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Syrykh C, DI Proietto V, Brion E, Copie-Bergman C, Jardin F, Dartigues P, Gaulard P, Jo Molina T, Briere J, Oberic L, Haioun C, Tilly H, Maussion C, Morel M, Schiratti JB, Laurent C. MYC Rearrangement Prediction from LYSA Whole Slide Images in Large B-cell Lymphoma: A Multi-centric Validation of Self-supervised Deep Learning Models. Mod Pathol 2024:100610. [PMID: 39265953 DOI: 10.1016/j.modpat.2024.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/25/2024] [Accepted: 09/03/2024] [Indexed: 09/14/2024]
Abstract
Large B-cell lymphoma (LBCL) is a heterogeneous lymphoid malignancy in which MYC gene rearrangement (MYC-R) is associated with a poor prognosis, prompting the recommendation for more intensive treatment. MYC-R detection relies on fluorescence in situ hybridization (FISH) method which is time consuming, expensive and not available in all laboratories. Automating MYC-R detection on hematoxylin and eosin (HE) stained whole slide images (WSI) of LBCL would decrease the need for costly molecular testing and improve pathologists' productivity. We developed an interpretable deep learning (DL) algorithm to detect MYC-R considering recent advances in self-supervised learning and providing an extensive comparison of seven feature extractors and six multiple instance learning models, themselves. Four different multicentric cohorts, including 1 247 LBCL patients, were used for training and validation. The best DL model reached an average ROC AUC score of 81.9% during cross-validation on the largest LBCL cohort, and ROC AUC scores ranging from 62.2% to 74.5% when evaluated on other unseen cohorts. In addition, we demonstrated that using this model as a pre-screening tool (with a false-negative rate of 0%), FISH testing would be avoided in 35% of cases. This work demonstrates the feasibility of developing a medical device to efficiently detect MYC gene rearrangement on HE WSI in daily practice.
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Affiliation(s)
| | | | | | - Christiane Copie-Bergman
- LYSA (The Lymphoma Study Association) and LYSARC (The Lymphoma Academic Research Organisation), Pierre-Bénite, France
| | - Fabrice Jardin
- Department of Hematology and U1245, Henri Becquerel Center, IRIB, Normandy University, Rouen, France
| | - Peggy Dartigues
- Department of Pathology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philippe Gaulard
- Department of Pathology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Mondor Institute for Biomedical Research, INSERM U955, Faculty of Medicine, University of Paris-Est Créteil, Créteil, France
| | - Thierry Jo Molina
- Department of Pathology, Necker Enfants Malades Hospital, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Institut Imagine, Unité INSERM 1163, Paris, France
| | - Josette Briere
- Department of Hematology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Paris, France
| | - Lucie Oberic
- Department of Hematology, IUCT Oncopole, Toulouse, France
| | - Corine Haioun
- Department of Hematology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Hervé Tilly
- Department of Hematology and U1245, Henri Becquerel Center, IRIB, Normandy University, Rouen, France
| | | | | | | | - Camille Laurent
- Department of Pathology, IUCT Oncopole, Toulouse, France; INSERM, U1037, Research Center In Cancer of Toulouse, laboratoire d'excellence TOUCAN, Toulouse, France.
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2
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Du KX, Wu YF, Hua W, Duan ZW, Gao R, Liang JH, Li Y, Yin H, Wu JZ, Shen HR, Wang L, Shao Y, Li JY, Liang JH, Xu W. Identify truly high-risk TP53-mutated diffuse large B cell lymphoma patients and explore the underlying biological mechanisms. Cell Commun Signal 2024; 22:401. [PMID: 39148095 PMCID: PMC11325619 DOI: 10.1186/s12964-024-01765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 07/23/2024] [Indexed: 08/17/2024] Open
Abstract
TP53 mutation (TP53-mut) correlates with inferior survival in many cancers, whereas its prognostic role in diffuse large B-cell lymphoma (DLBCL) is still in controversy. Therefore, more precise risk stratification needs to be further explored for TP53-mut DLBCL patients. A set of 2637 DLBCL cases from multiple cohorts, was enrolled in our analysis. Among the 2637 DLBCL patients, 14.0% patients (370/2637) had TP53-mut. Since missense mutations account for the vast majority of TP53-mut DLBCL patients, and most non-missense mutations affect the function of the P53 protein, leading to worse survival rates, we distinguished patients with missense mutations. A TP53 missense mutation risk model was constructed based on a 150-combination machine learning computational framework, demonstrating excellent performance in predicting prognosis. Further analysis revealed that patients with high-risk missense mutations are significantly associated with early progression and exhibit dysregulation of multiple immune and metabolic pathways at the transcriptional level. Additionally, the high-risk group showed an absolutely suppressed immune microenvironment. To stratify the entire cohort of TP53-mut DLBCL, we combined clinical characteristics and ultimately constructed the TP53 Prognostic Index (TP53PI) model. In summary, we identified the truly high-risk TP53-mut DLBCL patients and explained this difference at the mutation and transcriptional levels.
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Affiliation(s)
- Kai-Xin Du
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yi-Fan Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Wei Hua
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Zi-Wen Duan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Rui Gao
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Jun-Heng Liang
- Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, China
| | - Yue Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua Yin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hao-Rui Shen
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yang Shao
- Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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3
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Hua W, Li Y, Yin H, Du KX, Zhang XY, Wu JZ, Liang JH, Shen HR, Gao R, Li JY, Wang L, Liang JH, Xu W. Analysis of CCND3 mutations in diffuse large B-cell lymphoma. Ann Hematol 2024:10.1007/s00277-024-05844-3. [PMID: 38886191 DOI: 10.1007/s00277-024-05844-3] [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: 01/21/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL), accounts for 30-40% of newly diagnosed lymphomas, has an overall cure rate of approximately 60%. Despite previous reports suggesting a negative prognostic association between CCND3 mutations and Burkitt lymphoma, their prognostic implications in DLBCL remain controversial. To investigate this, we evaluated CCND3 mutation status in 2059 DLBCL patient samples from four database (integrated cohort) and additional 167 DLBCL patient samples in our center (JSPH cohort). The mutation was identified in 5.5% (113/2059) of the cases in the integrated cohort, with 86% (97/113) found in exon 5. Furthermore, P284, R271, I290 and Q276 are described as CCND3 mutation hotspots. CCND3 mutation was associated with decreased overall survival (OS) in the integrated cohort (P = 0.0407). Further subgroup analysis revealed that patients diagnosed as EZB subtype DLBCL by LymphGen algorithm with CCND3 mutations had poorer OS than patients diagnosed as EZB subtype without CCND3 mutations (P = 0.0140). Using the next-generation sequencing (NGS) in the JSPH cohort, it was found that both cell cycle and DNA replication pathways were highly upregulated in patients with CCND3 mutations. Our results suggest that CCND3 mutations can serve as a novel prognostic factor in DLBCL pathogenesis. Consequently, the development of personalized therapeutic strategies for DLBCL patients with CCND3 mutations might enhance their prognosis.
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Affiliation(s)
- Wei Hua
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yue Li
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua Yin
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Kai-Xin Du
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Xin-Yu Zhang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jun-Heng Liang
- Nanjing Geneseeq Technology Inc, Nanjing, Jiangsu, China
| | - Hao-Rui Shen
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Rui Gao
- Department of Endocrinology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Jian-Yong Li
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Jin-Hua Liang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Wei Xu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Key Laboratory of Hematology, Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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4
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Intzes S, Symeonidou M, Zagoridis K, Pentidou A, Bezirgianidou Z, Papoutselis M, Misidou C, Roumpakis C, Spanoudaki A, Liapis K, Spanoudakis E. How to improve RCHOP as frontline therapy for diffuse large B-cell lymphoma: a systematic review and meta-analysis of 21 randomized controlled trials. Ann Hematol 2024; 103:1623-1633. [PMID: 38191715 DOI: 10.1007/s00277-023-05551-5] [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: 05/12/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
RCHOP is the standard of care for patients with diffuse large b-cell lymphoma (DLBCL) but failures occur in approximately 40% of them. We performed a meta-analysis of 21 randomized controlled trials (RCTs) comparing experimental regimens with RCHOP. We searched the database of PubMed with proper criteria, and data of efficacy (Progression Free Survival-PFS) in the ITT population were extracted and analyzed. Cross comparisons of RCTs were performed by using the CINEMA software. Odds ratio (OR) and 95% confidence intervals (95%, CI) are reported. The literature search yielded 21 RCTs including 5785 patients in the RCHOP arm and 5648 patients in the experimental arm. Odds ratio (OR) for PFS in the total cohort was OR (95%, CI): 0.87 (0.76-0.99), p=0.02. Among different strategies to improve RCHOP, addition of a novel agent on RCHOP improved PFS. In total 1740 patients in the RCHOP arm were compared with 1755 in the RCHOP plus a novel agent arm, and the OR (95% CI) for PFS was 0.84 (0.71-0.97), p=0.02. Indirect comparisons of nine studies adding a novel agent on RCHOP does not give prominence to any agent. Subgroup analysis according to cell of origin was performed for non-GC DLBCL patients. In this subgroup, 1546 patients treated with RCHOP were compared with 1538 patients treated with experimental regimens. The OR (95% CI) for PFS was 0.86 (0.73-1.02), p=0.34. Overall survival data extracted from 18 studies showed no superiority of experimental regimens over RCHOP. Efficacy of RCHOP backbone is marginally improved when adding a novel anti-lymphoma agent.
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Affiliation(s)
- Stergios Intzes
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Marianthi Symeonidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Konstantinos Zagoridis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Aikaterini Pentidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Zoi Bezirgianidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Menelaos Papoutselis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Christina Misidou
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Christoforos Roumpakis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Athina Spanoudaki
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Konstantinos Liapis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Medical School, Democritus University of Thrace, Area of Dragana, 68100, Alexandroupolis, PC, Greece.
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5
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Wang Y, Liu D, Zhang X, Zhang M, Li S, Feng X, Dong M, Ma S, Qian S, Wang Z, Zhang Y, Wang P, Mei S, Chen Q. MYC overexpression but not MYC/BCL2 double expression predicts survival in bulky mass diffuse large B-cell lymphoma patients. Cancer Med 2023; 12:18568-18577. [PMID: 37641492 PMCID: PMC10557898 DOI: 10.1002/cam4.6463] [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: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The prognostic factors for diffuse large B-cell lymphoma (DLBCL) have been fully explored, but prognostic information for bulky mass DLBCL patients is limited. This study aimed to analyze the prognostic value of MYC protein expression and other biological parameters in bulky mass DLBCL patients. METHODS We defined a bulky mass as a maximum tumor diameter ≥7.5 cm and studied 227 patients with de novo bulky mass DLBCL. RESULTS In all patients with bulky mass DLBCL, the 1-year and 3-year OS rates were 72.7% and 57.1%, respectively, and the 1-year and 3-year PFS rates were 52.0% and 42.5%, respectively. The MYC overexpression group (n = 140) showed significantly worse overall survival (OS; p = 0.019) and progression-free survival (PFS; p = 0.001) than the non-MYC overexpression group (n = 87). Subgroup analyses demonstrated that the MYC overexpression group was associated with inferior OS and PFS in the subgroups with the International Prognostic Index score of 3-5 (OS: p = 0.011; PFS: p < 0.001), Ann Arbor stage 3-4 (OS: p = 0.014; PFS: p < 0.001) and GCB subtype (OS: p = 0.014; PFS: p = 0.010). Consolidation radiotherapy improved OS and PFS in patients with bulky mass DLBCL (OS: p = 0.008; PFS: p = 0.004) as well as in those with MYC overexpression (OS: p = 0.001; PFS: p = 0.001). The prognostic value of MYC overexpression was maintained in a multivariate model adjusted for the International Prognostic Index. CONCLUSION MYC overexpression is a poor predictor for bulky mass DLBCL patients. Consolidation radiotherapy for residual disease after induction therapy may improve outcomes for patients with bulky mass DLBCL.
