL BCR::ABL1, hindered by ABL1 kinase domain resistance mutations); (4) the growing incorporation of molecular measurable residual disease (MRD) in the management of lymphoma patients (e.g., molecular complete response and sequencing MRD-negative criteria in multiple myeloma). Altogether, our review spans the spectrum of lymphoma types, from the genetically defined subclasses of precursor B-cell lymphomas to the highly heterogeneous categories of small and large cell mature B-cell lymphomas, Hodgkin lymphomas, plasma cell neoplasms, and T/NK-cell lymphomas, and provides an expansive summary of our current understanding of their molecular pathology.
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Affiliation(s)
- J Bryan Iorgulescu
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Lebrun L, Allard-Demoustiez S, Salmon I. Pathology and new insights in central nervous system lymphomas. Curr Opin Oncol 2023; 35:347-356. [PMID: 37439536 PMCID: PMC10408733 DOI: 10.1097/cco.0000000000000978] [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] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW Primary central nervous system lymphoma (PCNSL) is a rare central nervous system (CNS) malignancy, which represents a heterogenous group of tumors. Among PCNSL, diffuse large B-cell lymphoma of the CNS (CNS-DLBCL) represents the most common tumor type. Multiomics studies have recently revealed the complex genomic landscape of these rare diseases. These findings lead to a potential new molecular and epigenetic classification. RECENT FINDINGS Our review is focused on CNS-DLBCL in immunocompetent patients. CNS-DLBCL are derived from self-reactive/polyreactive precursor cells. An early molecular event such as MYD88 mutation leads to escape elimination of precursor cells, which, by a dysregulated GC reaction, acquire auto-/polyreactivity of the B-cell tumoral cells for antigens physiologically expressed in the CNS. Most of CNS-DLBCL tumor cells harbor a non-GCB, ABC-like immunophenotype associated with a late GC (exit) B-cells genotype by gene expression profiling. Various mechanisms of genetic alterations are involved in the pathogenesis of PCNSL, including point mutations [nonsomatic hypermutation (SHM), aberrant SHM (aSHM)], SHM/aSHM, chromosome copy gains or losses, and DNA hypermethylation. Constitutive NFκB activation plays a key role in lymphoma cell proliferation and survival by dysregulation of toll-like receptor (mutations of CARD11 and MYD88 ), BCR ( CD79B ), JAK-STAT, and NFκB signaling pathways. SUMMARY Multiomics approaches have succeeded to substantially improve the understanding of the pathogenesis, as well as the molecular and epigenetic events in PCNSL. Challenges remain due to the obvious heterogeneity of CNS-DLBCL, and improvement is needed for their classification.
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Affiliation(s)
- Laetitia Lebrun
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Department of Pathology, Brussels
| | - Sacha Allard-Demoustiez
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Department of Pathology, Brussels
| | - Isabelle Salmon
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), CUB Hôpital Erasme, Erasme University Hospital, Department of Pathology, Brussels
- DIAPath, Center for Microscopy and Molecular Imaging (CMMI), ULB, Gosselies, Belgium
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Ferreri AJM, Calimeri T, Cwynarski K, Dietrich J, Grommes C, Hoang-Xuan K, Hu LS, Illerhaus G, Nayak L, Ponzoni M, Batchelor TT. Primary central nervous system lymphoma. Nat Rev Dis Primers 2023; 9:29. [PMID: 37322012 PMCID: PMC10637780 DOI: 10.1038/s41572-023-00439-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/17/2023]
Abstract
Primary central nervous system lymphoma (PCNSL) is a diffuse large B cell lymphoma in which the brain, spinal cord, leptomeninges and/or eyes are exclusive sites of disease. Pathophysiology is incompletely understood, although a central role seems to comprise immunoglobulins binding to self-proteins expressed in the central nervous system (CNS) and alterations of genes involved in B cell receptor, Toll-like receptor and NF-κB signalling. Other factors such as T cells, macrophages or microglia, endothelial cells, chemokines, and interleukins, probably also have important roles. Clinical presentation varies depending on the involved regions of the CNS. Standard of care includes methotrexate-based polychemotherapy followed by age-tailored thiotepa-based conditioned autologous stem cell transplantation and, in patients unsuitable for such treatment, consolidation with whole-brain radiotherapy or single-drug maintenance. Personalized treatment, primary radiotherapy and only supportive care should be considered in unfit, frail patients. Despite available treatments, 15-25% of patients do not respond to chemotherapy and 25-50% relapse after initial response. Relapse rates are higher in older patients, although the prognosis of patients experiencing relapse is poor independent of age. Further research is needed to identify diagnostic biomarkers, treatments with higher efficacy and less neurotoxicity, strategies to improve the penetration of drugs into the CNS, and roles of other therapies such as immunotherapies and adoptive cell therapies.
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Affiliation(s)
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - Jorg Dietrich
- Cancer and Neurotoxicity Clinic and Brain Repair Research Program, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Christian Grommes
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Khê Hoang-Xuan
- APHP, Groupe Hospitalier Salpêtrière, Sorbonne Université, IHU, ICM, Service de Neurologie 2, Paris, France
| | - Leland S Hu
- Department of Radiology, Neuroradiology Division, Mayo Clinic, Phoenix, AZ, USA
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Lakshmi Nayak
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele, Milan, Italy
| | - Tracy T Batchelor
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Parkhi M, Chatterjee D, Radotra BD, Bal A, Yadav BS, Tripathi M. Double-hit and double-expressor primary central nervous system lymphoma: Experience from North India of an infrequent but aggressive variant. Surg Neurol Int 2023; 14:172. [PMID: 37292392 PMCID: PMC10246369 DOI: 10.25259/sni_307_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/28/2023] [Indexed: 06/10/2023] Open
Abstract
Background High-grade non-Hodgkin B-cell lymphoma is an aggressive mature B-cell lymphoma that depicts poor treatment response and worse prognosis. The presence of MYC and B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6) rearrangements qualifies for triple-hit and double-hit lymphomas (THL/DHL), respectively. We attempted to explore the incidence, distribution, and clinical characteristics of the primary high-grade B-cell lymphoma of the central nervous system (CNS) in our cohort from North India. Methods All the histologically confirmed cases of primary CNS diffuse large B-cell lymphoma (PCNS-DLBCL) over a period of 8 years were included. Cases showing MYC and BCL2 and/or BCL6 expression on immunohistochemistry (IHC) (double- or triple-expressor) were further analyzed by fluorescence in situ hybridization for MYC, BCL2 and /or BCL6 rearrangements. The results were correlated with other clinical and pathological parameters, and outcome. Results Of total 117 cases of PCNS-DLBCL, there were seven (5.9%) cases of double/triple-expressor lymphomas (DEL/TEL) (six double- and one triple-expressor) with median age of 51 years (age range: 31-77 years) and slight female predilection. All were located supratentorially and were of non-geminal center B-cell phenotype. Only triple-expressor case (MYC+/BCL2+/BCL6+) demonstrated concurrent rearrangements for MYC and BCL6 genes indicating DHL (n = 1, 0.85%), while none of the double-expressors (n = 6) showed MYC, BCL2, or BCL6 rearrangements. The mean overall survival of the DEL/TEL was 48.2 days. Conclusion DEL/TEL and DHL are uncommon in CNS; mostly located supratentorially and are associated with poor outcome. MYC, BCL2, and BCL6 IHC can be used as an effective screening strategy for ruling out double/ triple-expressor PCNS-DLBCLs.
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Affiliation(s)
- Mayur Parkhi
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Dass Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Budhi Singh Yadav
- Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rachdi A, Hernandez-Tost H, Herzi D, Morales-Martinez A, Hernández-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Recent advances in the diagnosis and the treatment of primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:481-489. [PMID: 37045615 DOI: 10.1016/j.neurol.2023.03.012] [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: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
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Affiliation(s)
- A Rachdi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Institut Mongi Ben Hamida de neurologie de Tunis, Tunis, Tunisia
| | - H Hernandez-Tost
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - D Herzi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - A Morales-Martinez
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | | | - C Houillier
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; LOC network, France
| | - A Alentorn
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France
| | - K Hoang-Xuan
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France.
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Hernández-Verdin I, Kirasic E, Wienand K, Mokhtari K, Eimer S, Loiseau H, Rousseau A, Paillassa J, Ahle G, Lerintiu F, Uro-Coste E, Oberic L, Figarella-Branger D, Chinot O, Gauchotte G, Taillandier L, Marolleau JP, Polivka M, Adam C, Ursu R, Schmitt A, Barillot N, Nichelli L, Lozano-Sánchez F, Ibañez-Juliá MJ, Peyre M, Mathon B, Abada Y, Charlotte F, Davi F, Stewart C, de Reyniès A, Choquet S, Soussain C, Houillier C, Chapuy B, Hoang-Xuan K, Alentorn A. Molecular and clinical diversity in primary central nervous system lymphoma. Ann Oncol 2023; 34:186-199. [PMID: 36402300 DOI: 10.1016/j.annonc.2022.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity. PATIENTS AND METHODS To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data. RESULTS Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue. CONCLUSIONS The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.
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Affiliation(s)
- I Hernández-Verdin
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - E Kirasic
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - K Wienand
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Mokhtari
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neuropathology, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
| | - S Eimer
- Department of Pathology, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - H Loiseau
- Department of Neurosurgery, Bordeaux University Hospital Center, Pellegrin Hospital, Bordeaux, France; EA 7435-IMOTION, University of Bordeaux, Bordeaux, France
| | - A Rousseau
- Department of Pathology, PBH, CHU Angers, Angers, France; CRCINA, Université de Nantes-université d'Angers, Angers, France
| | - J Paillassa
- Department of Hematology, CHU Angers, Angers, France
| | - G Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | - F Lerintiu
- Department of Neuropathology, Hôpitaux Civils de Colmar, Strasbourg, France
| | - E Uro-Coste
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, Toulouse, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - L Oberic
- Department of Hematology, IUC Toulouse Oncopole, Toulouse, France
| | - D Figarella-Branger
- Neuropathology Department, University Hospital Timone, Aix Marseille University, Marseille, France; Inst Neurophysiopathol, CNRS, INP, Aix-Marseille University, Marseille, France
| | - O Chinot
- Department of Neuro-oncology, CHU Timone, APHM, Marseille, France; Institute of NeuroPhysiopathology, CNRS, INP, Aix-Marseille University, Marseille, France
| | - G Gauchotte
- Department of Biopathology, CHRU Nancy, CHRU/ICL, Bâtiment BBB, Vandoeuvre-lès-Nancy, France; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France; INSERM U1256, University of Lorraine, Vandoeuvre-lès-Nancy, France; Centre de Ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | - L Taillandier
- Department of Neuro-oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - J-P Marolleau
- Department of Hematology, CHU Amiens-Picardie, Amiens, France
| | - M Polivka
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, University of Paris, Paris, France
| | - C Adam
- Pathology Department, Bicêtre University Hospital, Public Hospital Network of Paris, Le Kremlin Bicêtre, France
| | - R Ursu
- Department of Neurology, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - A Schmitt
- Department of Hematology, Institut Bergonié Hospital, Bordeaux, France
| | - N Barillot
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - L Nichelli
- Department of Neuroradiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Lozano-Sánchez
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | | | - M Peyre
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Mathon
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Y Abada
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Charlotte
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - F Davi
- Department Hematology, APHP, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Stewart
- Department Broad Institute of MIT and Harvard, Cambridge, USA
| | - A de Reyniès
- Department INSERM UMR_S1138-Centre de Recherche des Cordeliers-Université Pierre et Marie Curie et Université Paris Descartes, Paris, France
| | - S Choquet
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Soussain
- Department Hematology Unit, Institut Curie, Saint-Cloud, France
| | - C Houillier
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Chapuy
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Hoang-Xuan
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Alentorn
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
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McLachlan T, Matthews WC, Jackson ER, Staudt DE, Douglas AM, Findlay IJ, Persson ML, Duchatel RJ, Mannan A, Germon ZP, Dun MD. B-cell Lymphoma 6 (BCL6): From Master Regulator of Humoral Immunity to Oncogenic Driver in Pediatric Cancers. Mol Cancer Res 2022; 20:1711-1723. [PMID: 36166198 PMCID: PMC9716245 DOI: 10.1158/1541-7786.mcr-22-0567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 01/15/2023]
Abstract
B-cell lymphoma 6 (BCL6) is a protooncogene in adult and pediatric cancers, first identified in diffuse large B-cell lymphoma (DLBCL) where it acts as a repressor of the tumor suppressor TP53, conferring survival, protection, and maintenance of lymphoma cells. BCL6 expression in normal B cells is fundamental in the regulation of humoral immunity, via initiation and maintenance of the germinal centers (GC). Its role in B cells during the production of high affinity immunoglobins (that recognize and bind specific antigens) is believed to underpin its function as an oncogene. BCL6 is known to drive the self-renewal capacity of leukemia-initiating cells (LIC), with high BCL6 expression in acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and glioblastoma (GBM) associated with disease progression and treatment resistance. The mechanisms underpinning BCL6-driven therapy resistance are yet to be uncovered; however, high activity is considered to confer poor prognosis in the clinical setting. BCL6's key binding partner, BCL6 corepressor (BCOR), is frequently mutated in pediatric cancers and appears to act in concert with BCL6. Using publicly available data, here we show that BCL6 is ubiquitously overexpressed in pediatric brain tumors, inversely to BCOR, highlighting the potential for targeting BCL6 in these often lethal and untreatable cancers. In this review, we summarize what is known of BCL6 (role, effect, mechanisms) in pediatric cancers, highlighting the two sides of BCL6 function, humoral immunity, and tumorigenesis, as well as to review BCL6 inhibitors and highlight areas of opportunity to improve the outcomes of patients with pediatric cancer.
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Affiliation(s)
- Tabitha McLachlan
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - William C. Matthews
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Evangeline R. Jackson
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Dilana E. Staudt
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Alicia M. Douglas
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Izac J. Findlay
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mika L. Persson
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ryan J. Duchatel
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Abdul Mannan
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Zacary P. Germon
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Matthew D. Dun
- University of Newcastle, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine & Wellbeing, Callaghan, New South Wales, Australia.,Precision Medicine Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Corresponding Author: Matthew D. Dun, Cancer Signalling Research Group, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, The University of Newcastle, Level 3, Life Sciences Bldg, Callaghan, NSW 2308, Australia. Phone: 612-4921-5693; E-mail:
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9
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Ohno H, Maekawa F, Nakagawa M, Chagi Y, Nakagawa M, Kishimori C, Fukutsuka K, Hayashida M, Takeoka K, Maruyama W, Ukyo N, Sumiyoshi S. Two cases of primary diffuse large B-cell lymphoma of the CNS associated with t(8;14)(q24;q32) or t(3;14)(q27;q32) identified by G-banding and fluorescence in situ hybridization applied to metaphase spreads. J Clin Exp Hematop 2022; 62:242-248. [PMID: 36436932 PMCID: PMC9898718 DOI: 10.3960/jslrt.22019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe two patients with primary diffuse large B-cell lymphoma of the central nervous system (PCNS-DLBCL). The first patient (case 1) was a woman in her late 70s who presented with a tumor in the left frontal lobe, whereas the second patient (case 2) was a man in his early 70s who presented with a left frontal lobe tumor associated with intratumoral hemorrhage. The histopathology of the tumor specimen disclosed the proliferation of large cells with centroblastic (case 1) or immunoblastic/plasmablastic (case 2) cytomorphology and an accumulation of the tumor cells within the perivascular space. The cells in both cases were positive for CD20, CD79a, BCL6, IRF4/MUM1, MYC, and BCL2 and negative for CD5 and CD10. G-banding revealed t(8;14)(q24;q32) in case 1, and the tetraploid-range karyotype including two or three copies of der(3)t(3;14)(q27;q32) and der(14)t(3;14)(q27;q32) in case 2. Fluorescence in situ hybridization applied to metaphase spreads confirmed colocalization of MYC and IGH (case 1) and BCL6 and IGH (case 2) hybridization signals on the relevant derivative chromosomes. Case 1 carried the MYD88L265P mutation. This case report provides clear evidence for the occurrence of t(8;14)(q24;q32) and t(3;14)(q27;q32) in PCNS-DLBCL using metaphase-based cytogenetic analysis.
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Affiliation(s)
- Hitoshi Ohno
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | - Fumiyo Maekawa
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | - Misumi Nakagawa
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | - Yoshinari Chagi
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | - Miho Nakagawa
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | - Chiyuki Kishimori
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | | | | | - Kayo Takeoka
- Tenri Institute of Medical Research, Tenri Hospital, Tenri, Nara, Japan
| | - Wataru Maruyama
- Department of Hematology, Tenri Hospital, Tenri, Nara, Japan
| | - Naoya Ukyo
- Department of Hematology, Tenri Hospital, Tenri, Nara, Japan
| | - Shinji Sumiyoshi
- Department of Diagnostic Pathology, Tenri Hospital, Tenri, Nara, Japan
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10
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Morales-Martinez A, Nichelli L, Hernandez-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Prognostic factors in primary central nervous system lymphoma. Curr Opin Oncol 2022; 34:676-684. [PMID: 36093869 DOI: 10.1097/cco.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal diffuse large B cell lymphoma. Despite its apparent immunopathological homogeneity, PCNSL displays a wide variability in outcome. Identifying prognostic factors is of importance for patient stratification and clinical decision-making. The purpose of this review is to focus on the clinical, neuroradiological and biological variables correlated with the prognosis at the time of diagnosis in immunocompetent patients. RECENT FINDINGS Age and performance status remain the most consistent clinical prognostic factors. The current literature suggests that neurocognitive dysfunction is an independent predictor of poor outcome. Cumulating data support the prognostic value of increased interleukin-10 level in the cerebrospinal fluid (CSF), in addition to its interest as a diagnostic biomarker. Advances in neuroimaging and in omics have identified several semi-quantitative radiological features (apparent diffusion restriction measures, dynamic contrast-enhanced perfusion MRI (pMRI) pattern and 18F-fluorodeoxyglucose metabolism) and molecular genetic alterations with prognostic impact in PCNSL. SUMMARY Validation of new biologic and neuroimaging markers in prospective studies is required before integrating future prognostic scoring systems. In the era of radiomic, large clinicoradiological and molecular databases are needed to develop multimodal artificial intelligence algorithms for the prediction of accurate outcome.
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Affiliation(s)
| | - Lucia Nichelli
- APHP, Sorbonne Université, IHU, ICM, Service de Neuroradiologie, Groupe Hospitalier Salpêtrière
| | - Isaias Hernandez-Verdin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| | | | - Agustí Alentorn
- APHP, Sorbonne Université, IHU, Service de Neurologie 2-Mazarin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
| | - Khê Hoang-Xuan
- APHP, Sorbonne Université, IHU, Service de Neurologie 2-Mazarin
- Laboratoire de Génétique et developpement des tumeurs cérébrales, Inserm, CNRS, UMR S 1127, ICM Institut du cerveau, Paris, France
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11
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Montesinos-Rongen M, Brunn A, Sanchez-Ruiz M, Küppers R, Siebert R, Deckert M. Impact of a Faulty Germinal Center Reaction on the Pathogenesis of Primary Diffuse Large B Cell Lymphoma of the Central Nervous System. Cancers (Basel) 2021; 13:cancers13246334. [PMID: 34944954 PMCID: PMC8699297 DOI: 10.3390/cancers13246334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023] Open
Abstract
Simple Summary The pathogenetic mechanisms and peculiar tropism of primary CNS lymphoma (PCNSL) of the central nervous system (CNS) have been the subject of debate for decades. Hypothesis-driven targeted molecular studies have revealed that PCNSLs derived from self-/polyreactive B cells that have escaped developmental control mechanisms. The early acquisition of activating mutations targeting the B cell receptor pathway provides a survival advantage. The failure of the germinal center (GC) reaction and its checkpoints increases tumor B cell affinity for the CNS. During this faulty GC reaction, PCNSL tumor cells acquire further oncogenic alterations converging on the Toll-like receptor, B cell receptor, and NF-κB pathway. These activated pathways sustain proliferation. Concomitantly, cells become unable to complete terminal B cell differentiation, becoming trapped within the vicious cycle of the GC reaction as low-affinity IgM+ B cells related to memory cells. Abstract Primary lymphoma of the central nervous system (PCNSL, CNS) is a specific diffuse large B cell lymphoma (DLBCL) entity confined to the CNS. Key to its pathogenesis is a failure of B cell differentiation and a lack of appropriate control at differentiation stages before entrance and within the germinal center (GC). Self-/polyreactive B cells rescued from apoptosis by MYD88 and/or CD79B mutations accumulate a high load of somatic mutations in their rearranged immunoglobulin (IG) genes, with ongoing somatic hypermutation (SHM). Furthermore, the targeting of oncogenes by aberrant SHM (e.g., PIM1, PAX5, RHOH, MYC, BTG2, KLHL14, SUSD2), translocations of the IG and BCL6 genes, and genomic instability (e.g., gains of 18q21; losses of 9p21, 8q12, 6q21) occur in these cells in the course of their malignant transformation. Activated Toll-like receptor, B cell receptor (BCR), and NF-κB signaling pathways foster lymphoma cell proliferation. Hence, tumor cells are arrested in a late B cell differentiation stage, corresponding to late GC exit B cells, which are genetically related to IgM+ memory cells. Paradoxically, the GC reaction increases self-/polyreactivity, yielding increased tumor BCR reactivity for multiple CNS proteins, which likely contributes to CNS tropism of the lymphoma. The loss of MHC class I antigen expression supports tumor cell immune escape. Thus, specific and unique interactions of the tumor cells with resident CNS cells determine the hallmarks of PCNSL.