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Affiliation(s)
- Yanjie Wang
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Donglin Liu
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xudong Zhang
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Mingzhi Zhang
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Shenglei Li
- Department of PathologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xiaoyan Feng
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Meng Dong
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Shanshan Ma
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Siyu Qian
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Zeyuan Wang
- Department of PathologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yue Zhang
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Pengyuan Wang
- Department of Medical OncologyXuchang Central HospitalXuchangChina
| | - Shuhao Mei
- Department of HematologyXuchang Central HospitalXuchangChina
| | - Qingjiang Chen
- Department of Oncology, Henan Province Lymphoma Treatment CenterThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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Chan JY, Somasundaram N, Grigoropoulos N, Lim F, Poon ML, Jeyasekharan A, Yeoh KW, Tan D, Lenz G, Ong CK, Lim ST. Evolving therapeutic landscape of diffuse large B-cell lymphoma: challenges and aspirations. Discov Oncol 2023; 14:132. [PMID: 37466782 PMCID: PMC10361453 DOI: 10.1007/s12672-023-00754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) represents the commonest subtype of non-Hodgkin lymphoma and encompasses a group of diverse disease entities, each harboring unique molecular and clinico-pathological features. The understanding of the molecular landscape of DLBCL has improved significantly over the past decade, highlighting unique genomic subtypes with implications on targeted therapy. At the same time, several new treatment modalities have been recently approved both in the frontline and relapsed settings, ending a dearth of negative clinical trials that plagued the past decade. Despite that, in the real-world setting, issues like drug accessibility, reimbursement policies, physician and patient preference, as well as questions regarding optimal sequencing of treatment options present difficulties and challenges in day-to-day oncology practice. Here, we review the recent advances in the therapeutic armamentarium of DLBCL and discuss implications on the practice landscape, with a particular emphasis on the context of the healthcare system in Singapore.
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Affiliation(s)
- Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore.
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Nicholas Grigoropoulos
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Francesca Lim
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
| | - Michelle Limei Poon
- Department of Haematology, National University Cancer Institute, Singapore, Singapore
| | - Anand Jeyasekharan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Kheng Wei Yeoh
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore
- Division of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Daryl Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Georg Lenz
- Department of Medicine A, Department of Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Choon Kiat Ong
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
- Lymphoma Genomic Translational Research Laboratory, Cellular and Molecular Research, National Cancer Centre Singapore, Singapore, Singapore.
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, 30 Hospital Blvd, Singapore, 168583, Singapore.
- Cancer and Stem Cell Biology, Duke-NUS Medical School, National Cancer Centre Singapore, 8 College Road, Singapore, 169857, Singapore.
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7
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Wang X, Yu L, Jiang X, Ding K. Real-world data for lenalidomide maintenance in responding patients of diffuse large B-cell lymphoma. Cancer Med 2023; 12:10553-10562. [PMID: 36912128 DOI: 10.1002/cam4.5790] [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: 11/23/2021] [Revised: 12/04/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Approximately 40% patients of diffuse large B-cell lymphoma (DLBCL) would develop disease recurrence/progression after first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) induction therapy, with highly poor prognosis. An effective strategy to prolong the survival of this patient population is the additional single-drug maintenance therapy. lenalidomide, an immunomodulatory drug with oral activity, has direct anti-tumor activity and indirect effects mediated by multiple immune cells in the tumor microenvironment, such as B, T, natural killer (NK), and dendritic cells. Combining its controllable toxicity, it is promising in long-term maintenance therapy. This study aims at evaluating the clinical effect of lenalidomide maintenance therapy in responding DLBCL patients with R-CHOP treatment. METHODS This retrospective study was devised in DLBCL cases who obtained complete response (CR) or partial response (PR) following 6-8 cycles of R-CHOP treatment between January 1, 2015 and July 31, 2019. Patients (n = 141) included were respectively assigned to receive lenalidomide maintenance treatment (lenalidomide, n = 50) and drug-free maintenance treatment (control, n = 91) after CR/PR. lenalidomide was provided orally at 25 mg/day for 10 days, with a cycle of 21 days and a treatment course of 2 years. Progression-free survival (PFS) was taken as the primary outcome. RESULTS Of the total 141 subjects, the median follow-up time was 30.9 months (range, 5.7-68.9 months). The 2-year PFS was 84% (95% CI: 74%-94%) in the lenalidomide group and 53% (95% CI: 43%-63%) in the control group. The median PFS of the lenalidomide group was not reached, and that of the control group was 42.9 months (HR = 0.32; 95% CI: 0.16-0.63; p = 0.001). No remarkable difference in overall survival (OS) between the two groups was indicated (HR = 0.42; 95% CI: 0.16-1.12; p = 0.08). Central nervous system (CNS) recurrence happened in 5 patients (5.5%) of the control group, while none of the patients with lenalidomide had CNS recurrence. Additionally, neutropenia and cutaneous reactions were the most common Grade 1-2 adverse reactions after lenalidomide treatment, and neutropenia was the most frequent Grade 3-4 adverse reaction. CONCLUSION Two-year lenalidomide maintenance treatment can significantly prolong the PFS of DLBCL patients who obtained CR/PR to first-line R-CHOP treatment.
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Affiliation(s)
- Xiaoyan Wang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Lu Yu
- Department of Hematology, Anqing Municipal Hospital, Anhui Medical University, Anqing, China
| | - Xinlu Jiang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Kaiyang Ding
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.,Department of Hematology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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8
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Liang Y, Liu X, Yang J, Wang H, Piao Y, Wei L, Wang L. Dose-adjusted EPOCH-R vs. R-CHOP in frontline management of Waldeyer's ring diffuse large B-cell lymphoma: a retrospective study from a single institution. Chin Med J (Engl) 2023; 136:167-175. [PMID: 36780421 PMCID: PMC10106141 DOI: 10.1097/cm9.0000000000002593] [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: 03/04/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. METHODS This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). RESULTS During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P = 0.025 and P = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. CONCLUSION Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.
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Affiliation(s)
- Yuanzheng Liang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xindi Liu
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jing Yang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Henan Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yingshi Piao
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Liqiang Wei
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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9
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Miura K, Takahashi H, Nakagawa M, Hamada T, Uchino Y, Iizuka K, Ohtake S, Iriyama N, Hatta Y, Nakamura H. Ideal dose intensity of R-CHOP in diffuse large B-cell lymphoma. Expert Rev Anticancer Ther 2022; 22:583-595. [PMID: 35472312 DOI: 10.1080/14737140.2022.2071262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The standard of care for diffuse large B-cell lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, its ideal dose intensity varies among cases. AREAS COVERED This review provides the latest insights on the dose intensity of R-CHOP for DLBCL patients. Specifically, we discussed the optimal dose intensity for elderly patients, the optimal number of treatment cycles for limited or advanced-stage diseases, and the role of dose-intensified therapies or adding targeted inhibitors. EXPERT OPINION Performing a comprehensive or simplified geriatric assessment can distinguish elderly DLBCL patients who will likely benefit from curative R-CHOP. Very elderly or medically unfit patients may need dose reduction in R-CHOP; the Age, Comorbidities, and Albumin index may aid decision-making. Four cycles of R-CHOP followed by two rituximab cycles comprise a new standard for low-risk, limited-stage DLBCL patients. Compared to eight cycles, six cycles of R-CHOP have similar efficacy and fewer toxicities for advanced-stage DLBCL. Dose-intensified therapy is not recommended in most DLBCL cases but may be considered for patients with double (or triple)-hit lymphoma. Applying targeted inhibitors and not merely escalating R-CHOP dose intensity through molecular subtyping will improve the treatment outcome for DLBCL.
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Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital (Director); 2Department of Hematology and Rheumatology, Nihon University School of Medicine (Associate Professor), Tokyo, Japan.,Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Masaru Nakagawa
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Takashi Hamada
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihito Uchino
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Iizuka
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.,Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine (Assistant Professor), Tokyo, Japan
| | - Shimon Ohtake
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Nakamura
- Department of Hematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan
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Schönefeldt S, Wais T, Herling M, Mustjoki S, Bekiaris V, Moriggl R, Neubauer HA. The Diverse Roles of γδ T Cells in Cancer: From Rapid Immunity to Aggressive Lymphoma. Cancers (Basel) 2021; 13:6212. [PMID: 34944832 PMCID: PMC8699114 DOI: 10.3390/cancers13246212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022] Open
Abstract
γδ T cells are unique players in shaping immune responses, lying at the intersection between innate and adaptive immunity. Unlike conventional αβ T cells, γδ T cells largely populate non-lymphoid peripheral tissues, demonstrating tissue specificity, and they respond to ligands in an MHC-independent manner. γδ T cells display rapid activation and effector functions, with a capacity for cytotoxic anti-tumour responses and production of inflammatory cytokines such as IFN-γ or IL-17. Their rapid cytotoxic nature makes them attractive cells for use in anti-cancer immunotherapies. However, upon transformation, γδ T cells can give rise to highly aggressive lymphomas. These rare malignancies often display poor patient survival, and no curative therapies exist. In this review, we discuss the diverse roles of γδ T cells in immune surveillance and response, with a particular focus on cancer immunity. We summarise the intriguing dichotomy between pro- and anti-tumour functions of γδ T cells in solid and haematological cancers, highlighting the key subsets involved. Finally, we discuss potential drivers of γδ T-cell transformation, summarising the main γδ T-cell lymphoma/leukaemia entities, their clinical features, recent advances in mapping their molecular and genomic landscapes, current treatment strategies and potential future targeting options.
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Affiliation(s)
- Susann Schönefeldt
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, 1210 Vienna, Austria; (S.S.); (T.W.); (R.M.)
| | - Tamara Wais
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, 1210 Vienna, Austria; (S.S.); (T.W.); (R.M.)
| | - Marco Herling
- Department of Hematology, Cellular Therapy and Hemostaseology, University of Leipzig, 04103 Leipzig, Germany;
| | - Satu Mustjoki
- Hematology Research Unit Helsinki, Helsinki University Hospital Comprehensive Cancer Center, 00290 Helsinki, Finland;
- iCAN Digital Precision Cancer Medicine Flagship, 00014 Helsinki, Finland
- Translational Immunology Research Program and Department of Clinical Chemistry and Hematology, University of Helsinki, 00014 Helsinki, Finland
| | - Vasileios Bekiaris
- Department of Health Technology, Technical University of Denmark, 2800 Kongens Lyngby, Denmark;
| | - Richard Moriggl
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, 1210 Vienna, Austria; (S.S.); (T.W.); (R.M.)
| | - Heidi A. Neubauer
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, 1210 Vienna, Austria; (S.S.); (T.W.); (R.M.)
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11
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Usuda D, Izumida T, Terada N, Sangen R, Higashikawa T, Sekiguchi S, Tanaka R, Suzuki M, Hotchi Y, Shimozawa S, Tokunaga S, Osugi I, Katou R, Ito S, Asako S, Takagi Y, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Oba J, Nomura T, Sugita M, Kasamaki Y. Diffuse large B cell lymphoma originating from the maxillary sinus with skin metastases: A case report and review of literature. World J Clin Cases 2021; 9:6886-6899. [PMID: 34447839 PMCID: PMC8362537 DOI: 10.12998/wjcc.v9.i23.6886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the most common type of malignant lymphoma (ML), accounting for 30%-40% of cases of non-Hodgkin’s lymphoma (NHL) in adults. Primary paranasal sinus lymphoma is a rare presentation of extranodal NHL that accounts for only 0.17% of all lymphomas. ML from the maxillary sinus (MS) is a particularly rare presentation, and is thus often difficult to diagnose. We have reported the first known case of DLBCL originating from the MS with rapidly occurrent multiple skin metastasis.
CASE SUMMARY An 81-year-old Japanese man visited our hospital due to continuous pain for 12 d in the left maxillary nerve area. His medical history included splenectomy due to a traffic injury, an old right cerebral infarction from when he was 74-years-old, hypertension, and type 2 diabetes mellitus. A plain head computed tomography (CT) scan revealed a 3 cm × 3.1 cm × 3 cm sized left MS. On day 25, left diplopia and ptosis occurred, and a follow-up CT on day 31 revealed the growth of the left MS mass. Based on an MS biopsy on day 50, we established a definitive diagnosis of DLBCL, non-germinal center B-cell-like originating from the left MS. The patient was admitted on day 62 due to rapid deterioration of his condition, and a plain CT scan revealed the further growth of the left MS mass, as well as multiple systemic metastasis, including of the skin. A skin biopsy on day 70 was found to be the same as that of the left MS mass. We notified the patient and his family of the disease, and they opted for palliative care, considering on his condition and age. The patient died on day 80.
CONCLUSION This case suggests the need for careful, detailed examination, and for careful follow-up, when encountering patients presenting with a mass.
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Affiliation(s)
- Daisuke Usuda
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Toshihide Izumida
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Nao Terada
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Ryusho Sangen
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Toshihiro Higashikawa
- Department of Geriatric Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
| | - Sayumi Sekiguchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Shungo Tokunaga
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Suguru Asako
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Yoshie Takagi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Jiro Oba
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima-ku 177-0035, Tokyo-to, Japan
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi-shi 935-8531, Toyama-ken, Japan
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Hwang J, Suh C, Kim K, Kim H, Kim AI, Craig JW, Chen KX, Roberson J, Guenette JP, Huang RY. The Incidence and Treatment Response of Double Expression of MYC and BCL2 in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:3369. [PMID: 34282799 PMCID: PMC8268769 DOI: 10.3390/cancers13133369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
MYC/BCL2 protein co-expression (i.e., double expressor) has been shown to be a negative predictor of outcome in diffuse large B-cell lymphoma (DLBCL). We aimed to establish the incidence of double expressor status in patients with de novo DLBCL and identify the predictive value of this biomarker on treatment response through systematic review and meta-analysis. PubMed and Embase were searched for studies published through December 2019 that reported proportions of double expressor DLBCL. The pooled proportions of MYC and BCL2 expression, both alone and in combination, were computed using the inverse variance method for calculating weights and by the DerSimonian-Laird method. The pooled odds ratios (ORs) of complete remission (CR) rate were calculated, and meta-regression analysis was conducted to explore heterogeneity. Forty-one studies (7054 patients) were included. The pooled incidence of double expressor status in DLBCL was 23% (95% confidence interval [CI], 20-26%), with an adjusted estimate of 31% (95% CI, 27-36%). Neither MYC/BCL2 protein cutoff values, race, mean, or median age of included patients, or overall study quality was a significant factor of heterogeneity (p ≥ 0.20). Cases without double expressor status demonstrated a higher probability of CR to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone treatment (OR, 2.69; 95% CI, 1.55-4.67). Our results reaffirm the predictive power of this important biomarker.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea;
| | - Chonghyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Kyungwon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Hosung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Austin I. Kim
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA;
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC V5Z 4E6, Canada;
| | - Ke Xun Chen
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Joel Roberson
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Raymond Y. Huang
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
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13
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Safety and Efficacy of Replacing Vindesine with Vincristine in R-ACVBP Regimen for the Treatment of Large B Cell Lymphomas. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:711-719. [PMID: 34140260 DOI: 10.1016/j.clml.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intensified immunochemotherapy with rituximab, doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (R-ACVBP) improves outcomes in younger adults with diffuse large B-cell lymphomas (DLBCL) compared with R-CHOP. Due to vindesine unavailability, we assessed the safety and efficacy of replacing vindesine with vincristine in a modified R-ACVBP protocol (mR-ACVBP). METHODS This is a retrospective study including all consecutive adult patients with newly diagnosed DLBCL who received first-line mR-ACVBP. Vindesine was replaced with vincristine 1.5 mg on days 1 and 5 of each cycle. Responders continued with published R-ACVBP consolidation. Patients with inadequate response on interim imaging were offered consolidative autologous stem cell transplantation. RESULTS We identified 56 patients with DLBCL, with a median age of 41 years (range, 21-67). Thirty-seven (66%) patients had an age-adjusted International Prognostic Index of ≥ 2. Complete response was achieved in 41 (80%) patients and partial response in 6 (12%). The most common adverse events during induction were anemia (91%), febrile neutropenia (64%; grade 4 in 46%), thrombocytopenia (39%), and mucositis (21%). Peripheral neuropathy was encountered in 7 (12%) patients (grade 3; n = 1). Two deaths from septic shock were reported in patients with initial poor performance status. After a median follow-up of 17 months, the 2-year progression-free survival and overall survival rates were 86% and 87%, respectively. CONCLUSION The replacement of vindesine with vincristine in mR-ACVBP seems feasible, with manageable adverse events and excellent 2-year progression-free survival. These data need validation in larger prospective trials.
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A refined cell-of-origin classifier with targeted NGS and artificial intelligence shows robust predictive value in DLBCL. Blood Adv 2021; 4:3391-3404. [PMID: 32722783 DOI: 10.1182/bloodadvances.2020001949] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity of B-cell lymphoma. Cell-of-origin (COO) classification of DLBCL is required in routine practice by the World Health Organization classification for biological and therapeutic insights. Genetic subtypes uncovered recently are based on distinct genetic alterations in DLBCL, which are different from the COO subtypes defined by gene expression signatures of normal B cells retained in DLBCL. We hypothesize that classifiers incorporating both genome-wide gene-expression and pathogenetic variables can improve the therapeutic significance of DLBCL classification. To develop such refined classifiers, we performed targeted RNA sequencing (RNA-Seq) with a commercially available next-generation sequencing (NGS) platform in a large cohort of 418 DLBCLs. Genetic and transcriptional data obtained by RNA-Seq in a single run were explored by state-of-the-art artificial intelligence (AI) to develop a NGS-COO classifier for COO assignment and NGS survival models for clinical outcome prediction. The NGS-COO model built through applying AI in the training set was robust, showing high concordance with COO classification by either Affymetrix GeneChip microarray or the NanoString Lymph2Cx assay in 2 validation sets. Although the NGS-COO model was not trained for clinical outcome, the activated B-cell-like compared with the germinal-center B-cell-like subtype had significantly poorer survival. The NGS survival models stratified 30% high-risk patients in the validation set with poor survival as in the training set. These results demonstrate that targeted RNA-Seq coupled with AI deep learning techniques provides reproducible, efficient, and affordable assays for clinical application. The clinical grade assays and NGS models integrating both genetic and transcriptional factors developed in this study may eventually support precision medicine in DLBCL.
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Candelaria M, Dueñas-Gonzalez A. Rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in diffuse large B-cell lymphoma. Ther Adv Hematol 2021; 12:2040620721989579. [PMID: 33796235 PMCID: PMC7970687 DOI: 10.1177/2040620721989579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/04/2021] [Indexed: 01/05/2023] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the most frequent non-Hodgkin lymphoma worldwide. The current standard of care is chemoimmunotherapy with an R-CHOP regimen. We aim to review the role of this regimen after two decades of being the standard of care. Methods A comprehensive literature review of DLBCL, including the epidemiology, trials defining R-CHOP as the standard of care, as well as dose intensification and dose reduction schemes. Additionally, we briefly review the development of rituximab biosimilars and the addition of targeted drugs to R-CHOP in clinical trials. Discussion R-CHOP cures approximately 70% of DLBCL patients. Dose-dense regimens do not show a benefit in response and increase toxicity. Dose reduction, particularly in elderly patients or with comorbidities, may be a treatment option. DLBCL constitutes a group of diseases that activate different biological pathways. Matching specific treatments to a defined genetic alteration is under development. Rituximab biosimilars have become available to a broader population, particularly in developing countries, where access to treatment is limited because of economic resources. Conclusion DLBCL landscape is heterogeneous. R-CHOP immunochemotherapy has been a standard of care for two decades and cures approximately 70% of cases. Molecular characterization of patients is evolving and may have critical therapeutic implications.
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Affiliation(s)
- Myrna Candelaria
- Clinical Research, Instituto Nacional de Cancerología México, Av San Fernando 22, Col Sección XVI, Tlalpan, 14370, Mexico City, Mexico
| | - Alfonso Dueñas-Gonzalez
- Instituto de Investigaciones Biomédicas, UNAM/Instituto Nacional de Cancerología México, Unit of Biomedical Research on Cancer, Mexico City, Mexico
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Frontline therapy with R-CHOP for diffuse large B-cell lymphoma: Where have we come (or not come)? A Perspective. J Geriatr Oncol 2020; 12:320-325. [PMID: 32972884 DOI: 10.1016/j.jgo.2020.09.015] [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: 06/13/2020] [Revised: 07/10/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022]
Abstract
A major evolution in the treatment of patients with diffuse large B-cell lymphoma (DLBCL) occurred almost two decades ago, with clinical trials demonstrating that the addition of rituximab (R) to cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP), which had been the "gold standard" of therapy since 1976, significantly improved outcome, including response rate and disease-free survival, of these patients. Since the adoption of R-CHOP, subsequent clinical trials have attempted to improve upon outcomes achieved with R-CHOP, with a variety of approaches examined. These have included dose intensification, which may be applicable in younger patients, but not in the many older or frailer patients with a disease with median age at diagnosis in the 60's. Newer anti-CD20 monoclonal antibodies have been substituted for rituximab in frontline regimens. A series of new agents, with unique mechanisms of action, have been added to the R-CHOP backbone. Rituximab-based, non-anthracycline regimens have been studied for older, more frail patients. The utility of maintenance therapy in responding patients has been re-examined, despite the lack of benefit found in the US Intergroup trial. Advances in molecular and genetic aspects of DLBCL have emerged since the seminal R-CHOP trials, demonstrating the DLBCL is not a single entity, but instead a spectrum of multiple disease subtypes. Attempts have been made to identify those patients at baseline who have poorer outcomes with standard approaches, utilizing laboratory and imaging findings. Moving forward, different risk-adapted treatment approaches will be studied to in an effort to improve overall outcome beyond R-CHOP.
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17
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Anti-Cancer Effects of CKD-581, a Potent Histone Deacetylase Inhibitor against Diffuse Large B-Cell Lymphoma. Int J Mol Sci 2020; 21:ijms21124377. [PMID: 32575557 PMCID: PMC7352247 DOI: 10.3390/ijms21124377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Double-hit lymphoma (DHL) and double-expressor lymphoma (DEL) are aggressive forms of lymphoma that require better treatments to improve patient outcomes. CKD-581 is a new histone deacetylase (HDAC) inhibitor that exhibited a better safety profile in clinical trials compared to other HDAC inhibitors. Here, we demonstrate that CKD-581 inhibited the class I-II HDAC family via histone H3 and tubulin acetylation. CKD-581 treatment also up-regulated the phosphorylation of histone H2AX (γH2AX, DNA double-strand break marker), and reduced levels of MYC and anti-apoptotic proteins such as BCL-2, BCL-6, BCL-XL, and MCL-1 in DH/DE-diffuse large B cell lymphoma (DLBCL) cell lines. Ultimately, CKD-581 also induced apoptosis via poly(ADP ribose) polymerase 1 (PARP1) cleavage. In a DLBCL SCID mouse xenograft model, CKD-581 exhibited anti-cancer effects comparable with those of rituximab (CD20 mAb). Our findings suggest that CKD-581 could be a good candidate for the treatment of DLBCL.
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18
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George P, Dasyam N, Giunti G, Mester B, Bauer E, Andrews B, Perera T, Ostapowicz T, Frampton C, Li P, Ritchie D, Bollard CM, Hermans IF, Weinkove R. Third-generation anti-CD19 chimeric antigen receptor T-cells incorporating a TLR2 domain for relapsed or refractory B-cell lymphoma: a phase I clinical trial protocol (ENABLE). BMJ Open 2020; 10:e034629. [PMID: 32041862 PMCID: PMC7044946 DOI: 10.1136/bmjopen-2019-034629] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Autologous T-cells transduced to express a chimeric antigen receptor (CAR) directed against CD19 elicit high response rates in relapsed or refractory (r/r) B-cell non-Hodgkin lymphoma (B-NHL). However, r/r B-NHL remissions are durable in fewer than half of recipients of second-generation CAR T-cells. Third-generation (3G) CARs employ two costimulatory domains, resulting in improved CAR T-cell efficacy in vitro and in animal models in vivo. This investigator-initiated, phase I dose escalation trial, termed ENABLE, will investigate the safety and preliminary efficacy of WZTL-002, comprising autologous T-cells expressing a 3G anti-CD19 CAR incorporating the intracellular signalling domains of CD28 and Toll-like receptor 2 (TLR2) for the treatment of r/r B-NHL. METHODS AND ANALYSIS Eligible participants will be adults with r/r B-NHL including diffuse large B-cell lymphoma and its variants, follicular lymphoma, transformed follicular lymphoma and mantle cell lymphoma. Participants must have satisfactory organ function, and lack other curative options. Autologous T-cells will be obtained by leukapheresis. Following WZTL-002 manufacture and product release, participants will receive lymphodepleting chemotherapy comprising intravenous fludarabine and cyclophosphamide. A single dose of WZTL-002 will be administered intravenously 2 days later. Targeted assessments for cytokine release syndrome and immune cell effector-associated neurotoxicity syndrome, graded by the American Society Transplantation and Cellular Therapy criteria, will be made. A modified 3+3 dose escalation scheme is planned starting at 5×104 CAR T-cells/kg with a maximum dose of 1×106 CAR T-cells/kg. The primary outcome of this trial is safety of WZTL-002. Secondary outcomes include feasibility of WZTL-002 manufacture and preliminary measures of efficacy. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the New Zealand Health and Disability Ethics Committee (reference 19/STH/69) on 23 June 2019 for Protocol V.1.2. Trial results will be reported in a peer-reviewed journal, and results presented at scientific conferences or meetings. TRIAL REGISTRATION NUMBER NCT04049513.