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Affiliation(s)
- Manuel Montesinos-Rongen
- Institute of Neuropathology, Faculty of Medicine, University Hospital Cologne, 50937 Cologne, Germany; (M.M.-R.); (A.B.); (M.S.-R.)
| | - Anna Brunn
- Institute of Neuropathology, Faculty of Medicine, University Hospital Cologne, 50937 Cologne, Germany; (M.M.-R.); (A.B.); (M.S.-R.)
| | - Monica Sanchez-Ruiz
- Institute of Neuropathology, Faculty of Medicine, University Hospital Cologne, 50937 Cologne, Germany; (M.M.-R.); (A.B.); (M.S.-R.)
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), Medical School, University of Duisburg-Essen, 45122 Essen, Germany;
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, 89081 Ulm, Germany;
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine, University Hospital Cologne, 50937 Cologne, Germany; (M.M.-R.); (A.B.); (M.S.-R.)
- Correspondence: ; Tel.: +49-221-478-5265; Fax: +49-221-478-3712
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12
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Kim J, Kim TG, Lee HW, Kim SH, Park JE, Lee M, Kim YZ. Clinical Outcomes of RTOG 9310 Protocol for Primary Central Nervous System Lymphoma: Single-Center Experience with 87 Patients. Curr Oncol 2021; 28:4655-4672. [PMID: 34898570 PMCID: PMC8628744 DOI: 10.3390/curroncol28060393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
The Radiation Therapy Oncology Group (RTOG) 9310 protocol clinical trial established high-dose methotrexate (HDMTX) as the standard for primary central nervous system lymphoma (PCNSL). We aimed to investigate the RTOG 9310 protocol’s PCNSL outcomes by examining progression-free survival (PFS) and overall survival (OS) rates and determining the influential factors. Between 2007 and 2020, 87 patients were histopathologically diagnosed with PCNSL and treated with the RTOG 9310 protocol. All received HDMTX 2.5 g/m2 and vincristine 1.4 mg/m2/day for 1 day during weeks 1, 3, 5, 7, and 9, and procarbazine 100 mg/m2/day for 1 day during weeks 1, 5, and 9. Dexamethasone was administered on a standard tapering schedule from the first week to the sixth week. Whole brain radiotherapy (WBRT), consisting of 45 Gy for patients with less than a complete response to the chemotherapy or 36 Gy for complete responders, was started 1 week after the last dose of chemotherapy was administered. Within three weeks of the completion of WBRT, patients received two courses of cytarabine, which were separated by 3–4 weeks. Clinical, radiological, and histopathological characteristics were retrospectively reviewed. All patients completed five HDMTX cycles and a mean follow-up of 60.2 (range, 6–150) months. Twenty-eight (32.2%) patients experienced recurrence during follow-up. The mean time to recurrence was 21.8 months, while the mean PFS was 104.3 (95% confidence interval (CI), 90.6–118.0) months. Eleven (12.6%) patients died; the mean OS was 132.1 (95% CI, 122.2–141.9) months. The 3- and 5-year survival rates were 92.0% and 87.4%, respectively. One patient experienced acute renal failure, while the remainder tolerated any cytotoxic side effects. On multivariate analysis, the Eastern Cooperative Oncology Group performance score ≤ 2; the International Extranodal Lymphoma Study Group low-risk status; XBP-1, p53, and c-Myc negativity; homogenous enhancement; gross total resection, independently correlated with long PFS and OS. The RTOG 9310 protocol is effective for PCNSL and features good outcomes.
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Affiliation(s)
- Jinuk Kim
- Division of Neuro Oncology, Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea;
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea;
| | - Hyoun Wook Lee
- Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea;
| | - Seok Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea;
| | - Ji Eun Park
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (J.E.P.); (M.L.)
| | - Moonok Lee
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea; (J.E.P.); (M.L.)
| | - Young Zoon Kim
- Division of Neuro Oncology, Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea;
- Correspondence: ; Tel.: +82-55-233-5241; Fax: +82-55-233-6527
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13
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Feng Y, Liu Y, Zhong M, Wang L. Complete Blood Count Score Model Predicts Inferior Prognosis in Primary Central Nervous System Lymphoma. Front Oncol 2021; 11:618694. [PMID: 33842320 PMCID: PMC8033023 DOI: 10.3389/fonc.2021.618694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL), an aggressive type of non-Hodgkin lymphoma, has a poor prognosis. Currently available prognostic scoring systems are inadequate. We therefore aimed to investigate the predictive values of complete blood counts (CBCs) in PCNSL. Materials and Methods The cohort of this retrospective study comprised 73 PCNSL patients. The predictive values of selected CBCs, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic inflammation response index (SIRI), were analyzed. Results Ages and Memorial Sloan Kettering Cancer Center (MSKCC) scores of PCNSL patients correlated with NLR, PLR, and SII values (p <0.05). Both age and MSKCC scores correlated with inferior progression-free survival (PFS) and overall survival (OS) (p <0.05). High NLR, PLR, SII, and SIRI were significant predictors of shorter PFS and OS (p <0.05). NLR, PLR, SII, and SIRI were integrated to generate a “CBC score” model that accurately stratified PCNSL patients into three risk groups. The median PFS for low-risk, intermediate-risk, and high-risk groups were 24 ((12.458–35.542), 17 (10.626–23.374), and 9 (8.893–19.107) months, respectively (p = 0.011), and the median OS were 33 (19.175–46.825), 18 (16.368–19.632), and 9 (6.521–11.479) months, respectively (p = 0.008). Multivariate Cox regression model showed that MSKCC score (hazard ratio (HR) = 3.791, p <0.001), PLR (HR = 1.003, p = 0.013), and CBC score (HR = 1.873, p = 0.011) were independent predictors for PFS, whereas MSKCC score (HR = 4.128, p <0.001), PLR (HR = 1.003, p = 0.005), and CBC score (HR = 1.907, p = 0.004) were independent predictors for OS. Conclusion The CBC score model may be a promising predictive system for PCNSL patients.
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Affiliation(s)
- Yuhua Feng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiping Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Meizuo Zhong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Leyuan Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
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14
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Zhang Y, Ma L, Liu J, Zhu H, Lu L, Deng K, Ma W, Pan H, Wang R, Yao Y. Case Report: Identification of Potential Prognosis-Related TP53 Mutation and BCL6-LPP Fusion in Primary Pituitary Lymphoma by Next Generation Sequencing: Two Cases. Front Endocrinol (Lausanne) 2021; 12:673908. [PMID: 34381423 PMCID: PMC8350335 DOI: 10.3389/fendo.2021.673908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary pituitary lymphoma (PPL) is an extremely rare disease with poor prognosis. Although PPL has been shown to be different from classical primary central nervous system lymphoma because of the embryological origin of structures, individual and precise treatment of PPL remains unknown. METHODS A 61-year-old man and a 65-year-old woman both diagnosed with primary pituitary diffuse large B cell lymphoma underwent genetic analysis of cerebrospinal fluid and tumor tissue by next generation sequencing. RESULTS In the first case, partial remission was achieved following R²-MTX chemotherapy. In the other case with TP53 mutation and BCL6-LPP fusion, disease progressed although different chemotherapy regimens were given. CONCLUSION The gene mutation of TP53 and BCL6 may be identified as a marker responsible for prognostic difference in patients with PPL. Genetic analysis may provide a novel approach for precise management and prognosis prediction.
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Affiliation(s)
- Yi Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Liyuan Ma
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Jie Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Huijuan Zhu
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Lin Lu
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Hui Pan
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Yong Yao,
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15
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Lauw MIS, Lucas CHG, Ohgami RS, Wen KW. Primary Central Nervous System Lymphomas: A Diagnostic Overview of Key Histomorphologic, Immunophenotypic, and Genetic Features. Diagnostics (Basel) 2020; 10:diagnostics10121076. [PMID: 33322508 PMCID: PMC7764608 DOI: 10.3390/diagnostics10121076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that primarily arises in the brain, spinal cord, leptomeninges, and vitreoretinal compartment of the eye. The term is sometimes used interchangeably with primary central nervous system diffuse large B-cell lymphoma (PCNS DLBCL) because DLBCL comprises a great majority (90–95%) of PCNSL. Although rare, other types of lymphomas can be seen in the central nervous system (CNS), and familiarity with these entities will help their recognition and further workup in order to establish the diagnosis. The latter is especially important in the case of PCNSL where procurement of diagnostic specimen is often challenging and yields scant tissue. In this review, we will discuss the most common types of primary lymphomas that can be seen in the CNS with emphasis on the diagnostic histomorphologic, immunophenotypic, and molecular genetic features. The differential diagnostic approach to these cases and potential pitfalls will also be discussed.
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Affiliation(s)
- Marietya I. S. Lauw
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Correspondence:
| | - Calixto-Hope G. Lucas
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
| | - Robert S. Ohgami
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94158, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94158, USA
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16
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Molecular features of a large cohort of primary central nervous system lymphoma using tissue microarray. Blood Adv 2020; 3:3953-3961. [PMID: 31805190 DOI: 10.1182/bloodadvances.2019000989] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/05/2019] [Indexed: 12/15/2022] Open
Abstract
The objective of this study was to evaluate the distribution and prognostic impact of a broad range of molecular attributes in a large cohort of immunocompetent patients with primary central nervous system lymphoma (PCNSL) by using tissue microarray. Patients diagnosed with PCNSL were initially identified in the BC Cancer Lymphoid Cancer clinical and pathology databases. Tissue microarrays were constructed by using archival formalin-fixed paraffin-embedded diagnostic biopsy tissue. Immunohistochemistry and fluorescent in situ hybridization studies were performed. A total of 115 patients with PCNSL with diffuse large B-cell lymphoma (DLBCL) histology were identified. The majority of cases (≥75%) had a non-germinal center B-cell phenotype according to immunohistochemistry algorithms, but cell of origin did not affect progression-free or overall survival. MYC (40%), BCL2 (75%), and programmed death-ligand 1 (29%) protein expression were common, but their corresponding gene rearrangements were rare (≤1% each), suggesting that alternate mechanisms were driving expression. There were no dual rearrangements involving MYC and BCL2. Only 22% of cases had membranous expression of major histocompatibility complex class II, suggesting a mechanism for escape from immune surveillance. Epstein-Barr virus-encoded RNA was positive in 1 immunocompetent patient. BCL6 protein expression (77%) and BCL6 rearrangements (31%) were frequent; the latter was the only factor associated with a poor prognosis in the overall cohort and in the subgroup of 52 patients treated with high-dose methotrexate-based regimens. This large population-based study shows that prominent molecular features of PCNSL are unique and different from those of systemic DLBCL. These results may better inform drug development in PCNSL.