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Affiliation(s)
- Philip George
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Nathaniel Dasyam
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Giulia Giunti
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Brigitta Mester
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Evelyn Bauer
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Bethany Andrews
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
| | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington Hospital, Newtown, Wellington, New Zealand
| | - Tess Ostapowicz
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Wellington Blood and Cancer Centre, Wellington Hospital, Newtown, Wellington, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Peng Li
- Key Laboratory of Regenerative Biology, South China Institute for Stem Cell Biology and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Guangzhou, Guangdong, China
| | - David Ritchie
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Medical Center, The George Washington University, Washington, District of Columbia, USA
| | - Ian F Hermans
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, Auckland, New Zealand
| | - Robert Weinkove
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Wellington Blood and Cancer Centre, Wellington Hospital, Newtown, Wellington, New Zealand
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19
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Beutler BD, Krishan R, Parafianowicz P, Ulanja MB, Elliott C, France J, Islam R, Gullapalli N. ABC-type diffuse large B-cell lymphoma presenting as rotator cuff tendinopathy: A diagnostic dilemma and review of the literature. Clin Case Rep 2020; 8:327-332. [PMID: 32128182 PMCID: PMC7044365 DOI: 10.1002/ccr3.2630] [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: 08/14/2019] [Revised: 10/07/2019] [Accepted: 12/01/2019] [Indexed: 11/08/2022] Open
Abstract
Diffuse large B-cell lymphoma often presents with extranodal manifestations involving the musculoskeletal system. Shoulder pain is particularly worrisome for malignancy. Individuals presenting with refractory upper extremity complaints should undergo a prompt and thorough evaluation for cancer, as a delay in diagnosis can result in an unfavorable outcome.
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Affiliation(s)
- Bryce David Beutler
- Department of Internal MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
| | - Rohee Krishan
- Department of Internal MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
| | - Pawel Parafianowicz
- Department of Internal MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
| | - Mark B. Ulanja
- Department of Internal MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
| | - Christie Elliott
- Department of Pathology and Laboratory MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
| | - Joel France
- Department of Pathology and Laboratory MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
| | - Raheel Islam
- Department of Internal MedicineReno School of MedicineUniversity of NevadaRenoNVUSA
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20
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Scherer F. Capturing Tumor Heterogeneity and Clonal Evolution by Circulating Tumor DNA Profiling. Recent Results Cancer Res 2020; 215:213-230. [PMID: 31605231 DOI: 10.1007/978-3-030-26439-0_11] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most malignancies are characterized by remarkable molecular heterogeneity. The understanding of genetic and epigenetic processes underlying tumor heterogeneity has become increasingly important for the clinical management of cancer patients. This includes the identification of patients who likely benefit from conventional or targeted therapies, classification of patients into risk groups based on their mutational landscape, and the detection of molecular mechanisms that drive treatment resistance and cancer progression. Detection of tumor heterogeneity by tumor tissue genotyping is hampered by the fact that tissue sampling is often insufficient for comprehensive genetic assessment and is associated with a higher risk of surgical complications. Detection and profiling of circulating tumor DNA (ctDNA) have emerged as a promising alternative to direct tumor genotyping. It potentially enables noninvasive and quantitative characterization of the full genetic landscape and identification of clonal evolution during treatment and towards disease progression in cancer patients. In the present chapter, we explore the role of noninvasive genotyping and ctDNA profiling for accurate and robust characterization of various types of tumor heterogeneity and its relevance for management of patients with hematologic and solid cancers.
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Affiliation(s)
- Florian Scherer
- Department of Hematology, Oncology, and Stem Cell Transplantation, University Medical Center Freiburg, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany.
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21
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Challenges and Opportunities for High-grade B-Cell Lymphoma With MYC and BCL2 and/or BCL6 Rearrangement (Double-hit Lymphoma). Am J Clin Oncol 2019; 42:304-316. [PMID: 29419530 DOI: 10.1097/coc.0000000000000427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The most common subtype of non-Hodgkin lymphoma, diffuse large B-cell lymphoma, is cured in approximately two thirds of patients after initial therapy. The remaining one-third of patients who suffer relapse or become refractory have very poor survival outcomes despite salvage chemotherapy with or without stem cell transplantation. A considerable proportion of relapsed or refractory large B cells belong to the WHO subtype known as high-grade B-cell lymphoma with rearrangement of MYC and BCL2 and/or BCL6, also known as double-hit lymphoma (DHL). Most DHL patients present with Ann Arbor's stage III/IV, a comparatively higher rate of extranodal involvement including bone marrow and central nervous system infiltration, high levels of lactate dehydrogenase, and an elevated Ki67 expression in the tumor cells. Newer therapeutic approaches, including targeted therapy against BCL2, MYC, or other associated pathways, are needed. In addition, recent therapies that harness the immune system, such as checkpoint inhibitors and chimeric antigen receptor T-cell therapy, are changing the paradigm of treatment for non-Hodgkin lymphoma and could impact the outcome of DHL.
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22
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Hori Y, Yamamoto H, Nozaki Y, Torisu T, Fujiwara M, Taguchi K, Nishiyama K, Nakamura S, Kitazono T, Oda Y. Colorectal diffuse large B-cell lymphoma: molecular subclassification and prognostic significance of immunoglobulin gene translocation. Hum Pathol 2019; 96:67-78. [PMID: 31734190 DOI: 10.1016/j.humpath.2019.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022]
Abstract
Primary colorectal diffuse large B-cell lymphoma (DLBCL) is rare, and its clinicopathological and genetic features are poorly understood. The aim of our study was to elucidate the frequency and prognostic significance of molecular subgroups in colorectal DLBCL. We examined 25 cases of colorectal lymphoma with DLBCL-like morphology and classified them into germinal center B-cell like (GCB)/non-GCB subgroups by immunohistochemistry (IHC) for CD10, bcl-6 and MUM1, or into double-expressor (DE)/non-DE subgroups by IHC for bcl-2 and c-myc. Translocations involving BCL2, BCL6, MYC, IGH, IGK, IGL, and MALT1 were also investigated using break-apart fluorescence in situ hybridization (FISH). The 25 cases were classified into two entities-DLBCL, not otherwise specified (NOS) (n = 23; 92%) and high grade B-cell lymphoma, double hit (n = 2; 8%)-according to the recent WHO classification. None of them showed histological evidence of Epstein-Barr virus infection or high-grade transformation from low grade B-cell lymphoma. Ten cases were GCB-type and four cases were DE-type, but these subtypes did not contribute to clinicopathological differences. Translocations involving BCL2, BCL6, MYC, IGH, IGK, IGL, and MALT1 were detected in 3 (12%), 3 (12%), 10 (40%), 14 (56%), 3 (12%), 3 (12%), and 0 (0%) of 25 cases, respectively. Of note, the presence of IGH translocation was significantly associated with better overall survival (P = .0053) and progression free survival (P = .0259). Similarly, the translocation involving at least one of the IGs (IGH, IGK, and/or IGL) was associated with more favorable prognosis in DLBCLs or even in DLBCL, NOS. This is the first report to reveal that a small subset of colorectal DLBCL corresponds to double-hit lymphoma. In addition, translocations involving at least one of the IGs may be a favorable prognostic factor in colorectal DLBCL. Testing the translocation involving rearrangement of IGs as well as MYC and BCL2/BCL6 may thus be useful for diagnosis and prognosis.
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Affiliation(s)
- Yoshifumi Hori
- Department of Anatomic Pathology, Kyushu University, Japan
| | | | - Yui Nozaki
- Department of Anatomic Pathology, Kyushu University, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | - Kenichi Taguchi
- Department of Pathology, National Kyushu Cancer Center, Fukuoka, Japan
| | | | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Kyushu University, Japan.
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23
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Dubois S, Tesson B, Mareschal S, Viailly PJ, Bohers E, Ruminy P, Etancelin P, Peyrouze P, Copie-Bergman C, Fabiani B, Petrella T, Jais JP, Haioun C, Salles G, Molina TJ, Leroy K, Tilly H, Jardin F. Refining diffuse large B-cell lymphoma subgroups using integrated analysis of molecular profiles. EBioMedicine 2019; 48:58-69. [PMID: 31648986 PMCID: PMC6838437 DOI: 10.1016/j.ebiom.2019.09.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 12/23/2022] Open
Abstract
Background Gene expression profiling (GEP), next-generation sequencing (NGS) and copy number variation (CNV) analysis have led to an increasingly detailed characterization of the genomic profiles of DLBCL. The aim of this study was to perform a fully integrated analysis of mutational, genomic, and expression profiles to refine DLBCL subtypes. A comparison of our model with two recently published integrative DLBCL classifiers was carried out, in order to best reflect the current state of genomic subtypes. Methods 223 patients with de novo DLBCL from the prospective, multicenter and randomized LNH-03B LYSA clinical trials were included. GEP data was obtained using Affymetrix GeneChip arrays, mutational profiles were established by Lymphopanel NGS targeting 34 key genes, CNV analysis was obtained by array CGH, and FISH and IHC were performed. Unsupervised independent component analysis (ICA) was applied to GEP data and integrated analysis of multi-level molecular data associated with each component (gene signature) was performed. Findings ICA identified 38 components reflecting transcriptomic variability across our DLBCL cohort. Many of the components were closely related to well-known DLBCL features such as cell-of-origin, stromal and MYC signatures. A component linked to gain of 19q13 locus, among other genomic alterations, was significantly correlated with poor OS and PFS. Through this integrated analysis, a high degree of heterogeneity was highlighted among previously described DLBCL subtypes. Interpretation The results of this integrated analysis enable a global and multi-level view of DLBCL, as well as improve our understanding of DLBCL subgroups.
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Affiliation(s)
- Sydney Dubois
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
| | | | - Sylvain Mareschal
- Cancer Research Center of Lyon, INSERM U1052 UMR CNRS 5286, Lyon, France
| | - Pierre-Julien Viailly
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France; Normandie Univ, EdN BISE 497, Normandy, France
| | - Elodie Bohers
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
| | - Philippe Ruminy
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
| | - Pascaline Etancelin
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
| | | | - Christiane Copie-Bergman
- Department of Pathology, Henri Mondor Hospital, APHP, INSERM U955, Université Paris-Est, Créteil, France
| | - Bettina Fabiani
- Laboratoire de Pathologie, AP-HP Hôpital Saint Antoine, Paris, France
| | - Tony Petrella
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Montréal, Quebec, Canada
| | - Jean-Philippe Jais
- Institut Imagine HGID, Inserm U1163, AP-HP Hôpital Necker, Université Paris Descartes, Paris, France
| | - Corinne Haioun
- Unité Hémopathies Lymphoïdes, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Gilles Salles
- Cancer Research Center of Lyon, INSERM U1052 UMR CNRS 5286, Lyon, France
| | - Thierry Jo Molina
- Pathology, AP-HP, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Karen Leroy
- Inserm U1016 - CNRS UMR8104 - Université Paris Descartes Groupe Hospitalier Cochin, Paris, France
| | - Hervé Tilly
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France
| | - Fabrice Jardin
- Inserm U1245, Centre Henri Becquerel, Université de Rouen, IRIB, Rouen, France.
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Li W, Gupta SK, Han W, Kundson RA, Nelson S, Knutson D, Greipp PT, Elsawa SF, Sotomayor EM, Gupta M. Targeting MYC activity in double-hit lymphoma with MYC and BCL2 and/or BCL6 rearrangements with epigenetic bromodomain inhibitors. J Hematol Oncol 2019; 12:73. [PMID: 31288832 PMCID: PMC6617630 DOI: 10.1186/s13045-019-0761-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/25/2019] [Indexed: 01/04/2023] Open
Abstract
Double/triple-hit lymphomas (DHL/THL) account for 5–10% of diffuse large B cell lymphoma (DLBCL) with rearrangement of MYC and BCL2 and/or BCL6 resulting in MYC overexpression. Despite the poor prognosis of DHL, R-CHOP chemotherapy remains the treatment backbone and new targeted therapy is needed. We performed comprehensive cytogenetic studies/fluorescence in situ hybridization on DLBCL and Burkitt lymphoma cell lines (n = 11) to identify the DHL/THL DLBCL in vitro model. We identified MYC/IG in Raji and Ramos (single hit); MYC/IG-BCL2 (DHL) in DOHH2, OCI-LY1, SUDHL2, and OCI-LY10; MYC/IG-BCL2/BCL6 (THL) in VAL; and no MYC rearrangement in U2932 and HBL1 (WT-MYC). Targeting MYC in the DHL/THL DLBCLs through bromodomain extra-terminal inhibitors (BETi) (JQ1, I-BET, and OTX015) significantly (p < 0.05) reduced proliferation, similar to WT-MYC cells, accompanied by decreased MYC but not BCL2 protein. Moreover, BETi suppressed MYC transcription and decreased BRD4 binding to MYC promoter in DHL cells. CD47 and PD-L1 are immunoregulatory molecules often expressed on tumors and regulated by MYC. High levels of surface CD47 but not surface PD-L1 was observed in DHL/THL, which was reduced by JQ1 treatment. BETi in combination with Pan-HDAC inhibitor had a limited effect on survival of DHL/THL, while combination of BETi and BCL2 inhibitor (ABT-199) had a significant (p < 0.005) inhibitory effect on survival followed by BCL-XL inhibition. Overall, the data suggests that MYC-expressing DLBCLs are probably addicted to the MYC-oncogenic effect regardless of MYC rearrangements. In summary, we identified an in vitro model for DHL/THL DLBCLs and provide evidence for the therapeutic potential of BET inhibitor alone or in combination with BCL2 inhibitor.