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Pina-Oviedo S, Bellamy WT, Gokden M. Analysis of primary central nervous system large B-cell lymphoma in the era of high-grade B-cell lymphoma: Detection of two cases with MYC and BCL6 rearrangements in a cohort of 12 cases. Ann Diagn Pathol 2020; 48:151610. [PMID: 32889391 DOI: 10.1016/j.anndiagpath.2020.151610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
High-grade diffuse large B-cell lymphoma (HG-DLBCL) refers to DLBCL with MYC and BCL2 and/or BCL6 rearrangements (double-hit or triple-hit DLBCL) that exhibits poor prognosis. Double-expressor DLBCL (c-myc+/bcl-2+) has intermediate prognosis when compared to HG-DLBCL. Primary central nervous system lymphoma (PCNSL) has distinct pathophysiology (frequent non-germinal center-like subtype and double-expressor) and has worse prognosis than systemic DLBCL. By fluorescence in situ hybridization (FISH), 25-30% of PCNSLs harbor BCL6 abnormalities with rare alterations in MYC, BCL2, double-hit or triple-hit events. We describe the clinicopathologic features and status of MYC, BCL2 and BCL6 in 12 PCNSLs (7 women, 5 men; median age 63 years; range: 28-79). Six cases showed focal starry-sky pattern. Immunohistochemically, all (100%) were of non-germinal center-like subtype, and 8/10 (80%) cases were double-expressors. Ki-67 ranged from 70 to 100%. FISH was positive in 9/12 (75%) cases: 4 (33%) harbored a BCL6 rearrangement, 3 (25%) had a gain of BCL2, 2 (17%) cases each had a gain of BCL6 and gain of IGH, and gain of MYC and deletion of MYC were observed in 1 case each (8%). Two (16%) cases were MYC/BCL6 double-hit PCNSLs. No MYC/BCL2 or triple-hit cases were identified. Eleven (92%) patients received chemotherapy and one also received whole brain radiation. The median time of follow-up was 4.4 months (range, 0.3-40.3). Seven (58%) patients are alive, 4 (33%) have died, and 1 (8%) had no follow-up. Five alive patients are in remission, including one MYC/BCL6 double-hit PCNSL. Our results add two new cases of rare double-hit PCNSL to the literature.
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Affiliation(s)
- Sergio Pina-Oviedo
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - William T Bellamy
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Murat Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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18
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Parrott AM, Haggiagi AM, Murty VV, Bhagat G, Alobeid B. Primary large B-cell lymphoma of the central nervous system with cyclin D1 expression and t(11;14) (IGH-CCND1): Diffuse large B-cell lymphoma with CCND1 rearrangement or mantle cell lymphoma? Hematol Oncol 2020; 38:817-822. [PMID: 32639587 DOI: 10.1002/hon.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
Mantle cell lymphomas (MCLs) are the prototypic B-cell non-Hodgkin lymphomas defined by cyclin D1 gene (CCND1; or other cyclin D family gene) rearrangements. However, extremely rare cases of diffuse large B-cell lymphomas (DLBCLs) harboring CCND1 rearrangements, resulting in cyclin D1 protein expression, have also been reported. In this report, we describe an unusual primary large B-cell lymphoma of non-germinal center immunophenotype of the central nervous system (CNS) in an elderly male patient, which was negative for CD5 and SOX11, and exhibited cyclin D1 expression. Fluorescence in situ hybridization analysis detected IGH-CCND1 and BCL6 rearrangements. This case may represent the first report of a primary CNS DLBCL with IGH-CCND1 rearrangement. The clinico-pathologic features that can help differentiate primary CNS MCL from primary DLBCL of the CNS with IGH-CCND1 rearrangement are discussed.
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Affiliation(s)
- Andrew M Parrott
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Aya M Haggiagi
- Department of Neurology & Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Vundavalli V Murty
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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19
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Abstract
Primary lymphoid neoplasms of the central nervous system are rare tumors that span a wide range of histopathologic appearances and can overlap occasionally with non-neoplastic processes. Application of modern molecular techniques has not only begun to unravel their unique underlying biology but has also started to lay a valuable diagnostic and therapeutic framework for these frequently aggressive malignancies. This review summarizes the existing landscape of clinicopathologic and genomic features of lymphoid neoplasms that may arise primarily within the central nervous system.
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Affiliation(s)
- David M Meredith
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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20
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Karschnia P, Batchelor TT, Jordan JT, Shaw B, Winter SF, Barbiero FJ, Kaulen LD, Thon N, Tonn JC, Huttner AJ, Fulbright RK, Loeffler J, Dietrich J, Baehring JM. Primary dural lymphomas: Clinical presentation, management, and outcome. Cancer 2020; 126:2811-2820. [PMID: 32176324 DOI: 10.1002/cncr.32834] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/04/2020] [Accepted: 02/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clinical experience is limited for primary central nervous system (CNS) lymphoma that arises from the dura mater, which is denoted with the term primary dural lymphoma (PDL). This study was aimed at determining the relative incidence, presentation, and outcomes of PDL. METHODS The institutional databases of the Divisions of Neuro-Oncology at the Massachusetts General Hospital and the Yale School of Medicine were retrospectively searched for patients with primary CNS lymphoma. Patients with pathologically confirmed dural lymphoma and no evidence of primary cerebral or systemic involvement were identified. Clinical data, diagnostic findings, treatments, and outcomes were recorded. RESULTS A total of 20 patients with PDL were identified, and they represented 6.3% of the individuals with primary CNS lymphomas (20 of 316). Histopathological examination of PDL revealed the following underlying subtypes: diffuse large B-cell lymphoma (10 of 20 patients), marginal zone lymphoma (6 of 20), follicular lymphoma (2 of 20), undefined B-cell non-Hodgkin lymphoma (1 of 20), and T-cell non-Hodgkin lymphoma (1 of 20). On imaging, all tumors appeared as extra-axial masses with avid contrast enhancement and mostly mimicked meningioma. The median apparent diffusion coefficient value was 667 ± 26 mm2 /s. Cerebrospinal fluid analyses and symptoms were nonspecific, and the diagnosis rested on tissue analysis. Therapeutic approaches included surgery, radiotherapy, and chemotherapy. The median overall survival was not reached after 5 years. Three patients were deceased at database closure because of tumor progression. The extent of tumor resection correlated positively with overall survival (P = .044). CONCLUSIONS PDL is a rare variant of primary CNS lymphoma that can be radiographically mistaken for meningioma. The outcome is excellent with multimodality treatment, and aggressive surgery may convey a survival advantage in select cases.
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Affiliation(s)
- Philipp Karschnia
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Yale School of Medicine, New Haven, Connecticut.,Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany
| | - Tracy T Batchelor
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Justin T Jordan
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Brian Shaw
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Sebastian F Winter
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Frank J Barbiero
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Leon D Kaulen
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Niklas Thon
- Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany
| | | | - Anita J Huttner
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Robert K Fulbright
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Jay Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Joachim M Baehring
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
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21
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High Incidence and Clinical Significance of MYC Rearrangements in Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type. Am J Surg Pathol 2019; 42:1488-1494. [PMID: 30113335 DOI: 10.1097/pas.0000000000001132] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) and primary cutaneous follicle center lymphoma (PCFCL) are cutaneous B-cell lymphomas (CBCL) with different clinical characteristics and behavior. PCDLBCL-LT is the most aggressive CBCL with a relatively poor prognosis. In nodal diffuse large B-cell lymphoma (DLBCL), rearrangements of the MYC gene, especially in combination with a second hit in BCL2 and/or BCL6, and double protein expression of MYC and BCL2 (DE) are adverse prognostic factors. As the clinical significance of these factors in CBCL is largely unknown, we studied the frequency and prognostic value of MYC rearrangements and DE in a cohort of 44 patients with PCDLBCL-LT and 17 patients with PCFCL. Compared with nodal DLBCL (9% to 14%), the PCDLBCL-LT patients had a high incidence of MYC rearrangements (32%), but only 2 patients (4%) had a second hit, both with BCL6. PCDLBCL-LT patients with a MYC rearrangement showed an inferior disease-specific survival (Log-rank, P=0.036) and disease-free survival (Log-rank, P=0.028), but no significant adverse effect on overall survival (Log-rank, P=0.157) at 5 years compared with patients without a MYC rearrangement. DE, present in 65% of the PCDLBCL-LT patients, was not associated with reduced survival. In the PCFCL group, MYC rearrangements and DE were not detected. In conclusion, this study identifies a high incidence of MYC rearrangements in PCDLBCL-LT compared to nodal DLBCL and further shows that a MYC rearrangement is an inferior prognostic marker in these patients. Therefore, our data suggest that it is useful to perform MYC-FISH in all newly diagnosed PCDLBCL-LT patients.
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23
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Yin W, Xia X, Wu M, Yang H, Zhu X, Sun W, Ge M. The impact of BCL-2/MYC protein expression and gene abnormality on primary central nervous system diffuse large B-cell lymphoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:2215-2223. [PMID: 31934044 PMCID: PMC6949630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 06/10/2023]
Abstract
We determined the effects of the BCL-2, C-MYC, and BCL-6 gene aberrations and their protein expressions on the prognosis of primary central nervous system diffuse B-cell lymphoma (PCNS-DLBCL) patients. The pathological and clinical information of 47 immunocompetent patients was reviewed, and the immunohistochemical markers for BCL2, CD10, BCL6, MUM1, and MYC were reevaluated. Genetic abnormalities included increased copy number, translocation, gene amplification, and double aberration and were detected by fluorescence in situ hybridization (FISH). A survival analysis showed that elevated protein levels in the cerebrospinal fluid (CSF), increased the IPI score, and EBV infection adversely affected survival. However, high BCL2 (≥70%) and positive MYC expressions (≥40%) showed no significant influence on survival or BCL-2 gene abnormality, and BCL2/MYC double expression and BCL-2/C-MYC double aberrations were associated with adverse outcomes for PCNS-DLBCL patients.