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Affiliation(s)
- Weiping Li
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shiv K Gupta
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Weiguo Han
- Department of Molecular, Cellular and Biomedical Sciences, University of New Hampshire, Durham, NH, USA
| | - Ryan A Kundson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sara Nelson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Darlene Knutson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sherine F Elsawa
- Department of Molecular, Cellular and Biomedical Sciences, University of New Hampshire, Durham, NH, USA
| | - Eduardo M Sotomayor
- Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, George Washington University, GW Cancer Center, Washington, DC, 20052, USA
| | - Mamta Gupta
- Department of Hematology, Mayo Clinic, Rochester, MN, USA. .,Department of Biochemistry and Molecular Medicine, School of Medicine and Health Sciences, George Washington University, GW Cancer Center, Washington, DC, 20052, USA.
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Abramson JS. Hitting back at lymphoma: How do modern diagnostics identify high-risk diffuse large B-cell lymphoma subsets and alter treatment? Cancer 2019; 125:3111-3120. [PMID: 31287161 DOI: 10.1002/cncr.32145] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a clinically and biologically heterogeneous disease. Diagnostic tools in the clinic can now identify distinct subsets characterized by unique molecular features, which are increasingly transforming how these patients are managed. Activated B-cell-like DLBCL is characterized by NF-κB activation and chronic B-cell receptor signaling and may be targeted with lenalidomide or ibrutinib in the relapsed setting. Germinal center-like DLBCL is enriched for activating EZH2 mutations, and encouraging activity has been observed for the EZH2 inhibitor tazemetostat, which now has a fast-track US Food and Drug Administration designation. Double-hit lymphoma is a high-grade B-cell lymphoma characterized by translocations of MYC and BCL2 and/or BCL6 and carries a poor prognosis. Intensive chemoimmunotherapy strategies appear to be superior to standard R-CHOP (rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone) as initial therapy, and anti-CD19 chimeric antigen receptor T cells are inducing remission in patients with relapsed/refractory disease who previously had few available options. Primary mediastinal (thymic) large B-cell lymphoma is a molecularly distinct large-cell lymphoma with clinical and molecular features that overlap with those of classical Hodgkin lymphoma. R-CHOP has been associated with an unacceptably high rate of primary treatment failure in this young population, whereas dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab) produces durable remissions without the need for radiotherapy in most patients. For relapsed/refractory disease, immune checkpoint inhibitors targeting PD-1 have shown promising activity in chemotherapy-refractory disease, as have anti-CD19 chimeric antigen receptor T cells. Additional therapeutic targets, including JAK2, continue to be evaluated. The identification of discrete biological subsets is steadily moving us away from a "one-size-fits-all" approach in DLBCL.
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Affiliation(s)
- Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
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26
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Perfecto-Avalos Y, Garcia-Gonzalez A, Hernandez-Reynoso A, Sánchez-Ante G, Ortiz-Hidalgo C, Scott SP, Fuentes-Aguilar RQ, Diaz-Dominguez R, León-Martínez G, Velasco-Vales V, Cárdenas-Escudero MA, Hernández-Hernández JA, Santos A, Borbolla-Escoboza JR, Villela L. Discriminant analysis and machine learning approach for evaluating and improving the performance of immunohistochemical algorithms for COO classification of DLBCL. J Transl Med 2019; 17:198. [PMID: 31185999 PMCID: PMC6560900 DOI: 10.1186/s12967-019-1951-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is classified into germinal center-like (GCB) and non-germinal center-like (non-GCB) cell-of-origin groups, entities driven by different oncogenic pathways with different clinical outcomes. DLBCL classification by immunohistochemistry (IHC)-based decision tree algorithms is a simpler reported technique than gene expression profiling (GEP). There is a significant discrepancy between IHC-decision tree algorithms when they are compared to GEP. Methods To address these inconsistencies, we applied the machine learning approach considering the same combinations of antibodies as in IHC-decision tree algorithms. Immunohistochemistry data from a public DLBCL database was used to perform comparisons among IHC-decision tree algorithms, and the machine learning structures based on Bayesian, Bayesian simple, Naïve Bayesian, artificial neural networks, and support vector machine to show the best diagnostic model. We implemented the linear discriminant analysis over the complete database, detecting a higher influence of BCL6 antibody for GCB classification and MUM1 for non-GCB classification. Results The classifier with the highest metrics was the four antibody-based Perfecto–Villela (PV) algorithm with 0.94 accuracy, 0.93 specificity, and 0.95 sensitivity, with a perfect agreement with GEP (κ = 0.88, P < 0.001). After training, a sample of 49 Mexican-mestizo DLBCL patient data was classified by COO for the first time in a testing trial. Conclusions Harnessing all the available immunohistochemical data without reliance on the order of examination or cut-off value, we conclude that our PV machine learning algorithm outperforms Hans and other IHC-decision tree algorithms currently in use and represents an affordable and time-saving alternative for DLBCL cell-of-origin identification. Electronic supplementary material The online version of this article (10.1186/s12967-019-1951-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yocanxóchitl Perfecto-Avalos
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Ave. Eugenio Garza Sada 2501, 64849, Monterrey, NL, Mexico
| | - Alejandro Garcia-Gonzalez
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Ave. Morones Prieto 3000, 64710, Monterrey, NL, Mexico
| | | | - Gildardo Sánchez-Ante
- Universidad Politécnica de Yucatán, Tablaje Catastral 4448, Carretera Mérida-Tetiz. Km.4.5., 97357, Ucú, Yucatán, Mexico
| | - Carlos Ortiz-Hidalgo
- Department of Pathology, Hospital y Fundación Medica Sur, 14050, Mexico City, Mexico
| | - Sean-Patrick Scott
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Ave. Morones Prieto 3000, 64710, Monterrey, NL, Mexico
| | - Rita Q Fuentes-Aguilar
- Escuela de Ingeniería y Ciencias, Tecnologico de Monterrey, Ave. Eugenio Garza Sada 2501, 64849, Monterrey, NL, Mexico
| | - Ricardo Diaz-Dominguez
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Ave. Morones Prieto 3000, 64710, Monterrey, NL, Mexico
| | - Grettel León-Martínez
- Department of Pathology, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Hospital General Tacuba, Lago Ontario 36, Tacuba, 11410, Mexico City, Mexico
| | - Verónica Velasco-Vales
- Department of Pathology, Hospital Angeles Lomas, Col. Valle de las Palmas, Hacienda de las Palmas, 52763, Huixquilucan, Mexico
| | | | - José A Hernández-Hernández
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Ave. Morones Prieto 3000, 64710, Monterrey, NL, Mexico
| | - Arturo Santos
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Ave. Morones Prieto 3000, 64710, Monterrey, NL, Mexico
| | | | - Luis Villela
- Centro Médico "Dr. Ignacio Chávez". ISSSTESON, 83000, Hermosillo, SON, Mexico. .,Universidad del Valle de México, 83165, Hermosillo, SON, Mexico.
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GAPDH Expression Predicts the Response to R-CHOP, the Tumor Metabolic Status, and the Response of DLBCL Patients to Metabolic Inhibitors. Cell Metab 2019; 29:1243-1257.e10. [PMID: 30827861 DOI: 10.1016/j.cmet.2019.02.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 02/06/2023]
Abstract
Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease treated with anti-CD20-based immuno-chemotherapy (R-CHOP). We identified that low levels of GAPDH predict a poor response to R-CHOP treatment. Importantly, we demonstrated that GAPDHlow lymphomas use OxPhos metabolism and rely on mTORC1 signaling and glutaminolysis. Consistently, disruptors of OxPhos metabolism (phenformin) or glutaminolysis (L-asparaginase) induce cytotoxic responses in GAPDHlow B cells and improve GAPDHlow B cell-lymphoma-bearing mice survival, while they are low or not efficient on GAPDHhigh B cell lymphomas. Ultimately, we selected four GAPDHlow DLBCL patients, who were refractory to all anti-CD20-based therapies, and targeted DLBCL metabolism using L-asparaginase (K), mTOR inhibitor (T), and metformin (M) (called KTM therapy). Three out of the four patients presented a complete response upon one cycle of KTM. These findings establish that the GAPDH expression level predicts DLBCL patients' response to R-CHOP treatment and their sensitivity to specific metabolic inhibitors.
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28
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Xu PP, Fu D, Li JY, Hu JD, Wang X, Zhou JF, Yu H, Zhao X, Huang YH, Jiang L, Liu F, Su LP, Chen ZW, Zeng QS, Chen JP, Fang MY, Ma J, Liu T, Song YP, Yu K, Li Y, Qiu LG, Chen XQ, Gu J, Yan JS, Hou M, Huang HY, Wang L, Cheng S, Shen Y, Xiong H, Chen SJ, Zhao WL. Anthracycline dose optimisation in patients with diffuse large B-cell lymphoma: a multicentre, phase 3, randomised, controlled trial. LANCET HAEMATOLOGY 2019; 6:e328-e337. [DOI: 10.1016/s2352-3026(19)30051-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/19/2022]
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29
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Mondello P, Mian M. Frontline treatment of diffuse large B-cell lymphoma: Beyond R-CHOP. Hematol Oncol 2019; 37:333-344. [PMID: 30938848 DOI: 10.1002/hon.2613] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022]
Abstract
Although the majority of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with the standard immunochemotherapy R-CHOP, one-third of them relapses with a dismal outcome in most cases. In the recent years, remarkable advances have been achieved based on the discovery of molecular genetics in DLBCL. In addition to the major cell-of-origin designations of germinal center B-cell and activated B-cell subtypes, next-generation sequencing has unveiled the remarkable complexity of DLBCL and identified potential molecular targets for tailored therapies. Despite these findings, the current standard of care for DLBCL patients is still R-CHOP, and optimization of frontline therapy remains an important goal. In this review, we summarize recent updates on the evolution of frontline therapies for DLBCL.
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Affiliation(s)
- Patrizia Mondello
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, New York, USA.,Department of Human Pathology, University of Messina, Messina, Italy
| | - Michael Mian
- Department of Hematology & CBMT, Ospedale di Bolzano, Bolzano, Italy
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30
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Vähämurto P, Mannisto S, Pollari M, Karjalainen-Lindsberg ML, Mäkitie AA, Leppä S. Clinical features and outcome of the patients with sinonasal tract diffuse large B-cell lymphoma in the pre-rituximab and rituximab eras. Eur J Haematol 2019; 102:457-464. [PMID: 30834564 DOI: 10.1111/ejh.13225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Sinonasal tract diffuse large B-cell lymphoma (SNT-DLBCL), a rare extranodal lymphoma, is not well characterized. We performed a population-based study to determine cell-of-origin, clinical presentation and impact of rituximab (R) and central nervous system (CNS) directed chemotherapy on survival. PATIENTS AND METHODS Patients with SNT-DLBCL were identified from pathology databases. Clinical information was collected and outcomes between different treatment modalities evaluated. RESULTS Thirty-two percent of the patients had germinal centre B-cell phenotype. Forty-six patients were treated with curative intent using CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like chemotherapy, 21 (46%) before and 25 (54%) in the R-era. Additionally, 24 (52%) received CNS-directed chemotherapy. Addition of R to chemotherapy reduced the risk of progression (RR = 0.368, 95% CI 0.138-0.976, P = 0.045) and death (RR = 0.245, 95% CI 0.068-0.883, P = 0.032), and translated into better survival (5-year PFS, 67% vs 38%, P = 0.037; 5-year OS, 81% vs 48%, P = 0.020). CNS-directed chemotherapy reduced the risk of progression (RR = 0.404, 95% CI 0.159-1.029, P = 0.057) and death (RR = 0.298, 95% CI 0.093-0.950, P = 0.041), and translated into favorable survival (5-year PFS, 67% vs 32%, P = 0.050; 5-year OS 82% vs 43%, P = 0.030). CONCLUSION Patients with SNT-DLBCL benefit from rituximab and CNS-directed chemotherapy.
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Affiliation(s)
- Pauli Vähämurto
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Mannisto
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjukka Pollari
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oncology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Sirpa Leppä
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Dahi PB, Moskowitz CH, Giralt SA, Lazarus HM. Novel agents may positively impact chemotherapy and transplantation in subsets of diffuse large B-cell lymphoma. Expert Rev Hematol 2019; 12:407-418. [PMID: 30884247 DOI: 10.1080/17474086.2019.1596793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Molecular and biologic heterogeneity in diffuse large B-cell lymphoma (DLBCL) has resulted in a broad range of clinical outcomes. While standard frontline chemoimmunotherapy cures majority of patients with DLBCL, treatment failure in certain DLBCL subsets remains high. Prognosis in these patients is dismal. Therefore, optimization of front-line therapy, as well as development of more effective salvage treatments, is an unmet medical need. Areas covered: This article reviews the treatment advances in DLBCL with novel and targeted agents that are aimed to improve efficacy especially in those with high-risk features. Expert opinion: Incorporation of novel therapies such as immunomodulatory agents and Bruton tyrosine kinase (BTK) inhibitors in the treatment of higher-risk DLBCL subgroups have shown to be effective; however, confirmatory data are required to change the standard of care. While autologous chimeric antigen receptor (CAR) T-cell therapy targeting CD19-positive B-cells have revolutionized the outcomes of refractory DLBCL, the complexity of its production, post-infusion care, and the associated cost, currently has limited its use to select academic centers in the US. A multitude of other targeted agents and combinations as well as cellular and immunotherapeutic agents are under investigation.
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Affiliation(s)
- Parastoo B Dahi
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , NY , New York , USA.,b Weill Cornell Medical College , NY , New York , USA
| | - Craig H Moskowitz
- c Sylvester Comprehensive Cancer Center , University of Miami , Coral Gables , FL , USA
| | - Sergio A Giralt
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , NY , New York , USA.,b Weill Cornell Medical College , NY , New York , USA
| | - Hillard M Lazarus
- d Case Comprehensive Cancer Center , Case Western Reserve University , Cleveland , OH , USA
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32
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Lynch RC, Gratzinger D, Advani RH. Clinical Impact of the 2016 Update to the WHO Lymphoma Classification. Curr Treat Options Oncol 2018; 18:45. [PMID: 28670664 DOI: 10.1007/s11864-017-0483-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OPINION STATEMENT The 2016 revision of the WHO classification of lymphoid neoplasms includes new entities along with a clearer definition of provisional and definitive subtypes based on better understanding of the molecular drivers of lymphomas. These changes impact current treatment paradigms and provide a framework for future clinical trials. Additionally, this update recognizes several premalignant or predominantly indolent entities and underscores the importance of avoiding unnecessarily aggressive treatment in the latter subsets.
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Affiliation(s)
- Ryan C Lynch
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ranjana H Advani
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford University Medical Center, 875 Blake Wilbur Drive, Suite CC-2338, Stanford, CA, 94305-5821, USA.
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33
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González-Barca E, Coronado M, Martín A, Montalbán C, Montes-Moreno S, Panizo C, Rodríguez G, Sancho JM, López-Hernández A. Spanish Lymphoma Group (GELTAMO) guidelines for the diagnosis, staging, treatment, and follow-up of diffuse large B-cell lymphoma. Oncotarget 2018; 9:32383-32399. [PMID: 30190794 PMCID: PMC6122355 DOI: 10.18632/oncotarget.25892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/23/2018] [Indexed: 01/23/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30% of non-Hodgkin lymphoma (NHL) cases in adult series. DLBCL is characterized by marked clinical and biological heterogeneity, encompassing up to 16 distinct clinicopathological entities. While current treatments are effective in 60% to 70% of patients, those who are resistant to treatment continue to die from this disease. An expert panel performed a systematic review of all data on the diagnosis, prognosis, and treatment of DLBCL published in PubMed, EMBASE and MEDLINE up to December 2017. Recommendations were classified in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) framework, and the proposed recommendations incorporated into practical algorithms. Initial discussions between experts began in March 2016, and a final consensus was reached in November 2017. The final document was reviewed by all authors in February 2018 and by the Scientific Committee of the Spanish Lymphoma Group GELTAMO.
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Affiliation(s)
- Eva González-Barca
- Department of Hematology, Institut Català d' Oncologia and IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Coronado
- Department of Nuclear Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - Carlos Montalbán
- Department of Hematology, MD Anderson Cancer Center, Madrid, Spain
| | - Santiago Montes-Moreno
- Department of Pathology and Translational Hematopathology Lab, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain
| | - Carlos Panizo
- Department of Hematology, Clínica Universidad de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Guillermo Rodríguez
- Department of Hematology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Juan Manuel Sancho
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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34
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Optimizing initial therapy in DLBCL. Best Pract Res Clin Haematol 2018; 31:199-208. [PMID: 30213389 DOI: 10.1016/j.beha.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a group of lymphomas comprising heterogeneous molecular and biological subtypes, reflected in a broad range of clinical outcomes. With the standard R-CHOP regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab administered every 21 days, the treatment failure rate remains unacceptably high in certain DLBCL subsets. Here we review possible avenues for optimizing initial therapy. The role of functional imaging and biological features, such as double-hit lymphomas, defined by the dual translocation of MYC and BCL2, and dual protein-expresser lymphomas, defined by the overexpression of MYC and BCL2, activated B-cell (ABC)-like DLBCL, to better define these high-risk patient subsets, and their use to guide and personalize treatment decisions are discussed. Secondly, the implications of varying dose-intensification of the various agents administered, and the link to imaging are reviewed. Thirdly, the results of the addition of novel drugs to standard R-CHOP will be analyzed, when added at induction or in maintenance. Finally, with CNS relapse in DLBCL representing a major and devastating unmet medical need, an overview and future directions for CNS prophylaxis is presented.
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35
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Bohers E, Viailly PJ, Becker S, Marchand V, Ruminy P, Maingonnat C, Bertrand P, Etancelin P, Picquenot JM, Camus V, Menard AL, Lemasle E, Contentin N, Leprêtre S, Lenain P, Stamatoullas A, Lanic H, Libraire J, Vaudaux S, Pepin LF, Vera P, Tilly H, Jardin F. Non-invasive monitoring of diffuse large B-cell lymphoma by cell-free DNA high-throughput targeted sequencing: analysis of a prospective cohort. Blood Cancer J 2018; 8:74. [PMID: 30069017 PMCID: PMC6070497 DOI: 10.1038/s41408-018-0111-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 12/15/2022] Open
Abstract
From a liquid biopsy, cell-free DNA (cfDNA) can provide information regarding basal tumoral genetic patterns and changes upon treatment. In a prospective cohort of 30 diffuse large B-cell lymphomas (DLBCL), we determined the clinical relevance of cfDNA using targeted next-generation sequencing and its correlation with PET scan imaging at the time of diagnosis and during treatment. Using a dedicated DLBCL panel, mutations were identified at baseline for 19 cfDNAs and profiles were consistent with expected DLBCL patterns. Tumor burden-related clinical and PET scan features (LDH, IPI, and metabolic tumor volume) were significantly correlated with the quantity of tumoral cfDNA. Among the four patients presenting additional mutations in their cfDNAs, three had high metabolic tumor volumes, suggesting that cfDNA more accurately reflects tumor heterogeneity than tissues biopsy itself. Mid-treatment, four patients still had basal mutations in their cfDNAs, including three in partial response according to their Deauville scores. Our study highlights the major interests in liquid biopsy, in particular in the context of bulky tumors where cfDNA allows capturing the entire tumoral mutation profile. Therefore, cfDNA analysis in DLBCL represents a complementary approach to PET scan imaging.
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Affiliation(s)
- Elodie Bohers
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | | | - Stéphanie Becker
- Department of Nuclear Medicine, Centre Henri Becquerel, University of Rouen, Rouen, France
- QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - Vinciane Marchand
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Philippe Ruminy
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | | | - Philippe Bertrand
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
| | | | | | - Vincent Camus
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Anne-Lise Menard
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Emilie Lemasle
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Nathalie Contentin
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Stéphane Leprêtre
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | | | - Hélène Lanic
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
| | - Julie Libraire
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | | | | | - Pierre Vera
- Department of Nuclear Medicine, Centre Henri Becquerel, University of Rouen, Rouen, France
- QuantIF-LITIS (EA 4108-FR CNRS 3638), Faculty of Medicine, University of Rouen, Rouen, France
| | - Hervé Tilly
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Fabrice Jardin
- INSERM U1245, Centre Henri Becquerel, University of Rouen, Rouen, France.
- Department of Clinical Haematology, Centre Henri Becquerel, Rouen, France.
- Clinical Research Unit, Centre Henri Becquerel, Rouen, France.
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36
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Goy A. Reply to H. Tilly et al. J Clin Oncol 2018; 36:923-925. [DOI: 10.1200/jco.2017.76.8754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andre Goy
- Andre Goy, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
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37
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Tilly H, Salles G, Molina TJ, Casasnovas RO, Morschhauser F, Coiffier B. Through the Glass Ceiling. J Clin Oncol 2018; 36:923. [DOI: 10.1200/jco.2017.76.3961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hervé Tilly
- Hervé Tilly, Centre Henri Becquerel, Université de Rouen, Institut National de la Santé et de la Recherche Médicale 1245, Rouen, France; Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon-1, Institut National de la Santé et de la Recherche Médicale 1052, Pierre-Bénite, France; Thierry J. Molina, Assistance Publique–Hôpitaux de Paris, Necker, Université Paris Descartes, Paris, France; René-Olivier Casasnovas, Hôpital Le Bocage, Dijon, France; Franck
| | - Gilles Salles
- Hervé Tilly, Centre Henri Becquerel, Université de Rouen, Institut National de la Santé et de la Recherche Médicale 1245, Rouen, France; Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon-1, Institut National de la Santé et de la Recherche Médicale 1052, Pierre-Bénite, France; Thierry J. Molina, Assistance Publique–Hôpitaux de Paris, Necker, Université Paris Descartes, Paris, France; René-Olivier Casasnovas, Hôpital Le Bocage, Dijon, France; Franck
| | - Thierry J. Molina
- Hervé Tilly, Centre Henri Becquerel, Université de Rouen, Institut National de la Santé et de la Recherche Médicale 1245, Rouen, France; Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon-1, Institut National de la Santé et de la Recherche Médicale 1052, Pierre-Bénite, France; Thierry J. Molina, Assistance Publique–Hôpitaux de Paris, Necker, Université Paris Descartes, Paris, France; René-Olivier Casasnovas, Hôpital Le Bocage, Dijon, France; Franck
| | - René-Olivier Casasnovas
- Hervé Tilly, Centre Henri Becquerel, Université de Rouen, Institut National de la Santé et de la Recherche Médicale 1245, Rouen, France; Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon-1, Institut National de la Santé et de la Recherche Médicale 1052, Pierre-Bénite, France; Thierry J. Molina, Assistance Publique–Hôpitaux de Paris, Necker, Université Paris Descartes, Paris, France; René-Olivier Casasnovas, Hôpital Le Bocage, Dijon, France; Franck
| | - Franck Morschhauser
- Hervé Tilly, Centre Henri Becquerel, Université de Rouen, Institut National de la Santé et de la Recherche Médicale 1245, Rouen, France; Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon-1, Institut National de la Santé et de la Recherche Médicale 1052, Pierre-Bénite, France; Thierry J. Molina, Assistance Publique–Hôpitaux de Paris, Necker, Université Paris Descartes, Paris, France; René-Olivier Casasnovas, Hôpital Le Bocage, Dijon, France; Franck
| | - Bertrand Coiffier
- Hervé Tilly, Centre Henri Becquerel, Université de Rouen, Institut National de la Santé et de la Recherche Médicale 1245, Rouen, France; Gilles Salles, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon-1, Institut National de la Santé et de la Recherche Médicale 1052, Pierre-Bénite, France; Thierry J. Molina, Assistance Publique–Hôpitaux de Paris, Necker, Université Paris Descartes, Paris, France; René-Olivier Casasnovas, Hôpital Le Bocage, Dijon, France; Franck
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Boltežar L, Prevodnik VK, Perme MP, Gašljević G, Novaković BJ. Comparison of the algorithms classifying the ABC and GCB subtypes in diffuse large B-cell lymphoma. Oncol Lett 2018; 15:6903-6912. [PMID: 29731865 PMCID: PMC5921237 DOI: 10.3892/ol.2018.8243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
Different immunohistochemical algorithms for the classification of the activated B-cell (ABC) and germinal center B-cell (GCB) subtypes of diffuse large B-cell lymphoma (DLBCL) are applied in different laboratories. In the present study, 127 patients with DLCBL were investigated, all treated with rituximab and cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP) or CHOP-like regimens between April 2004 and December 2010. Multi-tumor tissue microarrays were prepared and were tested according to 4 algorithms: Hans; modified Hans; Choi; and modified Choi. For 39 patients, the flow cytometric quantification of CD19 and CD20 antigen expression was performed and the level of expression presented as molecules of equivalent soluble fluorochrome units. The Choi algorithm was demonstrated to be prognostic for OS and classified patients into the GCB subgroup with an HR of 0.91. No difference in the expression of the CD19 antigen between the ABC and GCB groups was observed, but the ABC subtype exhibited a decreased expression of the CD20 antigen compared with the GCB subtype.