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Affiliation(s)
- Wenjuan Yin
- Department of Pathology, Zhejiang Chinese Medical University Affiliated Zhejiang Cancer Hospital1# Banshan East Road, Hangzhou, Zhejiang, China
- The Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvinceZhejiang, China
| | - Xianghou Xia
- Department of Breast Cancer Surgery, Zhejiang Chinese Medical University Affiliated Zhejiang Cancer Hospital1# Banshan East Road, Hangzhou, Zhejiang, China
| | - Meijuan Wu
- Department of Pathology, Zhejiang Chinese Medical University Affiliated Zhejiang Cancer Hospital1# Banshan East Road, Hangzhou, Zhejiang, China
| | - Haiyang Yang
- Department of Lymphoma, Zhejiang Chinese Medical University Affiliated Zhejiang Cancer Hospital1# Banshan East Road, Hangzhou, Zhejiang, China
| | - Xiu Zhu
- Department of Pathology, Zhejiang Chinese Medical University Affiliated Zhejiang Cancer Hospital1# Banshan East Road, Hangzhou, Zhejiang, China
| | - Wenyong Sun
- Department of Pathology, Zhejiang Chinese Medical University Affiliated Zhejiang Cancer Hospital1# Banshan East Road, Hangzhou, Zhejiang, China
| | - Minghua Ge
- Departmrnt of Head, Neck and Thyroid Surgery, Zhejiang Provincial People’s Hospital158# Santang Road, Hangzhou, Zhejiang, China
- The Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang ProvinceZhejiang, China
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24
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Xu T, Jia Q, Wang Y, Liu Y, Han D, Li P, Ma J, Fan L, Yan Q, Guo S, Li M, Wang Z. Rare cases of primary central nervous system anaplastic variant of diffuse large B-cell lymphoma. Diagn Pathol 2019; 14:45. [PMID: 31109360 PMCID: PMC6528307 DOI: 10.1186/s13000-019-0826-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/13/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary central nervous system (CNS) diffuse large B-cell lymphoma (DLBCL) is a rare intracranial tumor, defined as DLBCL arising from the brain, spinal cord, leptomeninges and eye, with an overall annual incidence of 5 cases per million. The primary CNS anaplastic variant of DLBCL (A-DLBCL) is even less common; to our knowledge, there are only two other case reports in the literature. The aim of this report is to present rare cases of primary CNS A-DLBCL and study their clinicopathologic and genetic features. CASE PRESENTATION We report 3 patients, two men and one woman, aged 54, 55 and 67 years old, with primary CNS A-DLBCL. All 3 patients had a high International Extranodal Lymphoma Study Group (IELSG) score; although the patients were treated with methotrexate-based regimens and/or with radiation therapy, the overall survival was only 2, 5, and 8 months. All 3 patients presented with characteristic features of perivascular space infiltration with bizarre-shaped tumor cells, leading to the diagnosis of primary CNS A-DLBCL. Concurrent of MYC and BCL2 and/or BCL6 abnormalities and MYC/BCL2 double-expressor DLBCL occurred in all 3 patients; two patients had MYC/BCL2/BCL6 triple extra copies, and one patient had MYC extra copy and BCL6 translocation. All 3 patients displayed mutations in MYD88 L265P and nuclear positivity for RELA, RELB and/or c-Rel, indicating constitutive activation of the NF-κB pathway. CONCLUSIONS These cases shed light on the unique genetic alterations and biological features of primary CNS A-DLBCL. Patients with primary CNS A-DLBCL may often have a MYC/BCL2 double-expressor and concurrent MYC and BCL2 and/or BCL6 genetic abnormalities, as well as constitutive activation of the NF-κB pathway. Primary CNS A-DLBCL follows a very aggressive disease course and poor prognosis. In the future, a large number of cases should be analyzed, and the evaluation of molecular genetic characteristics could help with practical and therapeutic implications for primary CNS A-DLBCL.
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Affiliation(s)
- Tianqi Xu
- Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Qingge Jia
- Second Retired Cadres Sanitarium of Xi'an, Shaanxi Province Military Region, Xi'an, 710032, China
| | - Yingmei Wang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Yixiong Liu
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Donghui Han
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Peifeng Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Jing Ma
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Linni Fan
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Qingguo Yan
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Shuangping Guo
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Mingyang Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China.
| | - Zhe Wang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China.
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25
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Kalogeropoulos D, Vartholomatos G, Mitra A, Elaraoud I, Ch'ng SW, Zikou A, Papoudou-Bai A, Moschos MM, Kanavaros P, Kalogeropoulos C. Primary vitreoretinal lymphoma. Saudi J Ophthalmol 2019; 33:66-80. [PMID: 30930667 PMCID: PMC6424706 DOI: 10.1016/j.sjopt.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 11/30/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, which consists a subset of primary central system lymphoma (PCNSL) and the most common type of intraocular lymphoma. The involvement of eyes is estimated to be approximately 20% of PCNSL, but the brain involvement may be up to 80% of PVRL. Typically, PVRL is a high grade B-cell malignancy of the retina and needs to be assorted from choroidal low-grade B-cell lymphomas. Very often PVRL masquerades and can be erroneously diagnosed as chronic uveitis, white dot syndromes or other neoplasms. Establishing an accurate diagnosis may involve cytology/pathology, immunohistochemistry, flow cytometry, molecular pathology and cytokine profile analysis. There is inadequate information about PVRL’s true incidence, ethnic/geographical variation and pathogenetic mechanisms. The therapeutic approach of PVRL involves aggressive chemotherapy and radiation therapy. Although PVRL tends to have a good response to the initial treatment, the prognosis is poor and the survival restricted due to the high relapse rates and CNS involvement.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom.,Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Arijit Mitra
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | | | - Soon Wai Ch'ng
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Anastasia Zikou
- Department of Radiology, Faculty of Medicine, School of Health Science, University of Ioannina, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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26
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Cai Q, Fang Y, Young KH. Primary Central Nervous System Lymphoma: Molecular Pathogenesis and Advances in Treatment. Transl Oncol 2019; 12:523-538. [PMID: 30616219 PMCID: PMC6371000 DOI: 10.1016/j.tranon.2018.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a group of extranodal non-Hodgkin lymphoma that exhibits specific biological characteristics and clinical behavior, with an aggressive disease course and unsatisfactory patient outcomes. It is of great importance to identify aberrant genetic loci and important molecular pathways that might suggest potential targets for new therapeutics and provide prognostic information. In this review, we listed various genetic and epigenetic alterations that are involved in PCNSL pathogenesis. In the aspect of treatment, we summarized the related literatures and evaluated the efficacy of surgery, induction chemotherapy, radiotherapy, intrathecal chemotherapy, and autologous stem cell transplantation in PCNSL. We also proposed the possible new agents for recurrent and relapse PCNSL based on the result of recent clinical researches.
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Affiliation(s)
- Qingqing Cai
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R China.
| | - Yu Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R China
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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27
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Nosrati A, Monabati A, Sadeghipour A, Radmanesh F, Safaei A, Movahedinia S. MYC, BCL2, and BCL6 rearrangements in primary central nervous system lymphoma of large B cell type. Ann Hematol 2018; 98:169-173. [PMID: 30306208 DOI: 10.1007/s00277-018-3498-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare specific subtype of non-Hodgkin lymphoma limited to the brain, leptomeninges, spinal cord, or eyes without any systemic presentation and relapse which mostly takes place in CNS. In more than 95% of patients, it is of diffuse large B cell lymphoma (DLBCL) type. Categorizing PCNSL to germinal center cell like or activated B cell like, as we usually do for DLBCL NOS, may not be applicable for predicting outcome. Possible prognostic significance of MYC, BCL2, and/or BCL6 rearrangements may be important given what we know about their impact in systemic DLBCL, but we have limited knowledge about the status of double or triple hit molecular changes in PCNSL. Here, we have investigated prevalence of these molecular alterations in PCNSL. Two independent tissue microarrays constructed from 78 formalin-fixed paraffin-embedded blocks of confirmed PCNSL were tested for rearrangement of MYC, BCL2, and BCL6 by interphase fluorescent in situ hybridization (FISH) using break apart dual color probes. BCL6 translocation was detected in 15 (12%) cases. Translocation involving MYC and BCL2 was identified in 3 cases (3.8%) and 1 case (1.3%) respectively. One double hit lymphoma was discovered with both MYC/BCL2 translocation (1.3%). To the best of our knowledge, few organized studies have been conducted for MYC, BCL2, and/or BCL6 rearrangement in PCNSL. This study is evaluating large number of PCNSL. Double or triple hit events which are rarely seen in PCNSL.
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Affiliation(s)
- Anahita Nosrati
- Hematopatholgy Service, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Hematopatholgy Service, Department of Pathology and Hematology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Sadeghipour
- Department of Pathology, Rasool-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Radmanesh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Akbar Safaei
- Molecular Pathology and Cytogenetics, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajjadeh Movahedinia
- Pathology and Stem Cell Research Center, Afzalipour Medical School, Kerman University of Medical Sciences, Kerman, Iran.,Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
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28
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Zorofchian S, El-Achi H, Yan Y, Esquenazi Y, Ballester LY. Characterization of genomic alterations in primary central nervous system lymphomas. J Neurooncol 2018; 140:509-517. [PMID: 30171453 DOI: 10.1007/s11060-018-2990-6] [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: 06/18/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a non-Hodgkin lymphoma that affects the central nervous system (CNS). Although previous studies have reported the most common mutated genes in PCNSL, including MYD88 and CD79b, our understanding of genetic characterizations in primary CNS lymphomas is limited. The aim of this study was to perform a retrospective analysis investigating the most frequent mutation types, and their frequency, in PCNSL. METHODS Fifteen patients with a diagnosis of PCNSL from our institution were analyzed for mutations in 406 genes and rearrangements in 31 genes by next generation sequencing (NGS). RESULTS Missense mutations were identified as the most common mutation type (32%) followed by frame shift mutations (23%). The highest mutation rate was reported in the MYD88 (33.3%), CDKN2A/B (33.3%), and TP53 (26.7%) genes. Intermediate tumor mutation burden (TMB) and high TMB was detected in 13.3% and 26.7% of PCNSL, respectively. The most frequent gene rearrangement involved the IGH-BCL6 genes (20%). CONCLUSIONS This study shows the most common genetic alterations in PCNSL as determined by a commercial next generation sequencing assay. MYD88 and CD79b are frequently mutated in PCNSL, IGH-BCL6 is the most frequent gene rearrangement and approximately 1/4 of cases show a high TMB. Mutations in multiple genes, in addition to high TMB and gene rearrangements, highlights the complex molecular heterogeneity of PCNSL. Knowledge about genetic alterations in PCNSL can inform the development of novel targets for diagnosis and treatment.
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Affiliation(s)
- Soheil Zorofchian
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA
| | - Hanadi El-Achi
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA
| | - Yuanqing Yan
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA.
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA. .,Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA.
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Bruno A, Labreche K, Daniau M, Boisselier B, Gauchotte G, Royer-Perron L, Rahimian A, Lemoine F, de la Grange P, Guégan J, Bielle F, Polivka M, Adam C, Meyronet D, Figarella-Branger D, Villa C, Chrétien F, Eimer S, Davi F, Rousseau A, Houillier C, Soussain C, Mokhtari K, Hoang-Xuan K, Alentorn A. Identification of novel recurrent ETV6-IgH fusions in primary central nervous system lymphoma. Neuro Oncol 2018; 20:1092-1100. [PMID: 29432597 PMCID: PMC6280140 DOI: 10.1093/neuonc/noy019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) represents a particular entity within non-Hodgkin lymphomas and is associated with poor outcome. The present study addresses the potential clinical relevance of chimeric transcripts in PCNSL discovered by using RNA sequencing (RNA-seq). Methods Seventy-two immunocompetent and newly diagnosed PCNSL cases were included in the present study. Among them, 6 were analyzed by RNA-seq to detect new potential fusion transcripts. We confirmed the results in the remaining 66 PCNSL. The gene fusion was validated by fluorescence in situ hybridization (FISH) using formalin-fixed paraffin-embedded (FFPE) samples. We assessed the biological and clinical impact of one new gene fusion. Results We identified a novel recurrent gene fusion, E26 transformation-specific translocation variant 6-immunoglobulin heavy chain (ETV6-IgH). Overall, ETV6-IgH was found in 13 out of 72 PCNSL (18%). No fusion conserved an intact functional domain of ETV6, and ETV6 was significantly underexpressed at gene level, suggesting an ETV6 haploinsufficiency mechanism. The presence of the gene fusion was also validated by FISH in FFPE samples. Finally, PCNSL samples harboring ETV6-IgH showed a better prognosis in multivariate analysis, P = 0.03, hazard ratio = 0.33, 95% CI = 0.12-0.88. The overall survival at 5 years was 69% for PCNSL harboring ETV6-IgH versus 29% for samples without this gene fusion. Conclusions ETV6-IgH is a new potential surrogate marker of PCNSL with favorable prognosis with ETV6 haploinsufficiency as a possible mechanism. The potential clinical impact of ETV6-IgH should be validated in larger prospective studies.
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Affiliation(s)
- Aurélie Bruno
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
| | - Karim Labreche
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
| | - Maïlys Daniau
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
- Institut du Cerveau et de la Moelle épinière, Plateforme iGenSeq, Paris, France
| | - Blandine Boisselier
- Département de pathologie cellulaire et tissulaire, CHU d’Angers, Angers, France
| | | | - Louis Royer-Perron
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
| | - Amithys Rahimian
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
- Onconeurotek, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Lemoine
- Genosplice, Institut du Cerveau et de la Moelle épinière, Paris, France
| | | | - Justine Guégan
- Institut du Cerveau et de la Moelle épinière, ICONICS (bioinformatic and biostatistics core facility), Paris, France
| | - Franck Bielle
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
- Onconeurotek, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Neuropathologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Polivka
- Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Service d’Anatomie et Cytologie Pathologiques, Paris, France
| | - Clovis Adam
- Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Service d’anatomopathologie, Le Kremlin-Bicêtre Cedex, France
| | - David Meyronet
- Hospices Civils de Lyon, Hôpital Neurologique, Bron, France and INSERM U842, Université Lyon, Lyon, France
| | - Dominique Figarella-Branger
- Centre Hospitalier Universitaire La Timone, Laboratoire d’anatomie pathologique-neuropathologique and Tumorothèque de l’Assistance Publique-Hôpitaux de Marseille (AC 2013-1786), Marseille Cedex, France
- Aix-Marseille University, AP-HM, CNRS, INP, Institute Neurophypathology, Hôpital de la Timone, Service d’Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Chiara Villa
- Hôpital Foch, Service d’anatomie pathologique, Suresnes, France
| | - Fabrice Chrétien
- Centre hospitalier Sainte Anne, Université Paris Descartes, Paris, France
| | - Sandrine Eimer
- Centre Hospitalier Universitaire Bordeaux, Service de Pathologie, Site Pellegrin,Rue Léo Saignat Victor Segalen University, Bordeaux Cedex, France
| | - Frédéric Davi
- Hématologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; and UMR_S, Sorbonne Universités, UPMC, University Paris, Paris, France
| | - Audrey Rousseau
- Département de pathologie cellulaire et tissulaire, CHU d’Angers, Angers, France
| | - Caroline Houillier
- Service de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Réseau Expert National LOC (Lymphomes Oculo-Cérébraux)
| | - Carole Soussain
- Réseau Expert National LOC (Lymphomes Oculo-Cérébraux)
- Hôpital René Huguenin, Institut Curie, Service d’Hématologie, Saint Cloud, France
| | - Karima Mokhtari
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
- Onconeurotek, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Neuropathologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Khê Hoang-Xuan
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
- Service de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Réseau Expert National LOC (Lymphomes Oculo-Cérébraux)
| | - Agusti Alentorn
- Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, UPMC, University Paris, Institut du Cerveau et de la Moelle épinière, INSERM, CNRS UMR, Paris, France
- Service de Neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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MiR-1260b promotes the migration and invasion in non-small cell lung cancer via targeting PTPRK. Pathol Res Pract 2018; 214:776-783. [PMID: 29628123 DOI: 10.1016/j.prp.2018.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/16/2018] [Accepted: 02/08/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Non-small cell lung cancer (NSCLC) accounts for 80-85% of lung cancer cases which cause most of cancer-related deaths globally. As our previous study discovered miR-1260b can be regarded as a specific signature for metastasis in NSCLC patients. However, the molecular mechanisms of miR-1260b underlying NSCLC progression and metastasis remain dismal. METHODS The expression of miR-1260b in NSCLC tissues and cell lines were examined by real-time PCR, the effects of miR-1260b on cell migration, invasion and proliferation were evaluated in vitro. Furthermore, luciferase reporter assay was performed to identify the targets of miR-1260b, and the association between miR-1260b and its target gene was determined by real-time PCR and western blot assay. RESULTS The results showed that miR-1260b was significantly upregulated in NSCLC cell lines. The inhibition of miR-1260b expression decreased the migratory and invasive rates in A549 cells while miR-1260b overexpression had the opposite effect. Furthermore, PTPRK was identified as a direct target of miR-1260b, and PTPRK expression was inversely correlated with miR-1260b in NSCLC cell lines and clinical tissues. CONCLUSIONS These results suggested that miR-1260b may play an important role in NSCLC metastasis progression and could serve as a putative target for diagnosis and treatment of NSCLC.
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Carnevale J, Rubenstein JL. The Challenge of Primary Central Nervous System Lymphoma. Hematol Oncol Clin North Am 2017; 30:1293-1316. [PMID: 27888882 DOI: 10.1016/j.hoc.2016.07.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary central nervous system (CNS) lymphoma is a challenging subtypes of aggressive non-Hodgkin lymphoma. Emerging clinical data suggest that optimized outcomes are achieved with dose-intensive CNS-penetrant chemotherapy and avoiding whole brain radiotherapy. Anti-CD20 antibody-based immunotherapy as a component of high-dose methotrexate-based induction programs may contribute to improved outcomes. An accumulation of insights into the molecular and cellular basis of disease pathogenesis is providing a foundation for the generation of molecular tools to facilitate diagnosis as well as a roadmap for integration of targeted therapy within the developing therapeutic armamentarium for this challenging brain tumor.
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Affiliation(s)
- Julia Carnevale
- Division of Hematology/Oncology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - James L Rubenstein
- Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, M1282 Box 1270, San Francisco, CA 94143, USA.
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Ghassibi MP, Ulloa-Padilla JP, Dubovy SR. Neural Tumors of the Orbit -- What Is New? Asia Pac J Ophthalmol (Phila) 2017; 6:273-282. [PMID: 28558180 DOI: 10.22608/apo.2017157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/07/2017] [Indexed: 01/01/2023] Open
Abstract
Primary neural tumors of the orbit account for approximately 10% of all orbital tumors. Different tumor entities include meningiomas, optic nerve gliomas, neurofibromas, schwannomas, malignant peripheral nerve sheath tumors, and granular cell tumors. This review summarizes current concepts regarding epidemiology, clinical presentation, diagnosis, pathology, immunohistochemistry, prognosis, and treatment for neural tumors of the orbit based on the available literature.
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Affiliation(s)
- Mark P Ghassibi
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jan P Ulloa-Padilla
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Sander R Dubovy
- Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Araujo I, Coupland SE. Primary Vitreoretinal Lymphoma -- A Review. Asia Pac J Ophthalmol (Phila) 2017; 6:283-289. [PMID: 28558176 DOI: 10.22608/apo.2017150] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 11/08/2022] Open
Abstract
Primary vitreoretinal lymphoma (PVRL) is the most common intraocular lymphoma occurring in the eye. It is a high-grade typically B-cell malignancy, arising in the retina, and is often associated with central nervous system (CNS) disease and thereby a poor prognosis. It needs to be distinguished from choroidal low-grade B-cell lymphomas, which do not disseminate to the brain and have a good prognosis. Because of the rarity of PVRL, information is lacking regarding its true incidence, its geographical or ethnic variation, and underlying risk factors apart from immunosuppression associated with human immunodeficiency virus (HIV) and Epstein Barr virus. PVRL often presents masquerading as other intraocular diseases and is therefore often associated with diagnostic delays. This is compounded by the fragility of the neoplastic B cells, which hampers vitrectomy yields and pathological work-up. The latter includes cytomorphology and immunoprofiling, with adjunctive tests such as cytokine analysis, polymerase chain reaction for clonality, MYD88 mutational testing, and possibly bespoke next generation sequencing. Recent examinations of PVRL and CNS lymphoma (CNSL) using whole genome sequencing confirm that these tumors arise from activated postgerminal center cells, reflecting their aggressive course in most cases. The treatment of PVRL varies between centers and is dependent on presence or absence of concomitant CNS disease. The prognosis remains poor, and yet progress is steadily being made through international collaborative clinical trials.
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Affiliation(s)
- Iguaracyra Araujo
- Department of Pathology and Forensic Medicine, University Hospital Professor Edgard Santos, Salvador, Brazil
| | - Sarah E Coupland
- Department of Cellular Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, England
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England
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Prognostic impact of MYC protein expression in central nervous system diffuse large B-cell lymphoma: comparison with MYC rearrangement and MYC mRNA expression. Mod Pathol 2017; 30:4-14. [PMID: 27687005 DOI: 10.1038/modpathol.2016.56] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 12/14/2022]
Abstract
The prognostic role of MYC has been well documented in non-central nervous system diffuse large B-cell lymphoma; however, it remains controversial in central nervous system diffuse large B-cell lymphoma. To investigate the prognostic value of MYC, we analyzed the MYC protein expression by immunohistochemistry, mRNA expression by RNA in situ hybridization, and gene status by fluorescence in situ hybridization in 74 cases of central nervous system diffuse large B-cell lymphoma. Moreover, we examined the correlation between MYC translocation, mRNA expression, and protein expression. The mean percentage of MYC immunopositive cells was 49%. Using a 44% cutoff value, 49 (66%) cases showed MYC protein overexpression. The result of mRNA in situ hybridization using the RNA scope technology was obtained using the H-scoring system; the median value was 34.2. Using the cutoff value of 63.5, 16 (22%) cases showed MYC mRNA overexpression. MYC gene rearrangement was detected in five out of 68 (7%) cases. MYC translocation showed no statistically significant correlation with mRNA expression; however, all MYC translocation-positive cases showed MYC protein overexpression, with a higher mean percentage of MYC protein expression than that of translocation-negative cases (78 vs 48%, P=0.001). The level of MYC mRNA expression was moderately correlated with the level of MYC protein expression (P<0.001). The mean percentage of MYC protein expression in the high MYC mRNA group was higher than that in the low MYC mRNA group (70 vs 47%, P<0.001). A univariate analysis showed that age over 60 years, Eastern Cooperative Oncology Group (ECOG) performance status ≥2 and MYC protein overexpression were significantly associated with an increased risk of death. MYC translocation and MYC mRNA expression had no prognostic significance. On multivariate analysis, MYC protein overexpression and ECOG score retained prognostic significance.