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Affiliation(s)
- Lučka Boltežar
- Division of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Maja Pohar Perme
- Institute of Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Gorana Gašljević
- Department of Pathology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
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Petrella T, Copie-Bergman C, Brière J, Delarue R, Jardin F, Ruminy P, Thieblemont C, Figeac M, Canioni D, Feugier P, Fabiani B, Leroy K, Parrens M, André M, Haioun C, Salles GA, Gaulard P, Tilly H, Jais JP, Molina TJ. BCL2 expression but not MYC and BCL2 coexpression predicts survival in elderly patients with diffuse large B-cell lymphoma independently of cell of origin in the phase 3 LNH03-6B trial. Ann Oncol 2018; 28:1042-1049. [PMID: 28327893 DOI: 10.1093/annonc/mdx022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Our aim was to evaluate whether the cell of origin (COO) as defined by the Hans algorithm and MYC/BCL2 coexpression, which are the two main biological risk factors in elderly patients treated with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone (R-CHOP), maintain their prognostic value in a large prospective clinical trial. Patients and methods We evaluated 285 paraffin-embedded samples from patients (60-80 years of age) enrolled in the Lymphoma Study Association trial LNH03-6B who were treated with R-CHOP. We correlated the COO defined by the transcriptome according to the Wright algorithm with that defined by the Hans algorithm in a subset of 62 tumors with available frozen tissue samples. Results The non-germinal center B-cell-like phenotype according to the Hans algorithm and BCL2 expression (but not MYC and BCL2 coexpression) predicted worse progression-free survival [hazard ratio (HR)=1.78, P = 0.003 and HR = 1.79, P = 0.003, respectively] and overall survival (HR = 1.85, P = 0.005 and HR = 1.67, P = 0.02, respectively) independently of the International Prognostic Index. The correlation between the Hans algorithm and the Wright algorithm was 91%, with an almost perfect concordance according to a kappa test (0.81). Conclusions Our results suggest that immunohistochemically defined COO remains a useful tool for predicting prognosis in diffuse large B-cell lymphoma when performed under optimized standardized conditions and that BCL2 expression may help to identify elderly patients at risk for relapse and who could potentially respond to anti-BCL2 targeted agents. In this prospective phase III trial, the coexpression of MYC and BCL2 does not appear to predict worse survival. Clinical trial Number NCT00144755.
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Affiliation(s)
| | - C Copie-Bergman
- Pathology, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil and IMRB, INSERM U955 Unité, Créteil
| | - J Brière
- Pathology, AP-HP, Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | - R Delarue
- Hematology, AP-HP, Necker Enfants-Malades, Paris
| | - F Jardin
- Hematology and UMR918, Centre Henri Becquerel, Université de Rouen, Rouen
| | - P Ruminy
- Hematology and UMR918, Centre Henri Becquerel, Université de Rouen, Rouen
| | - C Thieblemont
- Hemato-Oncology, AP-HP, Saint-Louis, Université Paris Diderot, Sorbonne Paris Cité and EA 7324, Paris Descartes, Sorbonne Paris Cité, Paris
| | - M Figeac
- Functional Genomic Platform, Cancer Research Institute, Lille
| | - D Canioni
- Pathology, AP-HP, Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | | | - B Fabiani
- Pathology, AP-HP, Saint-Antoine, Paris
| | - K Leroy
- Pathology, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil and IMRB, INSERM U955 Unité, Créteil
| | - M Parrens
- Pathology, CHU Bordeaux, Inserm U1053, Bordeaux, France
| | - M André
- Hematology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - C Haioun
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil
| | - G A Salles
- Haematology, Hospices Civils de Lyon, Université Claude Bernard, Pierre Bénite
| | - P Gaulard
- Pathology, AP-HP, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Université Paris-Est Créteil, Créteil and IMRB, INSERM U955 Unité, Créteil
| | - H Tilly
- Hematology and UMR918, Centre Henri Becquerel, Université de Rouen, Rouen
| | - J P Jais
- Biostatistics, AP-HP, Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris
| | - T J Molina
- Pathology, AP-HP, Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris.,EA7324, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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40
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Broséus J, Chen G, Hergalant S, Ramstein G, Mounier N, Guéant JL, Feugier P, Gisselbrecht C, Thieblemont C, Houlgatte R. Relapsed diffuse large B-cell lymphoma present different genomic profiles between early and late relapses. Oncotarget 2018; 7:83987-84002. [PMID: 27276707 PMCID: PMC5356640 DOI: 10.18632/oncotarget.9793] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023] Open
Abstract
Despite major advances in first-line treatment, a significant proportion of patients with diffuse large B-cell lymphoma (DLBCL) will experience treatment failure. Prognosis is particularly poor for relapses occurring less than one year after the end of first-line treatment (early relapses/ER) compared to those occurring more than one year after (late relapses/LR). To better understand genomic alterations underlying the delay of relapse, we identified copy number variations (CNVs) on 39 tumor samples from a homogeneous series of patients included in the Collaborative Trial in Relapsed Aggressive Lymphoma (CORAL) prospective study. To identify CNVs associated with ER or LR, we devised an original method based on Significance Analysis of Microarrays, a permutation-based method which allows control of false positives due to multiple testing. Deletions of CDKN2A/B (28%) and IBTK (23%) were frequent events in relapsed DLBCLs. We identified 56 protein-coding genes and 25 long non-coding RNAs with significantly differential CNVs distribution between ER and LR DLBCLs, with a false discovery rate < 0.05. In ER DLBCLs, CNVs were related to transcription regulation, cell cycle and apoptosis, with duplications of histone H1T (31%), deletions of DIABLO (26%), PTMS (21%) and CK2B (15%). In LR DLBCLs, CNVs were related to immune response, with deletions of B2M (20%) and CD58 (10%), cell proliferation regulation, with duplications of HES1 (25%) and DVL3 (20%), and transcription regulation, with MTERF4 deletions (20%). This study provides new insights into the genetic aberrations in relapsed DLBCLs and suggest pathway-targeted therapies in ER and LR DLBCLs.
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Affiliation(s)
- Julien Broséus
- Inserm U954, Faculty of Medicine, Nancy, France.,Hematology, Laboratory Department, University Hospital of Nancy, Nancy, France
| | - Gaili Chen
- ZhongNan Hospital of Wuhan University, Wuhan, China
| | | | | | - Nicolas Mounier
- Hemato-oncology, University Hospital of l'Archet, Nice, France
| | - Jean-Louis Guéant
- Inserm U954, Faculty of Medicine, Nancy, France.,Biochemistry, Laboratory Department, University Hospital of Nancy, Nancy, France
| | - Pierre Feugier
- Inserm U954, Faculty of Medicine, Nancy, France.,Hematology Department, University Hospital of Nancy, Nancy, France
| | | | - Catherine Thieblemont
- APHP, Saint-Louis Hospital, Hemato-Oncology Department, Paris, France.,Paris Diderot University-Sorbonne Paris-Cité, Paris, France
| | - Rémi Houlgatte
- Inserm U954, Faculty of Medicine, Nancy, France.,DRCI, University Hospital of Nancy, Nancy, France
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41
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Kawashima I, Inamoto Y, Maeshima AM, Nomoto J, Tajima K, Honda T, Shichijo T, Kawajiri A, Takemura T, Onishi A, Ito A, Tanaka T, Fuji S, Kurosawa S, Kim SW, Maruyama D, Tobinai K, Kobayashi Y, Fukuda T. Double-Expressor Lymphoma Is Associated with Poor Outcomes after Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2018; 24:294-300. [DOI: 10.1016/j.bbmt.2017.10.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023]
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42
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Bobée V, Ruminy P, Marchand V, Viailly PJ, Abdel Sater A, Veresezan L, Drieux F, Bérard C, Bohers E, Mareschal S, Dubois S, Jais JP, Leroy K, Figeac M, Picquenot JM, Molina TJ, Salles G, Haioun C, Tilly H, Jardin F. Determination of Molecular Subtypes of Diffuse Large B-Cell Lymphoma Using a Reverse Transcriptase Multiplex Ligation-Dependent Probe Amplification Classifier: A CALYM Study. J Mol Diagn 2017; 19:892-904. [PMID: 29054399 DOI: 10.1016/j.jmoldx.2017.07.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/11/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma. It includes three major subtypes termed germinal center B-cell-like, activated B-cell-like, and primary mediastinal B-cell lymphoma. With the emergence of novel targeted therapies, accurate methods capable of interrogating this cell-of-origin classification should soon become essential in the clinics. To address this issue, we developed a novel gene expression profiling DLBCL classifier based on reverse transcriptase multiplex ligation-dependent probe amplification. This assay simultaneously evaluates the expression of 21 markers, to differentiate primary mediastinal B-cell lymphoma, activated B-cell-like, germinal center B-cell-like, and also Epstein-Barr virus-positive DLBCLs. It was trained using 70 paraffin-embedded biopsies and validated using >160 independent samples. Compared with a reference classification established from Affymetrix U133 + 2 data, reverse transcriptase multiplex ligation-dependent probe amplification classified 85.0% samples into the expected subtype, comparing favorably with current diagnostic methods. This assay also proved to be highly efficient in detecting the MYD88 L265P mutation, even in archival paraffin-embedded tissues. This reliable, rapid, and cost-effective method uses common instruments and reagents and could thus easily be implemented into routine diagnosis workflows, to improve the management of these aggressive tumors.
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Affiliation(s)
- Victor Bobée
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France; Department of Biological Hematology, Rouen University Hospital, Rouen, France
| | - Philippe Ruminy
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France.
| | | | | | - Ahmad Abdel Sater
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France; LITIS EA 4108, UNIROUEN, University of Normandie, Rouen, France
| | - Liana Veresezan
- Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Fanny Drieux
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France; Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Caroline Bérard
- LITIS EA 4108, UNIROUEN, University of Normandie, Rouen, France
| | - Elodie Bohers
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France
| | | | - Sydney Dubois
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France
| | | | - Karen Leroy
- INSERM U955 Team 09, AP-HP Henri Mondor Hospital, Creteil, France
| | - Martin Figeac
- Functional Genomics Platform, Center for Biology and Pathology, University of Lille, Lille Cedex, France
| | - Jean-Michel Picquenot
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France; Department of Pathology, Centre Henri Becquerel, Rouen, France
| | - Thierry Jo Molina
- Department of Pathology, Necker Hospital, AP-HP, Université Paris Descartes Sorbonne Cité, Paris, France
| | - Gilles Salles
- Department of Hematology, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Pierre-Benite, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Hospital Henri Mondor, Creteil, France
| | - Hervé Tilly
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France
| | - Fabrice Jardin
- INSERM U1245, UNIROUEN, University of Normandie, Rouen, France
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43
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High-Grade B-Cell Neoplasm with Surface Light Chain Restriction and Tdt Coexpression Evolved in a MYC-Rearranged Diffuse Large B-Cell Lymphoma: A Dilemma in Classification. Case Rep Hematol 2017; 2017:6891957. [PMID: 28884033 PMCID: PMC5572605 DOI: 10.1155/2017/6891957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/21/2017] [Accepted: 07/02/2017] [Indexed: 01/02/2023] Open
Abstract
According to World Health Organization (WHO) classification (2008), B-cell neoplasms are classified into precursor B-cell or a mature B-cell phenotype and this classification was also kept in the latest WHO revision (2016). We are reporting a male patient in his fifties, with tonsillar swelling diagnosed as diffuse large B-cell lymphoma (DLBCL), germinal center. He received 6 cycles of RCHOP and showed complete metabolic response. Two months later, he presented with severe CNS symptoms. Flow cytometry on bone marrow (BM) showed infiltration by CD10-positive Kappa-restricted B-cells with loss of CD20 and CD19, and downregulation of CD79b. Moreover, the malignant population showed Tdt expression. BM Cytogenetics revealed t(8;14)(q24;q32) within a complex karyotype. Retrospectively, MYC and Tdt immunostains performed on original diagnostic tissue and came negative for Tdt and positive for MYC. It has been rarely reported that mature B-cell neoplasms present with features of immaturity; however the significance of Tdt acquisition during disease course was not addressed before. What is unique in this case is that the emerging disease has acquired an immaturity marker while retaining some features of the original mature clone. No definitive WHO category would adopt high-grade neoplasms that exhibit significant overlapping features between mature and immature phenotypes.