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Four M, Cacheux V, Tempier A, Platero D, Fabbro M, Marin G, Leventoux N, Rigau V, Costes-Martineau V, Szablewski V. PD1 and PDL1 expression in primary central nervous system diffuse large B-cell lymphoma are frequent and expression of PD1 predicts poor survival. Hematol Oncol 2016; 35:487-496. [PMID: 27966264 DOI: 10.1002/hon.2375] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/28/2016] [Accepted: 11/13/2016] [Indexed: 01/02/2023]
Abstract
Primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) is a rare and aggressive type of diffuse large B-cell lymphoma (DLBCL) whit poorly understood pathogenesis. Finding biomarkers associated with patient survival may be important for understanding its physiopathology and to develop new therapeutic approaches. We investigated 32 PCNS-DLBCL from immunocompetent patients for BCL2, CMYC, LMO2, and P53 expression and for cytogenetic aberrations of BCL2, BCL6, and MYC genes, all known for their prognostic value in systemic DLBCL (s-DLBCL). We analyzed PD1 and PDL1 protein expression in both tumor infiltrating lymphocytes (TILs) and tumor cells. Finally, we searched for correlation between biological data and clinical course. The PCNS-DLBCL expressed BCL2, CMYC, LMO2, and P53 at similar frequency than s-DLBCL but without significant prognostic on survival. None cases harbored aberrations involving BCL2 and MYC gene whereas BCL6 abnormalities were present in 20.7% of cases but without value on survival. Expression of PD1 in TILs and PDL1 in tumor cells was observed at higher rates than in s-DLBCL (58% and 37%, respectively). The PD1 expression in TILs correlated with PDL1 expression in tumor cells (P = .001). Presence of PD1 positive TILs was associated with poorer overall survival (P = .011). Patients with PDL1 overexpression tended to better response to chemotherapy (P = .23). In conclusion PCNS-DLBCL pathogenesis differs from s-DLBCL without prognostic value of the phenotypic and cytogenetic parameters known for their pejorative impact in the latter. The PD1/PDL1 pathway plays a strong role in PCNS-DLBCL and represents an attractive target for this aggressive lymphoma.
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Affiliation(s)
- Marion Four
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Valère Cacheux
- Département d' Hématologie biologique, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
| | - Ariane Tempier
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Dolorès Platero
- Département d' Hématologie biologique, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Michel Fabbro
- Département d' Oncologie Médicale, Institut du Cancer de Montpellier, Montpellier, France
| | - Grégory Marin
- Département d' Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Nicolas Leventoux
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Valérie Rigau
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
| | - Valérie Costes-Martineau
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
| | - Vanessa Szablewski
- Département de Biopathologie, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France.,Faculté de Médecine, Université Montpellier 1, Montpellier, France
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Debliquis A, Voirin J, Harzallah I, Maurer M, Lerintiu F, Drénou B, Ahle G. Cytomorphology and flow cytometry of brain biopsy rinse fluid enables faster and multidisciplinary diagnosis of large B-cell lymphoma of the central nervous system. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:182-188. [DOI: 10.1002/cyto.b.21403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/04/2016] [Accepted: 07/29/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Agathe Debliquis
- Groupe Hospitalier de la Région Mulhouse Sud Alsace; Laboratoire d'Hématologie; France
| | - Jimmy Voirin
- Service de Neurochirurgie, Hôpitaux Civils de Colmar et Hautepierre; Strasbourg France
| | - Inès Harzallah
- Groupe Hospitalier de la Région Mulhouse Sud Alsace; Laboratoire d'Hématologie; France
| | - Maxime Maurer
- Laboratoire d'Hématologie, Hôpitaux Civils de Colmar; France
| | - Felix Lerintiu
- Service d'Anatomo-Pathologie, Hôpitaux Civils de Colmar; France
| | - Bernard Drénou
- Groupe Hospitalier de la Région Mulhouse Sud Alsace; Laboratoire d'Hématologie; France
| | - Guido Ahle
- Service de Neurologie, Hôpitaux Civils de Colmar; France
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Abstract
BACKGROUND Primary CNS lymphoma (PCNSL), a rare form of aggressive extranodal non-Hodgkin's lymphoma (NHL), has increased in incidence during the last three decades and occurs in both immune compromised and immune competent hosts. It has an overall poor prognosis. OBJECTIVE This study attempts to further delineate the clinico-pathological, immunohistochemical and radiological profile of PCNSL at Jeddah to King Faisal Hospital and Research Center. METHODS Computerized search through the archives of King Faisal Hospital and Research Centre between July 2000- December 2012 identified 15 patients with pathologically confirmed PCNSL. These were analyzed retrospectively. Their clinico-pathological, immunohistochemical and radiological data were analyzed. RESULTS Of the 15 PCNSL patients, 8 (53.3%) were females and 7 (46.6%) were males. There was female predilection especially in the age group of 40-59 years. Mean age at diagnosis for all patients was 50.4 years. There was no patient in the pediatric age group. The most common location in the brain was the frontal region in 7 patients (46.6%), 7 (46.6%) had multiple intracranial masses; all 15 (100%) were Non Hodgkin B-cell lymphomas, among which 13 (86.6%) were diffuse large B-cell lymphomas. All 15 (100%) cases showed diffuse and strong positivity for CD 45, and CD 20. Fourteen patients were immune competent while one was immune compromised. CONCLUSIONS PCNSL often occurs in middle-aged and aged patients. There is female predilection especially in the middle age. Frontal region is the most common location with diffuse large B-cell lymphoma being the predominant subtype.
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Affiliation(s)
- Shagufta T Mufti
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saleh S Baeesa
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jaudah A Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; Department of Pathology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with considerable heterogeneity reflected in the 2008 World Health Organization classification. In recent years, genome-wide assessment of genetic and epigenetic alterations has shed light upon distinct molecular subsets linked to dysregulation of specific genes or pathways. Besides fostering our knowledge regarding the molecular complexity of DLBCL types, these studies have unraveled previously unappreciated genetic lesions, which may be exploited for prognostic and therapeutic purposes. Following the last World Health Organization classification, we have witnessed the emergence of new variants of specific DLBCL entities, such as CD30 DLBCL, human immunodeficiency virus-related and age-related variants of plasmablastic lymphoma, and EBV DLBCL arising in young patients. In this review, we will present an update on the clinical, pathologic, and molecular features of DLBCL incorporating recently gained information with respect to their pathobiology and prognosis. We will emphasize the distinctive features of newly described or emerging variants and highlight advances in our understanding of entities presenting a diagnostic challenge, such as T-cell/histiocyte-rich large B-cell lmphoma and unclassifiable large B-cell lymphomas. Furthermore, we will discuss recent advances in the genomic characterization of DLBCL, as they may relate to prognostication and tailored therapeutic intervention. The information presented in this review derives from English language publications appearing in PubMed throughout December 2015. For a complete outline of this paper, please visit: http://links.lww.com/PAP/A12.
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40
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Abstract
The eye is a rare site for the development of malignant lymphoma. Based on cell type and involved intraocular structures, which as a whole represent an immune-privileged site, several subtypes of primary intraocular lymphoma need to be discerned. Primary vitreoretinal lymphoma (PVRL), the most common form, is an aggressive B-cell malignancy and considered a subtype of primary central nervous system (CNS) lymphoma. Ocular symptoms are non-specific and often mimic uveitis, frequently resulting in delayed diagnosis. Bilateral ocular involvement and dissemination/relapse in the CNS are common. Diagnosis of PVRL is usually based on the analysis of vitreous biopsy material. In addition to cytological and immunocytochemical examination, measurements of cytokine levels and molecular determination of B-cell clonality and recurrent mutations increase the diagnostic yield. Both systemic chemotherapy and exclusively local treatment, including ocular radiotherapy and intravitreal chemotherapy, are successful approaches for the management of PVRL, although it is currently not predictable which patients require systemic treatment in order to avoid cerebral dissemination, a complication associated with a considerably worse prognosis.
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Affiliation(s)
- Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
| | - Andrés J M Ferreri
- Department of Onco-Hematology, Unit of Lymphoid Malignancies, Division of Onco-Hematological Medicine, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
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41
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Fraser E, Gruenberg K, Rubenstein JL. New approaches in primary central nervous system lymphoma. Chin Clin Oncol 2016; 4:11. [PMID: 25841718 DOI: 10.3978/j.issn.2304-3865.2015.02.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/30/2014] [Indexed: 12/19/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) has long been associated with an inferior prognosis compared to other aggressive non-Hodgkin's lymphomas (NHLs). However, during the past 10 years an accumulation of clinical experience has demonstrated that long-term progression-free survival (PFS) can be attained in a major proportion of PCNSL patients who receive dose-intensive consolidation chemotherapy and avoid whole brain radiotherapy. One recent approach that has reproducibly demonstrated efficacy for newly diagnosed PCNSL patients is an immunochemotherapy combination regimen used during induction that consists of methotrexate, temozolomide, and rituximab followed by consolidative infusional etoposide plus high-dose cytarabine (EA), administered in first complete remission (CR). Other high-dose chemotherapy-based consolidative regimens have shown efficacy as well. Our goal in this review is to update principles of diagnosis and management as well as data regarding the molecular pathogenesis of PCNSL, information that may constitute a basis for development of more effective therapies required to make additional advances in this phenotype of aggressive NHL.
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Affiliation(s)
- Eleanor Fraser
- Division of Hematology/Oncology, University of California, San Francisco, CA 94143, USA
| | - Katherine Gruenberg
- UCSF School of Pharmacy, University of California, San Francisco, CA 94143, USA
| | - James L Rubenstein
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143, USA.
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Izumi K, Fujita K, Fukutsuka K, Hayashida M, Akasaka T, Ohno H. MYC/BCL2/BCL6 triple-hit lymphoma that presented with a suprasellar tumor and meningeal dissemination: A case report. ACTA ACUST UNITED AC 2016. [DOI: 10.12936/tenrikiyo.19-007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Kumi Fujita
- Department of Diagnostic Pathology, Tenri Hospital
| | | | | | | | - Hitoshi Ohno
- Department of Hematology, Tenri Hospital
- Tenri Institute of Medical Research
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Abstract
Primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system is an aggressive malignancy that exhibits unique biological features and characteristic clinical behaviour, with overall long-term survival rates of around 20–40 %. Clinical outcome has improved following the advent of chemoradiation protocols incorporating high-dose methotrexate in the mid-1980s, but disease relapse and adverse neurocognitive sequelae remain major clinical challenges. To address this, investigators have focused on improving drug therapy with novel cytotoxic combinations, monoclonal antibody therapy, and intensive chemotherapy consolidation approaches, in an attempt to improve disease control whilst reducing the requirement for whole-brain radiotherapy. Outcomes for patients that are older, immunocompromised, or have relapsed/refractory disease remain unsatisfactory and there is a paucity of clinical trial data to guide treatment of these groups. This review highlights recent advances in pathobiology, imaging, and clinical management of PCNSL and looks ahead to research priorities for this rare and challenging lymphoid malignancy.