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44
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Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet 2017; 390:298-310. [PMID: 28153383 DOI: 10.1016/s0140-6736(16)32407-2] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/09/2016] [Accepted: 09/22/2016] [Indexed: 12/12/2022]
Abstract
Lymphomas can affect any organ in the body, present with a wide range of symptoms, and be seen by primary care physicians and physicians from most specialties. They are traditionally divided into Hodgkin's lymphoma (which accounts for about 10% of all lymphomas) and non-Hodgkin lymphoma, which is the topic of this Seminar. Non-Hodgkin lymphoma represents a wide spectrum of illnesses that vary from the most indolent to the most aggressive malignancies. They arise from lymphocytes that are at various stages of development, and the characteristics of the specific lymphoma subtype reflect those of the cell from which they originated. Since this topic was last reviewed in The Lancet in 2012, advances in understanding the biology and genetics of non-Hodgkin lymphoma and the availability of new diagnostic methods and therapies have improved our ability to manage patients with this disorder.
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Affiliation(s)
| | - Randy D Gascoyne
- British Columbia Cancer Agency and British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | | | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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45
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Jais JP, Molina TJ, Ruminy P, Gentien D, Reyes C, Scott DW, Rimsza LM, Wright G, Gascoyne RD, Staudt LM, Haioun C, Tilly H, Gaulard P, Salles GA, Jardin F, Leroy K. Reliable subtype classification of diffuse large B-cell lymphoma samples from GELA LNH2003 trials using the Lymph2Cx gene expression assay. Haematologica 2017; 102:e404-e406. [PMID: 28679653 DOI: 10.3324/haematol.2017.166827] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jean-Philippe Jais
- AP-HP, Cochin and Necker Hospitals and Paris Descartes University, France
| | - Thierry Jo Molina
- AP-HP, Cochin and Necker Hospitals and Paris Descartes University, France.,Paris Descartes University, EA 7324, France
| | | | - David Gentien
- Institut Curie, PSL Research University, Translational Research Department, Genomic Platform, Paris, F-75248, France
| | - Cecile Reyes
- Institut Curie, PSL Research University, Translational Research Department, Genomic Platform, Paris, F-75248, France
| | | | | | - George Wright
- Center for Cancer Research, National Institute of Health, Bethesda, MD, USA
| | | | - Louis M Staudt
- Center for Cancer Research, National Institute of Health, Bethesda, MD, USA
| | | | - Herve Tilly
- INSERM U918, Centre Henri Becquerel, Rouen, France
| | | | | | | | - Karen Leroy
- AP-HP, Cochin and Necker Hospitals and Paris Descartes University, France
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46
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Therapeutic Options in Diffuse Large B-Cell Lymphoma - A Retrospective Study and Review of the Literature. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:269-274. [PMID: 30595888 PMCID: PMC6284846 DOI: 10.12865/chsj.43.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/16/2017] [Indexed: 11/18/2022]
Abstract
The aim of this retrospective study was to assess the differences between standard R-CHOP and other Rituximab-associated chemotherapy (R-miniCHOP and R-CHOEP) regimens in terms of survival and potential adverse effects. The six-month survival outcomes of 94 diffuse large B-cell lymphomas (DLBCL) patients indicated no statistical difference between overall survival and disease-free survival in the two subgroups. The biological response to therapy (blood count, LDH levels) was similar in both subgroups. Despite having different clinical indications, R-miniCHOP and R-CHOEP provide viable therapeutic alternatives to the standard R-CHOP regimen.
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47
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Sujobert P, Salles G, Bachy E. Molecular Classification of Diffuse Large B-cell Lymphoma: What Is Clinically Relevant? Hematol Oncol Clin North Am 2017; 30:1163-1177. [PMID: 27888873 DOI: 10.1016/j.hoc.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Major progress in the understanding of diffuse large B-cell lymphoma (DLBCL) biology has been made in the last decade. Many specific compounds have now entered early phase clinical trials. However, further efforts are needed to find an accurate, fast, reproducible, and affordable technique to translate DLBCL subtype determination by gene expression profiles into clinical application. This article discusses the advantages and drawbacks of the currently available techniques of DLBCL subtype determination as well as important prognostic implications related to the cell of origin. Furthermore, the article provides a schematic description of how molecularly defined DLBCL subtypes could guide tailored therapy.
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Affiliation(s)
- Pierre Sujobert
- Laboratory of Hematology, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite 69310, France; Université Claude Bernard Lyon1, Université de Lyon, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Lyon, France
| | - Gilles Salles
- Université Claude Bernard Lyon1, Université de Lyon, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Lyon, France; Department of Hematology, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite 69310, France.
| | - Emmanuel Bachy
- Université Claude Bernard Lyon1, Université de Lyon, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Lyon, France; Department of Hematology, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite 69310, France
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48
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Thieblemont C, Tilly H, Gomes da Silva M, Casasnovas RO, Fruchart C, Morschhauser F, Haioun C, Lazarovici J, Grosicka A, Perrot A, Trotman J, Sebban C, Caballero D, Greil R, van Eygen K, Cohen AM, Gonzalez H, Bouabdallah R, Oberic L, Corront B, Choufi B, Lopez-Guillermo A, Catalano J, Van Hoof A, Briere J, Cabeçadas J, Salles G, Gaulard P, Bosly A, Coiffier B. Lenalidomide Maintenance Compared With Placebo in Responding Elderly Patients With Diffuse Large B-Cell Lymphoma Treated With First-Line Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. J Clin Oncol 2017; 35:2473-2481. [PMID: 28426350 DOI: 10.1200/jco.2017.72.6984] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose The standard treatment of patients with diffuse large B-cell lymphoma (DLBCL) is rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Lenalidomide, an immunomodulatory agent, has shown activity in DLBCL. This randomized phase III trial compared lenalidomide as maintenance therapy with placebo in elderly patients with DLBCL who achieved a complete response (CR) or partial response (PR) to R-CHOP induction. Methods Patients with previously untreated DLBCL or other aggressive B-cell lymphoma were 60 to 80 years old, had CR or PR after six or eight cycles of R-CHOP, and were randomly assigned to lenalidomide maintenance 25 mg/d or placebo for 21 days of every 28-day cycle for 24 months. The primary end point was progression-free survival (PFS). Results A total of 650 patients were randomly assigned. At the time of the primary analysis (December 2015), with a median follow-up of 39 months from random assignment, median PFS was not reached for lenalidomide maintenance versus 58.9 months for placebo (hazard ratio, 0.708; 95% CI, 0.537 to 0.933; P = .01). The result was consistent among analyzed subgroups (eg, male v female, age-adjusted International Prognostic Index 0 or 1 v 2 or 3, age younger than 70 v ≥ 70 years), response (PR v CR) after R-CHOP, and positron emission tomography status at assignment (negative v positive). With longer median follow-up of 52 months (October 2016), overall survival was similar between arms (hazard ratio, 1.218; 95% CI, 0.861 to 1.721; P = .26). Most common grade 3 or 4 adverse events associated with lenalidomide versus placebo maintenance were neutropenia (56% v 22%) and cutaneous reactions (5% v 1%), respectively. Conclusion Lenalidomide maintenance for 24 months after obtaining a CR or PR to R-CHOP significantly prolonged PFS in elderly patients with DLBCL.
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Affiliation(s)
- Catherine Thieblemont
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Hervé Tilly
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Maria Gomes da Silva
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Rene-Olivier Casasnovas
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Christophe Fruchart
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Franck Morschhauser
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Corinne Haioun
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Julien Lazarovici
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Anida Grosicka
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Aurore Perrot
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Judith Trotman
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Catherine Sebban
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Dolores Caballero
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Richard Greil
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Koen van Eygen
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Amos M Cohen
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Hugo Gonzalez
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Reda Bouabdallah
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Lucie Oberic
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Bernadette Corront
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Bachra Choufi
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Armando Lopez-Guillermo
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - John Catalano
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Achiel Van Hoof
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Josette Briere
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Jose Cabeçadas
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Gilles Salles
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Philippe Gaulard
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Andre Bosly
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
| | - Bertrand Coiffier
- Catherine Thieblemont, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis; Diderot University, Sorbonne Paris-Cité; Catherine Thieblemont and Josette Briere, Descartes University; Josette Briere, Hôpital Necker, Paris; Hervé Tilly, University of Rouen, Institut National de la Santé et de la Recherche Médicale U1245, Rouen; Rene-Olivier Casasnovas, Centre Hospitalier Universitaire Dijon; Institut National de la Santé et de la Recherche Médicale UMR1231, Dijon; Christophe Fruchart, Institut d'Hématologie de Basse Normandie, Centre Hospitalier Universitaire, Caen; Franck Morschhauser, Centre Hospitalier Universitaire Régional de Lille, Lille; Corinne Haioun and Philippe Gaulard, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Mondor; Philippe Gaulard, Institut National de la Santé et de la Recherche Médicale U955; Université Paris-Est, Créteil; Julien Lazarovici, Gustave Roussy Cancer Center, Villejuif; Aurore Perrot, University Hospital, Vandoeuvre les Nancy; Catherine Sebban, Centre Leon Berard, University Claude Bernard Lyon 1; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard U1052, Lyon; Hugo Gonzalez, Centre Hospitalier René Dubos, Pontoise; Reda Bouabdallah, Institut Paoli Calmettes, Marseille; Lucie Oberic, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse; Bernadette Corront, Centre Hospitalier Régional Annecy, Annecy; Bachra Choufi, Centre Hospitalier Dr Duchenne, Boulogne-sur-mer; Gilles Salles and Bertrand Coiffier, Institut National de la Santé et de la Recherche Médicale U1052, Hospices Civils de Lyon, Pierre-Benite, France; Maria Gomes da Silva and Jose Cabeçadas, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal; Anida Grosicka, Medical University of Silesia, Katowice, Poland; Judith Trotman, Concord Repatriation General Hospital, University of Sydney, Concord; John Catalano, Frankston Hospital and Monash University, Frankston, Australia; Dolores Caballero, Hospital Universitario de Salamanca, Salamanca; Armando Lopez-Guillermo, Hospital Clinic Barcelona, Barcelona, Spain; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute; Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; Koen van Eygen, Algemeen Ziekenhuis Groeninge Hospital, President Kennedylaan 4, Kortrijk; Achiel Van Hoof, Algemeen Ziekenhuis Sint Jan AV, Brugge; Andre Bosly, UCL Mont Godinne, Yvoir, Belgium; and Amos M. Cohen, Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel-Aviv University, Ramat-Aviv, Israel
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Role of MYC in B Cell Lymphomagenesis. Genes (Basel) 2017; 8:genes8040115. [PMID: 28375188 PMCID: PMC5406862 DOI: 10.3390/genes8040115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
B cell lymphomas mainly arise from different developmental stages of B cells in germinal centers of secondary lymphoid tissue. There are a number of signaling pathways that affect the initiation and development of B cell lymphomagenesis. The functions of several key proteins that represent branching points of signaling networks are changed because of their aberrant expression, degradation, and/or accumulation, and those events determine the fate of the affected B cells. One of the most influential transcription factors, commonly associated with unfavorable prognosis for patients with B cell lymphoma, is nuclear phosphoprotein MYC. During B cell lymphomagenesis, oncogenic MYC variant is deregulated through various mechanisms, such as gene translocation, gene amplification, and epigenetic deregulation of its expression. Owing to alterations of downstream signaling cascades, MYC-overexpressing neoplastic B cells proliferate rapidly, avoid apoptosis, and become unresponsive to most conventional treatments. This review will summarize the roles of MYC in B cell development and oncogenesis, as well as its significance for current B cell lymphoma classification. We compared communication networks within transformed B cells in different lymphomas affected by overexpressed MYC and conducted a meta-analysis concerning the association of MYC with tumor prognosis in different patient populations.
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Abstract
Diffuse large B-cell lymphoma (DLBCL) comprises a heterogeneous group with pathophysiological, genetic and clinical features. Many patients can be cured with R-CHOP therapy, which is the current standard regimen. Despite recent progress in improving patient survival, the 40% survival of DLBCL patients remains poor. Therefore, the most important issue for patients with DLBCL remains the development of a new front-line therapy. Several studies have reported that intensified chemotherapy with dose-adjusted EPOCH-R or R-ACVBP was superior to R-CHOP. Gene expression profiling has identified two distinct forms of DLBCL: activated B cell-like (ABC) and germinal center B-cell-like (GCB) types. ABC DLBCL exhibits a worse prognosis than GCB DLBCL by molecular diagnosis after R-CHOP therapy. Next-generation sequencing has identified unique oncogenic mechanisms and genetic complexity, which has provided rational therapeutic targets. There are also a number of biomarkers, including CD5, and prognostic factors. Efforts to distinguish many biomarkers will be crucial for individualized treatment in the future.
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Affiliation(s)
- Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine
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