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Tapia G, Baptista MJ, Muñoz-Marmol AM, Gaafar A, Puente-Pomposo M, Garcia O, Marginet-Flinch R, Sanz C, Navarro JT, Sancho JM, Ribera JM, Ariza A, Mate JL. MYC protein expression is associated with poor prognosis in primary diffuse large B-cell lymphoma of the central nervous system. APMIS 2015; 123:596-603. [PMID: 26010683 DOI: 10.1111/apm.12390] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
MYC and BCL2 gene translocations and protein expression have recently demonstrated to be of prognostic significance in systemic diffuse large B-cell lymphoma (DLBCL). However, their role in primary central nervous system DLBCL (CNS-DLBCL) prognosis has been scarcely analyzed. We studied the immunophenotype, the status of the MYC, BCL2, and BCL6 genes and the clinical features of a series of 42 CNS-DLBCL and evaluated their prognostic significance. We found high MYC protein expression in 43% of cases, and this was associated with lower overall survival (OS). Cases with concurrent expression of MYC and BCL2 showed a lower OS, although the difference did not reach statistical significance. Translocations involving the MYC or BCL2 genes were not detected. The BCL6 gene was frequently translocated, but was unrelated to survival. We conclude that MYC protein expression detected by immunohistochemistry identifies a CNS-DLBCL subset with worse prognosis and may contribute to a more accurate risk stratification of CNS-DLBCL patients.
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Affiliation(s)
- Gustavo Tapia
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Maria-Joao Baptista
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ana-Maria Muñoz-Marmol
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Ayman Gaafar
- Department of Pathology, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Olga Garcia
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ruth Marginet-Flinch
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Carolina Sanz
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Jose-Tomas Navarro
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Juan-Manuel Sancho
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Josep-Maria Ribera
- Department of Hematology, ICO- Hospital Germans Trias i Pujol, Josep Carreras Leukaemia Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Aurelio Ariza
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Jose-Luis Mate
- Department of Pathology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
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Braggio E, Van Wier S, Ojha J, McPhail E, Asmann YW, Egan J, da Silva JA, Schiff D, Lopes MB, Decker PA, Valdez R, Tibes R, Eckloff B, Witzig TE, Stewart AK, Fonseca R, O'Neill BP. Genome-Wide Analysis Uncovers Novel Recurrent Alterations in Primary Central Nervous System Lymphomas. Clin Cancer Res 2015; 21:3986-94. [PMID: 25991819 DOI: 10.1158/1078-0432.ccr-14-2116] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/03/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin lymphoma confined to the central nervous system. Whether there is a PCNSL-specific genomic signature and, if so, how it differs from systemic diffuse large B-cell lymphoma (DLBCL) is uncertain. EXPERIMENTAL DESIGN We performed a comprehensive genomic study of tumor samples from 19 immunocompetent PCNSL patients. Testing comprised array-comparative genomic hybridization and whole exome sequencing. RESULTS Biallelic inactivation of TOX and PRKCD was recurrently found in PCNSL but not in systemic DLBCL, suggesting a specific role in PCNSL pathogenesis. In addition, we found a high prevalence of MYD88 mutations (79%) and CDKN2A biallelic loss (60%). Several genes recurrently affected in PCNSL were common with systemic DLBCL, including loss of TNFAIP3, PRDM1, GNA13, TMEM30A, TBL1XR1, B2M, CD58, activating mutations of CD79B, CARD11, and translocations IgH-BCL6. Overall, B-cell receptor/Toll-like receptor/NF-κB pathways were altered in >90% of PNCSL, highlighting its value for targeted therapeutic approaches. Furthermore, integrated analysis showed enrichment of pathways associated with immune response, proliferation, apoptosis, and lymphocyte differentiation. CONCLUSIONS In summary, genome-wide analysis uncovered novel recurrent alterations, including TOX and PRKCD, helping to differentiate PCNSL from systemic DLBCL and related lymphomas.
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Affiliation(s)
| | | | | | | | | | - Jan Egan
- Mayo Clinic, Scottsdale, Arizona
| | | | - David Schiff
- University of Virginia, Charlottesville, Virginia
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Gill KZ, Iwamoto F, Allen A, Hoehn D, Murty VV, Alobeid B, Bhagat G. MYC protein expression in primary diffuse large B-cell lymphoma of the central nervous system. PLoS One 2014; 9:e114398. [PMID: 25479599 PMCID: PMC4257680 DOI: 10.1371/journal.pone.0114398] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/06/2014] [Indexed: 11/18/2022] Open
Abstract
Primary diffuse large B-cell lymphoma of the central nervous system (CNS DLBCL) is a rare, aggressive subtype of DLBCL, the biology of which is poorly understood. Recent studies have suggested a prognostic role of MYC protein expression in systemic DLBCL, but little is known about the frequency and significance of MYC protein expression in CNS DLBCL. Hence, we investigated MYC protein expression profiles of CNS DLBCL and assessed the relationship between MYC expression and a variety of histopathologic, immunophenotypic, genetic, and clinical features. Fifty-nine CNS DLBCL diagnosed at our institution over the past 13 years were evaluated. The majority of cases (80%) showed centroblastic morphology, and 12 (20%) displayed a perivascular pattern of infiltration. According to the Hans criteria, 41 (69%) cases had a non-germinal center B-cell and 18 (31%) had a germinal center B-cell cell-of-origin (COO) phenotype. Mean MYC protein expression was 50% (median: 50%, range: 10-80%). Forty-three cases (73%) showed MYC overexpression (≥ 40%), and 35 (60%) showed MYC/BCL2 coexpression. MYC overexpression was seen in the single case harboring MYC translocation and in the cases showing increased copies of MYC (27%); however, no significant difference in mean MYC expression was seen between groups harboring or lacking MYC aberrations. In our series, age was associated with a significantly increased risk of death, and the perivascular pattern of infiltration was associated with a significantly increased risk of disease progression. Neither MYC expression (with or without BCL2 coexpression) nor other variables, including COO subtype were predictive of clinical outcome. Our findings indicate that the proportion of CNS DLBCL overexpressing MYC is higher compared to systemic DLBCL, and MYC overexpression appears to be independent of genetic MYC abnormalities. Thus, MYC expression and other immunophenotypic markers used for prognostication of systemic DLBCL might not apply to CNS DLBCL due to differences in disease biology.
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Affiliation(s)
- Kamraan Z. Gill
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, 10032, United States of America
| | - Fabio Iwamoto
- Department of Neurology, Columbia University Medical Center, New York, NY, 10032, United States of America
| | - Ashleigh Allen
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, 10032, United States of America
| | - Daniela Hoehn
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, 10032, United States of America
| | - Vundavalli V. Murty
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, 10032, United States of America
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, 10032, United States of America
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, 10032, United States of America
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47
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Montesinos-Rongen M, Purschke F, Küppers R, Deckert M. Immunoglobulin Repertoire of Primary Lymphomas of the Central Nervous System. J Neuropathol Exp Neurol 2014; 73:1116-25. [DOI: 10.1097/nen.0000000000000133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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48
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Translocation of the proto-oncogene Bcl-6 in human glioblastoma multiforme. Cancer Lett 2014; 353:41-51. [DOI: 10.1016/j.canlet.2014.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 01/13/2023]
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49
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The mutational pattern of primary lymphoma of the central nervous system determined by whole-exome sequencing. Leukemia 2014; 29:677-85. [PMID: 25189415 DOI: 10.1038/leu.2014.264] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/05/2014] [Accepted: 08/29/2014] [Indexed: 01/15/2023]
Abstract
To decipher the mutational pattern of primary CNS lymphoma (PCNSL), we performed whole-exome sequencing to a median coverage of 103 × followed by mutation verification in 9 PCNSL and validation using Sanger sequencing in 22 PCNSL. We identified a median of 202 (range: 139-251) potentially somatic single nucleotide variants (SNV) and 14 small indels (range: 7-22) with potentially protein-changing features per PCNSL. Mutations affected the B-cell receptor, toll-like receptor, and NF-κB and genes involved in chromatin structure and modifications, cell-cycle regulation, and immune recognition. A median of 22.2% (range: 20.0-24.7%) of somatic SNVs in 9 PCNSL overlaps with the RGYW motif targeted by somatic hypermutation (SHM); a median of 7.9% (range: 6.2-12.6%) affects its hotspot position suggesting a major impact of SHM on PCNSL pathogenesis. In addition to the well-known targets of aberrant SHM (aSHM) (PIM1), our data suggest new targets of aSHM (KLHL14, OSBPL10, and SUSD2). Among the four most frequently mutated genes was ODZ4 showing protein-changing mutations in 4/9 PCNSL. Together with mutations affecting CSMD2, CSMD3, and PTPRD, these findings may suggest that alterations in genes having a role in CNS development may facilitate diffuse large B-cell lymphoma manifestation in the CNS. This may point to intriguing mechanisms of CNS tropism in PCNSL.
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50
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Wang CC, Carnevale J, Rubenstein JL. Progress in central nervous system lymphomas. Br J Haematol 2014; 166:311-25. [PMID: 24837460 DOI: 10.1111/bjh.12938] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/28/2014] [Indexed: 12/13/2022]
Abstract
Until recently, primary central nervous system lymphoma (PCNSL) was associated with a uniformly dismal prognosis. It is now reasonable to anticipate long-term survival and possibly cure for a significant proportion of patients diagnosed with PCNSL. Accumulated data generated over the past 10 years has provided evidence that long-term progression-free survival (PFS) can reproducibly be attained in a significant fraction of PCNSL patients that receive dose-intensive chemotherapy consolidation, without whole brain radiotherapy. One consolidative regimen that has reproducibly demonstrated promise is the combination of infusional etoposide plus high-dose cytarabine (EA), administered in first complete remission after methotrexate, temozolomide and rituximab-based induction. Given evolving principles of management and the mounting evidence for reproducible improvements in survival rates in prospective clinical series, our goal in this review is to highlight and update principles in diagnosis, staging and management as well as to review data regarding the pathogenesis of central nervous system lymphomas, information that is likely to constitute a basis for the implementation of novel therapies that are requisite for further progress in this unique phenotype of non-Hodgkin lymphoma.
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Affiliation(s)
- Chia-Ching Wang
- Division of Hematology/Oncology, Helen Diller Comprehensive Cancer Center University of California, San Francisco, CA, USA
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